Comparison of the demographic characteristics, national institutes of health stroke scale (NIHSS) and charlson comorbidity scales (CCS) of chronic hemodialysis patients with other patients admitted in intensive care with indication of cerebral stroke in emergency department

Stroke is the fourth reason of death in the worldwide. It is the leading cause of neurologic mortality and morbidity in adults, however. Chronic renal disease (CRD) is one of the major risk factor of cerebrovascular disease (CVD). However, there are few studies assessing the relationship between stroke and CRD / hemodialysis (HD). In this study, we aimed to compare the demographic characteristics, Charlson Comorbidity Score (CCS) and National Institutes of Health Stroke Scale (NIHSS) of chronic HD patients who were hospitalized in intensive care as cerebral stroke, with other groups, to define the differences, if there is, and within enlighten of this information, to contribute the management of such stroke patients in decrease of the mortality and morbidity rates in Emergency Department. Patients who referred to the Baskent University Faculty of Medicine, Adana Training and Research Center, Emergency Department between January 2011 and December 2013, diagnosed as stroke by World Health Organization (WHO) criteria, hospitalized in intensive care unit and age ≥18 years old, were retrospectively analyzed. Patients were divided into four groups. The first group was represented CRD patients; the second group was included the patients had one comorbidity, except CRD; the third group had at least 2-comorbidities, except CRD; and the fourth group had none of any comorbidity. Patients with CRD were compared with other groups. In the retrospective analysis of our study, we found that stroke risk and disease related mortality were increased in CRD patients consistent with the literature. In hemodialysis patients; being male gender, >64 age, hypertension (HT) and/or diabetes mellitus (DM), higher CCS score (CCS > 4, p:0,000), relative increase in pulse without tachycardia (87/min, p=0.003), anemia (Hematocrit: Hct < 40%, p=0.000), decreased HDL cholesterol (HDL-k < 40 mg/dL, p=0,003), increased trigliseride (TG > 95 mg/dL, p=0,033) and higher C-reactif protein levels (CRP > 6mg/L, p=0,000) were related in increased risk of stroke. NIHSS values were detected as statistically significantly decreased compared to the other groups (mean NIHSS= 6,5 p=0,009). HD patients were admitted to the Emergency Department earlier then the others (3,5 hour p=0,020). Middle cerebral artery watersheed infarcts were the most seen findings in brain magnetic rezonans imaging (MRI) (n=238, p=%41,8) however, the rate was lowest in HD patients (n=16, %26,6 p=0,024). Also hemorrhagic stroke was much more frequent in HD patients (n=16, %26,7; p=0,002) and in brain computerized tomography (BCT) intracranial hemorrhage (İCH) was seen mostly in this group (n=15, %25; p=0,023). The mortality in HD patients admitted with stroke was increased than other groups (n=22, %20,4 p=0,009). In HD patients, awareness of risk factors related to the stroke, management of underlying disease, education of patients and their relatives about stroke disease symptoms and immediate intervention, rapid and accurate management of patients in the Emergency Department may supply decreased morbidity and mortality in stroke patients with hemodialysis. Keywords: Cerebral stroke, Chronic Hemodialysis, Emergency Medicine, National Institutes of Health Stroke Scale (NIHSS), Charlson Comorbidity Score (CCS),