Abstract W P336: Sepsis in Intracranial Hemorrhage - Should We Be Bugged?

Abstract

INTRODUCTION: Intracerebral hemorrhage (ICH) has the highest mortality rate of all stroke subtypes and accounts for 10-40% of all strokes. ICH patients are known to be at higher risk for infection and subsequent complications, however there is sparse data regarding the incidence of sepsis in critically ill patients with ICH. We hypothesize that the incidence of sepsis is high in ICH patients with terminal outcomes, and type of ICH would impact risk of developing sepsis. METHODOLOGY: A retrospective review was done of 200 patients with ICH admitted to an inner city hospital between June 1, 2013 and June 30, 2014. Inclusion criteria included patients with ICH and a terminal outcome, defined as death or comfort care as a result of their immediate condition. Exclusion criteria included patients with hemorrhagic infarcts, pre-existing conditions contributing to terminal outcomes, or conditions where ICH was a direct result of sepsis. ICH was subdivided into types: Spontaneous ICH (SICH), Subarachnoid Hemorrhage (SAH), Subdural Hematoma (SDH) and Intraventricular Hemorrhage (IVH). We collected age, sex, history of hypertension, location of ICH, evidence of sepsis, sever sepsis or septic shock, presence of intra-ventricular extension, volume of ICH, GCS, and calculated ICH score where applicable. RESULTS: Of 200 patients admitted with ICH, 22 patients had terminal outcomes (11.5%). Of the 22 patients, 8 had or were suspected of having sepsis (36.6%) of which three (37.8%) were due to pneumonia and in five, a source was not identified. Two of the patients had septic shock. Non-septic patients had worse ICH scores (3.42 vs. 2.88) than septic patients but this was not statistically significant. Non-septic patients had shorter lengths of stay (3.29 vs. 5.9, p=0.07). Sepsis was distributed evenly throughout various ICH types. CONCLUSION: The incidence of sepsis in ICH patients with terminal outcomes is high (36.6%) and increased to 50% in patients with a length of stay of at least 4 days. The primary source of sepsis was pneumonia; this can be used to target sepsis prevention in ICH patients in the future. Future studies need to be performed analyzing a larger sample size.