Abstract WP314: Renal Insufficiency Worsens Outcomes in Cerebrovascular Disease

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Abstract

Introduction/Hypothesis: We were interested in studying patient outcomes with acute cerebrovascular disease (ACVD) who had concomitant acute or chronic renal insufficiency (RI).

Methods: We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (1998-2009) and identified 1,760,415 adult ACVD patients among 92,848,710 patients enrolled. Using SAS 6.4 and applying SPSS 22 the outcome variables mortality, length of hospital stay (LOS), HC (HC) >$20,000, and disposition (home or any care facility) were selected. Logistic regression analyses were performed adjusting for the covariates hypertension (HTN), diabetes mellitus (DM), age, race, sex, number of comorbidities, and care complexity (numbers of inpatient procedures) among all ACVD with and without RI.

Results: Mean age was 71 years (SD 15) with 76% >65 years old; 54% female gender; 55% Whites, 11% Blacks, 6% Hispanics. Among all ACVD, 66% had HTN, 28% DM, RI 9%, LOS 7.6 days (SD 9.8), in-patient mortality 12%; disposition home 42% and facility 44%, and mean HC $36,010 (SD $63,331). After covariate adjustment, the mortality rate of ACVD patients with RI was 24% vs 11% (P<0.001) for those without RI; LOS ≥7 days 50% vs 29% (P<0.001); and facility discharge 62% vs 51% (P<0.001). In subgroup analysis, adjusted HC were significantly greater in patients with acute RI (78% vs 43%; P<0.001). The frequency of hemodialysis (HD) in all ACVD patients was 2.3%. Notably, HD was associated with LOS ≥7 days (61% vs 30%; p<0.001), increased mortality rate (25% vs 12%; p<0.001), and HC (76% vs 44%; p<0.001). However, there was no difference in disposition to facility (57% vs 52%; p<0.350).

Conclusions: Acute or chronic RI was present in 9% of patients with ACVD. RI was associated with significantly greater risks of in-patient mortality, LOS, and discharge to a facility. In subgroup analyses, the overall HC were greater in patients with acute RI. Patients undergoing HD experienced a similar negative impact on all outcome parameters except for disposition status. The negative impact of RI on vital outcome parameters in ACVD patients should be considered, i.e., when indicating the administration of contrast for imaging.

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