Infection after intracerebral hemorrhage: risk factors and association with outcomes in the ethnic/racial variations of intracerebral hemorrhage study.
Infection after intracerebral hemorrhage: risk factors and association with outcomes in the ethnic/racial variations of intracerebral hemorrhage study.
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DOI：
10.1161/strokeaha.114.006435
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发表时间：
2014-12
期刊：
影响因子：
8.3
通讯作者：
Elkind MS
中科院分区：
文献类型：
--
作者：
Lord AS;Langefeld CD;Sekar P;Moomaw CJ;Badjatia N;Vashkevich A;Rosand J;Osborne J;Woo D;Elkind MS
脑出血（ICH）后感染的危险因素及其与结果的关系尚不清楚。我们假设存在中风后感染的预测因素，而感染会导致更糟糕的结果。我们在一项多中心、三民族研究中确定了 ICH 的感染流行率。我们进行了单变量和多变量分析，以确定感染与入院特征和医院并发症的关联。在控制了 ICH 后已知的预后决定因素（体积、年龄、幕下位置、脑室内出血、格拉斯哥昏迷评分）后，我们对感染与结果的关联进行了逻辑回归。在 800 名患者中，245 名患者（31%）发生感染。多变量模型中与感染相关的入院特征为 ICH 体积（OR 1.02 每毫升，95% CI 1.01–1.03）、较低的 GCS（OR 0.91 每点，95% CI 0.87–0.95）、深位置（参考脑叶，OR 1.90，95% CI 1.28–2.88）和黑人种族（参考白人，OR 1.53， 95% CI 1.01–2.32）。在入院和医院因素的逻辑回归中，感染与插管（OR 3.1，95% CI 2.1–4.5）、吞咽困难（使用 PEG，OR 3.19，95% CI 2.03–5.05；不使用 PEG，OR 2.11，95% CI 1.04–4.23）、肺水肿（OR 3.71，95% CI 1.04–4.23）、肺水肿相关。 1.29–12.33）和 DVT（OR 5.6，95% CI 1.86–21.02），但不包括 ICH 体积或 GCS。感染患者的出院死亡率较高（16% vs. 8%，p=0.001），3 个月结局较差（mRS≥3，80% vs. 51%，p<0.001）。感染是 3 个月预后不良的独立预测因素（OR 2.6，95% CI 1.8-3.9）。 ICH 后存在可识别的感染危险因素，感染预示着不良后果。
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. 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). 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). There are identifiable risk factors for infection after ICH, and infections predict poor outcomes.