Abstract WP445: Characteristics of Methamphetamine-Related Intracerebral Hemorrhage and Factors Associated With Outcomes

Background: Risk factors for nosocomial infections and their impact on ICH outcomes are unclear. We hypothesized that factors present on admission are associated with developing infection, and patients who develop infections have worse outcomes. Methods: We determined prevalence of infections among patients in ERICH, a multicenter, triethnic case-control study of ICH. Exclusion criteria specific to this analysis were incomplete CT data and death/withdrawal of care <72 hours after admission. Patients with infection <two weeks before ICH were excluded from risk factor analyses, but included for outcomes assessments. We compared prevalence of risk factors for infections using chi-square and non-parametric tests, and performed multivariate logistic regression for risk of infection. Results: We enrolled 1397 individuals, 144 of whom died/had withdrawal of care within 72 hours and 210 with incomplete CT data, leaving 1043 patients. Nosocomial infections occurred in 300 patients (29%). Factors associated with presence of infections included ICH volume (13mL vs. 7mL, p <0.0001), GCS on admission (13 vs. 15, p <0.0001), WBC > 10 (42% vs. 32%), and higher CRP levels (4.9 vs. 1.8, p=0.01). Blacks had higher infection rates versus whites and Hispanics (33% vs. 27% and 24%, p=0.06). Procedural factors associated with infection included ventriculostomy, intrathecal-tPA, and intubation, while major neurosurgical procedures were associated with a 10-fold increase in CNS infection (all p <0.001). Infections were associated with bowel-bladder dysfunction, CHF/pulmonary edema, decubiti, DVT, dysphagia requiring PEG, and MI. Patients with infection were more likely to have DNR/DNI orders or to be dead at discharge (12.3% vs. 6.5%, p=0.0017). In a multivariate model for factors associated with infection, ICH volume, HIV history, intubation, CHF/pulmonary edema, and dysphagia requiring PEG were all associated with infection. Conclusion: There are identifiable risk factors associated with nosocomial infection after ICH, and infections are associated with mortality. Identification of patients at risk for infections may improve outcomes after ICH.

Download Full-text

Factors Associated with the Need for Ventriculoperitoneal Shunting in Patients with Spontaneous Intracerebral Hemorrhage Requiring Emergency Cerebrospinal Fluid Diversion

Indian Journal of Neurosurgery ◽

10.1055/s-0040-1710149 ◽

2020 ◽

Vol 9 (02) ◽

pp. 089-094

Author(s):

Ehsan Alimohammadi ◽

Seyed Reza Bagheri ◽

Homa Hadidi ◽

Shabnam Habibi ◽

Akram Amiri ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Intracerebral Hemorrhage ◽

Medical Condition ◽

External Ventricular Drain ◽

Univariate Analysis ◽

Factors Associated ◽

Protein Levels ◽

Ventriculoperitoneal Shunting ◽

Long Term Treatment ◽

Csf Diversion

Abstract Introduction Intracerebral hemorrhage (ICH) is a serious medical condition that is frequently complicated by acute hydrocephalus, necessitating emergency cerebrospinal fluid (CSF) diversion in a subset of patients, ultimately requiring long-term treatment via placement of permanent ventricular shunts. The present study aimed to determine factors associated with the need for permanent ventricular shunt placement in these patients. Methods A total of 309 consecutive patients who underwent emergent CSF diversion with external ventricular drain (EVD) as a treatment for ICH between July 2009 and July 2018 were studied retrospectively to assess the factors that might be correlated with shunt-dependent chronic hydrocephalus. A binary logistic regression model was designed to identify independent related factors of shunt-dependent hydrocephalus after ICH. Results Of 309 patients included in this study, 102 (33.00%) required permanent ventricular CSF shunting before discharge. In univariate analysis, age,ventriculitis, ICP elevation >30 mm Hg, ICH evacuation, the Graeb score, days of EVD in place, and CSF protein levels were significantly associated with the requirement for permanent CSF diversion (p < 0.05). The age and ICH evacuation were protective variables and the ventriculoperitoneal (VP) shunt possibility was reduced by 22.6 and 63.5%, respectively. Conclusion Our results showed that higher Graeb score, ICP elevation >30 mm Hg, more days of EVD in place, and higher CSF protein levels were associated with permanent CSF diversion in these patients. Advanced age and ICH evacuation decreased the possibility of VP shunting in our study.These factors may help in predicting which patients will need permanent CSF diversion and could ultimately lead to improvements in the management of these patients.

Download Full-text

Factors Associated with Fever in Intracerebral Hemorrhage

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2017.01.007 ◽

2017 ◽

Vol 26 (6) ◽

pp. 1204-1208 ◽

Cited By ~ 4

Author(s):

Sabreena J. Gillow ◽

Bichun Ouyang ◽

Vivien H. Lee ◽

Sayona John

Keyword(s):

Intracerebral Hemorrhage ◽

Factors Associated

Download Full-text

Factors Associated with Early Deterioration after Spontaneous Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

PLoS ONE ◽

10.1371/journal.pone.0096743 ◽

2014 ◽

Vol 9 (5) ◽

pp. e96743 ◽

Cited By ~ 34

Author(s):

Adrian V. Specogna ◽

Tanvir C. Turin ◽

Scott B. Patten ◽

Michael D. Hill

Keyword(s):

Systematic Review ◽

Intracerebral Hemorrhage ◽

Meta Analysis ◽

Spontaneous Intracerebral Hemorrhage ◽

Factors Associated

Download Full-text

Risk Scores for Predicting Post–thrombolysis Intracerebral Hemorrhage

US Neurology ◽

10.17925/usn.2010.05.02.39 ◽

2010 ◽

Vol 05 (02) ◽

pp. 39 ◽

Cited By ~ 3

Author(s):

James S McKinney ◽

Brett Cucchiara ◽

◽

Keyword(s):

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Acute Ischemic Stroke ◽

Clinical Assessment ◽

Scoring Systems ◽

Risk Scores ◽

Stroke Patients ◽

Factors Associated

Post-thrombolysis hemorrhage is a major concern for physicians treating acute ischemic stroke. Two scoring systems that incorporate factors associated with post-thrombolysis hemorrhage have been developed in an attempt to estimate the risk of developing post-thrombolysis hemorrhage among stroke patients. In this article we discuss these scoring systems and their utility in the clinical assessment of stroke patients.

Download Full-text

Unraveling the risk factors for spontaneous intracerebral hemorrhage among West Africans

Neurology ◽

10.1212/wnl.0000000000009056 ◽

2020 ◽

Vol 94 (10) ◽

pp. e998-e1012 ◽

Cited By ~ 7

Author(s):

Fred S. Sarfo ◽

Bruce Ovbiagele ◽

Mulugeta Gebregziabher ◽

Onoja Akpa ◽

Albert Akpalu ◽

...

Keyword(s):

Risk Factors ◽

Intracerebral Hemorrhage ◽

Conditional Logistic Regression ◽

Population Level ◽

Amyloid Angiopathy ◽

Spontaneous Intracerebral Hemorrhage ◽

Level Control ◽

Factors Associated ◽

West Africans ◽

Population Attributable Risks

ObjectiveTo characterize risk factors for spontaneous intracerebral hemorrhage (sICH) occurrence and severity among West Africans.MethodsThe Stroke Investigative Research and Educational Network (SIREN) study is a multicenter case-control study involving 15 sites in Ghana and Nigeria. Patients were adults ≥18 years old with CT-confirmed sICH with age-, sex-, and ethnicity-matched stroke-free community controls. Standard instruments were used to assess vascular, lifestyle, and psychosocial factors. Factors associated with sICH and its severity were assessed using conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% confidence intervals (CIs) for factors.ResultsOf 2,944 adjudicated stroke cases, 854 were intracerebral hemorrhage (ICH). Mean age of patients with ICH was 54.7 ± 13.9 years, with a male preponderance (63.1%), and 77.3% were nonlobar. Etiologic subtypes of sICH included hypertension (80.9%), structural vascular anomalies (4.0%), cerebral amyloid angiopathy (0.7%), systemic illnesses (0.5%), medication-related (0.4%), and undetermined (13.7%). Eight factors independently associated with sICH occurrence by decreasing order of PAR with their adjusted OR (95% CI) were hypertension, 66.63 (20.78–213.72); dyslipidemia, 2.95 (1.84–4.74); meat consumption, 1.55 (1.01–2.38); family history of CVD, 2.22 (1.41–3.50); nonconsumption of green vegetables, 3.61 (2.07–6.31); diabetes mellitus, 2.11 (1.29–3.46); stress, 1.68 (1.03–2.77); and current tobacco use, 14.27 (2.09–97.47). Factors associated with severe sICH using an NIH Stroke Scale score >15 with adjusted OR (95% CI) were nonconsumption of leafy green vegetables, 2.03 (1.43–2.88); systolic blood pressure for each mm Hg rise, 1.01 (1.00–1.01); presence of midline shift, 1.54 (1.11–2.13); lobar ICH, 1.72 (1.16–2.55); and supratentorial bleeds, 2.17 (1.06–4.46).ConclusionsPopulation-level control of the dominant factors will substantially mitigate the burden of sICH in West Africa.

Download Full-text

Abstract TP353: Long-term Outcomes in Patients With Intracerebral Hemorrhage and Delayed Hospital Presentation

Stroke ◽

10.1161/str.51.suppl_1.tp353 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Michael E Reznik ◽

Scott Moody ◽

Brian Mac Grory ◽

Christoph Stretz ◽

Tracy E Madsen ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Symptom Onset ◽

Delayed Presentation ◽

Long Term Outcomes ◽

Factors Associated ◽

Emergency Department Arrival ◽

Survivorship Bias ◽

Prolonged Delay ◽

Using Data

Background: Delays in medical care are known to be associated with worse outcomes in ischemic stroke, but outcomes in patients with intracerebral hemorrhage (ICH) and delayed presentation are unclear. We aimed to determine factors associated with prolonged delays from ICH symptom onset to hospital presentation and implications for long-term outcomes. Methods: We performed a single-center cohort study using data from consecutive ICH patients over 12 months. ICH characteristics and outcomes were prospectively collected, while time of symptom onset (or last-known-well) and emergency department arrival were retrospectively abstracted. We calculated time-to-arrival and defined prolonged delay as >24 hours. Using multivariable logistic regression, we determined factors associated with prolonged delays to presentation, then determined associations with unfavorable 3-month outcomes (modified Rankin Scale [mRS] 4-6) after adjusting for demographics and ICH severity. Results: Of 299 patients with out-of-hospital ICH, 21% (n=62) presented >24 hours from symptom onset; median time-to-arrival was 5.5 hours (IQR 1.2-17.8). There were not significant differences in age (mean 71.9±14.0 vs. 70.4±16.0, p=0.50), sex (48% vs. 50% male, p=0.80), race (89% vs. 82% white, p=0.22), or ICH size (mean 15.5±23.2 vs. 20.5±27.4cc, p=0.19) between patients presenting >24 hours and <24 hours from symptom onset, though patients with prolonged delays were less likely to have initial GCS <13 (16% vs. 34%, p=0.02) and therefore had modestly lower ICH scores (median 1 [0-2] vs. 1 [1-2], p=0.02). Patients with prolonged delays had lower 3-month mRS scores than patients who presented earlier (median 3 [1.5-4] vs. 4 [3-6], p=0.002), and lower odds of unfavorable 3-month outcome in adjusted models (OR 0.46, 95% CI 0.22-0.97). Conclusions: Outcomes in ICH patients with prolonged delays to presentation differ from those who present earlier. ICH severity in such patients may not be accurately captured by established predictors, and prognostication models should therefore account for inherent survivorship bias.

Download Full-text

Factors Associated With Emergency Department Length of Stay and In-hospital Mortality in Intracerebral Hemorrhage Patients

Journal of Neuroscience Nursing ◽

10.1097/jnn.0000000000000572 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Nicolle W. Davis ◽

Tiffany O. Sheehan ◽

Yi Guo ◽

Debra Lynch Kelly ◽

Ann L. Horgas ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Intracerebral Hemorrhage ◽

Hospital Mortality ◽

Factors Associated

Download Full-text

Abstract 18: Diffusion Weighted Imaging Lesions in Patients With Acute Intracerebral Hemorrhage: A Pooled Analysis of Individual Patient Data From MISTIE-III, ATACH-II, I-DEF, and ERICH

Stroke ◽

10.1161/str.51.suppl_1.18 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Santosh B Murthy ◽

Sung-Min Cho ◽

Ajay Gupta ◽

Ashkan Shoamanesh ◽

Radhika Avadhani ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Diffusion Weighted Imaging ◽

Individual Patient Data ◽

Mixed Effects ◽

Patient Data ◽

Factors Associated ◽

Diffusion Weighted ◽

Younger Age ◽

Acute Intracerebral Hemorrhage

Introduction: The etiology and significance of diffusion weighted imaging (DWI) lesions in patients with acute intracerebral hemorrhage (ICH) remain unclear. We evaluated which factors were associated with DWI lesions, whether associated factors differed by ICH location, and whether DWI lesions were associated with functional outcomes. Methods: We pooled individual patient data from the MISTIE III trial, the ATACH-II trial, the i-DEF trial, and the ERICH study. We included only patients who underwent protocolized magnetic resonance imaging (MRI) of the brain. A poor functional outcome was defined as a modified Rankin Scale (mRS) score of 4-6 at 3-6 months. We used mixed effects logistic regression with the study database as a random effect. Results: Among 1,775 ICH patients, there were 621 (35.6%) lobar, 978 (55.9%) deep, and 148 (8.5%) infratentorial ICHs. Median time to MRI scan was 1.5 days (IQR, 1-4). DWIHLs occurred in 559 (31.5%) patients, with 190 (34.3%) in lobar ICH and 320 (57.8%) in deep ICHs. In mixed effects regression models, factors associated with DWIHLs included younger age factors associated with DWIHLs after acute ICH included younger age (OR, 0.98; 95% CI, 0.97-0.99), black race (OR, 1.59; 95% CI, 1.18-2.16), admission systolic blood pressure (SBP per 10 mm Hg, OR, 1.13; 95% CI, 1.05-1.22), cerebral microbleeds (OR, 1.71, 95% CI, 1.24-2.35), and leukoaraiosis (OR, 1.60; 95% CI, 1.14-2.25). Patients with DWIHLs had higher odds of mRS 4-6 (OR, 1.57; 95% CI, 1.24-1.99) compared to those without, after adjustment for demographics and ICH severity. In subgroup analyses, similar factors influenced DWIHLs in deep ICH. However, in lobar ICH, younger age, admission SBP, and leukoaraiosis were associated with DWIHLs. Presence of DWIHLs was independently associated with poor mRS in deep ICH but not in lobar ICH. There was no relationship between acute BP lowering and DWIHLs, regardless of location. Conclusions: In a large, heterogeneous cohort of ICH patients, our results are consistent with the hypothesis that DWIHLs represent the effects of chronic hypertensive vasculopathy and acute blood pressure elevation. Furthermore, DWIHLs portend poor prognosis after ICH, particularly in deep hemorrhages.

Download Full-text

Race/ethnicity influences outcomes in young adults with supratentorial intracerebral hemorrhage

Neurology ◽

10.1212/wnl.0000000000008930 ◽

2020 ◽

Vol 94 (12) ◽

pp. e1271-e1280

Author(s):

Laura C. Miyares ◽

Guido J. Falcone ◽

Audrey Leasure ◽

Opeolu Adeoye ◽

Fu-Dong Shi ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Young Patients ◽

Adult Age ◽

Factors Associated ◽

Poor Outcome ◽

Race Ethnicity ◽

Racial Ethnic ◽

Admission Glasgow Coma Scale ◽

Hispanic White

ObjectivesWe investigated the predictors of functional outcome in young patients enrolled in a multiethnic study of intracerebral hemorrhage (ICH).MethodsThe Ethnic/Racial Variations in Intracerebral Hemorrhage (ERICH) study is a prospective multicenter study of ICH among adult (age ≥18 years) non-Hispanic white, non-Hispanic black, and Hispanic participants. The study recruited 1,000 participants per racial/ethnic group. The present study utilized the subset of ERICH participants aged <50 years with supratentorial ICH. Functional outcome was ascertained using the modified Rankin Scale (mRS) at 3 months. Logistic regression was used to identify factors associated with poor outcome (mRS 4–6), and analyses were compared by race/ethnicity to identify differences across these groups.ResultsOf the 3,000 patients with ICH enrolled in ERICH, 418 were studied (mean age 43 years, 69% male), of whom 48 (12%) were white, 173 (41%) were black, and 197 (47%) were Hispanic. For supratentorial ICH, black participants (odds ratio [OR], 0.42; p = 0.046) and Hispanic participants (OR, 0.34; p = 0.01) had better outcomes than white participants after adjustment for other factors associated with poor outcome: age, baseline disability, admission blood pressure, admission Glasgow Coma Scale score, ICH volume, deep ICH location, and intraventricular extension.ConclusionsIn young patients with supratentorial ICH, black and Hispanic race/ethnicity is associated with better functional outcomes, compared with white race. Additional studies are needed to identify the biological and social mediators of this association.

Download Full-text