AUTHOR=Laible Mona , Jenetzky Ekkehart , Möhlenbruch Markus Alfred , Bendszus Martin , Ringleb Peter Arthur , Rizos Timolaos 

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

JOURNAL=Frontiers in Neurology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.665614

DOI=10.3389/fneur.2021.665614

ISSN=1664-2295

ABSTRACT=<p><bold>Background and Purpose:</bold> 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.</p><p><bold>Materials and Methods:</bold> 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 &gt;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.</p><p><bold>Results:</bold> 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, <italic>p</italic> = 0.023]. Furthermore, factors associated with in-hospital mortality encompassed higher age (OR = 1.03, 95% CI = 1.01–1.04, <italic>p</italic> = 0.002), stroke severity (OR = 1.05, 95% CI = 1.03–1.08, <italic>p</italic> &lt; 0.001), symptomatic intracerebral hemorrhage (OR = 3.20, 95% CI = 1.69–6.04, <italic>p</italic> &lt; 0.001), posterior circulation stroke (OR = 2.85, 95% CI = 1.72–4.71, <italic>p</italic> &lt; 0.001), and failed recanalization (OR = 2.00, 95% CI = 1.35–3.00, <italic>p</italic> = 0.001).</p><p><bold>Conclusion:</bold> 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.</p>