J Korean Neurosurg Soc.  2013 Oct;54(4):296-301. 10.3340/jkns.2013.54.4.296.

Prognostic Factors and Clinical Outcomes of Acute Intracerebral Hemorrhage in Patients with Chronic Kidney Disease

• Kim JK
• Shin JJ
• Park SK
• Hwang YS
• Kim TH
• Shin HS

• KMID: 1499334
• DOI: http://doi.org/10.3340/jkns.2013.54.4.296

Abstract

OBJECTIVE
We conducted a retrospective study examining the outcomes of intracerebral hemorrhage (ICH) in patients with chronic kidney disease (CKD) to identify parameters associated with prognosis.
METHODS
From January 2001 to June 2008, we treated 32 ICH patients (21 men, 11 women; mean age, 62 years) with CKD. We surveyed patients age, sex, underlying disease, neurological status using Glasgow Coma Scale (GCS), ICH volume, hematoma location, accompanying intraventricular hemorrhage, anti-platelet agents, initial and 3rd day systolic blood pressure (SBP), clinical outcome using the modified Rankin Scale (mRS) and complications. The severity of renal functions was categorized using a modified glomerular filtration rate (mGFR). Multifactorial effects were identified by regression analysis.
RESULTS
The mean GCS score on admission was 9.4+/-4.4 and the mean mRS was 4.3+/-1.8. The overall clinical outcomes showed a significant relationship on initial neurological status, hematoma volume, and mGFR. Also, the outcomes of patients with a severe renal dysfunction were significantly different from those with mild/moderate renal dysfunction (p<0.05). Particularly, initial hematoma volume and sBP on the 3rd day after ICH onset were related with mortality (p<0.05). However, the other factors showed no correlation with clinical outcome.
CONCLUSION
Neurological outcome was based on initial neurological status, renal function and the volume of the hematoma. In addition, hematoma volume and uncontrolled blood pressure were significantly related to mortality. Hence, the severity of renal function, initial neurological status, hematoma volume, and uncontrolled blood pressure emerged as significant prognostic factors in ICH patients with CKD.

Keyword

Intracerebral hemorrhage; Chronic kidney disease; Renal failure; Modified Rankin Scale; Prognosis; Mortality

MeSH Terms

Blood Pressure
Cerebral Hemorrhage*
Female
Glasgow Coma Scale
Glomerular Filtration Rate
Hematoma
Hemorrhage
Humans
Male
Mortality
Prognosis
Renal Insufficiency
Renal Insufficiency, Chronic*
Retrospective Studies

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