Nosocomial Infections and Outcomes after Intracerebral Hemorrhage: A Population-Based Study

Murthy, Santosh B.; Moradiya, Yogesh; Shah, Jharna N.; Merkler, Alexander E; Mangat, Halinder S.; Iadacola, Costantino; Hanley, Daniel F.; Kamel, Hooman; Ziai, Wendy

doi:10.1007/s12028-016-0282-6

Cited by 43 publications

(45 citation statements)

References 26 publications

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“…Post-stroke infection was strongly correlated with risk factors for infection such as poor gcs, intubation, dysphagia, pulmonary oedema, and invasive procedures. Potential mechanism include, infection may enhance pro-inflammatory cascades and causing a general activation of lymphocytes, might lead to secondary neuronal injury and worse functional outcomes after icH (27)(28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

Complications as poor prognostic factors in patients with hemorrhagic stroke: A hospital-based stroke registry

Pinzon¹,

Wijaya²

2020

Ro J Neurol.

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Introduction. Stroke patients commonly experience various medical complications during their rehabilitation stay. Understanding complications in hemorrhagic stroke patients can determine the patients prognosis. Aim. This study aimed to explore complications as prognostic factors among patients with hemorrhagic stroke. Methods. This was an observational analytic study with retrospective design. We analyzed the medical records of 480 patients admitted with hemorrhagic stroke between 2017 and 2018 at Bethesda Hospital, Indonesia. Disability, mortality, and length of stay (LoS) were assessed as clinical outcomes for this study. Multivariate logistic regression was used to analyze the data results. The data were obtained from 480 patients with hemorrhagic stroke that majority of males (58.5%), with < 60 years old (52.3%), stroke onset > 3 hours (87.5%), and had stroke for the first time (82.9%). The most common complications was GI tract bleeding (19.8%), whereas the least was decubitus ulcer (1.5%). There were 25.8% patients died during hospitalization period. Among 356 survivors, there were no significant prognosis factors of disability in subjects. Logistic regression found stroke onset > 3 hours (OR: 0.34; 95%CI: 0.19-0.59; p < 0.001) and GI tract bleeding (OR: 30.8; 95%CI: 16.93-55.88; p < 0.001) to be an independent predictors of mortality in hemorrhagic stroke, whereas GI tract bleeding (OR: 0.54; 95%CI: 0.31-0.95; p = 0.03) and UTI (OR: 4.73; 95%CI: 1.11-20.1; p = 0.04) were also an independent predictors of prolonged length of stay in hemorrhagic stroke. conclusion. This study identify complications as prognostic factors in hemorrhagic stoke patients. Stroke onset > 3 hours, GI tract bleeding, and UTI were independent predictors of poor prognosis in hemorrhagic stroke. There were no prognosis factor that affects disability in subjects.

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Section: Discussionmentioning

confidence: 99%

Complications as poor prognostic factors in patients with hemorrhagic stroke: A hospital-based stroke registry

Pinzon¹,

Wijaya²

2020

Ro J Neurol.

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“…The association between AL and infectious complications was investigated with a multivariable logistic regression analysis, adjusted for predictors of infections [19, 20]. All the variables with p value <0.1 in univariate analysis were included in the regression model.…”

Section: Methodsmentioning

confidence: 99%

Lymphopenia, Infectious Complications, and Outcome in Spontaneous Intracerebral Hemorrhage

et al. 2016

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Background Lymphopenia is increasingly recognized as a consequence of acute illness and may predispose to infections. We investigated whether admission lymphopenia (AL) is associated with increased risk of infectious complications and poor outcome in patients with spontaneous intracerebral hemorrhage (ICH). Methods We retrospectively analyzed a prospectively collected cohort of ICH patients ascertained between 1994 and 2015. We identified subjects with lymphocyte count obtained within 24 h from onset, and AL was defined as lymphocyte count < 1000/µL. Infectious complications were assessed through retrospective chart review. Association between AL, infections, and mortality was investigated using multivariable logistic regression. Results Of the 2014 patients meeting inclusion criteria, 548 (27.2%) had AL and 605 (30.0%) developed an infectious complication. Case-fatality at 90 days was 36.9%. Patients with AL had larger hematoma volumes, higher frequency of intraventricular hemorrhage, and lower Glasgow Coma Scale score on presentation (all p < 0.001). AL was independently associated with increased risk of pneumonia [odds ratio (OR) 1.97, 95% confidence interval (CI) 1.50–2.58, p < 0.001] and multiple infections (OR 1.84, 95% CI 1.24–2.71, p = 0.003). AL was also an independent predictor of 90-day mortality (OR 1.55, 95% CI 1.18–2.04, p = 0.002) after adjusting for confounders. Conclusions AL is common in ICH patients and independently associated with increased risk of infectious complications and poor outcome. Further studies will be needed to determine whether prophylactic antibiotics in ICH patients with AL can improve outcome.

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“…Acute supratentorial intracerebral hemorrhage (sICH) exhibits a 28-day mortality rate of 43.0% [ 8 ]. The incidence of intracerebral hemorrhage (ICH) patients who are at high risk for infections has increased [ 9 – 11 ], and as a result, the number of patients with ICH and SAE is also increasing. The mortality rate of SAE ranges from 51.0 to 71.9% [ 7 ], but the prognosis for sICH concurrent with SAE may be worse.…”

Section: Introductionmentioning

confidence: 99%

No Awakening in Supratentorial Intracerebral Hemorrhage Is Potentially Caused by Sepsis-Associated Encephalopathy

Tong

Zhou

2017

Med Sci Monit

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BackgroundAcute supratentorial intracerebral hemorrhage (sICH) with secondary sepsis is increasing in frequency. We investigated whether no awakening (NA) after sICH with coma is potentially caused by sepsis-associated encephalopathy (SAE).Material/MethodsA case-control study of 147 recruited sICH cases with NA and 198 sICH controls with subsequent awakening (SA) was performed at 2 centers in China. All patients underwent brain computed tomography (CT) scans on admission. The odds ratio (OR) of NA was calculated using logistic regression.ResultsDuring the study period, 56.5% (83/147) of the patients with sICH with coma and NA had SAE, and 10% (20/198) with sICH with coma and SA had SAE; this difference between the 2 groups was significant (p<0.000). The sICH patients with coma and NA exhibited a longer median time from onset to coma (2.0 days vs. 0.5 days), more frequent confirmed infection (98.0% vs. 24.2%), and a higher Sequential Organ Failure Assessment (SOFA) score (6.3±1.5 vs. 3.4±0.8). These patients also exhibited lower hematoma volume (28.0±18.8 vs. 38.3±24), a lower initial National Institutes of Health Stroke Scale score (19.5±6.6 vs. 30.3±6.8), more frequent brain midline shift (59.2% vs. 27.8%), more frequent diffuse cerebral swelling (64.6% vs. 16.0%), and higher 30-day mortality (54.4% vs. 0.0%) than the patients who did awaken. Logistic multivariable regression analyses revealed that only a higher SOFA score (OR, 1.4; 95% CI, 1.079–1.767; p=0.010) and SAE (OR, 4.0; 95% CI, 1.359–6.775; p=0.001) were associated with NA events in patients with sICH.ConclusionsNA in sICH patients with coma is potentially caused by secondary SAE.

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Nosocomial Infections and Outcomes after Intracerebral Hemorrhage: A Population-Based Study

Abstract: In a nationally representative cohort of ICH patients, nosocomial infection was associated with worse outcomes and greater resource utilization.

Cited by 43 publications

References 26 publications

Complications as poor prognostic factors in patients with hemorrhagic stroke: A hospital-based stroke registry

Complications as poor prognostic factors in patients with hemorrhagic stroke: A hospital-based stroke registry

Lymphopenia, Infectious Complications, and Outcome in Spontaneous Intracerebral Hemorrhage

No Awakening in Supratentorial Intracerebral Hemorrhage Is Potentially Caused by Sepsis-Associated Encephalopathy

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