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Lui HCH, He Z, Zhuang TF, Ng CF, Wong GKC. Tracheostomy decannulation outcomes in 131 consecutive neurosurgical patients. Br J Neurosurg 2024; 38:884-888. [PMID: 34730454 DOI: 10.1080/02688697.2021.1995591] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/02/2021] [Accepted: 10/14/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study was a retrospective study to investigate factors related to difficult tracheostomy decannulation, and to evaluate outcomes of tracheostomized neurosurgical patients. METHODS All consecutive tracheostomized neurosurgical patients in the Prince of Wales Hospital between 1st September 2016 and 31st August 2019 were reviewed retrospectively. Patients were grouped into easy decannulation and difficult decannulation groups using 3 months as cut-off time. Risk factors were analysed and outcomes were compared. RESULTS One hundred thirty-one patients were included. In univariate analyses, male gender, GCS less than or equal to 8 on admission, the presence of vocal cord palsy at 3 months, and pneumonia within 1-month post-tracheostomy were associated with difficult decannulation. In multivariable logistic regression for difficult decannulation, GCS on admission, the presence of vocal cord palsy at 3 months, and the presence of pneumonia within 1-month post-tracheostomy remained statistically significant. The easy decannulation group had a shorter length of in-patient stay, higher survival rate, and more favourable neurological outcome (GOS 4-5) than the difficult decannulation group at both 6 months and 1 year. The majority of easy decannulation group patients (54%) were discharged to home, while the majority of the difficult decannulation group (42%) of patients were discharged to the infirmary. CONCLUSION GCS less than or equal to 8 on admission, the presence of vocal cord palsy, and the presence of pneumonia were associated with difficult tracheostomy decannulation in neurosurgical patients. Difficult decannulation is associated with a longer length of in-patient stay and poor neurological outcomes.
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Affiliation(s)
- Hannaly Cheuk-Hang Lui
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zhexi He
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Neurosurgery, Tuen Mun Hospital, Hong Kong SAR, China
| | - Tin Fong Zhuang
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Neurosurgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Chat Fong Ng
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - George Kwok-Chu Wong
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
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Witsch J, Roh D, Oh S, Iadecola C, Diaz-Arrastia R, Kasner SE, Mayer SA, Murthy SB. Association Between Soluble Intercellular Adhesion Molecule-1 and Intracerebral Hemorrhage Outcomes in the FAST Trial. Stroke 2023; 54:1726-1734. [PMID: 37226773 PMCID: PMC10330250 DOI: 10.1161/strokeaha.123.042466] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/20/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Neutrophil-mediated inflammation in the acute phase of intracerebral hemorrhage (ICH) worsens outcome in preclinical studies. sICAM-1 (soluble intercellular adhesion molecule-1), an inducible ligand for integrins and cell-cell adhesion molecules, is critical for neutrophil extravasation. We aimed to determine whether serum levels of sICAM-1 are associated with worse outcomes after ICH. METHODS We conducted a post hoc secondary analysis of an observational cohort using data from the FAST trial (Factor-VII for Acute Hemorrhagic Stroke Treatment). The study exposure was the admission serum level of sICAM-1. The coprimary outcomes were mortality and poor outcome (modified Rankin Scale score 4-6) at 90 days. Secondary radiological outcomes were hematoma expansion at 24 hours and perihematomal edema expansion at 72 hours. We used multiple linear and logistic regression analyses to test for associations between sICAM-1 and outcomes, after adjustment for demographics, ICH severity characteristics, change in the systolic blood pressure in the first 24 hours, treatment randomization arm, and the time from symptom onset to study drug administration. RESULTS Of 841 patients, we included 507 (60%) with complete data. Hematoma expansion occurred in 169 (33%), while 242 (48%) had a poor outcome. In multivariable analyses, sICAM-1 was associated with mortality (odds ratio, 1.53 per SD increase [95% CI, 1.15-2.03]) and poor outcome (odds ratio, 1.34 per SD increase [CI, 1.06-1.69]). In multivariable analyses of secondary outcomes, sICAM-1 was associated with hematoma expansion (odds ratio, 1.35 per SD increase [CI, 1.11-1.66]), but was not associated with log-transformed perihematomal edema expansion at 72 hours. In additional analyses stratified by treatment assignment, similar results were noted in the recombinant activated factor-VII arm, but not in the placebo arm. CONCLUSIONS Admission serum levels of sICAM-1 were associated with mortality, poor outcome, and hematoma expansion. Given the possibility of a biological interaction between recombinant activated factor-VII and sICAM-1, these findings highlight the need to further explore the role of sICAM-1 as a potential marker of poor ICH outcomes.
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Affiliation(s)
- Jens Witsch
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David Roh
- Vagelos College of Physicians and Surgeons, Department of Neurology, Columbia University, New York, NY
| | - Stephanie Oh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Costantino Iadecola
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Ramon Diaz-Arrastia
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Scott E. Kasner
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stephan A. Mayer
- Departments of Neurology and Neurosurgery, New York Medical College, Valhalla, NY
| | - Santosh B. Murthy
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
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Hallenberger TJ, Guzman R, Bonati LH, Greuter L, Soleman J. Endoscopic surgery for spontaneous supratentorial intracerebral haemorrhage: A systematic review and meta-analysis. Front Neurol 2022; 13:1054106. [PMID: 36605784 PMCID: PMC9807598 DOI: 10.3389/fneur.2022.1054106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Treatment for spontaneous supratentorial intracerebral haemorrhage (SSICH) is limited and consist of either best medical treatment (BMT) or surgical hematoma evacuation. Treatment methods and choice of surgical technique are debated, and so far, no clear advantage of endoscopic surgery (ES) over conventional craniotomy (CC) or BMT was shown. The aim of this systematic review and meta-analysis was to investigate the differences in outcome, morbidity, and mortality between ES and CC or BMT. Methods We systematically searched Embase and PubMed databases for randomised controlled trials comparing ES to CC or BMT. The primary outcome was favourable functional outcome after 6 months. Secondary outcomes were morbidity and mortality rates and duration of surgery. Results Seven articles were eligible for the outcome analysis with 312 subjects in the control (216 CC, 96 BMT) and 279 in the treatment group (ES). Compared to BMT, ES showed significantly improved favourable functional outcome (RR 1.93 [1.12; 3.33], p = 0.02) and mortality rates (RR 0.63 [0.44; 0.90], p = 0.01). No significant difference in favourable functional outcome and mortality was seen in ES compared to CC (RR 2.13 [0.01; 737], p = 0.35; RR 0.42 [0.17; 1.05], p = 0.06). ES showed significantly lower morbidity (RR 0.41 [0.29; 0.58], p < 0.01), and overall infection rates (RR 0.33 [0.20; 0.54], p < 0.01) compared to CC. Duration of surgery was significantly shorter for ES compared to CC (SMD -3.17 [-4.35; -2.00], p < 0.01). Conclusion ES showed significantly improved favourable functional outcome and mortality rates compared to BMT while showing reduced length of surgery and lower complication rates compared to CC. Therefore, ES appears a promising approach for treatment of SSICH justifying further prospective trials. Systematic review registration PROSPERO, identifier: CRD42020181018.
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Affiliation(s)
- Tim J. Hallenberger
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland,Faculty of Medicine, University of Basel, Basel, Switzerland,Division of Paediatric Neurosurgery, Children's University Hospital of Basel, Basel, Switzerland
| | - Leo H. Bonati
- Faculty of Medicine, University of Basel, Basel, Switzerland,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Ladina Greuter
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland,Faculty of Medicine, University of Basel, Basel, Switzerland,Division of Paediatric Neurosurgery, Children's University Hospital of Basel, Basel, Switzerland,*Correspondence: Jehuda Soleman ✉
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Shah VA, Thompson RE, Yenokyan G, Acosta JN, Avadhani R, Dlugash R, McBee N, Li Y, Hansen BM, Ullman N, Falcone G, Awad IA, Hanley DF, Ziai WC. One-Year Outcome Trajectories and Factors Associated with Functional Recovery Among Survivors of Intracerebral and Intraventricular Hemorrhage With Initial Severe Disability. JAMA Neurol 2022; 79:856-868. [PMID: 35877105 PMCID: PMC9316056 DOI: 10.1001/jamaneurol.2022.1991] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Patients who survive severe intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH) typically have poor functional outcome in the short term and understanding of future recovery is limited. Objective To describe 1-year recovery trajectories among ICH and IVH survivors with initial severe disability and assess the association of hospital events with long-term recovery. Design, Setting, and Participants This post hoc analysis pooled all individual patient data from the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage phase 3 trial (CLEAR-III) and the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation (MISTIE-III) phase 3 trial in multiple centers across the US, Canada, Europe, and Asia. Patients were enrolled from August 1, 2010, to September 30, 2018, with a follow-up duration of 1 year. Of 999 enrolled patients, 724 survived with a day 30 modified Rankin Scale score (mRS) of 4 to 5 after excluding 13 participants with missing day 30 mRS. An additional 9 patients were excluded because of missing 1-year mRS. The final pooled cohort included 715 patients (71.6%) with day 30 mRS 4 to 5. Data were analyzed from July 2019 to January 2022. Exposures CLEAR-III participants randomized to intraventricular alteplase vs placebo. MISTIE-III participants randomized to stereotactic thrombolysis of hematoma vs standard medical care. Main Outcomes and Measures Primary outcome was 1-year mRS. Patients were dichotomized into good outcome at 1 year (mRS 0 to 3) vs poor outcome at 1 year (mRS 4 to 6). Multivariable logistic regression models assessed associations between prospectively adjudicated hospital events and 1-year good outcome after adjusting for demographic characteristics, ICH and IVH severity, and trial cohort. Results Of 715 survivors, 417 (58%) were male, and the overall mean (SD) age was 60.3 (11.7) years. Overall, 174 participants (24.3%) were Black, 491 (68.6%) were White, and 49 (6.9%) were of other races (including Asian, Native American, and Pacific Islander, consolidated owing to small numbers); 98 (13.7%) were of Hispanic ethnicity. By 1 year, 129 participants (18%) had died and 308 (43%) had achieved mRS 0 to 3. In adjusted models for the combined cohort, diabetes (adjusted odds ratio [aOR], 0.50; 95% CI, 0.26-0.96), National Institutes of Health Stroke Scale (aOR, 0.93; 95% CI, 0.90-0.96), severe leukoaraiosis (aOR, 0.30; 95% CI, 0.16-0.54), pineal gland shift (aOR, 0.87; 95% CI, 0.76-0.99]), acute ischemic stroke (aOR, 0.44; 95% CI, 0.21-0.94), gastrostomy (aOR, 0.30; 95% CI, 0.17-0.50), and persistent hydrocephalus by day 30 (aOR, 0.37; 95% CI, 0.14-0.98) were associated with lack of recovery. Resolution of ICH (aOR, 1.82; 95% CI, 1.08-3.04) and IVH (aOR, 2.19; 95% CI, 1.02-4.68) by day 30 were associated with recovery to good outcome. In the CLEAR-III model, cerebral perfusion pressure less than 60 mm Hg (aOR, 0.30; 95% CI, 0.13-0.71), sepsis (aOR, 0.05; 95% CI, 0.00-0.80), and prolonged mechanical ventilation (aOR, 0.96; 95% CI, 0.92-1.00 per day), and in MISTIE-III, need for intracranial pressure monitoring (aOR, 0.35; 95% CI, 0.12-0.98), were additional factors associated with poor outcome. Thirty-day event-based models strongly predicted 1-year outcome (area under the receiver operating characteristic curve [AUC], 0.87; 95% CI, 0.83-0.90), with significantly improved discrimination over models using baseline severity factors alone (AUC, 0.76; 95% CI, 0.71-0.80; P < .001). Conclusions and Relevance Among survivors of severe ICH and IVH with initial poor functional outcome, more than 40% recovered to good outcome by 1 year. Hospital events were strongly associated with long-term functional recovery and may be potential targets for intervention. Avoiding early pessimistic prognostication and delaying prognostication until after treatment may improve ability to predict future recovery.
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Affiliation(s)
- Vishank A. Shah
- Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard E. Thompson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gayane Yenokyan
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Julian N. Acosta
- Department of Neurology, Yale University, New Haven, Connecticut
| | - Radhika Avadhani
- Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Dlugash
- Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nichol McBee
- Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yunke Li
- Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- The George Institute China at Peking University Health Sciences Center, Beijing, China
| | | | - Natalie Ullman
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Guido Falcone
- Department of Neurology, Yale University, New Haven, Connecticut
| | - Issam A. Awad
- Department of Neurosurgery, University of Chicago, Chicago, Illinois
| | - Daniel F. Hanley
- Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wendy C. Ziai
- Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Zheng Y, Lin YX, He Q, Zhuo LY, Huang W, Gao ZY, Chen RL, Zhao MP, Xie ZF, Ma K, Fang WH, Wang DL, Chen JC, Kang DZ, Lin FX. Novel machine learning models to predict pneumonia events in supratentorial intracerebral hemorrhage populations: An analysis of the Risa-MIS-ICH study. Front Neurol 2022; 13:955271. [PMID: 36090880 PMCID: PMC9452786 DOI: 10.3389/fneur.2022.955271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background Stroke-associated pneumonia (SAP) contributes to high mortality rates in spontaneous intracerebral hemorrhage (sICH) populations. Accurate prediction and early intervention of SAP are associated with prognosis. None of the previously developed predictive scoring systems are widely accepted. We aimed to derive and validate novel supervised machine learning (ML) models to predict SAP events in supratentorial sICH populations. Methods The data of eligible supratentorial sICH individuals were extracted from the Risa-MIS-ICH database and split into training, internal validation, and external validation datasets. The primary outcome was SAP during hospitalization. Univariate and multivariate analyses were used for variable filtering, and logistic regression (LR), Gaussian naïve Bayes (GNB), random forest (RF), K-nearest neighbor (KNN), support vector machine (SVM), extreme gradient boosting (XGB), and ensemble soft voting model (ESVM) were adopted for ML model derivations. The accuracy, sensitivity, specificity, and area under the curve (AUC) were adopted to evaluate the predictive value of each model with internal/cross-/external validations. Results A total of 468 individuals with sICH were included in this work. Six independent variables [nasogastric feeding, airway support, unconscious onset, surgery for external ventricular drainage (EVD), larger sICH volume, and intensive care unit (ICU) stay] for SAP were identified and selected for ML prediction model derivations and validations. The internal and cross-validations revealed the superior and robust performance of the GNB model with the highest AUC value (0.861, 95% CI: 0.793–0.930), while the LR model had the highest AUC value (0.867, 95% CI: 0.812–0.923) in external validation. The ESVM method combining the other six methods had moderate but robust abilities in both cross-validation and external validation and achieved an AUC of 0.843 (95% CI: 0.784–0.902) in external validation. Conclusion The ML models could effectively predict SAP in sICH populations, and our novel ensemble model demonstrated reliable robust performance outcomes despite the populational and algorithmic differences. This attempt indicated that ML application may benefit in the early identification of SAP.
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Affiliation(s)
- Yan Zheng
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yuan-Xiang Lin
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Institute for Brain Disorders and Brain Science, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Clinical Research Center for Neurological Diseases, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Qiu He
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ling-Yun Zhuo
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wei Huang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zhu-Yu Gao
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ren-Long Chen
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ming-Pei Zhao
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ze-Feng Xie
- Department of Neurosurgery, Anxi County Hospital, Quanzhou, China
| | - Ke Ma
- Clinical Research and Translation Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wen-Hua Fang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Institute for Brain Disorders and Brain Science, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Clinical Research Center for Neurological Diseases, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Deng-Liang Wang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Institute for Brain Disorders and Brain Science, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Clinical Research Center for Neurological Diseases, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jian-Cai Chen
- Department of Neurosurgery, Anxi County Hospital, Quanzhou, China
| | - De-Zhi Kang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Institute for Brain Disorders and Brain Science, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Clinical Research Center for Neurological Diseases, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Clinical Research and Translation Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- De-Zhi Kang
| | - Fu-Xin Lin
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Institute for Brain Disorders and Brain Science, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Clinical Research Center for Neurological Diseases, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Clinical Research and Translation Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- *Correspondence: Fu-Xin Lin
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Firoozeh N, Agah E, Bauer ZA, Olusanya A, Seifi A. Catheter-Associated Urinary Tract Infection in Neurological Intensive Care Units: A Narrative Review. Neurohospitalist 2022; 12:484-497. [PMID: 35755214 PMCID: PMC9214946 DOI: 10.1177/19418744221075888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Catheter-associated urinary tract infection (CAUTI) is among the most common types of healthcare-associated infection (HAI), which is associated with poor outcomes and prolonged hospitalization in critically ill patients. Previous studies have mentioned that patients admitted to neurological ICUs are at higher risk of CAUTI compared to patients in other ICU settings. This review paper aims to review studies published during the last decade that evaluated the incidence, risk factors, causative pathogens, and preventive strategies and treatment in neuro-critically ill patients.
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Affiliation(s)
- Negar Firoozeh
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Agah
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zaith Anthony Bauer
- Department of Pulmonary Critical Care, Brooke Army Medical Center, San Antonio, TX, USA
| | - Adedeji Olusanya
- Department of Physical Medicine and Rehabilitation, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Ali Seifi
- Department of Neurosurgery, Division of Neurocritical Care, University of Texas Health, San Antonio, TX, USA
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Ding Y, Ji Z, Liu Y, Niu J. Braden scale for predicting pneumonia after spontaneous intracerebral hemorrhage. Rev Assoc Med Bras (1992) 2022; 68:904-911. [PMID: 35946766 PMCID: PMC9574960 DOI: 10.1590/1806-9282.20211339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/28/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Stroke-associated pneumonia is an infection that commonly occurs in patients with spontaneous intracerebral hemorrhage and causes serious burdens. In this study, we evaluated the validity of the Braden scale for predicting stroke-associated pneumonia after spontaneous intracerebral hemorrhage. METHODS Patients with spontaneous intracerebral hemorrhage were retrospectively included and divided into pneumonia and no pneumonia groups. The admission clinical characteristics and Braden scale scores at 24 h after admission were collected and compared between the two groups. Receiver operating characteristic curve analysis was performed to assess the predictive validity of the Braden scale. Multivariable analysis was conducted to identify the independent risk factors associated with pneumonia after intracerebral hemorrhage. RESULTS A total of 629 intracerebral hemorrhage patients were included, 150 (23.8%) of whom developed stroke-associated pneumonia. Significant differences were found in age and fasting blood glucose levels between the two groups. The mean score on the Braden scale in the pneumonia group was 14.1±2.4, which was significantly lower than that in the no pneumonia group (16.5±2.6), p<0.001. The area under the curve for the Braden scale for the prediction of pneumonia after intracerebral hemorrhage was 0.760 (95%CI 0.717-0.804). When the cutoff point was 15 points, the sensitivity was 74.3%, the specificity was 64.7%, the accuracy was 72.0%, and the Youden's index was 39.0%. Multivariable analysis showed that a lower Braden scale score (OR 0.696; 95%CI 0.631-0.768; p<0.001) was an independent risk factor associated with stroke-associated pneumonia after intracerebral hemorrhage. CONCLUSION The Braden scale, with a cutoff point of 15 points, is moderately valid for predicting stroke-associated pneumonia after spontaneous intracerebral hemorrhage.
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Affiliation(s)
- Yunlong Ding
- Affiliated Hospital of Yangzhou University, Jingjiang People's Hospital, Department of Neurology - Jiangsu, China
| | - Zhanyi Ji
- Zhoukou Central Hospital, Department of Neurology - Henan, China
| | - Yan Liu
- Affiliated Hospital of Yangzhou University, Jingjiang People's Hospital, Department of Neurology - Jiangsu, China
| | - Jiali Niu
- Affiliated Hospital of Yangzhou University, Jingjiang People's Hospital, Department of Clinical Pharmacy - Jiangsu, China
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8
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Asharaf S, Chakraborty K. Pharmacological potential of seaweed-associated heterotrophic Firmicutes. Lett Appl Microbiol 2022; 75:1042-1054. [PMID: 35771159 DOI: 10.1111/lam.13780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/11/2022] [Accepted: 06/21/2022] [Indexed: 11/27/2022]
Abstract
Seaweed-associated bacterial symbionts are sources of potential pharmacological properties. The present study resulted in the culture-dependent isolation of bioactive heterotrophs belonging to the bacterial phylum Firmicutes, which were dominated more than 30% of the 127 cultivable isolates, among which 23 of them showed potential antimicrobial activities against a wide range of pathogens. The symbionts isolated from the seaweed Sargassum wightii showed significant bioactivity. Those were characterised as Bacillus safensis MTCC13040, B. valismortis MTCC13041, B. velezensis MTCC13044, B. methylotrophicus MTCC13042, Oceanobacillus profundus MTCC13045, B. tequilensis MTCC13043, and B. altitudinis MTCC13046. The organic extracts of the studied isolates showed potential antimicrobial properties against methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci (minimum inhibitory concentration 6.25-12.5 μg ml-1 ). The organic extract of B. altitudinis MTCC13046 displayed significantly greater radical quenching ability (IC90 133 μg ml-1 , p < 0.05) other than attenuating hydroxymethyl glutaryl coenzyme A reductase (IC90 10.21 μg ml-1 , p < 0.05) and angiotensin converting enzyme-1 (IC90 498 μg ml-1 , p < 0.05) relative to other studied heterotrophs. The organic extract of B. tequilensis MTCC13043 displayed significantly greater attenuation potential against pro-inflammatory 5-lipooxygenase (IC90 5.94 μg ml-1 , p < 0.05) and dipeptidyl peptidase-4 (IC90 271 μg ml-1 , p < 0.05). The seaweed-associated B. altitudinis MTCC13046 and B. tequilensis MTCC13043 could be used to develop promising pharmacological leads.
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Affiliation(s)
- Sumayya Asharaf
- Marine Biotechnology Division, Central Marine Fisheries Research Institute, Ernakulam North, P.B. No, 1603, Cochin, -682018, Kerala State, India.,Faculty of Marine Sciences, Lakeside Campus, Cochin University of Science and Technology, Cochin, Kerala State, India
| | - Kajal Chakraborty
- Marine Biotechnology Division, Central Marine Fisheries Research Institute, Ernakulam North, P.B. No, 1603, Cochin, -682018, Kerala State, India
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9
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Developing and validating a mortality prediction model for ICH in ITP: a nationwide representative multicenter study. Blood Adv 2022; 6:4320-4329. [PMID: 35679462 PMCID: PMC9327537 DOI: 10.1182/bloodadvances.2022007226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/24/2022] [Indexed: 02/05/2023] Open
Abstract
Intraparenchymal hemorrhage, platelet count, serious infections, severe bleeding events, and Glasgow coma scale predict poor prognosis. A prognostic model was developed and validated, and an application was established.
Intracranial hemorrhage (ICH) is a rare and life-threatening hemorrhagic event in patients with immune thrombocytopenia (ITP). However, its mortality and related risk factors remain unclear. Herein, we conducted a nationwide multicenter real-world study of ICH in adult ITP patients. According to data from 27 centers in China from 2005 to 2020, the mortality rate from ICH was 33.80% (48/142) in ITP adults. We identified risk factors by logistic univariate and multivariate logistic regression for 30-day mortality in a training cohort of 107 patients as follows: intraparenchymal hemorrhage (IPH), platelet count ≤10 × 109/L at ICH, a combination of serious infections, grade of preceding bleeding events, and Glasgow coma scale (GCS) level on admission. Accordingly, a prognostic model of 30-day mortality was developed based on the regression equation. Then, we evaluated the performance of the prognostic model through a bootstrap procedure for internal validation. Furthermore, an external validation with data from a test cohort with 35 patients from 11 other centers was conducted. The areas under the receiver operating characteristic (ROC) curves for the internal and external validation were 0.954 (95% confidence interval [CI], 0.910-0.998) and 0.942 (95% CI, 0.871-1.014), respectively. Both calibration plots illustrated a high degree of consistency in the estimated and observed risk. In addition, the decision curve analysis showed a considerable net benefit for patients. Thus, an application (47.94.162.105:8080/ich/) was established for users to predict 30-day mortality when ICH occurred in adult patients with ITP.
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10
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Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, Hemphill JC, Johnson R, Keigher KM, Mack WJ, Mocco J, Newton EJ, Ruff IM, Sansing LH, Schulman S, Selim MH, Sheth KN, Sprigg N, Sunnerhagen KS. 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke 2022; 53:e282-e361. [PMID: 35579034 DOI: 10.1161/str.0000000000000407] [Citation(s) in RCA: 379] [Impact Index Per Article: 189.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - William J Mack
- AHA Stroke Council Scientific Statement Oversight Committee on Clinical Practice Guideline liaison
| | | | | | - Ilana M Ruff
- AHA Stroke Council Stroke Performance Measures Oversight Committee liaison
| | | | | | | | - Kevin N Sheth
- AHA Stroke Council Scientific Statement Oversight Committee on Clinical Practice Guideline liaison.,AAN representative
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11
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Thomas SM, Reindorp Y, Christophe BR, Connolly ES. Systematic Review of Resource Use and Costs in the Hospital Management of Intracerebral Hemorrhage. World Neurosurg 2022; 164:41-63. [PMID: 35489599 DOI: 10.1016/j.wneu.2022.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND While clinical guidelines provide a framework for hospital management of spontaneous intracerebral hemorrhage (ICH), variation in the resource use and costs of these services exists. We sought to perform a systematic literature review to assess the evidence on hospital resource use and costs associated with management of adult patients with ICH, as well as identify factors that impact variation in such hospital resource use and costs, regarding clinical characteristics and delivery of services. METHODS A systematic literature review was performed using PubMed, Cochrane Central Register of Controlled Trials, and Ovid MEDLINE(R) 1946 to present. Articles were assessed against inclusion and exclusion criteria. Study design, ICH sample size, population, setting, objective, hospital characteristics, hospital resource use and cost data, and main study findings were abstracted. RESULTS In total, 43 studies met the inclusion criteria. Pertinent clinical characteristics that increased hospital resource use included presence of comorbidities and baseline ICH severity. Aspects of service delivery that greatly impacted hospital resource consumption included intensive care unit length of stay and performance of surgical procedures and intensive care procedures. CONCLUSIONS Hospital resource use and costs for patients with ICH were high and differed widely across studies. Making concrete conclusions on hospital resources and costs for ICH care was constrained, given methodologic and patient variation in the studies. Future research should evaluate the long-term cost-effectiveness of ICH treatment interventions and use specific economic evaluation guidelines and common data elements to mitigate study variation.
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Affiliation(s)
- Steven Mulackal Thomas
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA.
| | - Yarin Reindorp
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Brandon R Christophe
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Edward Sander Connolly
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA
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12
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Ershova K, Savin I, Khomenko O, Wong D, Danilov G, Shifrin M, Sokolova E, O'Reilly-Shah VN, Lele AV, Ershova O. The incidence and outcomes of healthcare-associated respiratory tract infections in non-ventilated neurocritical care patients: Results of a 10-year cohort study. J Clin Neurosci 2022; 97:32-41. [PMID: 35033779 DOI: 10.1016/j.jocn.2021.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/25/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022]
Abstract
The incidence of healthcare-associated respiratory tract infections in non-ventilated patients (NVA-HARTI) in neurosurgical intensive care units (ICUs) is unknown. The impact of NVA-HARTI on patient outcomes and differences between NVA-HARTI and ventilator-associated healthcare-associated respiratory tract infections (VA-HARTI) are poorly understood. Our objectives were to report the incidence, hospital length of stay (LOS), ICU LOS, and mortality in NVA-HARTI patients and compare these characteristics to VA-HARTI in neurocritical care patients. This cohort study was conducted in a neurosurgical ICU in Moscow. From 2011 to 2020, all patients with an ICU LOS > 48 h were included. A competing risk model was used for survival and risk analysis. A total of 3,937 ICU admissions were analyzed. NVA-HARTI vs VA-HARTI results were as follows: cumulative incidence 7.2 (95%CI: 6.4-8.0) vs 15.4 (95%CI: 14.2-16.5) per 100 ICU admissions; incidence rate 4.2 ± 2.0 vs 9.5 ± 3.0 per 1000 patient-days in the ICU; median LOS 32 [Q1Q3: 21, 48.5] vs 46 [Q1Q3: 28, 76.5] days; median ICU LOS 15 [Q1Q3: 10, 28.75] vs 26 [Q1Q3: 17, 43] days; mortality 12.3% (95%CI: 7.9-16.8) vs 16.7% (95%CI: 13.6-19.7). The incidence of VA-HARTI decreased over ten years while NVA-HARTI incidence did not change. VA-HARTI was an independent risk factor of death, OR 1.54 (1.11-2.14), while NVA-HARTI was not. Our findings suggest that NVA-HARTI in neurocritical care patients represents a significant healthcare burden with relatively high incidence and associated poor outcomes. Unlike VA-HARTI, the incidence of NVA-HARTI remained constant despite preventive measures. This suggests that extrapolating VA-HARTI research findings to NVA-HARTI should be avoided.
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Affiliation(s)
- Ksenia Ershova
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 Pacific Street, Box 356540, Seattle, WA 98195, USA.
| | - Ivan Savin
- Burdenko National Medical Research Center of Neurosurgery, 4-Ya Tverskaya-Yamskaya Ulitsa, 16, Moscow 125047, Russia
| | - Oleg Khomenko
- Department of Computer Science, Skolkovo Institute of Science and Technology, Bolshoy Bulvar, 30, Moscow Oblast, 143026, Russia
| | - Darren Wong
- Division of Infectious Diseases, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA
| | - Gleb Danilov
- Burdenko National Medical Research Center of Neurosurgery, 4-Ya Tverskaya-Yamskaya Ulitsa, 16, Moscow 125047, Russia
| | - Michael Shifrin
- Burdenko National Medical Research Center of Neurosurgery, 4-Ya Tverskaya-Yamskaya Ulitsa, 16, Moscow 125047, Russia
| | - Ekaterina Sokolova
- Burdenko National Medical Research Center of Neurosurgery, 4-Ya Tverskaya-Yamskaya Ulitsa, 16, Moscow 125047, Russia
| | - Vikas N O'Reilly-Shah
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 Pacific Street, Box 356540, Seattle, WA 98195, USA
| | - Abhijit V Lele
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 Pacific Street, Box 356540, Seattle, WA 98195, USA
| | - Olga Ershova
- Burdenko National Medical Research Center of Neurosurgery, 4-Ya Tverskaya-Yamskaya Ulitsa, 16, Moscow 125047, Russia
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13
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Feng Y, Wu Q, Zhang T, Chen J, Wu X. Natural killer cell deficiency experiences higher risk of sepsis after critical intracerebral hemorrhage. Int J Immunopathol Pharmacol 2021; 35:20587384211056495. [PMID: 34931551 PMCID: PMC8725218 DOI: 10.1177/20587384211056495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Lymphopenia is common in intracerebral hemorrhage (ICH) and may
predispose to severe infections such as sepsis. However, what specific kind of
lymphocytes subsets decreases is still unclear. We investigated the impact of
lymphocytes subsets on post-critical ICH infections and mortality. Methods: Consecutive ICH patients (admitted to a single center between January
2017 and January 2018) were prospectively assessed to evaluate the following
main parameters: peripheral blood lymphocytes, infections, and clinical scores.
Predicting factors of sepsis were measured using multivariate Logistic
regressions analysis. A Kaplan–Meier survival curve was performed to compare the
mortality between septic and nonseptic patients. Survival status was evaluated
by multivariate Cox regression analysis. Results: In total, 112 critical ICH cases were enrolled including 29 septic
patients. Total counts of lymphocytes decreased accordingly with reduced
lymphocyte subsets, especially natural killer (NK) cells and CD8+T
lymphocytes after ICH. Septic patients had a higher incidence of pneumonia, a
longer length of stay, higher 90-day mortality, and worse long-term outcomes.
Multivariate Logistic regression analysis showed venous catheterization, high
APACHE-II score (>15), low GCS score (3–5), and NK cells percentages on
admission were independently associated with ensuing sepsis. After sepsis, the
percentages of CD4+T and NK cells percentages decreased, CD8+T cells increased
followed by a significantly decreased CD4/CD8 ratio. Bloodstream infection alone
directly affected the survival status of patients with sepsis. Conclusions: Critical ICH patients underwent immune dysfunction and NK cells
deficiency could favor nosocomial threatening sepsis after ICH.
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Affiliation(s)
- Yu Feng
- Department of Neurosurgery, 89674Wuhan University Zhongnan Hospital, Wuhan, China
| | - Qian Wu
- Department of Neurosurgery, 89674Wuhan University Zhongnan Hospital, Wuhan, China
| | - Tingbao Zhang
- Department of Neurosurgery, 89674Wuhan University Zhongnan Hospital, Wuhan, China
| | - Jincao Chen
- Department of Neurosurgery, 89674Wuhan University Zhongnan Hospital, Wuhan, China
| | - Xiaohui Wu
- Department of Neurosurgery, 89674Wuhan University Zhongnan Hospital, Wuhan, China
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14
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Kieninger M, Mandlinger A, Doblinger N, Kieninger B, Bele S, Salzberger B, Schneider-Brachert W, Graf B, Zeman F, Holzmann T. Impact of the implementation of a standard for preanalytical handling of samples for microbiological diagnostics on the quality of results at a neurocritical care unit. Medicine (Baltimore) 2021; 100:e27060. [PMID: 34449497 PMCID: PMC10545238 DOI: 10.1097/md.0000000000027060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Antibiotic stewardship (ABS) programs intend to improve outcomes of nosocomial infections and to counteract the emergence of further antimicrobial resistances. At the anesthesiologic-neurosurgical intensive care unit (ICU) of the University Medical Center Regensburg (Germany) we implemented a standard operating procedure (SOP) with clear instructions for the preanalytical handling and storage of microbiological samples. We intended to find out whether the instructions given in the SOP led to a higher rate of ideal material being sent to the laboratory and to overall better quality of the received results.We retraced retrospectively all samples taken in cases of suspected pneumonia, urinary tract infection, bloodstream infection, catheter infection associated with a central venous or arterial catheter and ventriculitis due to external ventricular drainage as well as all smears taken for the screening for multi-resistant bacteria within a time period of 1 year before to 1 year after the implementation of the SOP.In the case of suspected pneumonia and urinary tract infection, large amounts of ideal material were sent to the microbiological laboratory. A remarkable improvement after the implementation of the SOP, however, could only be observed regarding the number of urine samples taken from older urinary catheters, which was significantly lower in the "SOP group". Samples for microbiological diagnostics were taken much more often in the daytime, although storage of the probes did not lead to worse results.Concrete instructions enable adequate preanalytical handling of microbiological probes. However, we could not recognize substantial improvements probably due to a preexisting high process quality on the ICU. Microbiological diagnostics during the night shift has to be improved.
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Affiliation(s)
- Martin Kieninger
- Department of Anesthesiology, University Medical Center Regensburg, Germany
| | - Andreas Mandlinger
- Department of Anesthesiology, University Medical Center Regensburg, Germany
| | - Nina Doblinger
- Department of Anesthesiology, University Medical Center Regensburg, Germany
| | - Bärbel Kieninger
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Germany
| | - Sylvia Bele
- Department of Neurosurgery, University Medical Center Regensburg, Germany
| | - Bernd Salzberger
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Germany
| | - Wulf Schneider-Brachert
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Medical Center Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Germany
| | - Thomas Holzmann
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Germany
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15
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Zhou D, Xie L, Shi X, Liu F, Wu S, Zhang S, Liu R, Chang J, Zhu L. A meta-analysis of the clinical efficacy of Tanreqing injection combined with antibiotics vs antibiotics alone for treating pulmonary infection secondary to intracerebral hemorrhage. Medicine (Baltimore) 2021; 100:e24905. [PMID: 33725962 PMCID: PMC7982207 DOI: 10.1097/md.0000000000024905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/15/2020] [Accepted: 01/31/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Pulmonary infection is the most common complication to develop after intracerebral hemorrhage (ICH). Antibiotics have certain limitations when used to treat pulmonary infection, while Tanreqing injection (TRQI) is extensively used to treat pulmonary infection as an adjuvant to antibiotics. The aim of this meta-analysis was to investigate the clinical efficacy of TRQI for the treatment of lung infection secondary to ICH. METHODS Randomized controlled trials (RCTs) assessing the combination of TRQI and antibiotics compared to antibiotics alone for pulmonary infection after ICH were comprehensively searched for in 7 electronic databases from their establishment to August 2020. Two independent researchers conducted the literature retrieval, screening, and data extraction. The assessment tool of Cochrane risk of bias and Review Manager 5.3 software were applied to assess the methodological quality and analyze the data, respectively. RESULTS Seventeen RCTs involving 1122 patients with pulmonary infection after ICH were included. Compared to antibiotics alone, the combination treatment enhanced the clinical effective rate, shortened the hospital stay, reduced the white blood cell, procalcitonin, and C-reactive protein levels, ameliorated the times to the resolution of fever, cough, and lung rales, and increased the oxygenation index. The evidence indicated that TRQI combined with antibiotics caused no adverse reactions. CONCLUSIONS Our study showed that the combination of TRQI and antibiotics was effective for treating pulmonary infection after ICH. However, high-quality multicenter RCTs are needed to further verify the clinical efficacy of TRQI due to the publication bias and the low methodological quality of the included RCTs.
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Affiliation(s)
- Dongrui Zhou
- Key Laboratory of Chinese Internal Medicine of Educational Ministry and Beijing, Dongzhimen Hospital
| | - Liandi Xie
- Department of Cardiology, Dongfang Hospital, Beijing University of Chinese Medicine
| | - Xiaowei Shi
- Department of Massage, The Third Affiliated Hospital of Beijing University of Chinese Medicine
| | - Fengzhi Liu
- Key Laboratory of Chinese Internal Medicine of Educational Ministry and Beijing, Dongzhimen Hospital
| | - Shuang Wu
- Key Laboratory of Chinese Internal Medicine of Educational Ministry and Beijing, Dongzhimen Hospital
| | - Shuangshuang Zhang
- Department of Oncology, Beijing Daxing District Hospital of Integrated Chinese and Western Medicine
| | - Ruijia Liu
- Key Laboratory of Chinese Internal Medicine of Educational Ministry and Beijing, Dongzhimen Hospital
| | - Jingling Chang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Lingqun Zhu
- Key Laboratory of Chinese Internal Medicine of Educational Ministry and Beijing, Dongzhimen Hospital
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16
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Morais Filho ABD, Rego TLDH, Mendonça LDL, Almeida SSD, Nóbrega MLD, Palmieri TDO, Giustina GZD, Melo JP, Pinheiro FI, Guzen FP. The physiopathology of spontaneous hemorrhagic stroke: a systematic review. Rev Neurosci 2021; 32:631-658. [PMID: 33594841 DOI: 10.1515/revneuro-2020-0131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/22/2021] [Indexed: 12/29/2022]
Abstract
Hemorrhagic stroke (HS) is a major cause of death and disability worldwide, despite being less common, it presents more aggressively and leads to more severe sequelae than ischemic stroke. There are two types of HS: Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH), differing not only in the site of bleeding, but also in the mechanisms responsible for acute and subacute symptoms. This is a systematic review of databases in search of works of the last five years relating to the comprehension of both kinds of HS. Sixty two articles composed the direct findings of the recent literature and were further characterized to construct the pathophysiology in the order of events. The road to the understanding of the spontaneous HS pathophysiology is far from complete. Our findings show specific and individual results relating to the natural history of the disease of ICH and SAH, presenting common and different risk factors, distinct and similar clinical manifestations at onset or later days to weeks, and possible complications for both.
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17
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Roberts KA, Colley L, Agbaedeng TA, Ellison-Hughes GM, Ross MD. Vascular Manifestations of COVID-19 - Thromboembolism and Microvascular Dysfunction. Front Cardiovasc Med 2020; 7:598400. [PMID: 33195487 PMCID: PMC7649150 DOI: 10.3389/fcvm.2020.598400] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022] Open
Abstract
The coronavirus pandemic has reportedly infected over 31.5 million individuals and caused over 970,000 deaths worldwide (as of 22nd Sept 2020). This novel coronavirus, officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), although primarily causes significant respiratory distress, can have significant deleterious effects on the cardiovascular system. Severe cases of the virus frequently result in respiratory distress requiring mechanical ventilation, often seen, but not confined to, individuals with pre-existing hypertension and cardiovascular disease, potentially due to the fact that the virus can enter the circulation via the lung alveoli. Here the virus can directly infect vascular tissues, via TMPRSS2 spike glycoprotein priming, thereby facilitating ACE-2-mediated viral entry. Clinical manifestations, such as vasculitis, have been detected in a number of vascular beds (e.g., lungs, heart, and kidneys), with thromboembolism being observed in patients suffering from severe coronavirus disease (COVID-19), suggesting the virus perturbs the vasculature, leading to vascular dysfunction. Activation of endothelial cells via the immune-mediated inflammatory response and viral infection of either endothelial cells or cells involved in endothelial homeostasis, are some of the multifaceted mechanisms potentially involved in the pathogenesis of vascular dysfunction within COVID-19 patients. In this review, we examine the evidence of vascular manifestations of SARS-CoV-2, the potential mechanism(s) of entry into vascular tissue and the contribution of endothelial cell dysfunction and cellular crosstalk in this vascular tropism of SARS-CoV-2. Moreover, we discuss the current evidence on hypercoagulability and how it relates to increased microvascular thromboembolic complications in COVID-19.
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Affiliation(s)
- Kirsty A. Roberts
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Liam Colley
- School of Sport, Health & Exercise Science, Bangor University, Bangor, United Kingdom
| | - Thomas A. Agbaedeng
- Centre for Heart Rhythm Disorders, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Georgina M. Ellison-Hughes
- Centre for Human and Physiological Sciences, Faculty of Life Sciences & Medicine, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Mark D. Ross
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
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18
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Melmed KR, Boehme A, Ironside N, Murthy S, Park S, Agarwal S, Connolly ES, Claassen J, Elkind MSV, Roh D. Respiratory and Blood Stream Infections are Associated with Subsequent Venous Thromboembolism After Primary Intracerebral Hemorrhage. Neurocrit Care 2020; 34:85-91. [PMID: 32385835 PMCID: PMC7223996 DOI: 10.1007/s12028-020-00974-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infection and venous thromboembolism (VTE) are associated with worse outcomes after intracerebral hemorrhage (ICH). The relationship between infection and VTE in ICH patients is unclear. We hypothesized that infection would be associated with subsequent VTE after ICH. METHODS We retrospectively studied consecutively admitted spontaneous primary ICH patients from 2009 to 2018 surviving beyond 24 h. The primary predictor variable was infection, diagnosed prior to VTE. The primary outcome was VTE. We used multivariable logistic regression models to estimate the odds ratios and 95% confidence intervals (OR, 95% CI) for VTE risk after infection of any type, after adjusting for ICH score, length of stay and days to deep venous thrombosis (DVT) prophylaxis. Similar analysis was done to estimate the association of infection subtypes, including respiratory and urinary and blood stream infections (BSI) with VTE. RESULTS There were 414 patients (mean age 65 years, 47% female) that met were analyzed. Infection was diagnosed in 181 (44%) patients. Incident VTE was diagnosed in 36 (9%) patients, largely comprised of DVT (n = 32; 89%). Infection overall was associated with increased risk of subsequent VTE (adjusted OR 4.5, 95% CI 1.6-12.6). Respiratory (adjusted OR 5.7, 95% CI 2.8-11.7) and BSI (adjusted OR 4.0, 95% CI 1.3-11.0) were associated with future VTE. Urinary and other infections were not associated with subsequent VTE. CONCLUSIONS Infections are associated with subsequent risk of VTE among patients with ICH. Further investigation is required to elucidate mechanisms behind this association and to improve VTE prevention after ICH.
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Affiliation(s)
- Kara R Melmed
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Department of Neurology, NYU Langone Health, New York, NY, USA.
| | - Amelia Boehme
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Natasha Ironside
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Santosh Murthy
- Department of Neurology, Weill Cornell Medical Center, New York, NY, USA
| | - Soojin Park
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Sachin Agarwal
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - E Sander Connolly
- Department of Neurosurgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jan Claassen
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David Roh
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Marini S, Morotti A, Lena UK, Goldstein JN, Greenberg SM, Rosand J, Anderson CD. Men Experience Higher Risk of Pneumonia and Death After Intracerebral Hemorrhage. Neurocrit Care 2019; 28:77-82. [PMID: 28730561 DOI: 10.1007/s12028-017-0431-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Infectious complications worsen outcome after intracerebral hemorrhage (ICH). We investigated the impact of sex on post-ICH infections and mortality. METHODS Consecutive ICH patients (admitted to a single hospital between 1994 and 2015) were retrospectively assessed via chart review to ascertain the following in-hospital infections: urinary tract infection (UTI), pneumonia, and sepsis. Adjusted logistic regression was performed to identify associations between sex, infection, and mortality at 90 days. RESULTS Two thousand and four patients were investigated, 1071 (53.7%) males. Men were more likely to develop pneumonia (21.9 vs 15.5% p < 0.001) and sepsis (3.4 vs 1.6%, p = 0.009), whereas women had higher risk of UTI (19.9 vs 11.7% p < 0.001). Multivariate analyses confirmed association between male sex and pneumonia (Odds Ratio (OR) 1.37, 95% confidence interval (CI) 1.08-1.74, p = 0.011). Male sex (OR 1.40; CI 1.07-1.85; p = 0.015) and infection (OR 1.56; CI 1.11-1.85; p = 0.011) were independently associated with higher 90-day mortality. CONCLUSIONS Types and rates of infection following ICH differ by sex. Male sex independently increases pneumonia risk, which subsequently increases 90-day mortality. Sex-specific preventive strategies to reduce the risk of these complications may be one strategy to improve ICH outcomes.
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Affiliation(s)
- Sandro Marini
- Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA, 02114, USA. .,J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.
| | - Andrea Morotti
- Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA, 02114, USA.,J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.,Stroke Unit and Department of Emergency Neurology, C. Mondino National Neurological Institute, Pavia, Italy
| | - Umme K Lena
- Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA, 02114, USA
| | - Joshua N Goldstein
- J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Steven M Greenberg
- J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Rosand
- Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA, 02114, USA.,J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher D Anderson
- Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA, 02114, USA.,J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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20
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Lindner A, Kofler M, Rass V, Ianosi B, Gaasch M, Schiefecker AJ, Beer R, Loveys S, Rhomberg P, Pfausler B, Thomé C, Schmutzhard E, Helbok R. Early Predictors for Infectious Complications in Patients With Spontaneous Intracerebral Hemorrhage and Their Impact on Outcome. Front Neurol 2019; 10:817. [PMID: 31447758 PMCID: PMC6691092 DOI: 10.3389/fneur.2019.00817] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/15/2019] [Indexed: 01/05/2023] Open
Abstract
Background: Infectious complications (IC) commonly occur in patients with intracerebral hemorrhage (ICH) and are associated with increased length of hospitalization (LOS) and poor long-term outcome. Little is known about early ICH-related predictors for the development of IC to allow appropriate allocation of resources and timely initiation of preventive measures. Methods: We prospectively enrolled 229 consecutive patients with non-traumatic ICH admitted to the neurocritical care unit (NICU) of a tertiary care hospital. Patients were screened daily for IC. Multivariable regression models using generalized linear models were used to identify associated factors with the occurrence of IC and to study their impact on functional outcome, which was assessed using the modified Rankin Scale Score (mRS) after 3 months. Unfavorable outcome was defined as mRS ≥3. Results: The most common IC were pneumonia (n = 64, 28%) and urinary tract infection (n = 54, 24%), followed by sepsis (n = 9, 4%) and ventriculitis (n = 4, 2%). Patients with a higher admission ICH Score (>2) had higher odds to develop any IC during NICU stay (OR = 1.7, 95% CI 1.2-2.3, p = 0.02). Moreover, early-onset pneumonia (≤48 h after admission) was predictive of sepsis occurring at a later time-point (median at day 11 [IQR = 6-34 days], adjOR = 22.5, 95% CI 4.88-103.6, p < 0.001). Having at least one IC and pneumonia itself were independently associated with unfavorable 3-months outcome (adjOR = 3.0, 95% CI 1.41-6.54, p = 0.005; adjOR = 4.2, 95% CI 1.33-13.19, p = 0.015, respectively). All patients with sepsis died or had poor functional outcome. Conclusions: Infectious complications are common in ICH patients and independently associated with unfavorable outcome. An ICH Score >2 on admission and early pneumonia may help to early identify patients at high risk of IC to allocate resources and start careful surveillance.
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Affiliation(s)
- Anna Lindner
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Mario Kofler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Verena Rass
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bogdan Ianosi
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Medical Informatics, University for Health Sciences, Medical Informatics and Technology, Hall, Austria
| | - Max Gaasch
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alois J. Schiefecker
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ronny Beer
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sebastian Loveys
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Paul Rhomberg
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Pfausler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Erich Schmutzhard
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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21
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Nosocomial Infections among Patients with Intracranial Hemorrhage: A Retrospective Data Analysis of Predictors and Outcomes. Clin Neurol Neurosurg 2019; 182:158-166. [PMID: 31151044 DOI: 10.1016/j.clineuro.2019.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/15/2019] [Accepted: 05/18/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Intracranial hemorrhage is a critical medical emergency. Nosocomial infections may promote worse outcomes in these vulnerable patients. This study investigated microbial features, predictors, and clinical outcomes of nosocomial infections among patients with multiple subtypes of intracranial hemorrhage. PATIENTS AND METHODS We conducted a retrospective cohort study of patients that were hospitalized with intracranial hemorrhage between January 2015 and October 2018, and divided them into two groups based on the development of nosocomial infection. Within the cohort of patients with nosocomial infections, microbiology and resistance patterns were established across multiple sites of infection. Moreover, consequences of nosocomial infection such as mortality and length of hospital stay were determined. RESULTS A total of 233 cases were identified that met our inclusion and exclusion criteria out of which were 94 cases of nosocomial infection (40.3%) versus 139 cases with no nosocomial infection (59.7%). The most common infections were pneumonia, urinary tract infections, and bacteremia. Resistance accounted for 70.2% of cultures. Multivariable analysis revealed significant association of nosocomial infections with hypertension (OR: 2.62, 95% CI: 1.11-6.16, p = 0.027), hospital LOS (OR: 1.08, 95% CI: 1.05-1.12, p < 0.001), levetiracetam (OR: 3.6, 95% CI: 1.41-0.922, p = 0.007), and GCS category (OR: 5.42, 95% CI: 1.67-17.55, p = 0.005 and OR: 7.63, 95% CI: 2.44-23.87, p < 0.001 for moderate and severe, respectively). Patients with nosocomial infections witnessed a significant increase in the length of hospital stay (23 versus 8 hospital days, p < 0.001). This finding was significant across most types of brain hemorrhage. Mortality was significantly associated with GCS category (OR: 10.1, 95% CI: 4-25.7, p < 0.001) and percutaneous endoscopic gastrostomy tube insertion (OR: 19.6, 95% CI: 4.1-91, p < 0.001). CONCLUSIONS Collectively, these findings suggest that nosocomial infections are common among patients with intracranial hemorrhage and can be predictable by considering certain risk factors. Future studies are warranted to evaluate the efficacy of implementing infection control strategies or protocols on these patients to achieve better therapeutic outcomes.
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22
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Zhang X, Zhou S, Zhang Q, Fu X, Wu Y, Liu J, Liang B, Yang Z, Wang X. Stereotactic aspiration for hypertensive intracerebral haemorrhage in a Chinese population: a retrospective cohort study. Stroke Vasc Neurol 2019; 4:14-21. [PMID: 31105974 PMCID: PMC6475080 DOI: 10.1136/svn-2018-000200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/09/2019] [Accepted: 02/13/2019] [Indexed: 12/31/2022] Open
Abstract
Objective We aimed to compare the therapeutic effects of stereotactic aspiration and best medical management in patients who developed supratentorial hypertensive intracerebral haemorrhage (HICH) with a volume of haemorrhage between 20 and 40 mL. Methods The clinical data of 220 patients with supratentorial HICH with a volume between 20 and 40 mL were retrospectively analysed. Among them, 142 received stereotactic aspiration surgery (stereotactic aspiration group) and 78 received best medical management (conservative group). All were followed up for 6 months. Multivariate logistic regression and Kaplan-Meier survival curves were used to compare the outcome between the two groups. Results The rebleeding rate was lower in the group that had stereotactic aspiration when compared with the group with medical treatment (6 [4.2%] vs 9 [11.5%], χ2=4.364, p=0.037). After 6 months, although the mortality rate did not differ significantly between the two groups (8 cases [5.6%] vs 10 cases [12.8%], χ2=3.461, p=0.063), the rate of a favourable outcome was higher in the group who received stereotactic aspiration (χ2=15.870, p=0.000). Logistic regression identified that medical treatment (OR=1.64, p=0.000) was an independent risk factor for an unfavourable outcome. The Kaplan-Meier curves indicated that the median favourable outcome time in the stereotactic aspiration group was 59.5 days compared with that in the medically treated group (87.0 days). The log-rank test indicated that the prognosis at 6 months was better for those treated with stereotactic haematoma aspiration (χ2=29.866, p=0.000). However, the 6-month survival rate was similar between the two groups (χ2=3.253, p=0.068). Conclusions Stereotactic haematoma aspiration significantly improved the quality of life, although did not effectively reduce the rate of mortality. When selected appropriately, patients with HICH may benefit from this type of surgical intervention.
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Affiliation(s)
- Xuyang Zhang
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shaolong Zhou
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiang Zhang
- Department of Radiation Oncology and Comprehensive Cancer Center, The University of Michigan, Ann Arbor, Michigan, USA
| | - Xudong Fu
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuehui Wu
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiasheng Liu
- Department of Neurosurgery, Neihuang People’s Hospital, Neihuang, China
| | - Bo Liang
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhuo Yang
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinjun Wang
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Healthcare-associated infections in the neurological intensive care unit: Results of a 6-year surveillance study at a major tertiary care center. Am J Infect Control 2018; 46:656-662. [PMID: 29395511 DOI: 10.1016/j.ajic.2017.12.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/04/2017] [Accepted: 12/04/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) occur frequently in neurological intensive care units (neuro-ICUs); however, data differentiating associations with various diagnostic categories and resulting burdens are limited. This prospective cohort study reported incidence rates, pathogen distribution, and patient-related outcomes of HAIs in a neuro-ICU population from April 2010 to March 2016. METHODS Laboratory results and specific clinical indicators were used to categorize infections as per National Healthcare Safety Network nosocomial infection surveillance definitions. Patient outcomes studied included length of stay and mortality. RESULTS There were 6,033 neuro-ICU admissions resulting in 20,800 neuro-ICU days over the 6-year study period. A total of 227 HAIs were identified for a rate of 10.9/1,000 ICU days. Device-associated infections accounted for 80.6% of HAIs, with incidence rates (per 1,000 device days) being 18.4 for ventilator-associated pneumonia; 4.9 for catheter-associated urinary tract infections (CAUTIs); 4.0 for ventriculostomy-associated infections; and 0.6 for central line-associated blood stream infections (CLABSIs). Of the various diagnostic categories, subdural hematoma and intracerebral/intraventricular hemorrhage were associated with the highest pooled HAIs, with incidence rates of 21.3 and 21.1 per 1,000 neuro-ICU days, respectively. Prolonged neuro-ICU length of stay was strongly associated with all HAIs. CONCLUSIONS This large-scale surveillance study provides estimates of the risk of common HAIs in neurocritical care patients and their effect on hospitalization. Preventive strategies kept rates of infection very low, in particular CAUTI, CLABSI, and Clostridium difficile infections, and inhibited the emergence of resistant organisms.
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24
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Kong L, Xu H, Wu C, Zhao X, Wu X. Pharmacokinetics of imipenem in plasma and cerebrospinal fluid in patients with intracerebral hemorrhage. Eur J Clin Pharmacol 2018; 74:1193-1195. [PMID: 29797035 DOI: 10.1007/s00228-018-2488-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/16/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Lingti Kong
- Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Hongzhou Xu
- Department of Emergency Internal Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Chenchen Wu
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Xuguang Zhao
- Department of Emergency Medicine, Taihe People's Hospital, Fuyang, 236600, China
| | - Xiaofei Wu
- Department of Emergency Internal Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China.
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25
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Chang CC, Chen TL, Lin CS, Chung CL, Yeh CC, Hu CJ, Lane HL, Liao CC, Shih CC. Decreased risk of pneumonia in stroke patients receiving acupuncture: A nationwide matched-pair retrospective cohort study. PLoS One 2018; 13:e0196094. [PMID: 29782526 PMCID: PMC5962082 DOI: 10.1371/journal.pone.0196094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/07/2018] [Indexed: 11/29/2022] Open
Abstract
Background Acupuncture treatment is common among stroke patients, but there is limited information available on whether acupuncture effectively prevents post-stroke pneumonia. The aim of this study was to analyze the differential risk of pneumonia after stroke between patients who did and did not receive acupuncture after discharge. Methods We used the Taiwan National Health Insurance Research Database to conduct a retrospective cohort study using propensity score matched-pairs of new stroke patients in 2000–2004 who did and did not receive acupuncture post-stroke. Both cohorts were followed up until the end of 2009 for new-onset pneumonia. After correcting for immortal time bias, the incidence and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of pneumonia associated with acupuncture use were calculated using multivariate Cox proportional hazard models. Results Overall, 12557 stroke patients with 12557 paired controls were included in the analysis; pneumonia was diagnosed in 6796 (27.1%). Stroke patients receiving acupuncture had a lower incidence of pneumonia than those without acupuncture (53.4 vs. 58.9 per 1000 person-years), with an adjusted HR of 0.86 (95% CI 0.82–0.90). The association between pneumonia risk and acupuncture use was significant in men (HR 0.92, 95% CI 0.86–0.98) and women (HR 0.79, 95% 0.70–0.82) and was also observed in every age group from 20–79 years. Conclusion Stroke patients receiving acupuncture had a lower risk of pneumonia than those who did not. Further randomized control studies are needed to validate the protective effect of acupuncture on the risk of pneumonia among stroke patients.
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Affiliation(s)
- Chuen-Chau Chang
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chao-Shun Lin
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chi-Li Chung
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Surgery, University of Illinois, Chicago, IL, United States of America
| | - Chaur-Jong Hu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hsin-Long Lane
- School of Chinese Medicine for Post-Baccalaureate, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Anesthesiology, Shuan Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chuan Shih
- School of Chinese Medicine for Post-Baccalaureate, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Ph.D. Program for Clinical Drug Discovery from Botanical Herbs, Taipei Medical University, Taipei, Taiwan
- * E-mail: ,
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Jiang WL, Hu XP, Hu ZP, Tang Z, Wu HB, Chen LH, Wang ZW, Jiang YA. Morbidity and Mortality of Nosocomial Infection after Cardiovascular Surgery: A Report of 1606 Cases. Curr Med Sci 2018; 38:329-335. [DOI: 10.1007/s11596-018-1883-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/10/2018] [Indexed: 01/27/2023]
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Claude Hemphill Iii J. Improving Outcome After Intracerebral Hemorrhage: Maybe It is the Body, Not the Brain. Neurocrit Care 2018; 26:157-159. [PMID: 28233245 DOI: 10.1007/s12028-017-0384-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- J Claude Hemphill Iii
- Department of Neurology, Bldg 1, Room 101, Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.
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Spatenkova V, Bradac O, Fackova D, Bohunova Z, Suchomel P. Low incidence of multidrug-resistant bacteria and nosocomial infection due to a preventive multimodal nosocomial infection control: a 10-year single centre prospective cohort study in neurocritical care. BMC Neurol 2018. [PMID: 29514600 PMCID: PMC5842527 DOI: 10.1186/s12883-018-1031-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Nosocomial infection (NI) control is an important issue in neurocritical care due to secondary brain damage and the increased morbidity and mortality of primary acute neurocritical care patients. The primary aim of this study was to determine incidence of nosocomial infections and multidrug-resistant bacteria and seek predictors of nosocomial infections in a preventive multimodal nosocomial infection protocol in the neurointensive care unit (NICU). The secondary aim focused on their impact on stay, mortality and cost in the NICU. Methods A10-year, single-centre prospective observational cohort study was conducted on 3464 acute brain disease patients. There were 198 (5.7%) patients with nosocomial infection (wound 2.1%, respiratory 1.8%, urinary 1.0%, bloodstream 0.7% and other 0.1%); 67 (1.9%) with Extended spectrum beta-lactamase (ESBL); 52 (1.5%) with Methicillin-resistant Staphylococcus aureus (MRSA), nobody with Vancomycin-resistant enterococcus (VRE). The protocol included hygienic, epidemiological status and antibiotic policy. Univariate and multivarite logistic regression analysis was used for identifying predictors of nosocomial infection. Results From 198 NI patients, 153 had onset of NI during their NICU stay (4.4%; wound 1.0%, respiratory 1.7%, urinary 0.9%, bloodstream 0.6%, other 0.1%); ESBL in 31 (0.9%) patients, MRSA in 30 (0.9%) patients. Antibiotics in prophylaxis was given to 63.0% patients (59.2 % for operations), in therapy to 9.7% patients. Predictors of NI in multivariate logistic regression analysis were airways (OR 2.69, 95% CI 1.81-3.99, p<0.001), urine catheters (OR 2.77, 95% CI 1.00-7.70, p=0.050), NICU stay (OR 1.14, 95% CI 1.12-1.16, p<0.001), transfusions (OR 1.79, 95% CI 1.07-2.97, p=0.025) antibiotic prophylaxis (OR 0.50, 95% CI 0.34-0.74, p<0.001), wound complications (OR 2.30, 95% CI 1.33-3.97, p=0.003). NI patients had longer stay (p<0.001), higher mortality (p<0.001) and higher TISS sums (p<0.001) in the NICU. Conclusions The presented preventive multimodal nosocomial infection control management was efficient; it gave low rates of nosocomial infections (4.2%) and multidrug-resistant bacteria (ESBL 0.9%, MRSA 0.9% and no VRE). Strong predictors for onset of nosocomial infection were accesses such as airways and urine catheters, NICU stay, antibiotic prophylaxis, wound complications and transfusion. This study confirmed nosocomial infection is associated with worse outcome, higher cost and longer NICU stay.
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Affiliation(s)
- Vera Spatenkova
- Neurocenter, Neurointensive Care Unit, Regional Hospital, Husova 357/10, Regional Hospital, 46063, Liberec, Czech Republic.
| | - Ondrej Bradac
- Department of Neurosurgery, Military University Hospital and First Medical School, Charles University, Prague, Czech Republic
| | - Daniela Fackova
- Department of Clinical microbiology and immunology, Antibiotic Centre, Regional Hospital, Liberec, Czech Republic
| | - Zdenka Bohunova
- Department of Clinical microbiology and immunology, Antibiotic Centre, Regional Hospital, Liberec, Czech Republic
| | - Petr Suchomel
- Neurocenter, Department of Neurosurgery, Regional Hospital, Liberec, Czech Republic
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Boots R. Prevention of Nosocomial Infection in the Neurosciences Intensive Care Unit: Remember the Basics. Neurocrit Care 2018; 25:167-9. [PMID: 27535771 DOI: 10.1007/s12028-016-0314-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Rob Boots
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
- Burns Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia.
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30
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Abudeev SA, Kiselev KV, Kruglyakov NM, Belousova KA, Lobanova IN, Parinov OV, Udalov YD, Zabelin MA, Samoilov AS, Cesnulis E, Killeen T, Popugaev KA. Cerebrospinal Fluid Presepsin As a Marker of Nosocomial Infections of the Central Nervous System: A Prospective Observational Study. Front Neurol 2018; 9:58. [PMID: 29497398 PMCID: PMC5818702 DOI: 10.3389/fneur.2018.00058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/22/2018] [Indexed: 12/27/2022] Open
Abstract
Background Nosocomial CNS infection (NI-CNS) is a common and serious complication in neurocritical care patients. Timely, accurate diagnosis of NI-CNS is crucial, yet current infection markers lack specificity and/or sensitivity. Presepsin (PSP) is a novel biomarker of macrophage activation. Its utility in NI-CNS has not been explored. We first determined the normal range of cerebrospinal fluid (CSF) PSP in a control group without brain injury before collecting data on CSF PSP levels in neurocritical care patients. Samples were analyzed in four groups defined by systemic and neurological infection status. Results CSF PSP levels in 15 control patients without neurological injury were 50–100 pg/ml. Ninety-seven CSF samples were collected from 21 neurocritical care patients. In patients without NI-CNS or systemic infection, CSF PSP was 340.4 ± 201.1 pg/ml. Isolated NI-CNS was associated with CSF PSP levels of 640.8 ± 235.5 pg/ml, while levels in systemic infection without NI-CNS were 580.1 ± 329.7 pg/ml. Patients with both NI-CNS and systemic infection had CSF PSP levels of 1,047.7 ± 166.2 pg/ml. In neurocritical care patients without systemic infection, a cut-off value of 321 pg/ml gives sensitivity and specificity for NI-CNS of 100 and 58.3%, respectively. Conclusion CSF PSP may prove useful in diagnosing NI-CNS, but its current utility is as an additional marker only.
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Affiliation(s)
- Sergey A Abudeev
- Burnazian State Research Center, Federal Medical-Biological Agency, Moscow, Russia
| | - Kirill V Kiselev
- Pirogov Russian National Research Medical University, Russian Ministry of Education, Moscow, Russia
| | - Nikolay M Kruglyakov
- Burnazian State Research Center, Federal Medical-Biological Agency, Moscow, Russia
| | - Ksenia A Belousova
- Burnazian State Research Center, Federal Medical-Biological Agency, Moscow, Russia
| | - Inna N Lobanova
- Burnazian State Research Center, Federal Medical-Biological Agency, Moscow, Russia
| | - Oleg V Parinov
- Burnazian State Research Center, Federal Medical-Biological Agency, Moscow, Russia
| | - Yuriy D Udalov
- Burnazian State Research Center, Federal Medical-Biological Agency, Moscow, Russia
| | - Maxim A Zabelin
- Burnazian State Research Center, Federal Medical-Biological Agency, Moscow, Russia
| | - Alexandr S Samoilov
- Burnazian State Research Center, Federal Medical-Biological Agency, Moscow, Russia
| | - Evaldas Cesnulis
- Department of Neurosurgery, Klinik Hirslanden, Zurich, Switzerland
| | - Tim Killeen
- Department of Neurosurgery, Klinik Hirslanden, Zurich, Switzerland
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31
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Lymphopenia, Infectious Complications, and Outcome in Spontaneous Intracerebral Hemorrhage. Neurocrit Care 2017; 26:160-166. [PMID: 28004330 DOI: 10.1007/s12028-016-0367-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Lymphopenia is increasingly recognized as a consequence of acute illness and may predispose to infections. We investigated whether admission lymphopenia (AL) is associated with increased risk of infectious complications and poor outcome in patients with spontaneous intracerebral hemorrhage (ICH). METHODS We retrospectively analyzed a prospectively collected cohort of ICH patients ascertained between 1994 and 2015. We identified subjects with lymphocyte count obtained within 24 h from onset, and AL was defined as lymphocyte count <1000/μL. Infectious complications were assessed through retrospective chart review. Association between AL, infections, and mortality was investigated using multivariable logistic regression. RESULTS Of the 2014 patients meeting inclusion criteria, 548 (27.2%) had AL and 605 (30.0%) developed an infectious complication. Case-fatality at 90 days was 36.9%. Patients with AL had larger hematoma volumes, higher frequency of intraventricular hemorrhage, and lower Glasgow Coma Scale score on presentation (all p < 0.001). AL was independently associated with increased risk of pneumonia [odds ratio (OR) 1.97, 95% confidence interval (CI) 1.50-2.58, p < 0.001] and multiple infections (OR 1.84, 95% CI 1.24-2.71, p = 0.003). AL was also an independent predictor of 90-day mortality (OR 1.55, 95% CI 1.18-2.04, p = 0.002) after adjusting for confounders. CONCLUSIONS AL is common in ICH patients and independently associated with increased risk of infectious complications and poor outcome. Further studies will be needed to determine whether prophylactic antibiotics in ICH patients with AL can improve outcome.
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Tong DM, Zhou YT. No Awakening in Supratentorial Intracerebral Hemorrhage Is Potentially Caused by Sepsis-Associated Encephalopathy. Med Sci Monit 2017; 23:4408-4414. [PMID: 28900072 PMCID: PMC5608148 DOI: 10.12659/msm.905981] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Acute supratentorial intracerebral hemorrhage (sICH) with secondary sepsis is increasing in frequency. We investigated whether no awakening (NA) after sICH with coma is potentially caused by sepsis-associated encephalopathy (SAE). MATERIAL AND METHODS A case-control study of 147 recruited sICH cases with NA and 198 sICH controls with subsequent awakening (SA) was performed at 2 centers in China. All patients underwent brain computed tomography (CT) scans on admission. The odds ratio (OR) of NA was calculated using logistic regression. RESULTS During the study period, 56.5% (83/147) of the patients with sICH with coma and NA had SAE, and 10% (20/198) with sICH with coma and SA had SAE; this difference between the 2 groups was significant (p<0.000). The sICH patients with coma and NA exhibited a longer median time from onset to coma (2.0 days vs. 0.5 days), more frequent confirmed infection (98.0% vs. 24.2%), and a higher Sequential Organ Failure Assessment (SOFA) score (6.3±1.5 vs. 3.4±0.8). These patients also exhibited lower hematoma volume (28.0±18.8 vs. 38.3±24), a lower initial National Institutes of Health Stroke Scale score (19.5±6.6 vs. 30.3±6.8), more frequent brain midline shift (59.2% vs. 27.8%), more frequent diffuse cerebral swelling (64.6% vs. 16.0%), and higher 30-day mortality (54.4% vs. 0.0%) than the patients who did awaken. Logistic multivariable regression analyses revealed that only a higher SOFA score (OR, 1.4; 95% CI, 1.079-1.767; p=0.010) and SAE (OR, 4.0; 95% CI, 1.359-6.775; p=0.001) were associated with NA events in patients with sICH. CONCLUSIONS NA in sICH patients with coma is potentially caused by secondary SAE.
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Affiliation(s)
- Dao-Ming Tong
- Department of Neurology, Affiliated Shuyang People' Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China (mainland).,Department of Neurology, Affiliated Pingxiang Hospital, Southern Medical University, Pingxiang, Jiangxi, China (mainland)
| | - Ye-Ting Zhou
- Department of Clinical Research, Affiliated Shuyang People' Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China (mainland).,Department of General Surgery, Affiliated Shuyang People's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China (mainland)
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33
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Kong L, Tang Y, Zhang X, Lu G, Yu M, Shi Q, Wu X. Pharmacokinetic/Pharmacodynamic Analysis of Meropenem for the Treatment of Nosocomial Pneumonia in Intracerebral Hemorrhage Patients by Monte Carlo Simulation. Ann Pharmacother 2017; 51:970-975. [PMID: 28677407 DOI: 10.1177/1060028017719715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Nosocomial pneumonia (NP) is a frequent complication among patients with intracerebral hemorrhage (ICH). However, there are currently no pharmacokinetic (PK) and pharmacodynamic (PD) data to guide meropenem dosing in these patients. OBJECTIVE To investigate the PK/PD properties of meropenem in these patients and whether the usual dosing regimens of meropenem (2-hour infusion, 1 g, every 8 hours) was suitable. METHODS A total of 11 patients with a diagnosis of ICH complicated with NP were selected in the emergency internal medicine and treated with a 1-g/2-hours extended infusion model. The plasma concentrations of meropenem were determined by high-performance liquid chromatography. PK parameters were estimated by plasma concentration versus time profile using WinNonlin software. The probability of target attainments (PTAs) of meropenem at different minimum inhibitory concentrations (MICs) based on percentage time that concentrations were above the minimum inhibitory concentration (%T>MIC) value were performed by Monte Carlo simulation. RESULTS The volume of distribution and total body clearance of meropenem were 55.55 L/kg and 22.89 L/h, respectively. Using 40%T>MIC, PTA was >90% at MICs ≤4 µg/mL. Using 80% or 100%T>MIC, PTA was >90% only at MICs ≤1 µg/mL. CONCLUSIONS The PK/PD profile of dosing regimens tested will assist in selecting the appropriate meropenem regimens for these patients. At a target of 40%T>MIC, the usual dosing regimens can provide good coverage for pathogens with MICs of ≤4 µg/mL. However, when a higher target (80% or 100%) is desired for difficult-to-treat infections, larger doses, prolonged infusions, shorter intervals, and/or combination therapy may be required.
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Affiliation(s)
- Lingti Kong
- 1 Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yan Tang
- 2 Department of Emergency Internal Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Xiaohua Zhang
- 2 Department of Emergency Internal Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Guoyu Lu
- 2 Department of Emergency Internal Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Meiling Yu
- 1 Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Qingping Shi
- 1 Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Xiaofei Wu
- 2 Department of Emergency Internal Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
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Morotti A, Marini S, Lena UK, Crawford K, Schwab K, Kourkoulis C, Ayres AM, Edip Gurol M, Viswanathan A, Greenberg SM, Anderson CD, Rosand J, Goldstein JN. Significance of admission hypoalbuminemia in acute intracerebral hemorrhage. J Neurol 2017; 264:905-911. [PMID: 28283821 PMCID: PMC7436338 DOI: 10.1007/s00415-017-8451-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 01/01/2023]
Abstract
Low levels of serum albumin may increase the risk of infections and mortality in critically ill patients. We tested the hypothesis that admission hypoalbuminemia predicted infectious complications and poor outcome in subjects with acute intracerebral hemorrhage (ICH). We analyzed a single center cohort of ICH patients collected between 1994 and 2015. Pneumonia, urinary tract infection and sepsis were retrospectively identified, according to validated criteria. Serum albumin was measured on admission and hypoalbuminemia was defined as total albumin ≤3.5 g/dL. The association between albumin levels, infections, and mortality at 90 days was tested with multivariable logistic regression analyses. A total of 2010 patients were included (median age 74 years, 54.5% males) of whom 444 (22.1%) had hypoalbuminemia on admission and 763 (38%) died within 90 days. The frequency of pneumonia, urinary tract infection, and sepsis was 19.9, 15.1, and 2.7%, respectively. Hypoalbuminemic patients had lower admission Glasgow coma scale, higher frequency of intraventricular hemorrhage and were more likely to have a history of chronic kidney or liver disease. After adjustment for potential confounders, hypoalbuminemia was an independent predictor of pneumonia [odds ratio (OR) 1.76, 95% confidence interval (CI) 1.34-2.33, p < 0.001] and sepsis (OR 2.29, 95% CI 1.22-4.30, p = 0.010). Low levels of albumin were also independently associated with higher mortality at 90 days (OR 1.78, 95% CI 1.30-2.44, p < 0.001). In conclusion, early hypoalbuminemia is common and predicts poor outcome in ICH patients. Increased susceptibility to pneumonia and sepsis may be the pathophysiological mechanism underlying this association.
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Affiliation(s)
- Andrea Morotti
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, USA.
- J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
| | - Sandro Marini
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, USA
- J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Umme K Lena
- J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Katherine Crawford
- J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Kristin Schwab
- J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Christina Kourkoulis
- J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Alison M Ayres
- J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - M Edip Gurol
- J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Anand Viswanathan
- J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Steven M Greenberg
- J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Christopher D Anderson
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, USA
- J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Jonathan Rosand
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, USA
- J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Joshua N Goldstein
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, USA
- J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
- Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, USA
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