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Acute Renal Failure in Aneurysmal Subarachnoid Hemorrhage: Nationwide Analysis of Hospitalizations in the United States.
World Neurosurg. 2016 Jul; 91:542-547.e6.WN

Abstract

OBJECTIVE

Medical complications in the setting of aneurysmal subarachnoid hemorrhage (aSAH) are common and associated with poor prognosis. We analyzed the incidence, risk factors, and short-term outcomes associated with acute renal failure (ARF) in aSAH.

METHODS

We queried discharge records from all patients admitted to U.S. hospitals between 2002 and 2011 to identify primary diagnoses of aSAH and secondary diagnoses of ARF. The effect of demographics, hospital characteristics, and pre-existing comorbidity on ARF occurrence and the impact of ARF occurrence on length of stay (LOS), in-hospital costs, moderate to severe disability, and in-hospital mortality were explored in both bivariate and multivariable analyses.

RESULTS

The incidence of ARF in patients hospitalized for aSAH (N = 260,885) was 4.0% and increased from 2.1% in 2002 to 5.7% in 2011 (P < 0.0001). The strongest predictors of ARF in multivariable analysis were fluid and electrolyte disorder (odds ratio [OR], 3.24; 95% confidence interval [CI], 3.07-3.42), coagulopathy (OR, 2.43; 95% CI, 2.25-2.63), HIV (OR, 2.42; 95% CI, 1.79-3.27), and diabetes (OR, 2.37; 95% CI, 2.08-2.69). ARF onset in aSAH increased the mean length of stay by 7.2 days and mean total costs by $28,813 (all P < 0.0001). After adjusting for confounding factors, patients with ARF had increased likelihood of moderate to severe disability (OR, 2.03; 95% CI, 1.89-2.19) and in-hospital death (OR, 2.14; 95% CI, 2.03-2.26).

CONCLUSION

The burden of ARF in hospitalized patients with aSAH has increased in the past decade and is detrimental to patient outcomes and healthcare costs. The identification of patient-centered risk factors may allow for close surveillance of high-risk patients.

Authors+Show Affiliations

Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA.Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA. Electronic address: mmittal2@kumc.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26970481

Citation

Rumalla, Kavelin, and Manoj K. Mittal. "Acute Renal Failure in Aneurysmal Subarachnoid Hemorrhage: Nationwide Analysis of Hospitalizations in the United States." World Neurosurgery, vol. 91, 2016, pp. 542-547.e6.
Rumalla K, Mittal MK. Acute Renal Failure in Aneurysmal Subarachnoid Hemorrhage: Nationwide Analysis of Hospitalizations in the United States. World Neurosurg. 2016;91:542-547.e6.
Rumalla, K., & Mittal, M. K. (2016). Acute Renal Failure in Aneurysmal Subarachnoid Hemorrhage: Nationwide Analysis of Hospitalizations in the United States. World Neurosurgery, 91, 542-e6. https://doi.org/10.1016/j.wneu.2016.03.003
Rumalla K, Mittal MK. Acute Renal Failure in Aneurysmal Subarachnoid Hemorrhage: Nationwide Analysis of Hospitalizations in the United States. World Neurosurg. 2016;91:542-547.e6. PubMed PMID: 26970481.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute Renal Failure in Aneurysmal Subarachnoid Hemorrhage: Nationwide Analysis of Hospitalizations in the United States. AU - Rumalla,Kavelin, AU - Mittal,Manoj K, Y1 - 2016/03/10/ PY - 2016/02/02/received PY - 2016/03/02/revised PY - 2016/03/03/accepted PY - 2016/3/13/entrez PY - 2016/3/13/pubmed PY - 2017/10/4/medline KW - Acute renal failure KW - Aneurysm KW - Epidemiology KW - Nationwide inpatient sample KW - Subarachnoid hemorrhage SP - 542 EP - 547.e6 JF - World neurosurgery JO - World Neurosurg VL - 91 N2 - OBJECTIVE: Medical complications in the setting of aneurysmal subarachnoid hemorrhage (aSAH) are common and associated with poor prognosis. We analyzed the incidence, risk factors, and short-term outcomes associated with acute renal failure (ARF) in aSAH. METHODS: We queried discharge records from all patients admitted to U.S. hospitals between 2002 and 2011 to identify primary diagnoses of aSAH and secondary diagnoses of ARF. The effect of demographics, hospital characteristics, and pre-existing comorbidity on ARF occurrence and the impact of ARF occurrence on length of stay (LOS), in-hospital costs, moderate to severe disability, and in-hospital mortality were explored in both bivariate and multivariable analyses. RESULTS: The incidence of ARF in patients hospitalized for aSAH (N = 260,885) was 4.0% and increased from 2.1% in 2002 to 5.7% in 2011 (P < 0.0001). The strongest predictors of ARF in multivariable analysis were fluid and electrolyte disorder (odds ratio [OR], 3.24; 95% confidence interval [CI], 3.07-3.42), coagulopathy (OR, 2.43; 95% CI, 2.25-2.63), HIV (OR, 2.42; 95% CI, 1.79-3.27), and diabetes (OR, 2.37; 95% CI, 2.08-2.69). ARF onset in aSAH increased the mean length of stay by 7.2 days and mean total costs by $28,813 (all P < 0.0001). After adjusting for confounding factors, patients with ARF had increased likelihood of moderate to severe disability (OR, 2.03; 95% CI, 1.89-2.19) and in-hospital death (OR, 2.14; 95% CI, 2.03-2.26). CONCLUSION: The burden of ARF in hospitalized patients with aSAH has increased in the past decade and is detrimental to patient outcomes and healthcare costs. The identification of patient-centered risk factors may allow for close surveillance of high-risk patients. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/26970481/Acute_Renal_Failure_in_Aneurysmal_Subarachnoid_Hemorrhage:_Nationwide_Analysis_of_Hospitalizations_in_the_United_States_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(16)00407-1 DB - PRIME DP - Unbound Medicine ER -