Lindner Anna, Kofler Mario, Rass Verena, Ianosi Bogdan, Gaasch Max, Schiefecker Alois J, Beer Ronny, Loveys Sebastian, Rhomberg Paul, Pfausler Bettina, Thomé Claudius, Schmutzhard Erich, Helbok Raimund
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Institute of Medical Informatics, University for Health Sciences, Medical Informatics and Technology, Hall, Austria.
Front Neurol. 2019 Aug 6;10:817. doi: 10.3389/fneur.2019.00817. eCollection 2019.
Infectious complications (IC) commonly occur in patients with intracerebral hemorrhage (ICH) and are associated with increased length of hospitalization (LOS) and poor long-term outcome. Little is known about early ICH-related predictors for the development of IC to allow appropriate allocation of resources and timely initiation of preventive measures. We prospectively enrolled 229 consecutive patients with non-traumatic ICH admitted to the neurocritical care unit (NICU) of a tertiary care hospital. Patients were screened daily for IC. Multivariable regression models using generalized linear models were used to identify associated factors with the occurrence of IC and to study their impact on functional outcome, which was assessed using the modified Rankin Scale Score (mRS) after 3 months. Unfavorable outcome was defined as mRS ≥3. The most common IC were pneumonia ( = 64, 28%) and urinary tract infection ( = 54, 24%), followed by sepsis ( = 9, 4%) and ventriculitis ( = 4, 2%). Patients with a higher admission ICH Score (>2) had higher odds to develop any IC during NICU stay (OR = 1.7, 95% CI 1.2-2.3, = 0.02). Moreover, early-onset pneumonia (≤48 h after admission) was predictive of sepsis occurring at a later time-point (median at day 11 [IQR = 6-34 days], adjOR = 22.5, 95% CI 4.88-103.6, < 0.001). Having at least one IC and pneumonia itself were independently associated with unfavorable 3-months outcome (adjOR = 3.0, 95% CI 1.41-6.54, = 0.005; adjOR = 4.2, 95% CI 1.33-13.19, = 0.015, respectively). All patients with sepsis died or had poor functional outcome. Infectious complications are common in ICH patients and independently associated with unfavorable outcome. An ICH Score >2 on admission and early pneumonia may help to early identify patients at high risk of IC to allocate resources and start careful surveillance.
感染性并发症（IC）在脑出血（ICH）患者中普遍存在，与住院时间（LOS）延长及长期预后不良相关。关于ICH相关的早期预测因素对IC发生的影响，目前了解甚少，而这些因素有助于合理分配资源并及时采取预防措施。我们前瞻性纳入了一家三级医院神经重症监护病房（NICU）连续收治的229例非创伤性ICH患者。每天对患者进行IC筛查。使用广义线性模型的多变量回归模型用于确定与IC发生相关的因素，并研究其对功能预后的影响，功能预后在3个月后使用改良Rankin量表评分（mRS）进行评估。不良预后定义为mRS≥3。最常见的IC是肺炎（n = 64，28%）和尿路感染（n = 54，24%），其次是脓毒症（n = 9，4%）和脑室炎（n = 4，2%）。入院时ICH评分较高（>2）的患者在NICU住院期间发生任何IC的几率更高（OR = 1.7，95%CI 1.2 - 2.3，P = 0.02）。此外，早发性肺炎（入院后≤48小时）可预测后期发生脓毒症（中位时间为第11天[IQR = 6 - 34天]，校正OR = 22.5，95%CI 4.88 - 103.6，P < 0.001）。发生至少一种IC以及肺炎本身均与3个月时的不良预后独立相关（校正OR分别为3.0，95%CI 1.41 - 6.54，P = 0.005；校正OR为4.2，95%CI 1.33 - 13.19，P = 0.015）。所有脓毒症患者均死亡或功能预后不良。感染性并发症在ICH患者中很常见，且与不良预后独立相关。入院时ICH评分>2以及早发性肺炎可能有助于早期识别IC高危患者，以便分配资源并开始密切监测。
