Background:
Data on medical complications following intracerebral hemorrhage (ICH) are sparse. We assessed trends in the prevalence of urinary tract infection (UTI), pneumonia, sepsis, deep venous thrombosis (DVT), pulmonary embolism (PE), acute renal failure (ARF) and acute myocardial infarction (AMI) following ICH in the United States and evaluated their association with in-hospital mortality (IM), cost, length-of-stay (LOS) and home disposition (HD).
Methods:
Adults admitted to US hospitals from 2004-2013 (n=582,736) were identified from the Nationwide Inpatient Sample. Weighted complication risks were computed by sex and by mechanical ventilation (MV) status. Multivariate models were used to evaluate trends in complication and to assess their association with IM, cost, LOS, and HD.
Results:
Overall risks of UTI, pneumonia, sepsis, DVT, PE, ARF and AMI following ICH were 14.8%, 7.7%, 4.1%, 2.7%, 0.7%, 8.2% and 2.0% respectively. Risks differed by sex (UTI: females (F) 19.8% vs males (M) 9.9%; ARF: M 10.6% vs F 5.9%; sepsis: M 4.8% vs F 3.4%) and by MV status (pneumonia: MV 17.7% vs non-MV 3.9%; DVT: MV 4.3% vs non-MV 3.2%). From 2004 to 2103, odds of DVT and ARF increased while odds of pneumonia, sepsis and mortality declined over time (figure 1). Each complication was associated with > 2.5-day increase in mean LOS, > $8,000 increase in cost and reduced odds of HD. ARF and AMI were associated with increased IM in all patients; sepsis and pneumonia were associated with increased IM only in non-MV patients while UTI and DVT were associated with reduced IM in all patients.
Conclusion and Relevance:
Despite IM reduction, ARF and DVT risk following ICH in the US have increased while odds of sepsis and pneumonia have declined over time. All complications were associated with increased cost, LOS and reduced odds of HD but their associations with IM were variable, likely due in part to survival bias. Innovative strategies are needed to prevent ICH-associated medical complications.
Ten-Year Temporal Trends in Medical Complications After Acute Intracerebral Hemorrhage in the United States