Association between acute kidney injury and long-term mortality in patients with aneurysmal subarachnoid hemorrhage: A retrospective study

Yangchun Xiao; Jun Wan; Yu Zhang; Xing Wang; Hanwen Zhou; Han Lai; Weelic Chong; Yang Hai; L Dade Lunsford; Chao You; Shui Yu; Fang Fang

doi:10.3389/fneur.2022.864193

Association between acute kidney injury and long-term mortality in patients with aneurysmal subarachnoid hemorrhage: A retrospective study

Front Neurol. 2022 Sep 1:13:864193. doi: 10.3389/fneur.2022.864193. eCollection 2022.

Authors

Yangchun Xiao¹, Jun Wan², Yu Zhang^{1

3}, Xing Wang³, Hanwen Zhou⁴, Han Lai⁵, Weelic Chong⁶, Yang Hai⁷, L Dade Lunsford⁸, Chao You³, Shui Yu⁹, Fang Fang³

Affiliations

¹ Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, China.
² Key Laboratory of Pattern Recognition and Intelligent Information Processing, Institutions of Higher Education of Sichuan Province, Chengdu University, Chengdu, China.
³ Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
⁴ West China School of Public Health, Sichuan University, Chengdu, China.
⁵ Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁶ Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States.
⁷ Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States.
⁸ Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
⁹ Department of Neurosurgery, Dujiangyan People's Hospital, Dujiangyan, China.

Abstract

Background: Though acute kidney injury (AKI) in the context of aneurysmal subarachnoid hemorrhage (aSAH) worsens short-term outcomes, its impact on long-term survival is unknown.

Aim: We aimed to evaluate the association between long-term mortality and AKI during hospitalization for aSAH.

Methods: This was a retrospective study of patients who survived >12 months after aSAH. All patients were evaluated at West China Hospital, Sichuan University, between December 2013 and June 2019. The minimum follow-up time was over 1 year. the maximum follow-up time was about 7.3 years. AKI was defined by the KDIGO (The Kidney Disease Improving Global Outcomes) guidelines, which stratifies patients into three stages of severity. The primary outcome was long-term mortality, which was analyzed with Kaplan-Meier curves and Cox proportional hazards models.

Results: During this study period, 238 (9.2%) patients had AKI among 2,592 patients with aSAH. We confirmed that AKI during care for aSAH significantly increased long-term mortality (median 4.3 years of follow-up) and that risk increased with the severity of the kidney failure, with an adjusted hazard ratio (HR) of 2.08 (95% CI 1.49-2.89) for stage 1 AKI, 2.15 (95% CI 1.05-4.43) for stage 2 AKI, and 2.66 (95% CI 1.08-6.53) for stage 3 AKI compared with patients without AKI. Among patients with an AKI episode, those with renal recovery still had increased long-term mortality (HR 1.96; 95% CI 1.40-2.74) compared with patients without AKI but had better long-term outcomes than those without renal recovery (HR 0.51, 95% CI 0.27-0.97).

Conclusions: Among 12-month survivors of aSAH, AKI during their initial hospitalization for aSAH was associated with increased long-term mortality, even for patients who had normal renal function at the time of hospital discharge. Longer, multidisciplinary post-discharge follow-up may be warranted for these patients.

Keywords: acute kidney injury; complication; intracranial aneurysm; mortality; prognostic factors; subarachnoid hemorrhage.