Abstract TP335: Hospital-Acquired Infection is Associated with Poor Outcome in Young Adults with Hemorrhagic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kathryn M Sundheim ◽  
Eliza C Miller ◽  
Joshua Z Willey ◽  
Randolph S Marshall ◽  
Yuefan Shao ◽  
...  
Keyword(s):  
Young Adults ◽  
Hemorrhagic Stroke ◽  
Patient Characteristics ◽  
Single Center ◽  
Hospital Acquired Infection ◽  
Stroke Registry ◽  
Poor Outcome ◽  
Single Center Study ◽  
Poor Outcomes ◽  
Hospital Acquired

Background and Purpose: Infections are associated with poor outcomes in young people with ischemic stroke, particularly if they are hospital-acquired. However, the influence of infection on hemorrhagic stroke outcomes in a young population is less well characterized. Methods: We conducted a single-center retrospective analysis of a prospectively collected stroke registry, for patients, aged 18-45, admitted with hemorrhagic stroke of any type from 01/2008 to 03/2015. We reviewed charts for study variables, including patient characteristics, risk factors, and hospital-acquired infections (HAI) or infections present on admission (POA). Poor outcome was defined as modified Rankin score of 3-6 at time of discharge. We compared patients with HAI and infection POA to those without an infection. Results: Of the 219 hemorrhage cases in young adults, 31 (14%) had an infection POA, and 65 (29.7%) had a HAI. As shown in the table, patients who had a HAI and a POA infection had higher baseline NIHSS than those without an infection. In the unadjusted analyses, POA infections (OR = 2. 96, 95%CI: 1.91-4.58) and HAI (OR= 6.51, 95%CI: 4.06 - 10.44) are associated with poor mRS on discharge for hemorrhagic stroke. Adjusting for NIHSS, the relationship between POA infections and poor outcome is no longer significant (OR = 1.45, 95%CI: 0.34- 6.27) while HAI remains associated with poor outcome (OR= 6.73, 95%CI: 2.22 - 20.41). In SAH only patients, after adjusting for NIHSS, HAI remains associated with poor outcome (OR = 21.61, 95%CI: 3.35 - 139) while POA infections are not associated (OR = 3.01, 95%CI: 0.294 - 30.8). In ICH only patients, after adjusting for NIHSS, neither HAI (OR = 3.18, 95%CI: 0.656 - 15.4) nor POA infections (OR = 2.19, 95%CI: 0.334- 14.3) are associated with poor outcomes. Conclusions: In our single-center study, HAI, but not infections POA, were associated with poor outcomes in young adults with SAH. This relationship was not seen in patients with ICH.

Abstract WP186: Pregnancy Associated Hemorrhagic Strokes Differ in Mechanisms and Risk Factors Compared with Hemorrhagic Strokes in Non-pregnant Young Women and Men

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Eliza C Miller ◽  
Kathryn M Sundheim ◽  
Joshua Z Willey ◽  
Amelia K Boehme ◽  
Randolph S Marshall
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Pregnant Women ◽  
Patient Characteristics ◽  
Postpartum Women ◽  
Stroke Registry ◽  
Good Outcome ◽  
Cerebral Vasoconstriction ◽  
History Of ◽  
Stroke Mechanism

Background: Pregnancy-associated hemorrhagic stroke (HS), while rare, is a significant cause of maternal mortality. Prior studies have suggested that the pathophysiology of HS may differ in pregnant/postpartum women when compared with HS in other young adults. Methods: We conducted a single-center retrospective analysis of a prospectively collected stroke registry, for patients aged 18-45, admitted with HS of any type from 01/2008-03/2015. We reviewed charts for study variables, including patient characteristics, risk factors, stroke mechanisms, and outcomes. Good outcome was defined as modified Rankin score of 0-2 at time of discharge. We compared study variables between three groups: pregnant/postpartum women, non-pregnant/postpartum women, and men. Results: Of 219 young adults with HS during the study period, 93 (42%) were men and 126 (58%) were women, of whom 19 (15.1%) were pregnant/postpartum. Among men, 58 (62.4%) had ICH and 41 (33.3%) had SAH, 31 (75.6%) of which were aneurysmal. Among non-pregnant women, 49 (45.8%) had ICH and 61 (57%) had SAH, 53 (87%) of which were aneurysmal. Among pregnant/postpartum women, 10 had ICH (52.6%) and 11 (57.9%) had SAH, 1 of which was aneurysmal. Compared with men and with non-pregnant women, pregnant/postpartum women had fewer vascular risk factors, were more likely to have history of migraine, and were more likely to have the reversible cerebral vasoconstriction syndrome as stroke mechanism (11/19, 57.9% versus 0/93 men and 2/107 non-pregnant women, p=0.0001). While there were no deaths in the pregnant/postpartum group, there were no significant differences between groups in good outcome (Table). Conclusions: In our analysis, pregnancy-associated hemorrhages were uniquely non-aneurysmal and associated with fewer cerebrovascular risk factors than age-matched men and non-pregnant women, suggesting there is a pregnancy-specific pathophysiology for HS that requires special consideration.

scholarly journals Influence of Fever and Hospital-Acquired Infection on the Incidence of Delayed Neurological Deficit and Poor Outcome after Aneurysmal Subarachnoid Hemorrhage

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
G. Logan Douds ◽  
Bi Tadzong ◽  
Akash D. Agarwal ◽  
Satish Krishnamurthy ◽  
Erik B. Lehman ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Neurological Deficits ◽  
Multivariate Logistic Regression ◽  
Hospital Acquired Infection ◽  
Poor Outcome ◽  
Independent Association ◽  
Hospital Acquired ◽  
The Relationship ◽  
Retrospective Database

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.

scholarly journals Antioxidant vitamins status in children and young adults undergoing dialysis: A single center study

2015 ◽  
Vol 25 (4) ◽  
pp. 206
Author(s):  
M Naseri ◽  
HMotaghi Moghadam Shahri ◽  
M Horri ◽  
Z Rasoli ◽  
F Salemian ◽  
...  
Keyword(s):  
Young Adults ◽  
Antioxidant Vitamins ◽  
Single Center ◽  
Single Center Study ◽  
Children And Young Adults ◽  
Center Study

scholarly journals 396. Relationship Between Patient Characteristics and Critical Illness in Patients Admitted for CoVID-19

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S266-S267
Author(s):  
Samuel L Windham ◽  
Melissa P Wilson ◽  
Connor Fling ◽  
David W Sheneman ◽  
Taylor Wand ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Patient Characteristics ◽  
Minority Status ◽  
University Of Colorado ◽  
Early Intubation ◽  
Chart Abstraction ◽  
Male Sex ◽  
Poor Outcomes ◽  
Novel Coronavirus ◽  
Hospital Acquired

Abstract Background While several studies have explored hospitalization risk factors with the novel coronavirus (COVID-19) infection, the risk of poor outcomes during hospitalization has primarily relied upon laboratory or hospital-acquired data. Our goal was to identify clinical characteristics associated with intubation or death within 7 days of admission. Methods The first 436 patients admitted to the University of Colorado Hospital (Denver metropolitan area) with confirmed CoVID-19 were included. Demographics, comorbidities, and select medications were collected by chart abstraction. Missing height for calculating body mass index (BMI) was imputed using the median height for patients’ sex and race/ethnicity. Adjusted odds ratios (aOR) were estimated using multivariable logistic regression and a minimax concave penalty (MCP) regularized logistic regression explored prediction. Results Participants had a mean(SD) age 55(17), BMI 30.9(8.2), 55% were male and 80% were ethnic/racial minorities. Unadjusted comparisons by outcome are shown (Table 1). Male sex (aOR: 1.60, 95% CI (1.02, 2.54)), increasing age (aOR: 1.25(1.08, 1.47); per 10 years), higher BMI (aOR 1.03(1.00, 1.06) and poorly controlled diabetes (hemoglobin A1C ≥8) (aOR 2.33(1.27, 4.27) were significantly (p< 0.05) associated with greater odds of intubation or death. Minority status tended to be associated with higher odds (aOR:1.8(1.01,3.36); p=0.052). Surprisingly, need for hospital interpreter was associated with decreased odds (OR: 0.58(0.35, 0.95)) of intubation/death. Our final MCP model included indicators of A1C≥8, age >65, sex and minority status, but predicted intubation/death only slightly better than random chance (AUC= 0.61(0.56, 0.67)). Table 1. Patient Characteristics Stratified by Intubation and/or Death Within One Week of Admission (n=436) Conclusion In a hospitalized patient cohort with COVID-19, male sex, poorly controlled diabetes, increasing age and BMI were significantly associated with early intubation or death. These results complement larger cohort studies, and highlight risk differences across metropolitan areas with varying COVID-19 prevalence, demographics, and comorbid disease burden. Notably, our predictive model had limited success, which may suggest unmeasured factors also contribute to disease severity differences. Disclosures All Authors: No reported disclosures

Abstract P384: Outcomes of Endovascular Therapy in Patients With Pre-Stroke Mobility Impairment

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Rachel Beekman ◽  
Jie-Lena Sun ◽  
Brooke Alhanti ◽  
Lee H Schwamm ◽  
Eric Smith ◽  
...  
Keyword(s):  
Inpatient Rehabilitation ◽  
Stroke Severity ◽  
Limited Data ◽  
Mobility Impairment ◽  
Endovascular Thrombectomy ◽  
Stroke Registry ◽  
Logistic Regression Models ◽  
Poor Outcome ◽  
Poor Outcomes ◽  
Get With The Guidelines

Background and Purpose: Patients with pre-stroke mobility impairment were excluded from endovascular clinical trials. There is limited data regarding safety and outcomes of endovascular thrombectomy (EVT) in this population. We used a large, national dataset (Get With The Guidelines (GWTG)-Stroke) to evaluate the safety and outcomes of EVT in patients with pre-stroke mobility impairment (PSMI). Methods: We included patients who underwent EVT in the GWTG-Stroke registry between 2015 and 2019. PSMI was defined as inability to ambulate independently and poor outcome was defined as in-hospital mortality or discharge to hospice. GEE logistic regression models were used to evaluate the association between PSMI and outcomes. Results: Of 56,762 patients treated with EVT, 2919 (5.14%) had PSMI. Patients with PSMI were older (median 79 [IQR 70-87] vs 70 [59-80], P<0.001), more likely to be female (63.4% vs 49.2%, P<0.001), had more medical comorbidities, presented with a higher NIHSS (19 [12-24] vs 15 [9-21], P<0.001), and were less likely to be treated with tPA (36.8% vs 45.6%, P<0.001). PSMI was not associated with intracranial hemorrhage but was associated with poor outcome (Table 1). Patients with PSMI with poor outcomes were more likely to be older (83 [74-89] vs 77 [68-86], P<0.001) and have a higher presenting NIHSS (21 [16-25] vs 16 [11-22], p<0.001). Forty-nine percent of patients with PSMI with age >80 years and NIHSS >20 had a poor outcome. Conclusions: Amongst patients with PSMI treated with EVT, two thirds survived and one third were discharged to home or to inpatient rehabilitation. Advanced age and increased stroke severity increased the likelihood of poor outcomes. EVT appears safe in patients with PSMI, yet further study of effectiveness in this population is warranted.

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