The Impact of Post-contrast Acute Kidney Injury on In-hospital Mortality After Endovascular Thrombectomy in Patients With Acute Ischemic Stroke
Open Access
- 7 June 2021
- journal article
- research article
- Published by Frontiers Media SA in Frontiers in Neurology
Abstract
Background and Purpose: Clinical outcome and mortality after endovascular thrombectomy (EVT) in patients with ischemic stroke are commonly assessed after 3 months. In patients with acute kidney injury (AKI), unfavorable results for 3-month mortality have been reported. However, data on the in-hospital mortality after EVT in this population are sparse. In the present study, we assessed whether AKI impacts in-hospital and 3-month mortality in patients undergoing EVT. Materials and Methods: From a prospectively recruiting database, consecutive acute ischemic stroke patients receiving EVT between 2010 and 2018 due to acute large vessel occlusion were included. Post-contrast AKI (PC-AKI) was defined as an increase of baseline creatinine of ≥0.5 mg/dL or >25% within 48 h after the first measurement at admission. Adjusting for potential confounders, associations between PC-AKI and mortality after stroke were tested in univariate and multivariate logistic regression models. Results: One thousand one hundred sixty-nine patients were included; 166 of them (14.2%) died during the acute hospital stay. Criteria for PC-AKI were met by 29 patients (2.5%). Presence of PC-AKI was associated with a significantly higher risk of in-hospital mortality in multivariate analysis [odds ratio (OR) = 2.87, 95% confidence interval (CI) = 1.16–7.13, p = 0.023]. Furthermore, factors associated with in-hospital mortality encompassed higher age (OR = 1.03, 95% CI = 1.01–1.04, p = 0.002), stroke severity (OR = 1.05, 95% CI = 1.03–1.08, p < 0.001), symptomatic intracerebral hemorrhage (OR = 3.20, 95% CI = 1.69–6.04, p < 0.001), posterior circulation stroke (OR = 2.85, 95% CI = 1.72–4.71, p < 0.001), and failed recanalization (OR = 2.00, 95% CI = 1.35–3.00, p = 0.001). Conclusion: PC-AKI is rare after EVT but represents an important risk factor for in-hospital mortality and for mortality within 3 months after hospital discharge. Preventing PC-AKI after EVT may represent an important and potentially lifesaving effort in future daily clinical practice.This publication has 41 references indexed in Scilit:
- Systematic Review of Outcome After Ischemic Stroke Due to Anterior Circulation Occlusion Treated With Intravenous, Intra-Arterial, or Combined Intravenous+Intra-Arterial ThrombolysisStroke, 2012
- Acute Kidney Injury and Mortality in Hospitalized PatientsAmerican Journal of Nephrology, 2012
- Post-stroke infection: A systematic review and meta-analysisBMC Neurology, 2011
- Risk Score for In-Hospital Ischemic Stroke Mortality Derived and Validated Within the Get With The Guidelines–Stroke ProgramCirculation, 2010
- The Risk of Acute Radiocontrast-Mediated Kidney Injury Following Endovascular Therapy for Acute Ischemic Stroke Is LowAmerican Journal of Neuroradiology, 2010
- Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classificationsCritical Care, 2008
- Acute kidney injury in the intensive care unit according to RIFLE*Critical Care Medicine, 2007
- Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injuryCritical Care, 2007
- Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic StrokeStroke, 2003