scholarly journals Association between chronic kidney disease and outcomes among admissions for acute ischemic stroke receiving thrombolysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Weeda
Keyword(s):  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Funding Source ◽  
National Inpatient Sample ◽  
Risk Of Bleeding ◽  
Diagnostic Coding

Abstract Background Patients with chronic kidney disease may have hemostatic defects that increase the risk of bleeding following the administration of thrombolysis. Purpose We assessed the association between chronic kidney disease and intracerebral hemorrhage in acute ischemic stroke admissions receiving thrombolysis. Methods Using administrative data from the 2013 and 2014 National Inpatient Sample, adult acute ischemic stroke admissions treated with thrombolysis were identified. Patients with chronic kidney disease were identified via diagnostic coding. We used multivariable logistic regression to estimate the odds of intracerebral hemorrhage in patients with chronic kidney disease after adjustment for age and comorbidities. The association between chronic kidney disease and in-hospital mortality was also evaluated. Results Of 13,993 admissions treated with thrombolysis for acute ischemic stroke, 12.4% (n=1,739) had chronic kidney disease. Intracerebral hemorrhage occurred in 7.6% of patients and 7.0% experienced in hospital mortality. Chronic kidney disease did not increase the odds of intracerebral hemorrhage (odds ratio [OR]=1.00; 95% confidence interval [CI]=0.83–1.20). The adjusted odds of in-hospital mortality were also no different in those with versus without chronic kidney disease (OR=1.19; 95% CI=0.99–1.42). Conclusions Among admissions treated with thrombolysis for acute ischemic stroke, chronic kidney disease was not associated with a higher adjusted odd of intracerebral hemorrhage. Chronic kidney disease did not increase the odds of in-hospital mortality. Funding Acknowledgement Type of funding source: Other. Main funding source(s): SmartState Medication Safety

scholarly journals Serum uric acid, kidney function and acute ischemic stroke outcomes in elderly patients: a single-cohort, perspective study

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Lorenzo Falsetti ◽  
William Capeci ◽  
Nicola Tarquinio ◽  
Giovanna Viticchi ◽  
Mauro Silvestrini ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Uric Acid ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Serum Uric Acid ◽  
Kidney Function ◽  
Increased Risk

Chronic kidney disease and hyperuricemia have been associated to an increased risk and a worse prognosis in acute ischemic stroke. Several mechanisms, including platelet dysfunction, coagulation disorders, endothelial dysfunction, inflammation, and an increased risk of atrial fibrillation could be implicated. The role of serum uric acid in this setting is still object of debate. We enrolled all the consecutive patients admitted to our department for acute ischemic stroke. Cox regression analysis was used to evaluate the risk of in-hospital death considering serum uric acid levels and all the comorbidities. In the overall sample, hyperuricemia was independently associated to an increased risk of in-hospital mortality. This effect was stronger in patients with chronic kidney disease while, in the group of patients with normal renal function, the relationship between hyperuricemia and increased stroke mortality was not confirmed. Hyperuricemia could be associated to higher in-hospital mortality for ischemic stroke among elderly patients when affected by kidney disease. Survival does not seem to be affected by hyperuricemia in patients with normal kidney function.

Abstract 16: Racial Disparities in Clinical Outcomes and Resource Utilization in Acute Ischemic Stroke Hospitalizations in the United States: Results from the 2012 National Inpatient Sample

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Nilay Kumar ◽  
Anand Venkatraman ◽  
Neetika Garg
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Racial Minorities ◽  
National Inpatient Sample ◽  
The Us ◽  
To Receive ◽  
Total Charges

Background and objectives: There are limited data on racial differences in clinical and economic outcomes of acute ischemic stroke (AIS) hospitalizations in the US. We sought to ascertain the effect of race on AIS outcomes in a population based retrospective cohort study. Methods: We used the 2012 National Inpatient Sample (NIS), which is the largest database of inpatient stays in the US, to identify cases of AIS using ICD9-CM codes 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91 and 437.1 in patients >=18 years of age. Cases with missing data on race were excluded (5% of study sample). Primary outcome was in-hospital mortality. Secondary outcomes included proportion receiving endovascular mechanical thrombectomy (EMT) or thrombolysis, mean inflation adjusted charges and length of stay. Linear and logistic regression was used to test differences in continuous and categorical outcomes respectively. Survey techniques were used for all analyses. Results: There were 452, 330 hospitalizations for AIS in patients >=18 years in 2012. In univariate logistic regression using race as predictor, in-hospital mortality was significantly lower for Blacks (p<0.001), Hispanics (p=0.025) and Native Americans (p=0.047) compared to Whites. However, after adjusting for age, sex, Charlson comorbidity index, EMT and thrombolysis only blacks had a significantly lower mortality compared to whites (OR 0.74, 95% CI 0.66 - 0.82, p<0.001). Black patients were less likely to receive thrombolysis (OR 0.87, 95% CI 0.79 - 0.95; p=0.003) whereas Asian or Pacific Islanders were more likely to receive thrombolysis (OR 1.20, 95% CI 1.01 - 1.44; p=0.043) compared to whites. There was no difference in rates of EMT by race (p=0.18). Total charges and length of stay were significantly higher in racial minorities compared to whites (table). Conclusions: Blacks hospitalized for AIS have significantly lower in-hospital mortality compared to whites but are significantly less likely to receive thrombolysis compared to whites. Total charges and length of stay are significantly higher for racial minorities. Future studies should investigate mechanisms of this apparent protective effect of black race on in-hospital mortality in AIS.

Abstract TP199: Cerebral Microblees and Chronic Kidney Disease in Patients With First-ever Acute Ischemic Stroke or Transient Ischemic Attack

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Asako Nakamura ◽  
Masahiro Yasaka ◽  
Takahiro Kuwashiro ◽  
Seiji Gotoh ◽  
Yasuyuki Nakanishi ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Acute Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Ischemic Attack

scholarly journals Association of lipid profiles with severity and outcome of acute ischemic stroke in patients with and without chronic kidney disease

2020 ◽  
Author(s):  
Ailing Zhang ◽  
Wenjing Deng ◽  
Bin Zhang ◽  
Mengyang Ren ◽  
Long Tian ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Acute Ischemic Stroke ◽  
Lipid Profiles ◽  
Stepwise Logistic Regression ◽  
Stroke Severity ◽  
Severe Stroke ◽  
Adjusted Risk ◽  
Lipid Components

Abstract Background Contribution of lipid profiles to stroke severity and outcome was inconclusive, whether chronic kidney disease (CKD) (estimated glomerular filtration rate < 60 mL/min/1.73 m2) affects the association has not been investigated. We aim to evaluate this relationship. Methods A retrospective study of consecutive acute ischemic stroke patients was performed. We assessed the risk of severe stroke with the National Institutes of Health Stroke Scale (NIHSS) ≥ 5 at admission and poor outcome with the modified Rankin Scale (mRS) ≥ 3 at discharge. Multivariate stepwise logistic regression models were adopted to study interaction and independent association of lipid components with stroke severity and outcome according to lipid level quartiles by CKD stratification. Results Among the 875 included patients (mean age 64.9 years, 67.8% males), 213 (24.3%) presented with CKD. Elevated low-density lipoprotein cholesterol (LDL-C) was independently associated with severe stroke in patients with CKD (P for trend = 0.033) than in those without CKD (P for trend = 0.121). The association between the level of LDL-C and stroke severity was appreciably modified by CKD (Pinteraction = 0.013). Compared with without CKD patients in the lowest LDL-C quartile, the multivariable-adjusted risk of severe stroke increased significantly by 2.9-fold (95% CI 1.48–5.74) in patients with CKD in the highest LDL-C quartile. No significant association was observed between lipid components and early outcome in patients with and without CKD. Conclusion LDL-C levels are positively associated with stroke severity in only patients with CKD, with an interactive impact of LDL-C and CKD on ischemic stroke in the acute phase.

scholarly journals Real-World Impact of Retrievable Stents for Acute Ischemic Stroke on Disability Utilizing the National Inpatient Sample

2018 ◽  
Vol 8 (1) ◽  
pp. 60-68 ◽  
Author(s):  
Anit Behera ◽  
Eric Adjei Boakye ◽  
Jahnavi Trivedi ◽  
Eric Armbrecht ◽  
Amer Alshekhlee ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Real World ◽  
Severe Disability ◽  
National Inpatient Sample ◽  
Multivariable Logistic Regression ◽  
Fda Approval ◽  
The Impact

Purpose: We assess the impact of retrievable stent (RS) compared to first-generation devices on in-hospital mortality and disability in patients with acute ischemic stroke (AIS). Methods: Using the National Inpatient Sample, data were obtained for patients with a primary diagnosis of AIS who underwent mechanical thrombectomy (MT) and were admitted to US hospitals between 2010 and 2014. Two time periods were compared: 2010–2012 (pre-RS Food and Drug Administration [FDA] approval) and 2013–2014 (post-RS FDA approval). Disability level was used to classify outcomes as minimal disability, moderate to severe disability, or in-hospital mortality. Weighted, multivariable logistic regression was used to assess the association between MT device type and disability. Results: A total of 2,443,713 weighted patients admitted with AIS were identified; 148,923 (4.9%) of these received intravenous tissue plasminogen activator; and 23,719 (0.8%) underwent MT. In multivariable logistic regression analysis, the odds of in-hospital mortality decreased (OR 0.69, 95% CI 0.59–0.82) in the post-RS time-period compared with pre-RS time. The odds of moderate-to-severe disability decreased (OR 0.88, 95% CI 0.73–1.06) compared with minimal disability. In-hospital mortality rates decreased successively over the 4 years in the MT-treated patients (p < 0.001). Conclusions: The FDA approval of RS technology after 2012 was associated with decreased in-hospital mortality when compared with the 3-year interval prior. These findings provide an indication that the RCT data on the efficacy of RS technology are translating into improved real-world outcomes.

scholarly journals Impaired kidney function evaluated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is associated with more severe acute ischemic stroke

2017 ◽  
Vol 22 (5) ◽  
pp. 432-434 ◽  
Author(s):  
Konstantinos Tziomalos ◽  
Marina Georgaraki ◽  
Stella D Bouziana ◽  
Marianna Spanou ◽  
Stavroula Kostaki ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Acute Ischemic Stroke ◽  
Kidney Function ◽  
Disease Epidemiology
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