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Multicenter Study
. 2014 Dec;45(12):3535-42.
doi: 10.1161/STROKEAHA.114.006435. Epub 2014 Oct 14.

Infection after intracerebral hemorrhage: risk factors and association with outcomes in the ethnic/racial variations of intracerebral hemorrhage study

Aaron S Lord  1 , Carl D Langefeld  2 , Padmini Sekar  2 , Charles J Moomaw  2 , Neeraj Badjatia  2 , Anastasia Vashkevich  2 , Jonathan Rosand  2 , Jennifer Osborne  2 , Daniel Woo  2 , Mitchell S V Elkind  2
Affiliations
Multicenter Study

Infection after intracerebral hemorrhage: risk factors and association with outcomes in the ethnic/racial variations of intracerebral hemorrhage study

Aaron S Lord et al. Stroke. 2014 Dec.

Abstract

Background and purpose: Risk factors for infections after intracerebral hemorrhage (ICH) and their association with outcomes are unknown. We hypothesized there are predictors of poststroke 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, and Glasgow Coma Scale).

Results: Among 800 patients, infections occurred in 245 (31%). Admission characteristics associated with infection in multivariable models were ICH volume (odds ratio [OR], 1.02/mL; 95% confidence interval [CI], 1.01-1.03), lower Glasgow Coma Scale (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 percutaneous endoscopic gastrostomy: OR, 3.19; 95% CI, 2.03-5.05 and without percutaneous endoscopic gastrostomy: OR, 2.11; 95% CI, 1.04-4.23), pulmonary edema (OR, 3.71; 95% CI, 1.29-12.33), and deep vein thrombosis (OR, 5.6; 95% CI, 1.86-21.02), but not ICH volume or Glasgow Coma Scale. Infected patients had higher discharge mortality (16% versus 8%; P=0.001) and worse 3-month outcomes (modified Rankin Scale ≥3; 80% versus 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.

Keywords: cerebral hemorrhage; infection; outcomes assessment (health care); risk factors.

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Figures

Figure 1
Figure 1
Post-ICH Infection by Type and Race
Figure 2
Figure 2
3-month Functional Outcome by Infection Status
Figure 3
Figure 3. Receiver Operator Curves for ICH Score Alone and for ICH Score + Infection
A) Discharge Outcomes B) 3-month Outcomes
See this image and copyright information in PMC

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