Predictors and Outcomes of Acute Kidney Injury in Intracerebral Hemorrhage Patients: Evidence from a Large-Scale National Database Analysis

Acute kidney injury (AKI) is a significant complication in patients with intracerebral hemorrhage (ICH). This study sought to explore the incidence, risk factors, and outcomes of AKI in ICH patients using a comprehensive national database. Data from the Nationwide Inpatient Sample database (2010-2019) were analyzed. This analysis compared demographics, comorbidities, complications, mortality, and healthcare utilization between ICH patients who developed AKI and those who did not. Multivariate logistic regression was used to identify risk factors for AKI and assess their impact on in-hospital outcomes. The incidence of AKI among ICH patients increased from 10.7% in 2010 to 19.6% by 2019, yielding an overall incidence rate of 15%. Risk factors included, Black race, comorbidities (≥ 3), teaching hospital setting, and specific pre-existing conditions such as heart failure, coagulopathy, diabetes, fluid and electrolyte disorders, other neurological disorders, obesity, paralysis, chronic kidney disease excluding ESRD, peptic ulcer disease (without bleeding), and weight loss. Conversely, female sex and elective admissions acted as protective factors. AKI-related in-hospital complications encompassed acute myocardial infarction, pneumonia, sepsis, cardiac arrest, respiratory failure, and mechanical ventilation. AKI was associated with higher in-hospital mortality (26.9% vs. 18.5%), prolonged hospital stays (median duration of 9 days vs. 5 days for non-AKI patients) and increased requirement for dialysis (3.1% vs. 0.0%). Healthcare costs were significantly elevated, with median charges doubling for AKI patients. AKI is a frequent and severe complication among patients with ICH, markedly influencing clinical outcomes and healthcare resource utilization. Early identification of high-risk patients and implementation of effective preventive strategies are critical to enhance patient management and outcomes.