Predictors of in-hospital mortality after acute stroke: impact of renal dysfunction.
OBJECTIVE
The objective of this 1-year, hospital-based study was to identify the impact of renal dysfunction on in-hospital mortality after acute stroke.


METHODS
All patients admitted to Al-Watani governmental hospital and diagnosed with acute stroke from September 2006 to August 2007 were included in the study. Data were obtained from patients' medical files. Creatinine clearance (CrCl) was calculated using Cockcroft-Gault equation. Patients with CrCl < 60 ml/min were designated as Group 1 while those with CrCl > or = 60 ml/min were designated as Group 2. The main outcome measure in this study was vital status at discharge. Pearson chi2 and independent Student's t test were used in the univariate analysis while multiple logistic regression analysis was used to identify independent predictors of in-hospital mortality. Statistical testing and graphics were carried out using SPSS 15.


RESULTS
A total of 186 acute stroke cases were included. Hypertension (HTN) (69.9%) and diabetes mellitus (DM) (45.2%) were the most prevalent risk factors. Patients in Group 1 were significantly older than those in Group 2 (74.11 +/- 9.46 versus 66.53 +/- 10.74 years). Thirty nine (21%) of the stroke patients died during their hospital stay. In the total stroke patients, three predictors of in-hospital mortality were identified: CrCl (p = 0.004), number of post-stroke complications (p = 0.001), and type of stroke (p = 0.034). In Group 1, CrCl (p = 0.012) was the only independent predictor of mortality, with patients who died having significantly lower CrCl than those who survived. However, in Group 2, CrCl level was not a predictor of mortality and was not significantly different (p = 0.26) between those who died and those who survived. In Group 2, no predictors of mortality were identified.


CONCLUSIONS
Screening and better control of renal dysfunction is required to decrease the risk of in-hospital mortality among patients after acute stroke. Our study also shows that the lower the CrCl, the greater is the risk of in-hospital mortality after acute attack. This finding needs to be considered in preventive and therapeutic strategies of acute stroke.
Sweileh
W M
WM
Clinical Pharmacology, College of Pharmacy, Clinical Pharmacy Graduate Program, An-Najah National University Nablus, Palestine. waleedsweileh@najah.edu
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000401:mortality; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000401:mortality; D020300:Intracranial Hemorrhages / Q000150:complications / Q000401:mortality; D007674:Kidney Diseases / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000150:complications*
D003404:Creatinine