Relationship between Kidney Dysfunction, Stroke Severity, and Outcomes in a Nigerian Tertiary Hospital: A Prospective Study

Abstract

Background: Stroke is a common neurologic disease associated with fatal outcomes. Kidney dysfunction may be an important predictor  of stroke severity and outcome. 

Aim: To determine the relationship between kidney dysfunction at admission and stroke severity and 30- day outcome. 

Materials and Methods: This was a prospective study that involved 150 stroke patients. Stroke severity at admission was  assessed using the National Institutes of Health Stroke Scale (NIHSS). Renal dysfunction was assessed by the presence of albuminuria and or reduced glomerular filtration rate (GFR) at admission. Neurological outcome was assessed using mortality, modified Rankin Scale  (mRS), and Glasgow Outcome Scale (GCS). 

Results: The mean age of the study participants was 61.0 ± 13.2 years. Renal dysfunction was  present in 66% of the participants while the case fatality rate of stroke was 26%. Poor neurological outcome at 30 days was found in 44.1%  of survivors. Those with albuminuria had lower GCS (P = 0.041), lower GFR (P = 0.004), higher mRS score on day 14 (P = 0.041) and  day 30 (P = 0.032), and higher NIHSS score (P = 0.034). Independent predictors of 30-day mortality were albuminuria (Adjusted Odd Ratio  (AOR) 3.60, 95%CI: 1.07–12.17) and increasing NIHSS score (AOR = 1.15, 95%CI: 1.04–1.28). Lower GCS (P < 0.001), elevated white blood  cells (P = 0.003), serum creatinine (P = 0.048), and NIHSS score (P < 0.001) were associated with poor neurological outcome. NIHSS score  was the only significant predictor of neurologic outcome (AOR: 1.25; CI: 1.11-1.41; P ≤ 0.001). 

Conclusions: Kidney dysfunction was  associated with stroke severity and mortality. However, it was not an independent predictor of neurological outcome