From the Departments of Nephrology and Hypertension (A.S., J.D.S., S.D.N.), Quantitative Health Sciences (J.D.S.), and Neurology (I.K.), Cleveland Clinic, Cleveland, OH; and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee (G.K.).
Stroke. 2014 Jan;45(1):71-6. doi: 10.1161/STROKEAHA.113.003012. Epub 2013 Nov 19.
Subarachnoid hemorrhage (SAH) is associated with high mortality, and patients on maintenance dialysis have been shown to be at higher risk for stroke including SAH. However, the outcomes of patients on maintenance dialysis with SAH are not well known. This study was designed to look at incidence and outcomes of SAH in those on maintenance dialysis.
Using the Nationwide Inpatient Sample Database, hospitalizations with nontraumatic SAH were identified. Age-adjusted incidence rates were calculated by direct standardization to the 2000 US standard population. Logistic regression was used to assess the risk factors for mortality.
Of an estimated 149,091 hospitalizations with SAH, 1631 patients (10.9%) were on maintenance dialysis. Unadjusted incidence of SAH hospitalizations was higher in maintenance dialysis than in the general population (73.5 versus 11.2 per 100,000 population), and similar results were seen on age-adjusted analysis. The unadjusted all-cause inpatient mortality rate for SAH admissions was higher in maintenance dialysis versus the general population (38.4% versus 21.9%; P<0.001). Maintenance dialysis was an independent predictor of mortality (odds ratio, 2.48; 95% confidence interval, 1.85-3.34), although other significant predictors of mortality were similar in both subgroups. Incidence of SAH hospitalizations has been relatively stable during the study period, but mortality seems to be decreasing.
SAH hospitalizations are more common and associated with higher mortality in patients on maintenance dialysis than in the general population. Although being on maintenance dialysis is an independent predictor for mortality in patients with SAH, other predictors of mortality evaluated in this study are not necessarily different between the 2 groups.
蛛网膜下腔出血（SAH）死亡率高，维持性透析患者发生包括 SAH 在内的卒中风险更高。然而，维持性透析患者发生 SAH 的结局尚不清楚。本研究旨在观察维持性透析患者发生 SAH 的发病率和结局。
利用全美住院患者样本数据库，确定非创伤性 SAH 住院患者。采用直接标化法，将发病率标化至 2000 年美国标准人口，计算年龄校正发病率。采用 logistic 回归评估死亡率的危险因素。
在估计的 149091 例 SAH 住院患者中，有 1631 例（10.9%）在维持性透析。维持性透析患者未校正的 SAH 住院发病率高于普通人群（73.5 比 11.2/10 万人口），年龄校正后也如此。未校正的 SAH 住院患者全因住院死亡率在维持性透析患者中高于普通人群（38.4%比 21.9%；P<0.001）。维持性透析是死亡率的独立预测因素（比值比，2.48；95%置信区间，1.85-3.34），尽管其他显著的死亡率预测因素在两组中相似。研究期间，SAH 住院发病率相对稳定，但死亡率似乎在下降。
与普通人群相比，维持性透析患者 SAH 住院更常见，且死亡率更高。尽管维持性透析是 SAH 患者死亡的独立预测因素，但本研究评估的其他死亡率预测因素在两组之间不一定不同。
