Chronic Kidney Disease in Patients with Acute Intracerebral Hemorrhage: Association with Large Hematoma Volume and Poor Outcome

Molshatzki, Noa; Orion, David; Tsabari, Rakefet; Schwammenthal, Yvonne; Merzeliak, Oleg; Toashi, Maya; Tanné, David

doi:10.1159/000322155

Cited by 101 publications

(96 citation statements)

References 52 publications

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“…Because of platelet and coagulation abnormalities associated with renal dysfunction [4], such patients are prone to both ischemic events and bleeding complications when receiving antithrombotic treatment [19]. …”

Section: Discussionmentioning

confidence: 99%

“…Thrombolytic therapy using intravenous recombinant tissue-type plasminogen activator (rtPA) is the only approved effective treatment for acute ischemic stroke (AIS) [3]. Due to abnormalities of coagulation and platelet function, patients with CKD had higher risk to develop intracerebral hemorrhage [4]. Microvascular damage [5], leukoaraiosis [6] and cerebral microbleeds [7] may also increase the risk of cerebral hemorrhage in patients with renal dysfunction.…”

Section: Introductionmentioning

confidence: 99%

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Is Renal Dysfunction Associated with Adverse Stroke Outcome after Thrombolytic Therapy?

et al. 2013

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Background: Renal dysfunction is a prevalent comorbidity in acute stroke patients requiring thrombolytic therapy. Reports studying the relationship between renal dysfunction and risk of postthrombolytic symptomatic intracerebral hemorrhage (SICH) are contradictory. We aimed to compare the safety and effectiveness of thrombolytic therapy in acute stroke patients with and without renal dysfunction. Methods: Based on the prospective stroke registries of 4 hospitals in Taiwan from 2007-2012, we identified acute stroke patients who received thrombolytic therapy. Clinically significant renal dysfunction was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m². Renal dysfunction was further defined as stage 3 (30 ≤ eGFR < 60 ml/min/ 1.73 m²), stage 4 (15 ≤ eGFR < 30 ml/min/1.73 m²) and stage 5 (<15 ml/min/1.73 m²). The rates of SICH and poor outcome (defined as modified Rankin scale score ≥4) at 3 months after thrombolytic therapy were compared in patients with and without renal dysfunction. SICH was determined according to the definition of the National Institute of Neurological Disorders and Stroke. Multivariable logistic regression was used to determine the effect of renal dysfunction on outcome. Patients with different stages of renal dysfunction were further analyzed to determine the effect of disease severity on outcome. Results: Of the 657 stroke patients with thrombolysis, 239 (36%) had renal dysfunction, including 212 patients in stage 3, 17 patients in stage 4 and 10 patients in stage 5 of renal dysfunction. Patients with renal dysfunction were older and more likely to have hypertension, ischemic heart disease, congestive heart failure and prior antiplatelet use than those without. There were no differences in SICH (8 vs. 7%, p = 0.580) and poor outcome (41 vs. 39%, p = 0.758) between patients with and without renal dysfunction. After multivariable analysis, renal dysfunction was not associated with SICH (odds ratio: 1.03, 95% confidence interval: 0.55-1.92) and poor outcome. Pretreatment stroke severity was the only factor significantly associated with both SICH and poor outcome at 3 months. When stratifying renal dysfunction into stage 3 and stage ≥4, there was no significant increase in SICH as the severity of renal dysfunction increased after multivariable adjustment. Conclusions: Renal dysfunction did not increase the risk of SICH and poor outcome at 3 months after stroke thrombolysis. Further study comparing directly the risk and benefit of thrombolytic therapy versus no therapy in stroke patients with renal dysfunction is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is Renal Dysfunction Associated with Adverse Stroke Outcome after Thrombolytic Therapy?

et al. 2013

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“…5 Our study added renal failure as a kind of systemic disease (in addition to thrombocytopenia, liver cirrhosis, and nondrug-induced coagulopathy proposed by the SMASH-U classification system) 5 because it is a risk factor for spontaneous ICH, defined as chronic kidney disease stage 5 or as that requiring dialysis. 19 An ICH incident was deemed medication related if it had time-course related warfarin use with international normalized ratio ≥2, new oral anticoagulant use within 3 days, full-dose heparin, or thrombolytic agents. 5 CAA-related ICH was defined as lobar, cortical, or subcortical hemorrhage among individuals aged ≥55 years, according to the Boston criteria.…”

Section: Data Collectionmentioning

confidence: 99%

Pathogenetical Subtypes of Recurrent Intracerebral Hemorrhage

Yeh

Tang

Tsai

et al. 2014

Stroke

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Background and Purpose-Pathogenetic classification of intracerebral hemorrhage (ICH), using systems such as SMASH-U (structural vascular lesions, medication, cerebral amyloid angiopathy [CAA], systemic disease, hypertension, or undetermined), is important in predicting functional outcomes and mortality in patients with ICH. This study aimed to compare pathogenetic subtypes between the first and recurrent ICH. Methods-This study obtained data related to 4578 consecutive acute patients with ICH from the National Taiwan University Hospital Stroke Registry during January 1995 to December 2013. Using the SMASH-U method, patients were classified into 6 subtypes. We then analyzed the outcomes of first-ever ICH cases and pathogenetic classification of recurrent ICH. Results-Among 3785 patients who experienced first-ever ICH (male, 63.3%; mean age, 58.7±17.0 years), the most common cause was hypertensive angiopathy (54.9%), followed by CAA (12.2%), systemic disease (12.1%), undetermined (10.1%), structural vascular lesions (7.8%), and medication related (2.9%). In 185 cases of recurrent ICH, pathogenetic differences between the 2 ICH events were observed in 34 (18.4%) cases, most of which were CAA to hypertensive angiopathy (n=10) or vice versa (n=7). The rates of ICH recurrence were highest for systemic disease-related and CAA-related ICH at 1, 5, 10, and 15 years after the indexed ICH event. Conclusions-In

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“…Además de ello, la HIC en pacientes con ERC moderadasevera (tasa de filtración ? 45 ml/min) presenta hematomas de mayor tamaño, hipertensión arterial de difícil [23][24][25] control y un pronóstico sombrío .Neoplasias hematológicas. Después de las infecciones, la hemorragia intracraneal representa la segunda complicación mortal más frecuente en sujetos con una neoplasia hematológica.…”

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Efectos de la edad sobre la morbimortalidad de la hemorragia intracerebral

Kita¹

2015

Rev. virtual Soc. Parag. Med. Int

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ResumenIntroducción: los datos disponibles sobre factores de riesgo y mortalidad en sujetos jóvenes tras una hemorragia intracerebral (HIC) son muy escasos. Objetivo: determinar los factores de riesgo en dicha población y comparar la frecuencia de mortalidad y complicaciones asociadas entre adultos menores de 50 años edad y aquellos de 50 años o más. Material y métodos: se elaboraron dos cohortes, una de pacientes adultos menores de 50 años con HIC (cohorte 1) y otra de adultos de 50 años o más con HIC (cohorte 2), admitidos en el Hospital Nacional de Itauguá en el período [2013][2014]. Resultados: fueron incluidos 53 pacientes en la cohorte 1 y 89 en la cohorte 2. Ambas cohortes fueron similares en sus aspectos demográficos y clínicos. La mortalidad fue superior en la cohorte 2. La escala de Glasgow al egreso fue mayor en la cohorte 1. No hubo diferencias significativas entre ambas poblaciones en cuanto a incidencia de complicaciones infecciosas y neurológicas derivadas del hematoma. Conclusión: la HIC en sujetos mayores de 50 años de edad se asocia a una mayor mortalidad.Palabras claves: hemorragia intracerebral espontánea; edad; mortalidad; complicaciones neurológicas. Abstract Introduction:The available data about risk factors and mortality in young individuals after an intracerebral hemorrhage (ICH) are limited. Objectives: To determine the risk factors in this population and then compare the mortality frequency and associated complications between adults younger than 50 years and those of 50 years old or more. Materials and methods: Two cohorts were created, one of adult patients younger than 50 years old with ICH (cohort 1) and another of adults of 50 years and more with ICH (cohort 2), admitted into the National Hospital of Itauguá in the 2013-2014 period. Results: Fifty three patients were included in cohort 1 and 89 in cohort 2. Both cohorts were similar in the demographic and clinical aspects. Mortality was higher in cohort 2. Glasgow scale at discharge was higher in cohort 1. There were not any significant differences between both populations in relation to the incidence of infectious and neurological complications originated in the hematoma. Conclusion:The ICH in subjects older than 50 years old is associated with higher mortality.Keywords: spontaneous intracerebral hemorrhage; age; mortality; neurological complications. IntroducciónEl accidente vascular cerebral (ACV) es una entidad patológica caracterizada por un déficit neurológico atribuido a una lesión focal aguda del sistema nervioso central de causa vascular, en la que se incluyen al infarto cerebral, la hemorragia intracerebral (HIC) y la hemorragia subaracnoidea, consideradas en el mundo entero 1 como las causas más importantes de discapacidad y muerte .La rápida instalación de signos clínicos indicativos de disfunción neurológica debido a una colección focal de sangre en el parénquima cerebral o en el sistema ventricular, no generado por un trauma, es lo que 1 define al ACV ocasionado por una hemorragia intracerebral espontánea .Después de...

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Chronic Kidney Disease in Patients with Acute Intracerebral Hemorrhage: Association with Large Hematoma Volume and Poor Outcome

Cited by 101 publications

References 52 publications

Is Renal Dysfunction Associated with Adverse Stroke Outcome after Thrombolytic Therapy?

Is Renal Dysfunction Associated with Adverse Stroke Outcome after Thrombolytic Therapy?

Pathogenetical Subtypes of Recurrent Intracerebral Hemorrhage

Efectos de la edad sobre la morbimortalidad de la hemorragia intracerebral

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