Predictors of mortality among acute stroke patients with kidney failure in University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State
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Abstract
Background: Stroke is considered a leading cause of morbidity and mortality globally. Renal disease is also increasing globally with a consequent increase in morbidity and mortality. The cross-link between the brain and the kidney leading to the complex relationship between stroke and renal disease which may have adverse effects on mortality has been studied.
Aim: The study sought to determine the predictors of mortality among acute stroke patients admitted into the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt.
Methods: This was a hospital-based, prospective cohort study conducted among 150 acute stroke patients presenting at the UPTH. Selected stroke patients with kidney failure and those without kidney failure were assessed and followed up for 6 weeks for mortality. A multivariate logistic regression analysis was carried out to demonstrate the predictors of mortality.
Results: Of the one hundred and fifty participants studied, there were 93(62.0%) male and 57(38.0%) female patients, the mean age was 54.6±10.6 years. There were 95 stroke patients with Kidney Failure (KF) giving a prevalence of 63.3%. The predictors of mortality among respondents included age 70 – 79years (aOR=51.14; p – 0.005), severe Glasgow Coma Score (GCS) (aOR=7.58; p – 0.001),haemorrhagic stroke (aOR=3.99; p- 0.001), admitting hyperglycaemia (aOR=2.53; p – 0.042) and CKD (aOR=2.81; p – 0.00).
Conclusion: The predictors of mortality included age group 70 – 79years, severe GCS, haemorrhagic stroke, admitting hyperglycaemia and CKD. Therefore, early detection and prompt intervention will reduce morbidity and mortality in these patients.
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References
1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation 2016;133(4):e38-360.
2. GBD 2015 Mortality and Causes of Death Collaborators; Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388(10053):1459-1544.
3. Adeloye D. An estimate of the incidence and prevalence of stroke in Africa: a systematic review and meta-analysis. PLoS One 2014;9(6):e100724.
4. Guilbert JJ. The World Health Report 2002—reducing risks, promoting healthy life. Educ Health (Abingdon) 2003;16(2):230.
5. Wahab KW. The burden of stroke in Nigeria. Int J Stroke 2008;3(4):290-292.
6. Stanifer JW, Jing B, Tolan S, Helmke N, Mukerjee R, Naicker S, et al. The epidemiology of chronic kidney disease in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Glob Health 2014;2(3):e174-e181.
7. Cheng TY, Wen SF, Astor BC, Tao XG, Samet JM, Wen CP. Mortality risks for all causes and cardiovascular diseases and reduced GFR in a middle-aged working population in Taiwan. Am J Kidney Dis 2008;52(6):1051-1060.
8. Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL(Eds). Harrison's principles of internal medicine, 15th edition. New York: McGraw-Hill, 2001.
9. Tsagalis G, Akrivos T, Alevizaki M, Manios E, Stamatellopoulos K, Laggouranis A, et al. Renal dysfunction in acute stroke: an independent predictor of long-term all combined vascular events and overall mortality. Nephrol Dial Transplant 2009;24(1):194-200.
10. Snarska K, Kapica-Topczewska K, Bachórzewska-Gajewska H, Małyszko J. Renal function predicts outcomes in patients with ischaemic stroke and haemorrhagic stroke. Kidney Blood Press Res 2016;41(4):424-433.
11. Wu CL, Tsai CC, Kor CT, Tarng DC, Lian IB, Yang TH, et al. Stroke and risks of development and progression of kidney diseases and end-stage renal disease: a nationwide population-based cohort study. PLoS One 2016;11(6):e0158533.
12. Kish L. Survey sampling. New York: John Wiley & Sons, 1965.
13. Lima HD, Saibel T, Colato G, Cabral NL. The impact of acute kidney injury on fatality of ischemic stroke from a hospital-based population in Joinville, Brazil. Braz J Nephrol 2019;41(3):323-329. Erratum in: Braz J Nephrol 2019;41(3):445.
14. World Health Organization. Waist circumference and waist-hip ratio: report of a WHO expert consultation. Geneva: World Health Organization, 2008.
15. Muntner P, Shimbo D, Carey RM, Charleston JB, Gaillard T, Misra S, et al. Measurement of blood pressure in humans: a scientific statement from the American Heart Association. Hypertension 2019;73(5):e35-e66.
16. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18(6):499-502.
17. Florkowski CM, Chew-Harris JS. Methods of estimating GFR—different equations including CKD-EPI. Clin Biochem Rev 2011;32(2):75-79.
18. National Kidney Foundation; Levey AS, Coresh J, Bolton K, Culleton B, Harvey KS, Ikizler TA, et al. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(2 Suppl 1):S1-S266.
19. Palevsky PM, Liu KD, Brophy PD, Chawla LS, Parikh CR, Thakar CV, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis 2013;61(5):649-672.
20. National Institute of Neurological Disorders and Stroke. NIH stroke scale. Bethesda (MD): National Institute of Neurological Disorders and Stroke; 2024. Available from: https://www.ninds.nih.gov/health-information/public-education/know-stroke/health-professionals/nih-stroke-scale. Accessed February 14, 2026.
21. Hage V. The NIH stroke scale: a window into neurological status. Nurs Spectr 2011;24(15):44-49.
22. Hallan SI, Coresh J, Astor BC, Asberg A, Powe NR, Romundstad S, et al. International comparison of the relationship of chronic kidney disease prevalence and ESRD risk. J Am Soc Nephrol 2006;17(8):2275-2284.
23. Shitu AK, Akinsola A, Ayodele OE, Bademosi OF. Frequency of kidney dysfunction in patients with acute stroke and the relationship with the type, severity, and outcome. Niger Postgrad Med J 2022;29(3):214-220.
24. Mahmoud MI, Badawy AE, Shehta N, Ramadan BM. Baseline renal dysfunction in acute ischemic stroke patients: prevalence and impact on early mortality. Int J Adv Res 2016; 5(1): 502-508.
25. Pereg D, Rozenbaum Z, Vorobeichik D, Shlomo N, Gilad R, Bloch S, et al. Prevalence and significance of unrecognized renal dysfunction in patients with stroke. Am J Med 2016;129(10):1074-1081.
26. Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res. 2017;120(3):439-448.
27. Sulaiman MM, Watila MM, Shettima J, Ummate I, Nyandaiti YW. Role of renal dysfunction as a prognostic factor in acute stroke patients at a tertiary hospital in northeastern Nigeria. Saudi J Kidney Dis Transpl 2021;32(1):199-203.
28. Okaka EI, Imarhiagbe FA, Odiase FE, Okoye CA. Estimated glomerular filtration rate and risk of survival in acute stroke. East Afr Med J 2014;91(3):94-98.
29. Sardana V, Jain P. Assessment and prognostic significance of renal dysfunction in acute stroke patients. IP Indian J Neurosci 2021;7(1):5-10.
30. Nedeltchev K, Renz N, Karameshev A, Haefeli T, Brekenfeld C, Meier N, et al. Predictors of early mortality after acute ischaemic stroke. Swiss Med Wkly 2010;140(17-18):254-259.
31. Chwojnicki K, Król E, Wierucki Ł, Kozera G, Sobolewski P, Nyka WM, et al. Renal dysfunction in post-stroke patients. PLoS One 2016;11(8):e0159775.
32. Busari AA, Amira CO, Bello BT, Okubadejo NU, Abdusalam IA, Ojini FI. Renal dysfunction and 30-day mortality risk in patients with acute stroke. Afr J Nephrol 2019;22(1):28-34.
33. Nandyal S, Nandyal N. Study of renal function in patients of acute stroke and its relationship with in-hospital mortality. MedPulse Int J Med 2020;16(1):18-22.
34. Jain S, Margetis K, Iverson LM. Glasgow Coma Scale. In: StatPearls . Treasure Island (FL): StatPearls Publishing, 2025.
35. Hering D, Winklewski PJ. Autonomic nervous system in acute kidney injury. Clin Exp Pharmacol Physiol 2017;44(2):162-171. Erratum in: Clin Exp Pharmacol Physiol 2017;44(3):428.
36. Luyckx VA. Nephrotoxicity of alternative medicine practice. Adv Chronic Kidney Dis 2012;19(3):129-141.
37. Colombo A, Faglioni P, Marzullo M, Scarpa M, Sorgato P. [Risk factors and short-term prognosis in ischemic and hemorrhagic attacks: review of 503 patients admitted to the Neurologic Clinic of Modena]. Riv Neurol 1989;59(1):1-7.
38. Jover-Saenz A, Porcel-Perez JM, Vives-Soto M, Rubio-Caballero M. [Epidemiology of acute cerebrovascular disease in Lleida from 1996 to 1997. Predictive factors of mortality at short and medium term]. Rev Neurol 1999;28(10):941-948.
39. Mbala-Mukendi M, Tambwe MJ, Dikassa LN, M'Buyamba-Kabangu JR. [Initial arterial pressure and prognosis of cerebrovascular accidents]. Arch Mal Coeur Vaiss 1995;88(1):21-25.
40. Bhattacharjee K, Paul N, Roy S, Balamurali P. Acute kidney injury in acute stroke in relation to immediate outcome- a hospital based study. J Evid Based Med Healthc 2020;7(10):475-479.
41. Moulin T, Tatu L, Crépin-Leblond T, Chavot D. The Besançon Stroke Registry: an acute stroke registry of 2,500 consecutive patients. Eur Neurol 1997;38(1):10-20.
42. Siesjö BK, Bendek G, Koide T, Westerberg E, Wieloch T. Influence of acidosis on lipid peroxidation in brain tissues in vitro. J Cereb Blood Flow Metab 1985;5(2):253-258.
43. OuYang YB, Mellergård P, Kristian T, Kristianova V, Siesjö BK. Influence of acid-base changes on the intracellular calcium concentration of neurons in primary culture. Exp Brain Res 1994;101(2):265-271.
44. Seifu L, Gashaye Y, Taye M. Renal function abnormalities among patients with acute stroke at a tertiary hospital in Ethiopia. Ethiop J Health Sci 2022;32(6):1175-1182.
45. Hao Z, Wu B, Lin S, Kong FY, Tao WD, Wang DR, et al. Association between renal function and clinical outcome in patients with acute stroke. Eur Neurol 2010;63(4):237-242.
46. Xu J, Wang W, Shi H, Chen S, Liu Z, Li W, et al. chronic kidney disease is prevalent in Chinese patients admitted with verified cerebrovascular lesions and predicts short-term prognosis. Nephrol Dial Transplant 2011;26(8):2590-2594.
47. McCullough PA, Jurkovitz CT, Pergola PE, McGill JB, Brown WW, Collins AJ, et al. Independent components of chronic kidney disease as a cardiovascular risk state: results from the Kidney Early Evaluation Program (KEEP). Arch Intern Med 2007;167(11):1122-1129.