title: Renal dysfunction and discharge destination in patients with intracerebral hemorrhage.
abstract: Identifying predictors of outcome after intracerebral hemorrhage (ICH) may improve understanding of factors that contribute to recovery. We determined whether indices of renal insufficiency would predict early outcome in patients with ICH without established chronic kidney disease (CKD). Consecutive ICH patients discharged from a university stroke service between September 2005 and June 2009 were evaluated for proteinuria and estimated glomerular filtration rate (eGFR)<60 mL/min per 1.73 m(2) on admission. Patients with known CKD were excluded. The outcome assessed was discharge to home directly from the inpatient stroke service (vs transfer to rehabilitation, higher-level care unit, or nursing home). Independent effects of renal insufficiency on outcome were evaluated using multivariate regression modeling. Of 94 patients with recent ICH, 84 (89%) met the study inclusion criteria. In unadjusted analyses, patients discharged to home were less likely to have proteinuria (28% vs 57.9%; P=.02) and low eGFR (12.1% vs 30.2%; P=.06). After adjusting for 13 confounders, the likelihood of being discharged to home were lower in patients with initial proteinuria alone (odds ratio [OR]=0.41; 95% confidence interval [CI]=0.07-2.58), low eGFR alone (OR=0.24; 95% CI=0.04-1.39), or both conditions simultaneously (OR=0.20; 95% CI=0.02-1.76), but none of these associations reached statistical significance. In this study, proteinuria or low eGFR on admission were not independently linked with discharge directly to home. Larger studies are needed to further explore this issue, however.
authors.affiliation: Stroke Center and Department of Neurology, University of California Los Angeles Medical Center, Los Angeles, California 90095, USA. Ovibes@mednet.ucla.edu
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.forename: Sandra
authors.initials: S
authors.lastname: Pineda
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000150:complications*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006785:Hospitals, University; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016015:Logistic Models; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data; D016017:Odds Ratio; D010343:Patient Admission; D010351:Patient Discharge / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D011507:Proteinuria / Q000150:complications / Q000503:physiopathology; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D051437:Renal Insufficiency / Q000150:complications* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors