• Kavelin Rumalla and Manoj K Mittal.
• Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA.
• World Neurosurg. 2016 Jul 1; 91: 542-547.e6.

ObjectiveMedical complications in the setting of aneurysmal subarachnoid hemorrhage (aSAH) are common and associated with poor prognosis. We analyzed the incidence, risk factors, and short-term outcomes associated with acute renal failure (ARF) in aSAH.MethodsWe queried discharge records from all patients admitted to U.S. hospitals between 2002 and 2011 to identify primary diagnoses of aSAH and secondary diagnoses of ARF. The effect of demographics, hospital characteristics, and pre-existing comorbidity on ARF occurrence and the impact of ARF occurrence on length of stay (LOS), in-hospital costs, moderate to severe disability, and in-hospital mortality were explored in both bivariate and multivariable analyses.ResultsThe incidence of ARF in patients hospitalized for aSAH (N = 260,885) was 4.0% and increased from 2.1% in 2002 to 5.7% in 2011 (P < 0.0001). The strongest predictors of ARF in multivariable analysis were fluid and electrolyte disorder (odds ratio [OR], 3.24; 95% confidence interval [CI], 3.07-3.42), coagulopathy (OR, 2.43; 95% CI, 2.25-2.63), HIV (OR, 2.42; 95% CI, 1.79-3.27), and diabetes (OR, 2.37; 95% CI, 2.08-2.69). ARF onset in aSAH increased the mean length of stay by 7.2 days and mean total costs by $28,813 (all P < 0.0001). After adjusting for confounding factors, patients with ARF had increased likelihood of moderate to severe disability (OR, 2.03; 95% CI, 1.89-2.19) and in-hospital death (OR, 2.14; 95% CI, 2.03-2.26).ConclusionThe burden of ARF in hospitalized patients with aSAH has increased in the past decade and is detrimental to patient outcomes and healthcare costs. The identification of patient-centered risk factors may allow for close surveillance of high-risk patients.Copyright © 2016 Elsevier Inc. All rights reserved.

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