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Kidney Week

Abstract: FR-PO036

Renal Dysfunction and In-Hospital Mortality Among Critically Ill Patients with Stroke

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Ihara, Katsuhito, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
  • Danziger, John, Harvard Medical School, Boston, Massachusetts, United States
  • Mittleman, Murray, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
Background

The interplay between baseline renal function and acute kidney injury (AKI) on in-hospital mortality among critically ill patients hospitalized for stroke is largely unknown.

Methods

We used the multicenter eICU Collaborative Research Database to identify 4,736 adult non-dialysis patients admitted to ICU with acute stroke between 2013 and 2015. Baseline renal function was defined as estimated glomerular filtration rate (eGFR) calculated by the MDRD equation based on the first serum creatinine within 24 hours of ICU admission. AKI was defined based on the Kidney Disease: Improving Global Outcomes guidelines. We used a multivariable logistic regression with a restricted cubic spline of eGFR and an interaction with AKI to estimate the probability of in-hospital mortality according to baseline eGFR among patients who did and did not develop AKI.

Results

The mean age of the patients was 68.6 ± 14.8 years, 48.6% were male, and 80.8% were Caucasian. The mean eGFR on admission was 72.5 ± 30.7 ml/min/1.73m2 with 18.0% (n = 852) presenting with an eGFR between 90 and 120 ml/min/1.73m2 and 40.6% (n = 1,922) between 60 and 90 ml/min/1.73m2. Patients with lower eGFR were older, more likely to have diabetes, require intubation, and have lower Glasgow coma scales. There were 460 deaths (9.8%) during hospitalization. After adjusting for confounding, both reduced (eGFR <45, odds ratio (OR), 1.83; 95% confidence interval (CI), 1.20-2.79) and highly elevated eGFR (≥120, OR, 1.37; 95% CI, 0.69-2.74) were associated with increased mortality when comparing to eGFR between 75 and 90 ml/min/1.73m2. The figure shows that AKI was associated with higher in-hospital mortality and the relationship between eGFR at baseline and mortality was significantly different among those with and without AKI.

Conclusion

Both eGFR on admission and AKI are strong predictors of in-hospital mortality and the impact of eGFR is stronger among patients who develop AKI.