Health Care–Associated Infections after Subarachnoid Hemorrhage

Abulhasan, Yasser B.; Alabdulraheem, Najayeb; Schiller, Ian; Rachel, Susan P.; Dendukuri, Nandini; Angle, Mark; Frenette, Charles

doi:10.1016/j.wneu.2018.04.061

Cited by 34 publications

(40 citation statements)

References 39 publications

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“…We observed a nonsignificant increase in serum IL-10 levels in poor-grade SAH patients compared to good-grade patients (data not shown). This difference might be a result of differences in H&H grades used between studies, since the earlier study considered higher H&H grades (≥4) to represent clinically severe SAH patients, whereas we classified poor H&H grades above 2 (3)(4)(5). Interestingly, patients with intraventricular hemorrhage or a combined IVH and ICB ( Figure S1e) had higher IL-10 levels on admission, showing the influence of IVH in the brain, i.e., that it may control systemic IL-10 release through brain-immune-system interactions.…”

Section: Discussionmentioning

confidence: 99%

“…Aneurysmal subarachnoid hemorrhage (SAH) is associated with a mortality rate of around 40-50% [1,2]. Despite successful aneurysm obliteration from the systemic circulation, a very high proportion of SAH patients confront life-threatening complications, and more than one-third of SAH patients develop systemic or local infections [3][4][5][6][7][8][9]. Post-SAH immunodepression may influence occurrence of infections.…”

Section: Introductionmentioning

confidence: 99%

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Elevated Systemic IL-10 Levels Indicate Immunodepression Leading to Nosocomial Infections after Aneurysmal Subarachnoid Hemorrhage (SAH) in Patients

Chaudhry

Kahlert

Kinfe

et al. 2020

IJMS

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Background: Aneurysmal subarachnoid hemorrhage (SAH) is a highly complex disease with very high mortality and morbidity. About one-third of SAH patients suffer from systemic infections, predominantly pneumonia, that can contribute to excess mortality after SAH. Immunodepression is probably the most important mechanism leading to infections. Interleukin-10 (IL-10) is a master regulator of immunodepression, but it is still not clear if systemic IL-10 levels contribute to immunodepression, occurrence of infections and clinical outcome after SAH. Methods: This explorative study included 76 patients with SAH admitted to our neurointensive care unit within 24 h after ictus. A group of 24 patients without any known intracranial pathology were included as controls. Peripheral venous blood was withdrawn on day 1 and day 7 after SAH. Serum was isolated by centrifugation and stored at −80 °C until analysis. Serum IL-10 levels were determined by enzyme-linked immunoassay (ELISA). Patient characteristics, post-SAH complications and clinical outcome at discharge were retrieved from patients’ record files. Results: Serum IL-10 levels were significantly higher on day 1 and day 7 in SAH patients compared to controls. Serum IL-10 levels were significantly higher on day 7 in patients who developed any kind of infection, cerebral vasospasm (CVS) or chronic hydrocephalus. Serum IL-10 levels were significantly higher in SAH patients discharged with poor clinical outcome (modified Rankin Scale (mRS) 3–6 or Glasgow Outcome Scale (GOS) 1–3). Conclusion: Serum IL-10 might be an additional useful parameter along with other biomarkers to predict post-SAH infections.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Elevated Systemic IL-10 Levels Indicate Immunodepression Leading to Nosocomial Infections after Aneurysmal Subarachnoid Hemorrhage (SAH) in Patients

Chaudhry

Kahlert

Kinfe

et al. 2020

IJMS

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“…Abulhasan et al investigated the effect of respiratory disease on the LOS in ICU and reported a probability of 0.78 (coefficient = 2.43; 95% CI −0.74-5.59). Regarding the total LOS, a probability of 0.99 (coefficient = 13.17; 95% CI = 5.63-20.72) was reported 3 .…”

Section: Discussionmentioning

confidence: 99%

“…It is known that initial stay in ICU is one of the main cost-driving factors 5 . Many studies report the impact of different factors on the total hospital LOS, but analyses of the explicit LOS in ICU is rare 3,7,[18][19][20] . In our analysis, pneumonia (p = 0.0031), sepsis (p = 0.0031), hydrocephalus (p = 0.0014), DCI (p = 0.038), and decompressive craniectomy (p = 0.0077) were the factors that had a significant impact on LOS in ICU.…”

Section: Discussionmentioning

confidence: 99%

“…www.nature.com/scientificreports www.nature.com/scientificreports/ (including pneumonia and bloodstream infections) (probability = 1.00; coefficient = 9.01; 95% CI = 7.03-10.99), and vasospasm (probability = 1.00; coefficient = 6.23; 95% CI = 4.52-7.94) as significant risk factors for a prolonged LOS in ICU 3 . Dasenbrock et al also confirmed pneumonia (non routine hospital discharge: 86.2%; OR = 3.26; 95% CI = 2.72-3.91; p < 0.001) to be a significant factor regarding the LOS beside urinary tract infections (non routine hospital discharge: 69.8%; OR = 1.51; 95% CI = 1.29-1.77; p < 0.001), CVC-associated infections (non routine hospital discharge: 79.7%; OR = 2.97; 95% CI = 1.13-7.83; p < 0.03), and meningitis/ ventriculitis (non routine hospital discharge: 77.7%; OR = 2.37; 95% CI = 1.72-3.26; p < 0.001) 19 .…”

Section: Discussionmentioning

confidence: 99%

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Impact of Complications and Comorbidities on the Intensive Care Length of Stay after Aneurysmal Subarachnoid Haemorrhage

Hammer

Ranaie

Erbguth

et al. 2020

Sci Rep

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In this observational study, we analysed a cohort of 164 subarachnoid haemorrhage survivors (until discharge from intensive care) with the aim to detect factors that influence the length of stay (LOS) in intensive care with multiple linear regression methods. Moreover, binary logistic regression methods were used to examine whether the time in intensive care is a predictor of outcome after 1 year. The clinical 1-year outcome was measured prospectively in a 12-month follow-up by telephone interview and categorised by the modified Rankin Scale (mRS). Patients who died during their stay in intensive care were excluded. Complications like pneumonia (β = 5.11; 95% CI = 1.75-8.46; p = 0.0031), sepsis (β = 9.54; 95% CI = 3.27-15.82; p = 0.0031), hydrocephalus (β = 4.63; 95% CI = 1.82-7.45; p = 0.0014), and delayed cerebral ischemia (DCI) (β = 3.38; 95% CI = 0.19-6.56; p = 0.038) were critical factors depending the LOS in intensive care as well as decompressive craniectomy (β = 5.02; 95% ci = 1.35-8.70; p = 0.0077). All analysed comorbidities such as hypertension, diabetes, hypothyroidism, cholesterinemia, and smoking history had no significant impact on the LOS in intensive care. LOS in intensive care (OR = 1.09; 95% CI = 1.03-1.15; p = 0.0023) as well as WFNS grade (OR = 3.72; 95% ci = 2.23-6.21; p < 0.0001) and age (OR = 1.06; 95% CI = 1.02-1.10; p = 0.0061) were significant factors that had an impact on the outcome after 1 year. Complications in intensive care but not comorbidities are associated with higher LOS in intensive care. LOS in intensive care is a modest but significant predictor of outcomes after subarachnoid haemorrhage. Subarachnoid haemorrhage (SAH) is a devastating disease that challenges all treating disciplines. Aside from direct effects of SAH on the brain parenchyma, and directly associated complications like rebleeding, delayed cerebral ischemia, and hydrocephalus, there is evidence that further medical complications play a crucial role in the outcome after SAH 1,2. It was reported that the proportion of deaths from medical complications is comparable to the proportion of deaths attributed to the direct effects of the initial haemorrhage, rebleeding, and vasospasm 1,2. However, these complications might be preventable or at least controllable. A better outcome might be achievable with improved intensive care management 1. Beside high rates of morbidity and mortality, SAH is associated with prolonged ICU length of stay (LOS) 2-4. Initial poor clinical condition and treatment modality, but especially duration of stay in ICU, are substantial economic factors in SAH. Treatment costs of SAH in the first year easily exceed costs in the first year of ischemic stroke 5,6. Some nosocomial infections in SAH are known to determine prolonged LOS 3,7. Galea et al. reported that patients who had significantly longer LOS after SAH had unfavourable outcomes at discharge 8. However, it is uncertain whether the total LOS in ICU is a direct predictor of outcome.

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Mortality among patients treated for aneurysmal subarachnoid hemorrhage in Eastern Denmark 2017–2019

et al. 2022

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Health Care–Associated Infections after Subarachnoid Hemorrhage

Cited by 34 publications

References 39 publications

Elevated Systemic IL-10 Levels Indicate Immunodepression Leading to Nosocomial Infections after Aneurysmal Subarachnoid Hemorrhage (SAH) in Patients

Elevated Systemic IL-10 Levels Indicate Immunodepression Leading to Nosocomial Infections after Aneurysmal Subarachnoid Hemorrhage (SAH) in Patients

Impact of Complications and Comorbidities on the Intensive Care Length of Stay after Aneurysmal Subarachnoid Haemorrhage

Mortality among patients treated for aneurysmal subarachnoid hemorrhage in Eastern Denmark 2017–2019

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