The Impact of Post-contrast Acute Kidney Injury on In-hospital Mortality After Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

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Abstract

Background and Purpose: Clinical outcome and mortality after endovascular thrombectomy (EVT) in patients with ischemic stroke are commonly assessed after 3 months. In patients with acute kidney injury (AKI), unfavorable results for 3-month mortality have been reported. However, data on the in-hospital mortality after EVT in this population are sparse. In the present study, we assessed whether AKI impacts in-hospital and 3-month mortality in patients undergoing EVT.

Materials and Methods: From a prospectively recruiting database, consecutive acute ischemic stroke patients receiving EVT between 2010 and 2018 due to acute large vessel occlusion were included. Post-contrast AKI (PC-AKI) was defined as an increase of baseline creatinine of ≥0.5 mg/dL or >25% within 48 h after the first measurement at admission. Adjusting for potential confounders, associations between PC-AKI and mortality after stroke were tested in univariate and multivariate logistic regression models.

Results: One thousand one hundred sixty-nine patients were included; 166 of them (14.2%) died during the acute hospital stay. Criteria for PC-AKI were met by 29 patients (2.5%). Presence of PC-AKI was associated with a significantly higher risk of in-hospital mortality in multivariate analysis [odds ratio (OR) = 2.87, 95% confidence interval (CI) = 1.16–7.13, p = 0.023]. Furthermore, factors associated with in-hospital mortality encompassed higher age (OR = 1.03, 95% CI = 1.01–1.04, p = 0.002), stroke severity (OR = 1.05, 95% CI = 1.03–1.08, p < 0.001), symptomatic intracerebral hemorrhage (OR = 3.20, 95% CI = 1.69–6.04, p < 0.001), posterior circulation stroke (OR = 2.85, 95% CI = 1.72–4.71, p < 0.001), and failed recanalization (OR = 2.00, 95% CI = 1.35–3.00, p = 0.001).

Conclusion: PC-AKI is rare after EVT but represents an important risk factor for in-hospital mortality and for mortality within 3 months after hospital discharge. Preventing PC-AKI after EVT may represent an important and potentially lifesaving effort in future daily clinical practice.

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Most cited references 41

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Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection

Bruce C.V. Campbell, Peter J. Mitchell, Timothy J Kleinig … (2015)

New England Journal of Medicine, 372(11), 1009-1018

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Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke.

Jeffrey L Saver, Mayank Goyal, Alain Bonafe … (2016)

Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever, in addition to intravenous t-PA, increases reperfusion rates and may improve long-term functional outcome. We randomly assigned eligible patients with stroke who were receiving or had received intravenous t-PA to continue with t-PA alone (control group) or to undergo endovascular thrombectomy with the use of a stent retriever within 6 hours after symptom onset (intervention group). Patients had confirmed occlusions in the proximal anterior intracranial circulation and an absence of large ischemic-core lesions. The primary outcome was the severity of global disability at 90 days, as assessed by means of the modified Rankin scale (with scores ranging from 0 [no symptoms] to 6 [death]). The study was stopped early because of efficacy. At 39 centers, 196 patients underwent randomization (98 patients in each group). In the intervention group, the median time from qualifying imaging to groin puncture was 57 minutes, and the rate of substantial reperfusion at the end of the procedure was 88%. Thrombectomy with the stent retriever plus intravenous t-PA reduced disability at 90 days over the entire range of scores on the modified Rankin scale (P<0.001). The rate of functional independence (modified Rankin scale score, 0 to 2) was higher in the intervention group than in the control group (60% vs. 35%, P<0.001). There were no significant between-group differences in 90-day mortality (9% vs. 12%, P=0.50) or symptomatic intracranial hemorrhage (0% vs. 3%, P=0.12). In patients receiving intravenous t-PA for acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, thrombectomy with a stent retriever within 6 hours after onset improved functional outcomes at 90 days. (Funded by Covidien; SWIFT PRIME ClinicalTrials.gov number, NCT01657461.).

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Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury

Ravindra Mehta, John A. Kellum, Sudhir V Shah … (2007)

Introduction Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Methods Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. Results The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. Conclusion We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

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Author and article information

Contributors

Mona Laible: URI : http://loop.frontiersin.org/people/1077905/overview

Ekkehart Jenetzky: URI : http://loop.frontiersin.org/people/630877/overview

Markus Alfred Möhlenbruch: URI : http://loop.frontiersin.org/people/1212859/overview

Martin Bendszus: URI : http://loop.frontiersin.org/people/14659/overview

Peter Arthur Ringleb: URI : http://loop.frontiersin.org/people/9705/overview

Timolaos Rizos: URI : http://loop.frontiersin.org/people/766291/overview

Journal

Journal ID (nlm-ta): Front Neurol

Journal ID (iso-abbrev): Front Neurol

Journal ID (publisher-id): Front. Neurol.

Title: Frontiers in Neurology

Publisher: Frontiers Media S.A.

ISSN (Electronic): 1664-2295

Publication date (Electronic): 07 June 2021

Publication date Collection: 2021

Volume: 12

Electronic Location Identifier: 665614

Affiliations

[1] ¹Department of Neurology, Heidelberg University Hospital , Heidelberg, Germany

[2] ²Department of Neurology, University of Ulm , Ulm, Germany

[3] ³Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany

[4] ⁴Department for Child and Adolescent Psychiatry, Johannes Gutenberg-University , Mainz, Germany

[5] ⁵Department of Neuroradiology, Heidelberg University Hospital , Heidelberg, Germany

Author notes

Edited by: Osama O. Zaidat, Northeast Ohio Medical University, United States

Reviewed by: Wenbo Zhao, Capital Medical University, China; Shashvat M. Desai, University of Pittsburgh, United States; Chung-Wei Lee, National Taiwan University Hospital, Taiwan

*Correspondence: Mona Laible monalaible@ 123456gmail.com

This article was submitted to Endovascular and Interventional Neurology, a section of the journal Frontiers in Neurology

Article

DOI: 10.3389/fneur.2021.665614

PMC ID: 8215575

PubMed ID: 34163423

SO-VID: 94393e5d-8a2b-4264-af78-97064df0d817

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 08 February 2021

Date accepted : 20 April 2021

Page count

Figures: 1, Tables: 3, Equations: 0, References: 41, Pages: 9, Words: 6497

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The Impact of Post-contrast Acute Kidney Injury on In-hospital Mortality After Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

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Most cited references 41

Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection

Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke.

Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury

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