RENAL FUNCTION ASSESSMENT IN ACUTE STROKE PATIENTS AND ITS ASSOCIATION WITH IN-HOSPITAL MORTALITY
Keywords:Cerebrovascular stroke (CVS), acute kidney injury (AKI), Glasgow Coma Score (GCS)
Introduction: Stroke is one of the world's leading causes of death, and it causes significant impairment that has a profound effect on the long-term survival of patients. Not only neurological defects, but also medical co-morbidities decide the adverse effects after cerebrovascular stroke (CVS). In different studies, related kidney dysfunction has been shown to be a significant predictor. However, considering the elevated burden of stroke patients in India, there is a shortage of such studies in India. The current research was therefore conducted to assess renal function in acute stroke patients and to investigate the possible utility of preventive and early intervention interventions to minimize morbidity and mortality due to renal dysfunction.
Methods: This was a 1-year, longitudinal, retrospective analysis of 25 adult acute stroke patients who were admitted to the hospital. On the day of admission, and then on days 3, 7 and 14, patients underwent routine laboratory investigations, including baseline biochemical investigations. The approximate glomerular filtration rate (e-GFR) was determined and the renal function pattern was evaluated in the two stroke subgroups. Creatinine was known as the baseline for entry. During hospitalization, AKI was characterized as a 0.3 mg/dl creatinine increase or a percentage increase of at least 50 percent from baseline.
Results: Of the 25 stroke patients, 15 (59%) were ischemic while the remainder were hemorrhagic (41 percent ). The mean age of the subjects examined was 60.42 ± 8.45 years. In contrast to hemorrhagic stroke, the mean age of subjects with ischaemic stroke was higher (62.65 ± 7.32 years) (58.72 ± 9.86 years). Baseline Serum creatinine and blood urea were significantly higher in patients with hemorrhagic stroke relative to subjects with ischaemic stroke (p < 0.01), although e-GFR was significantly lower in patients with hemorrhagic stroke (56.12 ± 28.34 ml/min/1.73 m2) compared to patients with ischaemic stroke (86.34 ± 26.68 ml/min/1.73 m2).
The hospital stay period (days) was substantially higher in patients with hemorrhagic stroke (12.43 ± 5.36 days) relative to subjects with ischemic stroke (9.54 ± 2.65 days). In 24 per cent of stroke patients, acute kidney damage has been seen. In hemorrhagic stroke patients (34 percent), AKI was more common compared to ischemic stroke patients (17 percent ). In contrast to non-AKII, diabetes was substantially correlated with the production of AKI (54 percent) (16 percent ). In stroke patients, the mortality rate was 12% . Statistically, there were no variations between the ischemic stroke mortality rate (12%) and hemorrhagic stroke (12 percent ). The mortality rate was 29% among patients who developed AKI . The predictors of AKI were found to be hemorrhagic stroke, older age, diabetes mellitus and high baseline creatinine levels. It has been found that GCS score < 10, AKI, hemorrhagic stroke and AKI requiring renal replacement therapy are associated with longer hospital stays. In patients with aspiration pneumonia, GCS score < 10, AKI, older age and AKI needing Renal Replacement Therapy, mortality was significantly more likely.
Conclusion: In our research, the predictors of AKI were found to be hemorrhagic stroke, older age, high baseline creatinine and diabetes mellitus. It was also found that AKI was an autonomous indicator of extended hospital stay and increased mortality among stroke patients.
Key words: Cerebrovascular stroke (CVS), acute kidney injury (AKI), Glasgow Coma Score (GCS).
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