TY - JOUR
T1 - Impact of medical complications on outcome after subarachnoid hemorrhage
AU - Wartenberg, Katja E.
AU - Schmidt, J. Michael
AU - Claassen, Jan
AU - Temes, Richard E.
AU - Frontera, Jennifer A.
AU - Ostapkovich, Noeleen
AU - Parra, Augusto
AU - Connolly, E. Sander
AU - Mayer, Stephan A.
PY - 2006/3/1
Y1 - 2006/3/1
N2 - Objective: Medical complications occur frequently after subarachnoid hemorrhage (SAH). Their impact on outcome remains poorly defined. Design: Inception cohort study. Patients: Five-hundred eighty patients enrolled in the Columbia University SAH Outcomes Project between July 1996 and May 2002. Setting: Neurologic intensive care unit. Interventions: Patients were treated according to standard management protocols. Measurements and Main Results: Poor outcome was defined as death or severe disability (modified Rankin score, 4-6) at 3 months. We calculated the frequency of medical complications according to prespecified criteria and evaluated their impact on outcome, using forward stepwise multiple logistic regression after adjusting for known predictors of poor outcome. Thirty-eight% had a poor outcome; mortality was 21%. The most frequent complications were temperature >38.3°C (54%), followed by anemia treated with transfusion (36%), hyperglycemia >11.1 mmol/L (30%), treated hypertension (>160 mm Hg systolic; 27%), hypernatremia >150 mmol/L (22%), pneumonia (20%), hypotension (<90 mm Hg systolic) treated with vasopressors (18%), pulmonary edema (14%), and hyponatremia <130 mmol/L (14%). Fever (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-3.4; p = .02), anemia (OR, 1.8; 95% CI, 1.1-2.9; p = .02), and hyperglycemia (OR, 1.8; 95% CI, 1.1-3.0; p = .02) significantly predicted poor outcome after adjustment for age, Hunt-Hess grade, aneurysm size, rebleeding, and cerebral infarction due to vasospasm. Conclusions: Fever, anemia, and hyperglycemia affect 30% to 54% of patients with SAH and are significantly associated with mortality and poor functional outcome. Critical care strategies directed at maintaining normothermia, normoglycemia, and prevention of anemia may improve outcome after SAH.
AB - Objective: Medical complications occur frequently after subarachnoid hemorrhage (SAH). Their impact on outcome remains poorly defined. Design: Inception cohort study. Patients: Five-hundred eighty patients enrolled in the Columbia University SAH Outcomes Project between July 1996 and May 2002. Setting: Neurologic intensive care unit. Interventions: Patients were treated according to standard management protocols. Measurements and Main Results: Poor outcome was defined as death or severe disability (modified Rankin score, 4-6) at 3 months. We calculated the frequency of medical complications according to prespecified criteria and evaluated their impact on outcome, using forward stepwise multiple logistic regression after adjusting for known predictors of poor outcome. Thirty-eight% had a poor outcome; mortality was 21%. The most frequent complications were temperature >38.3°C (54%), followed by anemia treated with transfusion (36%), hyperglycemia >11.1 mmol/L (30%), treated hypertension (>160 mm Hg systolic; 27%), hypernatremia >150 mmol/L (22%), pneumonia (20%), hypotension (<90 mm Hg systolic) treated with vasopressors (18%), pulmonary edema (14%), and hyponatremia <130 mmol/L (14%). Fever (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-3.4; p = .02), anemia (OR, 1.8; 95% CI, 1.1-2.9; p = .02), and hyperglycemia (OR, 1.8; 95% CI, 1.1-3.0; p = .02) significantly predicted poor outcome after adjustment for age, Hunt-Hess grade, aneurysm size, rebleeding, and cerebral infarction due to vasospasm. Conclusions: Fever, anemia, and hyperglycemia affect 30% to 54% of patients with SAH and are significantly associated with mortality and poor functional outcome. Critical care strategies directed at maintaining normothermia, normoglycemia, and prevention of anemia may improve outcome after SAH.
KW - Anemia
KW - Fever
KW - Hyperglycemia
KW - Medical complications
KW - Outcome
KW - Subarachnoid hemorrhage
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U2 - 10.1097/01.CCM.0000201903.46435.35
DO - 10.1097/01.CCM.0000201903.46435.35
M3 - Article
C2 - 16521258
AN - SCOPUS:33644610186
VL - 34
SP - 617
EP - 623
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 3
ER -