Impact of the “weekend effect” on hospital-acquired pneumonia after aneurysmal subarachnoid hemorrhage

Although fever and infection have been implicated in the causation of delayed neurological deficits (DND) and poor outcome after aneurysmal subarachnoid hemorrhage (SAH), the relationship between these two often related events has not been extensively studied. We reviewed these events through of our retrospective database of patients with SAH. Multivariate logistic regression was used to determine independent predictors of DND and poor outcome. A total of 186 patients were analyzed. DND was noted in 76 patients (45%). Fever was recorded in 102 patients (55%); infection was noted in 87 patients (47%). A patient with one infection was more likely to experience DND compared to a patient with no infections (adjusted OR 3.73, 95% CI 1.62, 8.59). For those with more than two infections the likelihood of DND was even greater (adjusted OR 4.24, 95% CI 1.55, 11.56). Patients with 1-2 days of fever were less likely to have a favorable outcome when compared to their counterparts with no fever (adjusted OR 0.19, 95% CI 0.06, 0.62). This trend worsened as the number of days febrile increased. These data suggest that the presence of infection is associated with DND, but that fever may have a stronger independent association with overall outcome.

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Neutrophil Counts as Promising Marker for Predicting In-Hospital Mortality in Aneurysmal Subarachnoid Hemorrhage

Stroke ◽

10.1161/strokeaha.120.034024 ◽

2021 ◽

Author(s):

Yu Zhang ◽

Linjie Li ◽

Lu Jia ◽

Tiangui Li ◽

Yuanyuan Di ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Propensity Score ◽

Hospital Mortality ◽

Propensity Score Matching ◽

Odds Ratio ◽

Prognostic Value ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Inflammatory Factors ◽

Hospital Acquired Infections ◽

Hospital Acquired

Background and Purpose: Systemic inflammation is recognized as a hallmark of stroke. We aimed to evaluate the prognostic value of various inflammatory factors using blood at admission in patients with aneurysmal subarachnoid hemorrhage. Methods: In a multicenter observational study of patients with aneurysmal subarachnoid hemorrhage, the counts of neutrophil, platelet, and lymphocyte were collected on admission. Patients were stratified based on neutrophil counts with propensity score matching to minimize confounding. We calculated the adjusted odds ratios with 95% CIs for the primary outcome of in-hospital mortality and hospital-acquired infections. Results: A total of 6041 patients were included in this study and 344(5.7%) of them died in hospital. Propensity score matching analyses indicated that compared with the lower neutrophil counts, higher neutrophil counts were associated with increased risk of in-hospital mortality (odds ratio, 1.53 [95% CI, 1.14–2.06]), hospital-acquired infections (odds ratio, 1.61 [95% CI, 1.38–1.79]), and delayed neurological ischemic deficits (odds ratio, 1.52 [95% CI, 1.09–1.97]). Moreover, out of all the inflammatory factors studied, neutrophil counts demonstrated the highest correlation with in-hospital mortality and hospital-acquired infections. Conclusions: Among patients with aneurysmal subarachnoid hemorrhage, high neutrophil counts at admission were associated with increased mortality and hospital-acquired infections. The neutrophil count is a simple, useful marker with prognostic value in patients with aneurysmal subarachnoid hemorrhage.

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Serum glutamine and hospital-acquired infections after aneurysmal subarachnoid hemorrhage

Neurology ◽

10.1212/wnl.0000000000005902 ◽

2018 ◽

Vol 91 (5) ◽

pp. e421-e426 ◽

Cited By ~ 4

Author(s):

Neeraj Badjatia ◽

Serge Cremers ◽

Jan Claassen ◽

E. Sander Connolly ◽

Stephan A. Mayer ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Nitrogen Balance ◽

Telephone Interview ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Cognitive Status ◽

Inflammatory Factors ◽

Modified Rankin Scale ◽

Hospital Acquired Infections ◽

Increased Risk ◽

Hospital Acquired

ObjectiveTo understand nutritional and inflammatory factors contributing to serum glutamine levels and their relationship to hospital-acquired infections (HAIs) after aneurysmal subarachnoid hemorrhage (SAH).MethodsA prospective observational study of patients with SAH who had measurements of daily caloric intake and C-reactive protein, transthyretin, tumor necrosis factor α receptor 1a (TNFαR1a), glutamine, and nitrogen balance performed within 4 preset time periods during the 14 days after SAH. Factors associated with glutamine levels and HAIs were analyzed with multivariable regression. HAIs were tracked daily for time-to-event analyses. Outcome 3 months after SAH was assessed by the Telephone Interview for Cognitive Status and modified Rankin Scale.ResultsThere were 77 patients with an average age of 55 ± 15 years. HAIs developed in 18 (23%) on mean SAH day 8 ± 3. In a multivariable linear regression model, negative nitrogen balance (p = 0.02) and elevated TNFαR1a (p = 0.04) were independently associated with higher glutamine levels during the study period. The 14-day mean glutamine levels were lower in patients who developed HAI (166 ± 110 vs 236 ± 81 μg/mL, p = 0.004). Poor admission Hunt and Hess grade (p = 0.04) and lower glutamine levels (p = 0.02) predicted time to first HAI. Low 14-day mean levels of glutamine were associated with a poor recovery on the Telephone Interview for Cognitive Status score (p = 0.03) and modified Rankin Scale score (p = 0.04) at 3 months after injury.ConclusionsDeclining glutamine levels in the first 14 days after SAH are influenced by inflammation and associated with an increased risk of HAI.

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Hospital-Acquired Infections after Aneurysmal Subarachnoid Hemorrhage: A Nationwide Analysis

World Neurosurgery ◽

10.1016/j.wneu.2015.10.054 ◽

2016 ◽

Vol 88 ◽

pp. 459-474 ◽

Cited By ~ 30

Author(s):

Hormuzdiyar H. Dasenbrock ◽

Robert F. Rudy ◽

Timothy R. Smith ◽

Donovan Guttieres ◽

Kai U. Frerichs ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Hospital Acquired Infections ◽

Hospital Acquired

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Association between weekend admissions and mortality after aneurysmal subarachnoid hemorrhage: the “weekend effect” revisited

Journal of Neurosurgery ◽

10.3171/2019.1.jns183185 ◽

2020 ◽

Vol 132 (4) ◽

pp. 1167-1173 ◽

Cited By ~ 3

Author(s):

Mirriam Mikhail ◽

Oliver G. S. Ayling ◽

Matthew E. Eagles ◽

George M. Ibrahim ◽

R. Loch Macdonald

Keyword(s):

Logistic Regression ◽

Subarachnoid Hemorrhage ◽

Neurological Outcome ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Weekend Effect ◽

Medical Specialties ◽

Poor Grade ◽

Multivariable Logistic Regression ◽

Wide Range

OBJECTIVEHigher mortality has been reported with weekend or after-hours patient admission across a wide range of surgical and medical specialties, a phenomenon termed the “weekend effect.” The authors evaluated whether weekend admission contributed to death and long-term neurological outcome in patients following aneurysmal subarachnoid hemorrhage.METHODSA post hoc analysis of the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) study was conducted. Univariable and stepwise multivariable logistic regression analyses were performed to assess the associations between weekend admission and mortality and long-term neurological outcome.RESULTSOf 413 subjects included in the CONSCIOUS-1 study, 140 patients had been admitted during the weekend. A significant interaction was identified between weekend admission and neurological grade on presentation, suggesting that the outcomes of patients who had initially presented with a poor grade were disproportionately influenced by the weekend admission. On stepwise multivariable logistic regression in the subgroup of patients who had presented with a poor neurological grade (29 of 100 patients), admission on the weekend was found to be independently associated with death (OR 6.59, 95% CI 1.62–26.88, p = 0.009). Weekend admission was not associated with long-term neurological outcome.CONCLUSIONSWeekend admission was an independent risk factor for death within 12 weeks following aneurysmal subarachnoid hemorrhage in patients presenting with a poor neurological grade. Further work is required to identify and mitigate any mediating factors.

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