A double-hit: End-stage renal disease patients suffer worse outcomes in intracerebral hemorrhage

Aiden K Lui; Fangyi Lin; Anaz Uddin; Bridget Nolan; Kevin Clare; Terry Nguyen; Eris Spirollari; Eric Feldstein; Yarden Bornovski; Jose Dominguez; George Coritsidis; Chirag D Gandhi; Fawaz Al-Mufti

doi:10.4103/bc.bc_24_23

A double-hit: End-stage renal disease patients suffer worse outcomes in intracerebral hemorrhage

Brain Circ. 2023 Sep 27;9(3):172-177. doi: 10.4103/bc.bc_24_23. eCollection 2023 Jul-Sep.

Authors

Aiden K Lui¹, Fangyi Lin¹, Anaz Uddin¹, Bridget Nolan^{1

2}, Kevin Clare^{1

2}, Terry Nguyen¹, Eris Spirollari¹, Eric Feldstein², Yarden Bornovski², Jose Dominguez², George Coritsidis³, Chirag D Gandhi^{1

2}, Fawaz Al-Mufti^{1

2}

Affiliations

¹ School of Medicine at New York Medical College, Valhalla, New York USA.
² Brain and Spine Institute at Westchester Medical Center, Valhalla, New York USA.
³ Department of Nephrology at Westchester Medical Center, Valhalla, New York USA.

Abstract

Background: Intracerebral hemorrhage (ICH) carries significant morbidity and mortality. Previous single-center retrospective analysis suggests that end-stage renal disease (ESRD) is a risk factor for severe ICH and worse outcomes. This investigation aims to examine the impact of ESRD on ICH severity, complications, and outcomes using a multicenter national database.

Methods: The International Classification of Disease, Ninth and Tenth Revision Clinical Modification codes were used to query the National Inpatient Sample for patients with ICH and ESRD between 2010 and 2019. Primary endpoints were the functional outcome, length of stay (LOS), and in-hospital mortality. Multivariate variable regression models and a propensity-score matched analysis were established to analyze patient outcomes associated with baseline patient characteristics.

Results: We identified 211,266 patients with ICH, and among them, 7,864 (3.77%) patients had a concurrent diagnosis of ESRD. Patients with ESRD were younger (60.85 vs. 67.64, P < 0.01) and demonstrated increased ICH severity (0.78 vs. 0.77, P < 0.01). ESRD patients experienced higher rates of sepsis (15.9% vs. 6.15%, P < 0.01), acute myocardial infarction (8.05% vs. 3.65%, P < 0.01), and cardiac arrest (5.94% vs. 2.4%, P < 0.01). In addition, ESRD predicted poor discharge disposition (odds ratio [OR]: 2.385, 95% confidence interval [CI]: 2.227-2.555, P < 0.01), longer hospital LOS (OR: 1.629, 95% CI: 1.553-1.709, P < 0.01), and in-hospital mortality (OR: 2.786, 95% CI: 2.647-2.932, P < 0.01).

Conclusions: This study utilizes a multicenter database to analyze the effect of ESRD on ICH outcomes. ESRD is a significant predictor of poor functional outcomes, in-hospital mortality, and prolonged stay in the ICH population.

Keywords: Cerebral hemorrhage; kidney failure; patient outcome assessment.