Predictors of Clinical Outcomes among Kidney Disease Patients Presenting with Hemorrhagic Stroke

Abstract

Background: Kidney disease is an independent risk factor in the development of cerebrovascular diseases and is associated with poor outcomes. Objective: The study looked at various factors that can influence the outcomes of kidney disease patients who developed hemorrhagic stroke. MRS was used as the primary outcome. The NIHSS and ICH scores, and the initial hematoma volume were used as secondary outcomes. Methods: This is a retrospective cohort study which included patients admitted from July 2022 to June 2023 at a tertiary hospital in the Philippines. Those who had a hemorrhagic stroke upon admission and  an eGFR of <60mL/min were included. 161 patients were analyzed and grouped into two cohorts: discharged with MRS 0-2 or 3-5, and expired with MRS 6. Different factors were analyzed to check which has the greatest influence on mortality. Results: The most significant predictor of mortality is the hematoma volume (p<0.001 MRS 0-2, p=0.016 MRS 3-5). In terms of disability, the most significant associated with worse functional outcomes are increasing age and low levels of hemoglobin. Those who were given medical decompression upon admission still have higher MRS scores upon discharge. Low EGFR values were found to be associated with higher ICH scores upon admission. Conclusion: Most kidney disease patients who developed hemorrhagic stroke have poor outcomes with the hematoma volume as the strongest predictor of mortality. Even with the use of medical decompression, functional disability remains high. Older patients, those with low hemoglobin and low eGFR are also associated with worse outcomes and higher ICH/NIHSS scores. Hypertensive patients will likely benefit from acute blood pressure lowering to increase chances of good outcomes. The study is recommended to be continued on a larger scale to ascertain the significance of other factors, such as dialysis initiation and timing.