Abstract TP306: Impact of Medical Complications on Outcome Following Intracerebral Hemorrhage

Abstract

Introduction: Intracerebral hemorrhage (ICH) results in significant mortality and morbidity, half of which occurs in the first 6 hours. Patients surviving beyond the initial trauma are prone to medical complications during their stay in the neurological ICU (NICU). Prior studies have demonstrated increased mortality and morbidity in SAH and ischemic stroke related to medical complications. Here we report the major complications that occur during the acute care of ICH patients and how those complications impact outcome. Methods: Patients presenting with CT-identified ICH admitted to the NICU between 2009 and 2012 were prospectively enrolled in the Columbia Intra-Cerebral Hemorrhage Outcomes Project. All medical complications were identified prospectively by the NICU attending physician and adjudicated by a panel of neurologists and neurosurgeons. The modified Rankin Scale (mRS) was used to evaluate neurologic function at 3 months. Univariate analysis and stepwise logistic regression were used to identify predictors of poor 3-month outcome (mRS >3). All outcome measures were corrected for admission demographics and severity of presentation. Results: Out of 222 patients, 182 (81.9%) suffered from a medical complication. The mean number of complications was 1.92 (range 0-8). The most common complications were hyperglycemia (39.6%), pneumonia (26.6%), hyponatremia (24.8%), fever greater than 39.2% (19.4%), and catheter- associated urinary tract infection (UTI) (15.8%). Of the 164 surviving patients, 120 (73.2%) had available follow-up at 3 months. The mean follow-up mRS was 3.28. Multivariate analysis demonstrated an OR for poor outcome of 6.41 (1.33-48.16) with pneumonia, 8.05 (2.01-38.45) with UTI, and 12.99 (1.62-146.24) for acute renal failure. Conclusions: Medical complications are prevalent among ICH patients in the NICU. Protection against urological and respiratory diseases provides a reasonable target of morbidity reduction amongst ICH patients. Aggressive sterile procedure, frequent respiratory therapy, vigilant assessment of aspiration risk, and the use of antibiotic-impregnated catheters may reduce disease burden.