Abstract NS5: Early Infection Worsens ICH
Background: Intracerebral hemorrhage (ICH) is a dynamic disease in which coagulopathy, early re-bleeds, and tissue ischemia account for potential decline. Infection is known to contribute to coagulopathy and ischemia and may be a significant source of early decline and worse initial clinical presentation.
Hypothesis: Infection within 72 hours is an independent marker of early decline in hemorrhagic stroke.
Methods: To validate our hypothesis, we retrospectively analyzed infection and ICH presentation in 53 ICH patients at Houston Methodist Hospital from 2011-2013. We used the Glasgow Coma Score (GCS) on admission and the ICH Score as the primary outcome data on the severity of the initial clinical presentation of ICH patients. We considered the following diagnostic measures to determine infection within 72 hours: fever, leukocytosis, positive blood culture, positive urinalysis, positive chest X-ray, and use of non-prophylactic antibiotics. If any one of the diagnostic measures was positive then we counted the patient as having an infection within 72 hours. Additionally, we developed an Infection on Admission Score as the sum of each measure to establish a scale for the certainty and possible severity of infection with higher scores suggesting greater certainty and severity.
Results: Any marker of infection within 72 hours was independently associated with lower GCS on admission (P=0.0259). Using the Infection on Admission Score, we found that a higher score was also independently associated with higher (or more severe) ICH score (P= .0025) and with lower GCS (P= .0070).
Conclusions: Any sign of infection within 72 hours correlates with a worse initial clinical presentation of hemorrhagic stroke. Furthermore, these data suggest a physiological influence, as the severity of ICH rose in relationship to the severity of infection. We suggest further studies into this relationship to determine if infection itself causes decline or is simply a marker of overall decline.
Author Disclosures: A. Barrios-Anderson: None. E. Amin: None. A. Cung: None. J. Wiese: None. V. Belden: None. D. Espino: None. J.J. Volpi: None.
- © 2015 by American Heart Association, Inc.