Early Serum Creatinine Levels after Aneurysmal Subarachnoid Hemorrhage Predict Functional Neurological Outcome after 6 Months

Abstract

Acute kidney injury (AKI) is a known predictor of unfavorable outcome in patients treated at the ICU, irrespective of the disease. However, data on the potential influence of serum creatinine (sCr) on hospital admission on the outcome in patients suffering from aneurysmal subarachnoid hemorrhage (SAH) is scarce. A total of 369 consecutive patients suffering from SAH were included in this retrospective cohort study. Patients were divided into good-grade (WFNS I–III) versus poor-grade (WFNS IV–V). Outcome was assessed according to the modified Rankin Scale (mRS) after 6 months and stratified into favorable (mRS 0–2) versus unfavorable (mRS 3–6). SAH patients with sCr levels <1.0 mg/dL achieved significantly a favorable outcome more often compared to patients with sCr levels ≥1.0 mg/dL (p = 0.003). In the multivariable analysis, higher levels of sCr (p = 0.014, OR 2.4; 95% CI 1.2–4.7), poor-grade on admission (p < 0.001, OR 9.8; 95% CI 5.6–17.2), age over 65 years (p < 0.001, OR 3.3; 95% CI 1.7–6.1), and delayed cerebral ischemia (p < 0.001, OR 7.9; 95% CI 3.7–17.1) were independently associated with an unfavorable outcome. We identified increased sCr on admission as a predictor for unfavorable functional outcome after SAH. Further studies elucidating the pathophysiology of this association are necessary.

Association between serum creatinine and 30 days all-cause mortality in critically ill patients with non-traumatic subarachnoid hemorrhage: analysis of the MIMIC-IV database

“…However, there is limited research on the association between sCr and mortality rates in SAH patients. A previous study involving 369 SAH patients showed that patients with a sCr level ≥ 1.0 mg/dL had a higher likelihood of poorer prognosis (modified Rankin Scale score > 3) compared to SAH patients with sCr levels <1.0 mg/dL ( 11 ). These findings align with our study, which demonstrated that patients with sCr level ≥ 0.9 mg/dL had a higher mortality rate compared to those with sCr level < 0.9 mg/dL.…”

“…Acute kidney injury (AKI) is a common complication in critically ill patients and SAH patients, and its negative impact on outcomes is well known ( 10 ). Although the effect of sCr on the neurological function assessment of SAH patients has been described ( 11 ), the study’s sample size was small, and there was a lack of data on mortality in critically ill patients.…”

Anti-Inflammatory Drug Therapy in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Prospective Randomized and Placebo-Controlled Trials

“…Neurological outcome was measured using the modified Rankin Scale (mRS). If an article presented numerical data for individual mRS classes, the data were documented based on the definition of a poor outcome as a score ranging from 3 to 6 on the mRS scale, while a score ≤ 2 was considered indicative of a good outcome [ 21 ]. If a study presented the percentage of patients with a defined outcome event, the absolute numbers were computed using the provided percentages.…”

Anti-Inflammatory Drug Therapy in Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis of Prospective Randomized, Double-Blind and Placebo-Controlled Trials

“…Modified Ranking scale was used to measure the neurological outcome, which was, subsequently, evaluated in accordance with the definition of poor outcome as a score of 3-6 and good outcome as a score of 0-2 [21]. The Markwalder grading score was dichotomized into good (0-1) and poor (2-4) outcome.…”