Impact of Infection on Length of Intensive Care Unit Stay after Intracerebral Hemorrhage

Ohwaki, Kazuhiro; Yano, Eiji; Nagashima, Hiroshi; Nakagomi, Tadayoshi; Tamura, Akira

doi:10.1007/s12028-007-9007-1

Cited by 27 publications

(27 citation statements)

References 23 publications

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“…It may increase under various circumstances: in response to (brain) injury, infection or inflammation; moderately elevated CRP levels have been found in smokers, under psychological stress, in atherosclerosis and diabetes and in the elderly [29,30,31]. However, we hypothesize that maximal CRP levels in the current study in the majority of cases represented systemic infection, comparable to those of Ohwaki et al[ 21] where infection was significantly associated with maximum CRP levels (p < 0.001). Interestingly, in the group of patients where no infection could be identified, median maximal CRP level was 10.1 mg/dl, while 1 patient had a CRP level of 102.8 mg/dl without other signs of infection.…”

Section: Discussionsupporting

confidence: 84%

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C-Reactive-Protein Levels Associated with Infection Predict Short- and Long-Term Outcome after Supratentorial Intracerebral Hemorrhage

et al. 2009

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Background: The aim of the current study was to assess the occurrence of infection and its impact on the short- and long-term outcome of patients with supratentorial intracerebral hemorrhage (ICH). Methods: 247 patients suffering from supratentorial ICH were extracted from our local stroke database. Complete data sets including long-term functional outcome measured by the modified Rankin Scale (mRS), and baseline computed tomography data could be obtained in 113. The charts of these patients were screened for the presence and cause of infection, and baseline and maximal C-reactive protein (CRP) levels were recorded. Results: We identified 52 patients (50.5%) with infection during their hospital stay. Patients with infection, had significantly larger hemorrhages (28.7 vs. 11.9 ml; p = 0.002), a poorer admission status (National Institutes of Health Stroke Scale, NIHSS, score 14 vs. 6; p = 0.002) and more frequently intraventricular hemorrhage extension (46.2 vs. 23.5%; p = 0.016) than those without infection. In a multivariate logistic regression model, baseline NIHSS score (odds ratio, OR, 1.2, 95% confidence interval, CI, 1.1–1.31, p < 0.001), age (OR 1.1, 95% CI 1.03–1.16, p = 0.002) and maximal CRP levels (OR 1.72, 95% CI 1.12–2.64, p = 0.013) were independent predictors of poor long-term functional outcome (mRS >2). Conclusion: Infections were frequent complications in our cohort of ICH patients and occurred significantly more often in patients with poor functional outcome. Maximal CRP levels were an independent predictor of poor outcome in a multivariate model.

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Section: Discussionsupporting

confidence: 84%

“…Ohwaki et al[ 21] recently assessed the impact of infection on the length of ICU stay after ICH in a population of 148 patients. They report very high incidences of chest infection in 68% of patients, while 19% had urinary tract infections and 13% other infections.…”

Section: Discussionmentioning

confidence: 99%

C-Reactive-Protein Levels Associated with Infection Predict Short- and Long-Term Outcome after Supratentorial Intracerebral Hemorrhage

et al. 2009

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“…Three small studies (n=62 to 148) using single-institution databases found post-stroke infection rates of 51–58%, though two studies were ICU specific. 11–13 A study of 201 ICH patients from the Virtual International Stroke Trials Archive found a much lower rate of post-stroke infection (11%). 14 In multivariate analyses, post-ICH infection was associated with high NIH Stroke Scale (NIHSS) scores, age, CReactive Protein (CRP) levels, and invasive procedures.…”

Section: Introductionmentioning

confidence: 99%

Infection After Intracerebral Hemorrhage

Lord

Langefeld

Sekar

et al. 2014

Stroke

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Background and Purpose Risk factors for infections after intracerebral hemorrhage (ICH) and their association with outcomes are unknown. We hypothesized there are predictors of post-stroke infection and infections drive worse outcomes. Methods We determined prevalence of infections in a multicenter, triethnic study of ICH. We performed univariate and multivariate analyses to determine the association of infection with admission characteristics and hospital complications. We performed logistic regression on association of infection with outcomes after controlling for known determinants of prognosis after ICH (volume, age, infratentorial location, intraventricular hemorrhage, Glasgow Coma Score). Results Among 800 patients, infections occurred in 245 (31%). Admission characteristics associated with infection in multivariable models were ICH volume (OR 1.02 per mL, 95% CI 1.01–1.03), lower GCS (OR 0.91 per point, 95% CI 0.87–0.95), deep location (reference lobar, OR 1.90, 95% CI 1.28–2.88), and black race (reference white, OR 1.53, 95% CI 1.01–2.32). In a logistic regression of admission and hospital factors, infections were associated with intubation (OR 3.1, 95% CI 2.1–4.5), dysphagia (with PEG, OR 3.19, 95% CI 2.03–5.05; without PEG, OR 2.11, 95% CI 1.04–4.23), pulmonary edema (OR 3.71, 95% CI 1.29–12.33), and DVT (OR 5.6, 95% CI 1.86–21.02), but not ICH volume or GCS. Infected patients had higher discharge mortality (16% vs. 8%, p=0.001) and worse 3-month outcomes (mRS≥3, 80% vs. 51%, p<0.001). Infection was an independent predictor of poor 3-month outcome (OR 2.6, 95% CI 1.8–3.9). Conclusions There are identifiable risk factors for infection after ICH, and infections predict poor outcomes.

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“…Pneumonia is common after subarachnoid hemorrhage, but its impact on outcomes is not clear [6,7]. Pneumonia (diagnosed by nonstandardized criteria) probably worsens outcomes after intraparenchymal hemorrhage [8,9]. Patients with intracranial hemorrhage may have fever [10][11][12] or leukocytosis [13] from intracranial hemorrhage or steroid use (postoperatively or for chemical meningitis), complicating the clinical diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Reliability of the validated clinical diagnosis of pneumonia on validated outcomes after intracranial hemorrhage

Naidech¹,

Liebling²,

Duran³

et al. 2012

Journal of Critical Care

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Impact of Infection on Length of Intensive Care Unit Stay after Intracerebral Hemorrhage

Abstract: Complicating infection was an independent predictor of a prolonged ICU stay in patients with ICH.

Cited by 27 publications

References 23 publications

C-Reactive-Protein Levels Associated with Infection Predict Short- and Long-Term Outcome after Supratentorial Intracerebral Hemorrhage

C-Reactive-Protein Levels Associated with Infection Predict Short- and Long-Term Outcome after Supratentorial Intracerebral Hemorrhage

Infection After Intracerebral Hemorrhage

Reliability of the validated clinical diagnosis of pneumonia on validated outcomes after intracranial hemorrhage

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