Admission eGFR as a Marker of Systemic Vulnerability in Patients with Spontaneous Intracerebral Hemorrhage: Impact of Premorbid Disability and Acute Kidney Injury on Outcomes

TL;DR

Low kidney function on admission for brain hemorrhage reflects overall health issues, not just kidney problems, and is linked to higher risk of acute kidney injury.

Contribution

The study clarifies that low eGFR reflects systemic vulnerability rather than being an independent risk factor for poor outcomes in ICH.

Findings

33.3% of patients had eGFR < 60 mL/min/1.73 m2 on admission, but only 18.5% had pre-existing CKD.

AKI occurred more frequently in patients with eGFR < 60 mL/min/1.73 m2 compared to those with eGFR ≥ 60 mL/min/1.73 m2.

Admission eGFR was not independently associated with functional outcomes after adjusting for other factors.

Abstract

Background: Kidney dysfunction is common in intracerebral hemorrhage (ICH), but it is unclear whether reduced estimated glomerular filtration rate (eGFR) on admission is an independent driver of short-term outcomes or a marker of overall vulnerability. Methods: In this single-center retrospective study, we analyzed the data of consecutive patients with spontaneous ICH. Results: Among 276 patients, 92 (33.3%) presented with eGFR < 60 mL/min/1.73 m2 on admission. Only 17/92 (18.5%) had documented pre-existing chronic kidney disease (CKD). Acute kidney injury (AKI) occurred more often in patients with eGFR < 60 mL/min/1.73 m2 than in those with eGFR ≥ 60 mL/min/1.73 m2 (25.0% vs. 10.3%). In survival models, eGFR ≥ 60 mL/min/1.73 m2, predicted higher 90-day survival in the baseline model (OR 3.031, p = 0.013) but was attenuated after adjustment for age and premorbid modified Rankin Scale (mRS) and was no longer independent after additional adjustment for laboratory markers. Across all models, the National Institutes of Health Stroke Scale (NIHSS) score, hematoma volume, and history of coronary artery disease remained robust predictors. Higher leukocyte count predicted lower survival, whereas higher hemoglobin predicted higher survival. Among survivors, favorable functional outcome was independently associated with lower NIHSS, younger age, lower premorbid mRS, and absence of documented CKD. Admission eGFR category was not independently associated. Conclusions: Reduced admission eGFR primarily reflects baseline frailty and systemic derangement rather than an independent determinant of short-term survival after full adjustment, whereas documented CKD is more informative for disability among survivors. AKI occurs more frequently in patients presenting with reduced eGFR, supporting close renal monitoring in acute ICH.