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Huang YH, Lee TH. Effect of plasma transfusion on in-hospital mortality and morbidities in patients with spontaneous subarachnoid hemorrhage. Clin Neurol Neurosurg 2024; 237:108129. [PMID: 38277885 DOI: 10.1016/j.clineuro.2024.108129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 01/14/2024] [Accepted: 01/20/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Spontaneous subarachnoid hemorrhage (SAH) is a critical condition in which patients may require plasma transfusion during hospitalization. However, it remains unknown whether plasma administration has detrimental effects on the prognosis of SAH beyond the correction of coagulopathy or hypovolemia. This study aimed to analyze the association of plasma transfusion with in-hospital mortality and morbidities in patients with SAH. METHODS We retrospectively analyzed the data of 1689 adult patients with a primary diagnosis of spontaneous SAH. Differences in the clinical parameters were evaluated between patients who received plasma transfusion and those who did not. RESULTS Of 1689 patients, 158 (9.4%) received plasma transfusion. Statistical analysis revealed significant differences in pre-existing comorbidity prevalence between the two study groups. The post-SAH morbidities, including cerebral ischemic events (13.3% vs. 6.4%; p = 0.01), were more common in the plasma transfusion group, whereas the mortality rate was not different between the two study groups (p = 0.166). The mean duration of hospital stay was 19.3 ± 14.4 days and 15.1 ± 15.2 days for patients with and without plasma transfusion, respectively (p = 0.001). CONCLUSION Plasma transfusion following spontaneous SAH is not uncommon. Although the in-hospital mortality rate does not increase following plasma transfusion, cerebral ischemic events as well as other morbidities are more frequent in patients receiving plasma transfusion. Therefore, the indication for plasma transfusion following SAH needs careful weighing and should be further defined by well-controlled studies.
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Affiliation(s)
- Yu-Hua Huang
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsung-Han Lee
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Charalambous LT, Adil SM, Rajkumar S, Gramer R, Kirsch E, Liu B, Zomorodi A, McClellan M, Lad SP. A Nationwide Analysis of Aneurysmal Subarachnoid Hemorrhage Mortality, Complications, and Health Economics in the USA. Transl Stroke Res 2023; 14:347-356. [PMID: 35881231 PMCID: PMC10149048 DOI: 10.1007/s12975-022-01065-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 06/21/2022] [Accepted: 07/13/2022] [Indexed: 11/25/2022]
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating neurological condition. Endovascular coiling or surgical clipping have equivocal success rates, but relatively little is known regarding the health economics and complications of these procedures at the population level. We aimed to analyze the complication profiles and healthcare resource utilization (HRCU) associated with the treatment of aSAH in the USA. We performed a retrospective analysis utilizing the IBM MarketScan database between 2008 and 2015. Primary outcomes included economic analysis stratified by post-operative complication; determination of the effect of several factors on total cost by multivariable regression; and analysis of the incidence, timing, and associated HCRU of aSAH-related post-operative complications. Of the 2374 patients meeting inclusion criteria for economic analysis, 1783 (75.1%) patients had at least one of the ten complications. The most common complications included hydrocephalus (43.8%), transient cerebral ischemia (including vasospasm) (30.6%), ischemic stroke (29.1%), syndrome of inappropriate antidiuretic hormone (SIADH)/hyposmolarity/hyponatremia (22.1%), and seizures (14.9%). Patients who experienced complications had higher median 90-day total costs [$161,127 (Q1 to Q3, $101,411 to $257,662)] than those who did not [$97,376 (Q1 to Q3, $55,692 to $147,447)]. Length of stay was longest for those with pulmonary embolism and pneumonia (27 days) and shortest for those with SIADH/hyposmolarity/hyponatremia (16 days). Brain compression/herniation had the highest mortality rate (19.5%). In total, 14.6% of all patients experienced a readmission within 30 days. In conclusion, patients with aSAH have high post-operative complication rates and costs. Development of novel interventions to reduce complications and improve outcomes is crucial.
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Affiliation(s)
- Lefko T Charalambous
- Department of Neurosurgery, Duke University Medical Center, Duke University, Box 3807, Durham, NC, 27710, USA.
| | - Syed M Adil
- Department of Neurosurgery, Duke University Medical Center, Duke University, Box 3807, Durham, NC, 27710, USA
| | - Shashank Rajkumar
- Department of Neurosurgery, Duke University Medical Center, Duke University, Box 3807, Durham, NC, 27710, USA
| | - Robert Gramer
- Department of Neurosurgery, Duke University Medical Center, Duke University, Box 3807, Durham, NC, 27710, USA
| | - Elayna Kirsch
- Department of Neurosurgery, Duke University Medical Center, Duke University, Box 3807, Durham, NC, 27710, USA
| | - Beiyu Liu
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Ali Zomorodi
- Department of Neurosurgery, Duke University Medical Center, Duke University, Box 3807, Durham, NC, 27710, USA
| | - Mark McClellan
- Duke-Robert J. Margolis Center for Health Policy, Duke University, Box 3807, Durham, NC, 27710, USA
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Duke University, Box 3807, Durham, NC, 27710, USA.
- Duke-Robert J. Margolis Center for Health Policy, Duke University, Box 3807, Durham, NC, 27710, USA.
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Alessandro O, Rene W, Stefan W, Miodrag F, Martin S, Oliver B, Urs P. C-reactive protein elevation predicts in-hospital deterioration after aneurysmal subarachnoid hemorrhage: a retrospective observational study. Acta Neurochir (Wien) 2022; 164:1805-1814. [PMID: 35618852 PMCID: PMC9233629 DOI: 10.1007/s00701-022-05256-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Abstract
Background There is increasing evidence that inflammation plays a role in the pathogenesis of aneurysmal subarachnoid hemorrhage (aSAH) and in the development of delayed cerebral ischemia (DCI). However, the assessment and interpretation of classically defined inflammatory parameters is difficult in aSAH patients. The objective of this study was to investigate the relationship between easily assessable findings (hyperventilation, fever, white blood cell count (WBC), and C-reactive protein (CRP)) and the occurrence of DCI and unfavorable neurological outcome at discharge in aSAH patients. Methods Retrospective analysis of prospectively collected data from a single center cohort. We evaluated the potential of clinical signs of inflammation (hyperventilation, fever) and simple inflammatory laboratory parameters CRP and WBC to predict unfavorable outcomes at discharge and DCI in a multivariate analysis. A cutoff value for CRP was calculated by Youden’s J statistic. Outcome was measured using the modified Rankin score at discharge, with an unfavorable outcome defined as modified Rankin scale (mRS) > 3. Results We included 97 consecutive aSAH patients (63 females, 34 males, mean age 58 years) in the analysis. Twenty-one (22%) had major disability or died by the time of hospital discharge. Among inflammatory parameters, CRP over 100 mg/dl on day 2 was an independent predictor for worse neurological outcome at discharge. The average C-reactive protein level in the first 14 days was higher in patients with a worse neurological outcome (96.6, SD 48.3 vs 56.3 mg/dl, SD 28.6) in the first 14 days after aSAH. C-reactive protein on day 2 was an indicator of worse neurological outcome. No inflammatory parameter was an independent predictor of DCI. After multivariate adjustment, DCI, increased age, and more than 1 day of mechanical ventilation were significant predictors of worse neurological outcome. Conclusions Early elevated CRP levels were a significant predictor of worse neurological outcome at hospital discharge and may be a useful marker of later deterioration in aSAH.
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Affiliation(s)
- Ostini Alessandro
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, CH-3010, Bern, Switzerland.
- Division of Anaesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland.
| | - Warschkow Rene
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Wolf Stefan
- Department of Neurosurgery, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Filipovic Miodrag
- Division of Anaesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Seule Martin
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Bozinov Oliver
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Pietsch Urs
- Division of Anaesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Magnesium Levels and Diastolic Blood Pressure (DBP) as a Vasospasm Prediction Metric in Patients With Aneurysmal Subarachnoid Hemorrhage (SAH). Cureus 2022; 14:e23161. [PMID: 35444882 PMCID: PMC9010001 DOI: 10.7759/cureus.23161] [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: 02/14/2022] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Vasospasm is a significant cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study is to evaluate a possible link between vasospasm in patients with aneurysmal SAH and magnesium and blood pressure levels. Methods Subjects were selected based on chart review of patients presenting to a comprehensive stroke center in Southern California with aneurysmal SAH. 27 were included based on the following criteria: patients greater than 18 years of age, aneurysmal SAH, clinically symptomatic vasospasms and at least one diagnostic confirmation - either from a transcranial doppler (TCD) or digital subtraction angiogram (DSA). The following exclusion criteria also applied: 1) incomplete documentation in the medical record; 2) patients <18 years of age; and 3) patients without TCD measurements. Results In an overall analysis of all patients with or without vasospasm, it was found that the presence of vasospasm was significantly correlated with diastolic blood pressures (DBPs) on day of vasospasm with an r value of 0.418 and p<0.001. Average daily DBPs throughout hospital stay were also correlated with vasospasm with an r-value of 0.455 and p<0.001. Changes in magnesium overall were also significantly related to left Lindegaard ratios with an r value of -0.201 and p value of 0.032. Lindegaard ratios were significantly correlated with age with r values of 0.510, p<0.001, and r=-0.482, p<0.001 for left and right, respectively. A change in magnesium was inversely correlated to the left Lindegaard ratio with an n of 31 and p value of 0.014 (r= -0.439) in patients with vasospasm. We also found a lower incidence of vasospasm in patients older than 65. Conclusion Monitoring magnesium and increases in DBP might be effective as a prophylactic adjunct method in patients with SAH in an effort to predict clinical vasospasm.
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Park HS, Lee SH, Kim KM, Cho WS, Kang HS, Kim JE, Ha EJ. Readmission into intensive care unit in patients with aneurysmal subarachnoid hemorrhage. J Cerebrovasc Endovasc Neurosurg 2021; 23:327-333. [PMID: 34763380 PMCID: PMC8743824 DOI: 10.7461/jcen.2021.e2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating cerebrovascular event; patients are routinely admitted to the intensive care unit (ICU) for initial management. Because complications may be delayed, unplanned ICU readmissions can occur. Therefore, in this study we evaluate the rate of and factors associated with readmission after aSAH and identify if readmission is associated with poor clinical outcomes. Methods We retrospectively reviewed the medical records of all patients receiving surgical or endovascular treatment for aSAH and admitted to the ICU between January 2008 and December 2019. We categorized patients by readmission and analyzed their clinical parameters. Results Of the 345 patients who transferred to ward-level care after an initial ICU stay (Group 2), 27 (7.3%) were readmitted to the ICU (Group 1). History of hypertension (HTN), initial Glasgow Coma Scale (GCS) score, modified Fisher grade, and vasospasm therapy during first ICU stay were significantly different between the groups. The most common reason for readmission was delayed cerebral ischemia (DCI; 70.3%; OR 5.545; 95% CI 1.25-24.52; p=0.024). Comorbid HTN (OR 5.311; 95% CI 1.75-16.12; p=0.03) and vasospasm therapy during first ICU stay (OR 7.234; 95% CI 2.41-21.7; p<0.01) also were associated with readmission. Readmitted patients had longer hospital stay and lower GCS scores at discharge (p<0.01). Conclusions DCI was the most common cause of ICU readmission in patients with aSAH. Readmission may indicate clinical deterioration, and patients who are at a high risk for DCI should be monitored to prevent readmission.
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Affiliation(s)
- Hye Seok Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Ho Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kang Min Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Jin Ha
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
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Wells MA, Morbitzer K, Rhoney DH. Evaluation of the Accuracy of Standard Renal Function Equations in Critically Ill Patients with Subarachnoid Hemorrhage. Neurocrit Care 2021; 32:828-835. [PMID: 31591691 DOI: 10.1007/s12028-019-00854-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Obtaining an accurate estimation of renal function is germane to optimizing care in critically ill patients. However, there is no consensus on the most accurate renal function assessment to utilize in this patient population, particularly in aneurysmal subarachnoid hemorrhage (aSAH) patients. Thus, the objective of this observational study was to determine the comparability of renal function equations to body surface area (BSA)-adjusted 8-h creatinine clearance (CrCl) in aSAH patients. METHODS A PubMed search investigated the applicability of various renal function equations in critically ill patient populations. A subset of these equations was compared to BSA-adjusted 8-h CrCl from a previous study with aSAH patients with no evidence of renal dysfunction (admission serum creatinine < 1.5 mg/dL) and no history of chronic kidney disease. Area-under-the-curve (AUC) calculations were completed using serial laboratory measurements to validate preliminary findings. RESULTS A total of 14 renal function equations were identified with seven carried forward for further analysis based upon a priori criteria. Seven equations were excluded for various reasons, including lack of available clinical data, redundancy with other equations, and dissimilar patient populations to this study. When directly compared to the BSA-adjusted 8-h CrCl, only the Cockcroft-Gault and BSA-adjusted Cockcroft-Gault equations were not statistically significantly different (P = 0.0886 and P = 0.4805, respectively); all other equations were statistically significantly different (P < 0.0001). Additionally, only 52% and 44% of patients had average values within 20% of the BSA-adjusted 8-h CrCl using the Cockcroft-Gault and BSA-adjusted Cockcroft-Gault equations, respectively. Finally, the AUC calculations corroborated the preliminary findings with similar results in statistical testing for the Cockcroft-Gault and BSA-adjusted Cockcroft-Gault (P = 0.6300 and P = 0.1513, respectively). CONCLUSIONS The Cockcroft-Gault equation may be the best renal function equation to assess in critically ill patients diagnosed with aSAH. However, accuracy and consistency in assessing renal function when compared to the BSA-adjusted 8-h CrCl were lacking. Thus, this study suggests the BSA-adjusted 8-h CrCl may be the most appropriate assessment of renal function in patients with aSAH.
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Affiliation(s)
- Michael A Wells
- Division of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| | - Kathryn Morbitzer
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, 115E Beard Hall, Campus, Box 7574, Chapel Hill, NC, 27599-7574, USA
| | - Denise H Rhoney
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, 115E Beard Hall, Campus, Box 7574, Chapel Hill, NC, 27599-7574, USA.
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Arts S, van Lindert EJ, Aquarius R, Bartels RHMA, Boogaarts HD. Complications of external cerebrospinal fluid drainage in aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 2021; 163:1143-1151. [PMID: 33387044 PMCID: PMC7965850 DOI: 10.1007/s00701-020-04681-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/14/2020] [Indexed: 12/22/2022]
Abstract
Background The need for external cerebrospinal fluid (CSF) drains in aneurysmal subarachnoid haemorrhage (aSAH) patients is common and might lead to additional complications. Objective A relation between the presence of an external CSF drain and complication risk is investigated. Methods A prospective complication registry was analysed retrospectively. We included all adult aSAH patients admitted to our academic hospital between January 2016 and January 2018, treated with an external CSF drain. Demographic data, type of external drain used, the severity of the aSAH and complications, up to 30 days after drain placement, were registered. Complications were divided into (1) complications with a direct relation to the external CSF drain and (2) complications that could not be directly related to the use of an external CSF drain referred to as medical complications Results One hundred and forty drains were implanted in 100 aSAH patients. In total, 112 complications occurred in 59 patients. Thirty-six complications were drain related and 76 were medical complications. The most common complication was infection (n = 34). Drain dislodgement occurred 16 times, followed by meningitis (n = 11) and occlusion (n = 9). A Poisson model showed that the mean number of complications raised by 2.9% for each additional day of drainage (95% CI: 0.6–5.3% p = 0.01). Conclusion Complications are common in patients with aneurysmal subarachnoid haemorrhage of which 32% are drain-related. A correlation is present between drainage period and the number of complications. Therefore, reducing drainage period could be a target for further improvement of care.
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Affiliation(s)
- Sebastian Arts
- Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Erik J van Lindert
- Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Rene Aquarius
- Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Abstract
OBJECTIVES To evaluate enhanced renal clearance over time in patients with aneurysmal subarachnoid hemorrhage or intracerebral hemorrhage via measured creatinine clearance and to compare measured creatinine clearance to creatinine clearance calculated by the Cockcroft-Gault equation and estimated glomerular filtration rate calculated by the Modification of Diet in Renal Diseases equation. DESIGN Prospective, observational study. SETTING Neurosciences ICU in a tertiary care academic medical center. PATIENTS Study participants had an admission diagnosis of aneurysmal subarachnoid hemorrhage or intracerebral hemorrhage, an expected neurosciences ICU length of stay greater than 48 hours, no evidence of renal dysfunction (admission serum creatinine < 1.5 mg/dL), and no history of chronic kidney disease. INTERVENTIONS Eight-hour urine collections to measure creatinine clearance were collected daily as the primary method of measuring renal function. Creatinine clearance was also calculated using the Cockcroft-Gault equation and estimated glomerular filtration rate was calculated using the Modification of Diet in Renal Disease equation. Enhanced renal clearance was defined as a measured creatinine clearance greater than the calculated creatinine clearance via Cockcroft-Gault and estimated glomerular filtration rate via Modification of Diet in Renal Disease. Augmented renal clearance was defined by a measured creatinine clearance greater than or equal to 130 mL/min/1.73 m. Relevant demographic, clinical, and outcome data were recorded. MEASUREMENTS AND MAIN RESULTS Fifty aneurysmal subarachnoid hemorrhage patients and 30 intracerebral hemorrhage patients were enrolled, contributing 590 individual measurements. Patients with aneurysmal subarachnoid hemorrhage had a higher mean measured creatinine clearance compared with the mean calculated creatinine clearance based on the Cockcroft-Gault equation (147.9 ± 50.2 vs 109.1 ± 32.7 mL/min/1.73 m; p < 0.0001) and higher mean measured creatinine clearance compared with the mean calculated estimated glomerular filtration rate based on the Modification of Diet in Renal Disease equation (147.9 ± 50.2 vs 126.0 ± 41.9 mL/min/1.73 m; p = 0.04). Ninety-four percent of participants with aneurysmal subarachnoid hemorrhage experienced augmented renal clearance on at least 1 day. In patients with intracerebral hemorrhage, there was a higher mean measured creatinine clearance over the study period compared with the mean calculated creatinine clearance (119.5 ± 57.2 vs 77.8 ± 27.6 mL/min/1.73 m; p < 0.0001) and higher mean measured creatinine clearance compared with the mean calculated estimated glomerular filtration rate based on the Modification of Diet in Renal Disease equation (119.5 ± 57.2 vs 93.0.0 ± 32.8 mL/min/1.73 m; p = 0.02). Fifty percent of participants with intracerebral hemorrhage experienced augmented renal clearance on at least 1 day. CONCLUSIONS A substantial group of patients with aneurysmal subarachnoid hemorrhage or intracerebral hemorrhage experienced enhanced renal clearance, which may be otherwise unknown to clinicians. Enhanced renal clearance may lead to increased renal solute elimination over what is expected, resulting in subtherapeutic renally eliminated drug concentrations. This may result in underexposure to critical medications, leading to treatment failure and other medical complications.
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Morbitzer KA, Rhoney DH, Dehne KA, Jordan JD. Enhanced renal clearance and impact on vancomycin pharmacokinetic parameters in patients with hemorrhagic stroke. J Intensive Care 2019; 7:51. [PMID: 31832200 PMCID: PMC6868795 DOI: 10.1186/s40560-019-0408-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/15/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The majority of patients with hemorrhagic stroke experience enhanced renal clearance or augmented renal clearance (ARC). The purpose of this study was to determine the impact of enhanced renal clearance or ARC on vancomycin pharmacokinetic (PK) parameters. METHODS This was a post hoc analysis of a prospective study of adult patients with aneurysmal subarachnoid hemorrhage (aSAH) or intracerebral hemorrhage (ICH) admitted to the neurosciences intensive care unit who received vancomycin. Creatinine clearance (CrCl) was measured and also estimated using the Cockcroft-Gault equation. Predicted PK parameters were compared with calculated PK parameters using serum peak and trough concentrations. RESULTS Seventeen hemorrhagic stroke patients met inclusion criteria. All patients experienced enhanced renal clearance on the day that the vancomycin concentrations were obtained, and 12 patients (71%) experienced ARC. The mean calculated elimination rate constant was significantly higher than the predicted value (0.141 ± 0.02 vs. 0.087 ± 0.01 h-1; p = 0.004) and the mean calculated half-life was significantly lower than the predicted half-life (6.5 ± 0.9 vs. 8.7 ± 0.6 h; p = 0.03). CONCLUSIONS Patients with hemorrhagic stroke and enhanced renal clearance displayed PK alterations favoring an increased elimination of vancomycin than expected. This may result in underexposure to vancomycin, leading to treatment failure.
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Affiliation(s)
- Kathryn A. Morbitzer
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Denise H. Rhoney
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Kelly A. Dehne
- Department of Pharmacy, UNC Health Care, Chapel Hill, NC USA
| | - J. Dedrick Jordan
- Division of Neurocritical Care, Departments of Neurology and Neurosurgery, University of North Carolina School of Medicine, 170 Manning Drive, Physician Office Building 2118, Chapel Hill, NC 27599 USA
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Cho SS, Kim SE, Kim HC, Kim WJ, Jeon JP. Clazosentan for Aneurysmal Subarachnoid Hemorrhage: An Updated Meta-Analysis with Trial Sequential Analysis. World Neurosurg 2018; 123:418-424.e3. [PMID: 30508597 DOI: 10.1016/j.wneu.2018.10.213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Clazosentan, an endothelin receptor antagonist, reduced vasospasm and delayed ischemic neurologic deficit (DIND) but did not improve outcome after subarachnoid hemorrhage (SAH) in clinical trials. However, a lack of dose-dependent analysis and potential overestimation of clazosentan's effect are concerning. We used stratified analysis and trial sequential analysis (TSA) of existing data to investigate the effects of clazosentan on SAH outcome. METHODS Studies from PubMed, Embase, and Cochrane were reviewed for eligibility. Primary outcomes were DIND requiring rescue therapy, all-cause mortality, and vasospasm-related morbidity at 6 weeks. Secondary outcomes were moderate-to-severe angiographic vasospasm, new cerebral infarction, and poor clinical outcome at 3 months. TSA was performed to assess the required information size and the α-spending monitoring boundary effect of relative risk (RR) reduction. A stratified analysis of clazosentan dosage was performed. RESULTS Five studies (N = 2317) were included. Clazosentan significantly reduced the risk of DIND requiring rescue therapy (RR, 0.625; 95% confidence interval [CI], 0.462-0.846) and vasospasm (RR, 0.543; 95% CI, 0.464-0.635), but did not significantly affect mortality or vasospasm-related morbidity (RR, 0.775; 95% CI, 0.578-1.039), new cerebral infarction (RR, 0.604; 95% CI, 0.383-0.952), or outcome (RR, 1.131; 95% CI, 0.959-1.334). TSA revealed that the studies were underpowered to evaluate the effects of clazosentan on mortality and vasospasm-associated morbidity. We found 10-15 mg/h of clazosentan administration was associated with lower rates of vasospasm and new cerebral infarctions compared with 5 mg/h. CONCLUSIONS Clazosentan reduced the risk of DIND requiring rescue therapy and moderate-to-severe vasospasm. Further meta-analyses based on individual patient data with different clazosentan doses and more refined outcome measures are necessary to clarify clazosentan's efficacy in improving post-SAH outcome.
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Affiliation(s)
- Steve S Cho
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sung-Eun Kim
- Department of Emergency Medicine, Seoul Emergency Operations Center, Seoul, Korea
| | - Heung Cheol Kim
- Department of Radiology, Hallym University College of Medicine, Chuncheon, Korea
| | - Won Jin Kim
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Pyeong Jeon
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea; Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea.
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Chandler BT, Pernu P. Hyperinsulinaemic Euglycaemic Therapy Use in Neurogenic Stunned Myocardium following Subarachnoid Haemorrhage. Anaesth Intensive Care 2018; 46:575-578. [DOI: 10.1177/0310057x1804600607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a 62-year-old female who collapsed with a subarachnoid haemorrhage. This was complicated by profound shock secondary to neurogenic stunned myocardium. As the patient demonstrated life-threatening catecholamine-resistant shock that was unresponsive to conventional treatment measures, hyperinsulinaemic euglycaemic therapy was utilised as a rescue therapy. To our knowledge this has not previously been described in the literature. The patient proceeded to stabilise and made a good recovery.
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Affiliation(s)
- B. T. Chandler
- Anaesthetics and Critical Care, Scarborough General Hospital, Scarborough, North Yorkshire, United Kingdom
| | - P. Pernu
- Department of Anaesthetics, Scarborough General Hospital, Scarborough, North Yorkshire, United Kingdom
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Can Procalcitonin Be Used as a Reliable Marker for Infectious Fever in Patients with Intracranial Hemorrhage? World Neurosurg 2018; 116:e968-e974. [DOI: 10.1016/j.wneu.2018.05.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/19/2018] [Accepted: 05/19/2018] [Indexed: 12/20/2022]
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Badjatia N, Cremers S, Claassen J, Connolly ES, Mayer SA, Karmally W, Seres D. Serum glutamine and hospital-acquired infections after aneurysmal subarachnoid hemorrhage. Neurology 2018; 91:e421-e426. [PMID: 29959259 DOI: 10.1212/wnl.0000000000005902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/27/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To understand nutritional and inflammatory factors contributing to serum glutamine levels and their relationship to hospital-acquired infections (HAIs) after aneurysmal subarachnoid hemorrhage (SAH). METHODS A prospective observational study of patients with SAH who had measurements of daily caloric intake and C-reactive protein, transthyretin, tumor necrosis factor α receptor 1a (TNFαR1a), glutamine, and nitrogen balance performed within 4 preset time periods during the 14 days after SAH. Factors associated with glutamine levels and HAIs were analyzed with multivariable regression. HAIs were tracked daily for time-to-event analyses. Outcome 3 months after SAH was assessed by the Telephone Interview for Cognitive Status and modified Rankin Scale. RESULTS There were 77 patients with an average age of 55 ± 15 years. HAIs developed in 18 (23%) on mean SAH day 8 ± 3. In a multivariable linear regression model, negative nitrogen balance (p = 0.02) and elevated TNFαR1a (p = 0.04) were independently associated with higher glutamine levels during the study period. The 14-day mean glutamine levels were lower in patients who developed HAI (166 ± 110 vs 236 ± 81 μg/mL, p = 0.004). Poor admission Hunt and Hess grade (p = 0.04) and lower glutamine levels (p = 0.02) predicted time to first HAI. Low 14-day mean levels of glutamine were associated with a poor recovery on the Telephone Interview for Cognitive Status score (p = 0.03) and modified Rankin Scale score (p = 0.04) at 3 months after injury. CONCLUSIONS Declining glutamine levels in the first 14 days after SAH are influenced by inflammation and associated with an increased risk of HAI.
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Affiliation(s)
- Neeraj Badjatia
- From the Section of Neurocritical Care (N.B.), Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore; Neurological Institute of New York (J.C., E.S.C.), NY; Department of Neurology (S.A.M., W.K.), Henry Ford Hospital, Detroit, MI; and Institute of Human Nutrition and Division of Preventive Medicine and Nutrition (S.C., W.K.), Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY.
| | - Serge Cremers
- From the Section of Neurocritical Care (N.B.), Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore; Neurological Institute of New York (J.C., E.S.C.), NY; Department of Neurology (S.A.M., W.K.), Henry Ford Hospital, Detroit, MI; and Institute of Human Nutrition and Division of Preventive Medicine and Nutrition (S.C., W.K.), Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Jan Claassen
- From the Section of Neurocritical Care (N.B.), Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore; Neurological Institute of New York (J.C., E.S.C.), NY; Department of Neurology (S.A.M., W.K.), Henry Ford Hospital, Detroit, MI; and Institute of Human Nutrition and Division of Preventive Medicine and Nutrition (S.C., W.K.), Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - E Sander Connolly
- From the Section of Neurocritical Care (N.B.), Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore; Neurological Institute of New York (J.C., E.S.C.), NY; Department of Neurology (S.A.M., W.K.), Henry Ford Hospital, Detroit, MI; and Institute of Human Nutrition and Division of Preventive Medicine and Nutrition (S.C., W.K.), Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Stephan A Mayer
- From the Section of Neurocritical Care (N.B.), Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore; Neurological Institute of New York (J.C., E.S.C.), NY; Department of Neurology (S.A.M., W.K.), Henry Ford Hospital, Detroit, MI; and Institute of Human Nutrition and Division of Preventive Medicine and Nutrition (S.C., W.K.), Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Wahida Karmally
- From the Section of Neurocritical Care (N.B.), Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore; Neurological Institute of New York (J.C., E.S.C.), NY; Department of Neurology (S.A.M., W.K.), Henry Ford Hospital, Detroit, MI; and Institute of Human Nutrition and Division of Preventive Medicine and Nutrition (S.C., W.K.), Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - David Seres
- From the Section of Neurocritical Care (N.B.), Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore; Neurological Institute of New York (J.C., E.S.C.), NY; Department of Neurology (S.A.M., W.K.), Henry Ford Hospital, Detroit, MI; and Institute of Human Nutrition and Division of Preventive Medicine and Nutrition (S.C., W.K.), Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
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Doerfler S, Faerber J, McKhann GM, Elliott JP, Winn HR, Kumar M, Levine J, Le Roux PD. The Incidence and Impact of Secondary Cerebral Insults on Outcome After Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2018; 114:e483-e494. [DOI: 10.1016/j.wneu.2018.02.195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/25/2018] [Accepted: 02/28/2018] [Indexed: 02/04/2023]
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Teping F, Albanna W, Clusmann H, Schulze-Steinen H, Mueller M, Hoellig A, Schubert GA. Spontaneous Elevation of Blood Pressure After SAH: An Epiphenomenon of Disease Severity and Demand, But Not a Surrogate for Outcome? Neurocrit Care 2018; 29:214-224. [PMID: 29619659 DOI: 10.1007/s12028-018-0528-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Spontaneous blood pressure increase is frequently observed after aneurysmal subarachnoid hemorrhage (aSAH). These episodes of spontaneous blood pressure alterations are usually tolerated under the assumption of an endogenous response to maintain cerebral perfusion. The relevance of blood pressure variability and its relationship to disease severity and outcome, however, remain obscure. METHODS A total of 115 consecutive patients with aSAH were included for this retrospective analysis of a continuously collected data pool. Demographics, initial clinical severity of aSAH (HH°, mFS), treatment modality, clinical course, and outcome (development of DCI, cerebral infarction, and GOS after 3 months) were recorded. Hemodynamic information-recorded automatically with a frequency of 1/15 min-was analyzed for spontaneous blood pressure increase (SBI) and endogenous persistent hypertension (EPH) after exclusion of iatrogenic factors and relevant co-medication. Subgroup analysis included stratification for day 0-3, 4-14, and 14-21. RESULTS SBI and EPH incidence varied from 17 to 84% depending on detection threshold (15-35 mmHg) and time period under scrutiny. Incidence of blood pressure increase correlated with disease severity upon admission (p < 0.05), but the anticipated association with outcome was not observed. SBI and EPH were more likely to occur between day 4 and 14 (p < 0.001), but only early occurrence (day 0-3) was associated with higher incidence of DCI (p < 0.05). Persistent blood pressure elevation between day 4 and 21 was associated with fewer DCI. However, no influence of spontaneous upregulation on clinical outcome after three months was observed. CONCLUSIONS Spontaneous hemodynamic upregulation is a frequent phenomenon after aSAH. Our data support the hypothesis that spontaneous blood pressure alterations reflect an endogenous, demand-driven response correlating with disease severity. Early alterations may indicate an aggravated clinical course, while later upregulation in particular-if permitted-does not translate into a higher risk of unfavorable outcome.
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Affiliation(s)
- F Teping
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - W Albanna
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - H Clusmann
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - H Schulze-Steinen
- Department of Operative Intensive Care and Intermediate Care, RWTH Aachen University, Aachen, Germany
| | - M Mueller
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany
| | - A Hoellig
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - G A Schubert
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
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English SW, Fergusson D, Chassé M, Turgeon AF, Lauzier F, Griesdale D, Algird A, Kramer A, Tinmouth A, Lum C, Sinclair J, Marshall S, Dowlatshahi D, Boutin A, Pagliarello G, McIntyre LA. Aneurysmal SubArachnoid Hemorrhage-Red Blood Cell Transfusion And Outcome (SAHaRA): a pilot randomised controlled trial protocol. BMJ Open 2016; 6:e012623. [PMID: 27927658 PMCID: PMC5168610 DOI: 10.1136/bmjopen-2016-012623] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Anaemia is common in aneurysmal subarachnoid haemorrhage (aSAH) and is a potential critical modifiable factor affecting secondary injury. Despite physiological evidence and management guidelines that support maintaining a higher haemoglobin level in patients with aSAH, current practice is one of a more restrictive approach to transfusion. The goal of this multicentre pilot trial is to determine the feasibility of successfully conducting a red blood cell (RBC) transfusion trial in adult patients with acute aSAH and anaemia (Hb ≤100 g/L), comparing a liberal transfusion strategy (Hb ≤100 g/L) with a restrictive strategy (Hb ≤80 g/L) on the combined rate of death and severe disability at 12 months. METHODS Design This is a multicentre open-label randomised controlled pilot trial at 5 academic tertiary care centres. Population We are targeting adult aSAH patients within 14 days of their initial bleed and with anaemia (Hb ≤110 g/L). Randomisation Central computer-generated randomisation, stratified by centre, will be undertaken from the host centre. Randomisation into 1 of the 2 treatment arms will occur when the haemoglobin levels of eligible patients fall to ≤100 g/L. Intervention Patients will be randomly assigned to either a liberal (threshold: Hb ≤100 g/L) or a restrictive transfusion strategy (threshold: Hb ≤80 g/L). Outcome Primary: Centre randomisation rate over the study period. Secondary: (1) transfusion threshold adherence; (2) study RBC transfusion protocol adherence; and (3) outcome assessment including vital status at hospital discharge, modified Rankin Score at 6 and 12 months and Functional Independence Measure and EuroQOL Quality of Life Scale scores at 12 months. Outcome measures will be reported in aggregate. ETHICS AND DISSEMINATION The study protocol has been approved by the host centre (OHSN-REB 20150433-01H). This study will determine the feasibility of conducting the large pragmatic RCT comparing 2 RBC transfusion strategies examining the effect of a liberal strategy on 12-month outcome following aSAH. TRIAL REGISTRATION NUMBER NCT02483351; Pre-results.
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Affiliation(s)
- Shane W English
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - D Fergusson
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - M Chassé
- Centre Hospitalier de l'Université de Montréal (CHUM) Research Center, Evaluation, Care Systems and Services Theme, Montréal, Québec, Canada
- Department of Medicine (Critical Care), Université de Montréal, Montréal, Québec, Canada
| | - A F Turgeon
- Department of Anesthesiology and Critical Care, Division of Critical Care Medicine, Université Laval, Québec City, Quebec, Canada
- Population Health and Optimal Health Practices Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec—Université Laval Research Center, Québec City, Quebec, Canada
| | - F Lauzier
- Department of Anesthesiology and Critical Care, Division of Critical Care Medicine, Université Laval, Québec City, Quebec, Canada
- Population Health and Optimal Health Practices Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec—Université Laval Research Center, Québec City, Quebec, Canada
- Department of Medicine, Université Laval, Québec City, Quebec, Canada
| | - D Griesdale
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Algird
- Department of Surgery (Neurosurgery), McMaster University, Hamilton, Ontario, Canada
| | - A Kramer
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, The Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - A Tinmouth
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - C Lum
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - J Sinclair
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - S Marshall
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - D Dowlatshahi
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - A Boutin
- Population Health and Optimal Health Practices Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec—Université Laval Research Center, Québec City, Quebec, Canada
| | - G Pagliarello
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - L A McIntyre
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Zhang L, Qi S. Electrocardiographic Abnormalities Predict Adverse Clinical Outcomes in Patients with Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2016; 25:2653-2659. [PMID: 27476337 DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/13/2016] [Accepted: 07/02/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We conducted a retrospective cohort study of a large sample to assess whether electrocardiographic (ECG) abnormalities are independently associated with the occurrence of neurogenic pulmonary edema (NPE), delayed cerebral ischemia (DCI), and in-hospital death after nontraumatic subarachnoid hemorrhage (SAH). METHODS In this retrospective observational study, patients who were admitted within 72 hours of SAH symptom onset between 2013 and 2015 were enrolled. Twelve-lead ECG findings obtained within 72 hours after SAH and the presence of NPE, DCI, and in-hospital death were collected based on the results reported in the medical records. RESULTS We included 834 patients. NPE occurred in 192 patients (23%). The median delay from SAH onset to NPE was 3 days (interquartile range [IQR]: 5 days). DCI occurred in 223 patients (27%; median delay to DCI, 4 days; IQR: 5 days). In total, 141 patients (17%) died in the hospital (median time to death, 12 days; IQR: 18 days). The frequency of ECG abnormalities for all enrolled patients was 65%. Corrected QT prolongation had an adjusted risk ratio (RR) of 1.5 (1.1-2.2) for NPE and 1.8 (1.3-2.4) for DCI. ST depression had an adjusted RR of 3.0 (1.2-7.5) for in-hospital death. NSSTTCs (nonspecific ST- or T-wave changes) had an adjusted RR of 2.7 (1.8-4.2) for NPE, 2.8 (1.9-4.3) for DCI, and 2.2 (1.3-3.5) for in-hospital death. All RRs were adjusted for age and Hunt-Hess scores. CONCLUSIONS ECG abnormalities assessed within 72 hours after SAH using a standard 12-lead ECG are independently associated with an increased risk of adverse clinical outcomes in patients with nontraumatic SAH.
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Affiliation(s)
- Limin Zhang
- Department of Anaesthesiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Sihua Qi
- Department of Anaesthesiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China.
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Turner CL, Budohoski K, Smith C, Hutchinson PJ, Kirkpatrick PJ, Murray GD. Elevated Baseline C-Reactive Protein as a Predictor of Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From the Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) Trial. Neurosurgery 2016; 77:786-92; discussion 792-3. [PMID: 26280117 PMCID: PMC4605277 DOI: 10.1227/neu.0000000000000963] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
There remains a proportion of patients with unfavorable outcomes after aneurysmal subarachnoid hemorrhage, of particular relevance in those who present with a good clinical grade. A forewarning of those at risk provides an opportunity towards more intensive monitoring, investigation, and prophylactic treatment prior to the clinical manifestation of advancing cerebral injury.
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Affiliation(s)
- Carole L Turner
- Academic Division of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Chen I, Mitchell P. Serum potassium and sodium levels after subarachnoid haemorrhage. Br J Neurosurg 2016; 30:554-9. [DOI: 10.1080/02688697.2016.1181151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Subarachnoid Hemorrhage-Triggered Acute Hypotension Is Associated with Left Ventricular Cardiomyocyte Apoptosis in a Rat Model. ACTA NEUROCHIRURGICA. SUPPLEMENT 2016; 121:145-50. [PMID: 26463939 DOI: 10.1007/978-3-319-18497-5_26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Whether hypotension that occurs due to neurogenic stunned myocardium after subarachnoid hemorrhage (SAH) is associated with cardiomyocyte apoptotic cell death remains unknown. In this study, 18 male rats were subjected to sham or the endovascular perforation model of SAH surgery. Based on the mean arterial pressure (MAP) after SAH, rats were separated into SAH with hypotension (SAH hypotension) or SAH with blood pressure preservation (SAH BP preservation) groups. All animals were euthanized 2 h after the surgical procedure. Hearts were removed and separated transversely into base and apex parts, then Western blot analyses and immunohistochemistry were performed only in the apex part. One rat died as a result of severe SAH and two rats with mild SAH were excluded. We analyzed data from 15 rats that were divided into three groups: sham, SAH hypotension, and SAH BP preservation (n = 5, each). There was a significantly higher cleaved caspase-3/caspase-3 ratio in the SAH hypotension group compared with sham and the SAH BP preservation group. Cardiomyocyte apoptosis was demonstrated in the SAH rats. This is the first experimental report that describes SAH-induced neurogenic stunned myocardium with ensuing hypotension may result from the acute apoptotic cardiomyocyte cell death in the left ventricle.
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ECG abnormalities predict neurogenic pulmonary edema in patients with subarachnoid hemorrhage. Am J Emerg Med 2016; 34:79-82. [DOI: 10.1016/j.ajem.2015.09.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/12/2015] [Accepted: 09/21/2015] [Indexed: 11/19/2022] Open
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Heart Rate Variability Predicts Neurogenic Pulmonary Edema in Patients with Subarachnoid Hemorrhage. Neurocrit Care 2015; 25:71-8. [DOI: 10.1007/s12028-015-0237-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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The utility of serum procalcitonin in distinguishing systemic inflammatory response syndrome from infection after aneurysmal subarachnoid hemorrhage. Neurocrit Care 2015; 20:375-81. [PMID: 24522762 DOI: 10.1007/s12028-014-9960-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Systemic inflammatory response syndrome (SIRS) occurs frequently after aneurysmal subarachnoid hemorrhage (aSAH). It is a clinical challenge to distinguish between SIRS and incipient infection. Procalcitonin (PCT) has been studied among general critical care patients as a biomarker for infection. We hypothesized that PCT could be useful to distinguish SIRS from sepsis in aSAH patients. METHODS Prospective, observational study conducted in the multidisciplinary intensive care unit at Mayo Clinic, Jacksonville, FL between August 2009 and September 2010. Main predictor was serum PCT obtained on admission and with subsequent episodes of SIRS. A level of 0.2 ng/mL or higher was considered as elevated PCT. Main outcome was clinical infection, which was subsequently subcategorized into major (systemic) and minor (localized) infections in the sensitivity analysis. RESULTS Forty consecutive patients were enrolled. Majority (88 %) developed SIRS during the hospitalization. Infection developed in 16 (40 %) patients, with 6 patients meeting criteria for major infection. Overall, PCT was found to be highly specific for all infections and the subcategory of major infections (97 and 93 %, respectively) with related high negative predictive values. Odds ratio for elevated PCT with clinical infections ranged from 25.2 (95 % CI 2.7-233) to 33.3 (95 % CI 4.3-261) for all and major infections, respectively. Related receiver operating characteristic curves for elevated PCT were 0.74 and 0.96 for all and major infections, respectively. CONCLUSIONS Procalcitonin of 0.2 ng/mL or greater was demonstrated to be very specific for sepsis among patients with aSAH. Further studies should validate this result and establish its clinical applicability.
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Badjatia N, Monahan A, Carpenter A, Zimmerman J, Schmidt JM, Claassen J, Connolly ES, Mayer SA, Karmally W, Seres D. Inflammation, negative nitrogen balance, and outcome after aneurysmal subarachnoid hemorrhage. Neurology 2015; 84:680-7. [PMID: 25596503 DOI: 10.1212/wnl.0000000000001259] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To analyze the impact of inflammation and negative nitrogen balance (NBAL) on nutritional status and outcomes after subarachnoid hemorrhage (SAH). METHODS This was a prospective observational study of SAH patients admitted between May 2008 and June 2012. Measurements of C-reactive protein (CRP), transthyretin (TTR), resting energy expenditure (REE), and NBAL (g/day) were performed over 4 preset time periods during the first 14 postbleed days (PBD) in addition to daily caloric intake. Factors associated with REE and NBAL were analyzed with multivariable linear regression. Hospital-acquired infections (HAI) were tracked daily for time-to-event analyses. Poor outcome at 3 months was defined as a modified Rankin Scale score ≥ 4 and assessed by multivariable logistic regression. RESULTS There were 229 patients with an average age of 55 ± 15 years. Higher REE was associated with younger age (p = 0.02), male sex (p < 0.001), higher Hunt Hess grade (p = 0.001), and higher modified Fisher score (p = 0.01). Negative NBAL was associated with lower caloric intake (p < 0.001), higher body mass index (p < 0.001), aneurysm clipping (p = 0.03), and higher CRP:TTR ratio (p = 0.03). HAIs developed in 53 (23%) patients on mean PBD 8 ± 3. Older age (p = 0.002), higher Hunt Hess (p < 0.001), lower caloric intake (p = 0.001), and negative NBAL (p = 0.04) predicted time to first HAI. Poor outcome at 3 months was associated with higher Hunt Hess grade (p < 0.001), older age (p < 0.001), negative NBAL (p = 0.01), HAI (p = 0.03), higher CRP:TTR ratio (p = 0.04), higher body mass index (p = 0.03), and delayed cerebral ischemia (p = 0.04). CONCLUSIONS Negative NBAL after SAH is influenced by inflammation and associated with an increased risk of HAI and poor outcome. Underfeeding and systemic inflammation are potential modifiable risk factors for negative NBAL and poor outcome after SAH.
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Affiliation(s)
- Neeraj Badjatia
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY.
| | - Aimee Monahan
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Amanda Carpenter
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Jacqueline Zimmerman
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - J Michael Schmidt
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Jan Claassen
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - E Sander Connolly
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Stephan A Mayer
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Wahida Karmally
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - David Seres
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
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[Patients with subarachnoid haemorrhage in poor grade neurological status: Study of prognostic factors]. Neurocirugia (Astur) 2014; 26:32-8. [PMID: 25455762 DOI: 10.1016/j.neucir.2014.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 07/31/2014] [Accepted: 09/22/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate and predict factors influencing prognosis and/or clinical outcome at 6 months in patients with spontaneous subarachnoid haemorrhage, World Federation of Neurosurgical Societies (WFNS) grades iv and v. MATERIAL AND METHODS This was a retrospective study of a consecutive series of 394 patients admitted to our hospital with clinical and radiological diagnosis of spontaneous subarachnoid haemorrhage, from 1 January 1999 to 30 June 2009. We selected 121 patients who met the criteria of being in WFNS grades iv or v before treatment; 3 patients were excluded due to loss of tracking. The outcome variable was assessed 6 months after the event using the Glasgow Outcome Scale. A P value<.05 was considered statistically significant. RESULTS One hundred and twenty-one patients were included in the statistical analysis. The average age of the patients in the series was 54 years (14-92). Patients who had a mean Glasgow Coma Scale lower than 7 points (P<.0001), those who were grade v (P<.0001) in the pre-treatment WFNS scale and those with pupillary disorder (P=.002) had a worse clinical outcome. Likewise, those with associated intraparenchymal hematoma (P=.020) and those not receiving any treatment (P=.020) were also associated with a poor clinical outcome. These results were statistically significant. CONCLUSIONS Patients admitted with a WFNS grade v and/or presenting pupil disorder and/or intraparenchymal hematoma were associated with worse clinical outcomes.
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Bydon M, Abt NB, Macki M, Brem H, Huang J, Bydon A, Tamargo RJ. Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery. Surg Neurol Int 2014; 5:156. [PMID: 25422784 PMCID: PMC4235129 DOI: 10.4103/2152-7806.143754] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/19/2014] [Indexed: 01/26/2023] Open
Abstract
Background: Preoperative anemia may affect postoperative mortality and morbidity following elective cranial operations. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to identify elective cranial neurosurgical cases (2006-2012). Morbidity was defined as wound infection, systemic infection, cardiac, respiratory, renal, neurologic, and thromboembolic events, and unplanned returns to the operating room. For 30-day postoperative mortality and morbidity, adjusted odds ratios (ORs) were estimated with multivariable logistic regression. Results: Of 8015 patients who underwent elective cranial neurosurgery, 1710 patients (21.4%) were anemic. Anemic patients had an increased 30-day mortality of 4.1% versus 1.3% in non-anemic patients (P < 0.001) and an increased 30-day morbidity rate of 25.9% versus 14.14% in non-anemic patients (P < 0.001). The 30-day morbidity rates for all patients undergoing cranial procedures were stratified by diagnosis: 26.5% aneurysm, 24.7% sellar tumor, 19.7% extra-axial tumor, 14.8% intra-axial tumor, 14.4% arteriovenous malformation, and 5.6% pain. Following multivariable regression, the 30-day mortality in anemic patients was threefold higher than in non-anemic patients (4.1% vs 1.3%; OR = 2.77; 95% CI: 1.65-4.66). The odds of postoperative morbidity in anemic patients were significantly higher than in non-anemic patients (OR = 1.29; 95% CI: 1.03-1.61). There was a significant difference in postoperative morbidity event odds with a hematocrit level above (OR = 1.07; 95% CI: 0.78-1.48) and below (OR = 2.30; 95% CI: 1.55-3.42) 33% [hemoglobin (Hgb) 11 g/dl]. Conclusions: Preoperative anemia in elective cranial neurosurgery was independently associated with an increased risk of 30-day postoperative mortality and morbidity when compared to non-anemic patients. A hematocrit level below 33% (Hgb 11 g/dl) was associated with a significant increase in postoperative morbidity.
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Affiliation(s)
- Mohamad Bydon
- Johns Hopkins, Department of Neurosurgery, 600 N Wolfe Street, Sheik Zayed Tower Room 6115G, Baltimore, Maryland, 21287, USA
| | - Nicholas B Abt
- Johns Hopkins, Department of Neurosurgery, 600 N Wolfe Street, Sheik Zayed Tower Room 6115G, Baltimore, Maryland, 21287, USA
| | - Mohamed Macki
- Johns Hopkins, Department of Neurosurgery, 600 N Wolfe Street, Sheik Zayed Tower Room 6115G, Baltimore, Maryland, 21287, USA
| | - Henry Brem
- Johns Hopkins, Department of Neurosurgery, 600 N Wolfe Street, Sheik Zayed Tower Room 6115G, Baltimore, Maryland, 21287, USA
| | - Judy Huang
- Johns Hopkins, Department of Neurosurgery, 600 N Wolfe Street, Sheik Zayed Tower Room 6115G, Baltimore, Maryland, 21287, USA
| | - Ali Bydon
- Johns Hopkins, Department of Neurosurgery, 600 N Wolfe Street, Sheik Zayed Tower Room 6115G, Baltimore, Maryland, 21287, USA
| | - Rafael J Tamargo
- Johns Hopkins, Department of Neurosurgery, 600 N Wolfe Street, Sheik Zayed Tower Room 6115G, Baltimore, Maryland, 21287, USA
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Patabendige M. Acute subdural haemorrhage in the postpartum period as a rare manifestation of possible HELLP (haemolysis, elevated liver enzymes, and low-platelet count) syndrome: a case report. BMC Res Notes 2014; 7:408. [PMID: 24972626 PMCID: PMC4083337 DOI: 10.1186/1756-0500-7-408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 06/25/2014] [Indexed: 12/27/2022] Open
Abstract
Background The HELLP syndrome (haemolysis, elevated liver enzymes, and low-platelet count) occurs in about 0.5 to 0.9% of all pregnancies. With occurrence of thrombocytopaenia, it signals for several potentially lethal conditions such as complete or partial HELLP syndrome, thrombotic thrombocytopaenic purpura and acute fatty liver of pregnancy. Case presentation A previously healthy 27-year-old, Sinhala ethnic primigravida with pregnancy-induced hypertension was admitted at 38 weeks of gestation with lower abdominal pain and a blood pressure of 140/90 mmHg. She underwent emergency Caesarian section due to faetal distress giving birth to a healthy baby girl. Since postpartum day one, she was having intermittent fever spikes. All the routine investigations were normal in the first three weeks. Platelet count started dropping from post-partum day-20 onwards. On day-23, she had developed a seizure and computed tomography scan brain showed a subdural haemorrhage. She had a platelet count of 22,000 × 109/liter and was managed conservatively. She also had elevated liver enzymes, lactate dehydrogenase and bilirubin levels. Blood picture on day-24 showed haemolytic anemia. On day- 36, patient again developed seizures and she was having intermittent fever with generalized headache and signs of meningism. Computed tomography scan revealed an acute on chronic subdural haemorrhage. Conclusions Hypertensive disorders in pregnancy should be managed as high-risk throughout the postpartum period. Development of thrombocytopaenia can be considered as an early warning sign for HELLP, thrombotic thrombocytopaenic purpura or acute fatty liver of pregnancy which are lethal conditions. Prompt recognition of intracranial haemorrhages and early neurosurgical intervention is lifesaving.
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Affiliation(s)
- Malitha Patabendige
- University Obstetrics Unit, De Soysa Hospital for Women, Colombo, Sri Lanka.
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Alan N, Seicean A, Seicean S, Neuhauser D, Weil RJ. Impact of preoperative anemia on outcomes in patients undergoing elective cranial surgery. J Neurosurg 2014; 120:764-72. [DOI: 10.3171/2013.10.jns131028] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The objective of this study was to assess whether preoperative anemia in patients undergoing elective cranial surgery influences outcomes in the immediate perioperative period (≤ 30 days).
Methods
The National Surgical Quality Improvement Program (NSQIP) was used to identify 6576 patients undergoing elective cranial surgery between 2006 and 2011. Propensity scores were used to match patients with moderate to severe anemia (moderate-severe) or mild anemia with patients without anemia. Logistic regression analysis was used to predict the outcomes of interest. Sensitivity analyses were used to limit the sample to patients without perioperative transfusion as well as those who underwent craniotomy for definitive resection of a malignant brain tumor.
Results
A total of 6576 patients underwent elective cranial surgery, of whom 175 had moderate-severe anemia and 1868 had mild anemia. Patients with moderate-severe (odds ratio 1.8, 95% CI 1.1–2.8) and mild (odds ratio 1.5, 95% CI 1.3–1.7) anemia were more likely to have prolonged length of stay (LOS) in the hospital compared to those with no anemia. Similarly, in patients who underwent craniotomy for a malignant tumor resection (n = 2537), anemia of any severity was associated with prolonged LOS, but not postoperative complications nor death.
Conclusions
Anemia is not associated with an overall increased risk for adverse outcomes in patients undergoing elective cranial surgery. However, patients with anemia are more likely to experience prolonged hospitalization postoperatively, resulting in increased resource utilization.
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Affiliation(s)
- Nima Alan
- 1Case Western Reserve University School of Medicine
| | - Andreea Seicean
- 1Case Western Reserve University School of Medicine
- 2Department of Epidemiology and Biostatistics, Case Western Reserve University
| | - Sinziana Seicean
- 3Departments of Pulmonary, Critical Care and Sleep Medicine, University Hospitals
- 4Heart and Vascular Institute, Cleveland Clinic
| | - Duncan Neuhauser
- 2Department of Epidemiology and Biostatistics, Case Western Reserve University
| | - Robert J. Weil
- 5The Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, and Department of Neurosurgery, The Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Behrouz R, Sullebarger JT, Malek AR. Cardiac manifestations of subarachnoid hemorrhage. Expert Rev Cardiovasc Ther 2014; 9:303-7. [DOI: 10.1586/erc.10.189] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abate MG, Citerio G. Management of subarachnoid hemorrhage. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-013-0810-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ardelt A. From bench-to-bedside in catastrophic cerebrovascular disease: development of drugs targeting the endothelin axis in subarachnoid hemorrhage-related vasospasm. Neurol Res 2013; 34:195-210. [DOI: 10.1179/1743132811y.0000000081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Blood transfusion is an important predictor of hospital mortality among patients with aneurysmal subarachnoid hemorrhage. Neurocrit Care 2013; 18:209-15. [PMID: 22965325 DOI: 10.1007/s12028-012-9777-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Red blood cell (RBC) transfusion after aneurysmal subarachnoid hemorrhage (aSAH) has been associated with increased mortality but prior studies have not adequately adjusted for transfusion-indication bias. METHODS This is a retrospective study of consecutive aSAH patients admitted to the intensive care units of two academic medical centers over a 7-year period. Data collection included demographics, World Federation of Neurosurgical Surgeons score (WFNS), modified Fisher score (mFisher), admission and nadir hemoglobin (Hb) level, vasospasm, cerebral infarction, acute lung injury, and hospital mortality. The association between RBC transfusion and mortality was evaluated using a multivariate logistic regression analysis using the propensity for RBC transfusion as a covariate. RESULTS We identified 318 patients. The median age was 54 years (46, 65), and 204 (64 %) were females. Hospital mortality was 13 % (42/318). Seventy-two (23 %) patients were transfused. Predictors of transfusion were admit and nadir Hb levels (p < 0.001), age (p = 0.02), gender (0.008), WFNS score (p < 0.001), mFisher score (p = 0.009), surgical versus endovascular treatment (p < 0.001) and moderate to severe vasospasm (p = 0.025) were predictors of transfusion. After adjustment for probability of receiving RBC transfusion, APACHE IV and nadir Hb, transfusion remained independently associated with hospital mortality (OR 3.16, 95 % CI = 1.02-9.69, p = 0.047). CONCLUSIONS Among patients with aSAH, RBC transfusion was independently associated with an increased mortality after adjustment for the most common clinical indications for transfusion.
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Savardekar A, Gyurmey T, Agarwal R, Podder S, Mohindra S, Gupta SK, Chhabra R. Incidence, risk factors, and outcome of postoperative pneumonia after microsurgical clipping of ruptured intracranial aneurysms. Surg Neurol Int 2013; 4:24. [PMID: 23532567 PMCID: PMC3604814 DOI: 10.4103/2152-7806.107894] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/15/2013] [Indexed: 11/09/2022] Open
Abstract
Background: Occurrence of pneumonia challenges the medical management of patients who have undergone surgery for aneurysmal subarachnoid hemorrhage, and is associated with significant mortality and morbidity. There are very few studies evaluating the incidence and outcome of postoperative pneumonia in patients undergoing microsurgical clipping of ruptured intracranial aneurysms. The aim of this study was to determine the incidence, risk factors, and outcome of postoperative pneumonia in patients undergoing surgery for ruptured intracranial aneurysms. Methods: All patients operated for intracranial aneurysms, over a period of 9 months, were included prospectively. They were studied for risk factors predisposing them to pneumonia and their outcomes were noted at discharge. Patients with predisposing chronic lung disease, preexisting pneumonia, and chronic smoking habits were excluded. Results: One hundred and three patients [Mean age: 46.01 years; M:F – 58:45] underwent microsurgical clipping of aneurysm during the study period. Of these, 28 patients (27.2%) developed postoperative pneumonia. The variables associated with postoperative pneumonia were: [Preoperative] age >50 years, Glasgow Coma Scale (GCS) at presentation <15 and Hunt and Hess grade before surgery >2; [postoperative] duration of surgery >3 hours, GCS <15 after complete reversal from anesthesia, duration of intubation in the postoperative period >48 hours, tracheostomy, postoperative ventilation, intensive care unit (ICU) stay >5 days. Predictive factors for postoperative pneumonia by multivariate analysis were: Postoperative endotracheal intubation >48 hours, tracheostomy and ICU stay >5 days. Conclusions: There is a high incidence of postoperative pneumonia and mortality associated with pneumonia (27.2% and 9.7%, respectively in our study) in patients of ruptured intracranial aneurysms undergoing microsurgical clipping at our center, with Acinetobacter species being the predominant causative organism.
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Kumar MA, Boland TA, Baiou M, Moussouttas M, Herman JH, Bell RD, Rosenwasser RH, Kasner SE, Dechant VE. Red Blood Cell Transfusion Increases the Risk of Thrombotic Events in Patients with Subarachnoid Hemorrhage. Neurocrit Care 2013; 20:84-90. [DOI: 10.1007/s12028-013-9819-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Acute subarachnoid hemorrhage (SAH) is a severe and acute life-threatening cerebrovascular disease. Approximately 80% of all acute non-traumatic SAHs are the result of a ruptured cerebrovascular aneurysm. Despite advances in diagnosis and treatment a high morbidity and mortality still exists. Apart from the primary cerebral damage there are also secondary complications, such as vasospasm, rebleeding, hydrocephalus, cerebral edema or hydrocephalus. For an appropriate therapy an understanding of the extensive pathophysiology, the options in diagnostics and therapy and the complications of the disease are essential. Anesthesiologists are decisively involved in the therapy of the primary and secondary damages and subsequently in the outcome as well. This article provides an overview of the perioperative and intensive care management of patients with SAH.
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Abstract
Aneurysmal subarachnoid haemorrhage (SAH) is a devastating disease associated with high mortality and poor outcome in many survivors. Aggressive treatment by a comprehensive multidisciplinary team is associated with improved outcome, but the intensive care management of SAH presents significant challenges. Multimodal neuromonitoring may detect secondary insults before irreversible neuronal damage has occurred, and is increasingly being used to guide treatment. This article reviews current trends in the intensive care management of SAH from aspects of initial resuscitation to recent developments in the prevention and management of complications, including delayed cerebral ischaemia. Evidence from clinical trials and recent consensus guidance is reviewed.
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Affiliation(s)
- David Highton
- Academic Clinical Fellow in Anaesthesia and Critical Care, University College London Hospitals
| | - Martin Smith
- Consultant and Honorary Professor in Neurocritical Care, The National Hospital for Neurology and Neurosurgery, University College London Hospitals
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Desjardins P, Turgeon AF, Tremblay MH, Lauzier F, Zarychanski R, Boutin A, Moore L, McIntyre LA, English SW, Rigamonti A, Lacroix J, Fergusson DA. Hemoglobin levels and transfusions in neurocritically ill patients: a systematic review of comparative studies. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R54. [PMID: 22471943 PMCID: PMC3681381 DOI: 10.1186/cc11293] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Revised: 02/09/2012] [Accepted: 04/02/2012] [Indexed: 02/07/2023]
Abstract
Introduction Accumulating evidence suggests that, in critically ill patients, a lower hemoglobin transfusion threshold is safe. However, the optimal hemoglobin level and associated transfusion threshold remain unknown in neurocritically ill patients. Methods We conducted a systematic review of comparative studies (randomized and nonrandomized) to evaluate the effect of hemoglobin levels on mortality, neurologic function, intensive care unit (ICU) and hospital length of stay, duration of mechanical ventilation, and multiple organ failure in adult and pediatric neurocritically ill patients. We searched MEDLINE, The Cochrane Central Register of Controlled Trials, Embase, Web of Knowledge, and Google Scholar. Studies focusing on any neurocritical care conditions were included. Data are presented by using odds ratios for dichotomous outcomes and mean differences for continuous outcomes. Results Among 4,310 retrieved records, six studies met inclusion criteria (n = 537). Four studies were conducted in traumatic brain injury (TBI), one in subarachnoid hemorrhage (SAH), and one in a mixed population of neurocritically ill patients. The minimal hemoglobin levels or transfusion thresholds ranged from 7 to 10 g/dl in the lower-Hb groups and from 9.3 to 11.5 g/dl in the higher-Hb groups. Three studies had a low risk of bias, and three had a high risk of bias. No effect was observed on mortality, duration of mechanical ventilation, or multiple organ failure. In studies reporting on length of stay (n = 4), one reported a significant shorter ICU stay (mean, -11.4 days (95% confidence interval, -16.1 to -6.7)), and one, a shorter hospital stay (mean, -5.7 days (-10.3 to -1.1)) in the lower-Hb groups, whereas the other two found no significant association. Conclusions We found insufficient evidence to confirm or refute a difference in effect between lower- and higher-Hb groups in neurocritically ill patients. Considering the lack of evidence regarding long-term neurologic functional outcomes and the high risk of bias of half the studies, no recommendation can be made regarding which hemoglobin level to target and which associated transfusion strategy (restrictive or liberal) to favor in neurocritically ill patients.
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Affiliation(s)
- Philippe Desjardins
- Department of Anesthesiology, Division of Critical Care Medicine, Faculty of Medicine, Université Laval, 1050, Avenue de Médecine, Pavillon Ferdinand-Vandry, Québec, QC, G1V 0A6, Canada
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Dorhout Mees SM, Molyneux AJ, Kerr RS, Algra A, Rinkel GJE. Timing of aneurysm treatment after subarachnoid hemorrhage: relationship with delayed cerebral ischemia and poor outcome. Stroke 2012; 43:2126-9. [PMID: 22700527 DOI: 10.1161/strokeaha.111.639690] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The ideal timing of coiling or clipping after aneurysmal subarachnoid hemorrhage is unknown. Within the International Subarachnoid Aneurysm Trial we assessed differences in incidence of delayed cerebral ischemia and clinical outcome between different timings of treatment. METHODS The treated 2106 patients randomized to coiling or clipping were divided into 4 categories: treatment <2 days, on days 3 to 4, on days 5 to 10, and >10 days after the hemorrhage. ORs with 95% CI were calculated with logistic regression analysis for delayed cerebral ischemia, poor outcome at 2 months, and 1 year for the different timing categories, with treatment <2 days as reference. Analyses were performed for all patients, and for coiled and clipped patients separately, and were adjusted for baseline characteristics. RESULTS Adjusted ORs of delayed cerebral ischemia for treatment on days 5 to 10 were 1.18 (95% CI, 0.91-1.53) for all patients, 1.68 (95% CI, 1.17-2.43) after coiling, and 0.79 (95% CI, 0.54-1.16) after clipping. ORs for poor outcome at 2 months were 1.16 (95% CI, 0.89-1.50) for treatment (clipping and coiling combined) at 3 to 4 days, 1.39 (95% CI, 1.08-1.80) for treatment at 5 to 10 days, and 1.84 (95% CI, 1.36-2.51) for treatment >10 days. ORs for coiled and clipped patients separately were in the same range. Results for outcome at 1 year were similar. CONCLUSIONS Our results support the current practice for early aneurysm treatment in subarachnoid hemorrhage patients. The risk for poor outcome was highest when treatment was performed after day 10; postponing treatment in patients who are eligible for treatment between days 5 to 10 after subarachnoid hemorrhage is not recommended.
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Affiliation(s)
- Sanne M Dorhout Mees
- Rudolf Magnus Institute of Neuroscience, Department of Neurology and Neurosurgery, University Medical Center Utrecht, The Netherlands.
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Le Roux P, Diringer M. The Risks of Blood Transfusion in Patients with Subarachnoid Hemorrhage: Response to Dr. Paul E. Marik. Neurocrit Care 2012. [DOI: 10.1007/s12028-012-9674-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
Delayed cerebral ischemia after subarachnoid hemorrhage (SAH) may be affected by a number of factors, including cerebral blood flow and oxygen delivery. Anemia affects about half of patients with SAH and is associated with worse outcome. Anemia also may contribute to the development of or exacerbate delayed cerebral ischemia. This review was designed to examine the prevalence and impact of anemia in patients with SAH and to evaluate the effects of transfusion. A literature search was made to identify original research on anemia and transfusion in SAH patients. A total of 27 articles were identified that addressed the effects of red blood cell transfusion (RBCT) on brain physiology, anemia in SAH, and clinical management with RBCT or erythropoietin. Most studies provided retrospectively analyzed data of very low-quality according to the GRADE criteria. While RBCT can have beneficial effects on brain physiology, RBCT may be associated with medical complications, infection, vasospasm, and poor outcome after SAH. The effects may vary with disease severity or the presence of vasospasm, but it remains unclear whether RBCTs are a marker of disease severity or a cause of worse outcome. Erythropoietin data are limited. The literature review further suggests that the results of the Transfusion Requirements in Critical Care Trial and subsequent observational studies on RBCT in general critical care do not apply to SAH patients and that randomized trials to address the role of RBCT in SAH are required.
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Affiliation(s)
- Peter D Le Roux
- Department of Neurosurgery, University of Pennsylvania, 235 S 8th Street, Philadelphia, PA 19106, USA.
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Junttila E, Koskenkari J, Ohtonen P, Ala-Kokko T. Uncalibrated arterial pressure waveform analysis for cardiac output monitoring is biased by low peripheral resistance in patients with intracranial haemorrhage †. Br J Anaesth 2011; 107:581-6. [DOI: 10.1093/bja/aer170] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Badjatia N, Carpenter A, Fernandez L, Schmidt JM, Mayer SA, Claassen J, Lee K, Connolly ES, Seres D, Elkind MSV. Relationship between C-reactive protein, systemic oxygen consumption, and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Stroke 2011; 42:2436-42. [PMID: 21757662 DOI: 10.1161/strokeaha.111.614685] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Subarachnoid hemorrhage (SAH) is known to result in elevated systemic oxygen consumption (Vo(2)) and increases in high-sensitivity C-reactive protein (hsCRP), although the relationship among hsCRP, Vo(2), and delayed cerebral ischemia (DCI) after SAH remains unknown. We hypothesized that hsCRP is directly associated with Vo(2) and that elevated Vo(2) is a predictor of DCI after SAH. METHODS Prospective serial assessments of Vo(2) and hsCRP over 4 prespecified time periods during the first 14 days after bleed in consecutive SAH patients admitted to a single academic medical center for a 2-year period. RESULTS One hundred ten SAH patients met study criteria (mean age, 55±16 years; 62% women), with a median admission Hunt Hess grade of 3 (interquartile range, 2-4). In multivariate generalized estimating equation model of the first 14 days after bleed, Vo(2) was associated with younger age (P=0.01), male gender (P=0.01), and hsCRP levels (P=0.03). Twenty-four (22%) patients had DCI develop, with a median onset on day 7 after bleed (interquartile range, 5-11). The mean Vo(2) (291±65 mL/min versus 226±55 mL/min; P=0.003) was higher in DCI patients. In a multivariable Cox proportional hazards model, younger age (hazard ratio, 1.2 per 5 years; 95% CI, 1.1-1.3), a higher modified Fisher scale score (hazard ratio, 3.4 per 1-point increase; 95% CI, 1.7-6.9), and higher Vo(2) (HR, 1.2 per 50-mL/min increase; 95% CI, 1.1-1.3) were predictive of DCI. CONCLUSIONS Systemic oxygen consumption is associated with hsCRP levels in the first 14 days after SAH and is an independent predictor of DCI.
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Affiliation(s)
- Neeraj Badjatia
- Departments of Neurology, Neurological Institute of New York, NY, USA.
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Romero Kräuchi O, Verger Bennasar AM. [Protective measures against cerebral ischemia following subarachnoid hemorrhage: Part 1]. ACTA ACUST UNITED AC 2011; 58:230-5. [PMID: 21608279 DOI: 10.1016/s0034-9356(11)70045-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Cerebral vasospasm following aneurysmal subarachnoid hemorrhage contributes significantly to morbidity and mortality. Many studies on the various treatments aimed at preventing cerebral vasospasm have been carried out, but evidence of efficacy is limited. Our aim was to review the literature on the various therapies for which there is scientific evidence of protection against cerebral vasospasm following aneurysmal subarachnoid hemorrhage. METHODS MEDLINE search (1950 to the october 2009) and review of articles found on the prevention of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. The search was restricted to articles in English, French, and Spanish. The keywords were cerebral vasospasm, subarachnoid hemorrhage, therapy, nimodipine, triple H, clazosentan, statins, and magnesium in addition to the word forms derived from them. We also searched manually for references cited in the selected articles. A title was included if it was a randomized controlled trial, meta-analysis, nonrandomized clinical trial, descriptive study, observational study with statistical analysis, opinion article, or expert review. RESULTS Part 1 analyzed treatment with calcium antagonists and triple-H therapy (hypertension, hemodilution, and hypervolemia). Part 2 analyzed new therapies such as clazosentan, magnesium, and statins. A total of 597 titles were located; 283 were initially selected. The 61 articles finally selected for review were of the following types: 2 opinion articles, 21 randomized controlled trials, 22 expert review articles, 3 meta-analyses, 4 nonrandomized clinical trials, 1 descriptive study, and 5 observational studies with statistical analysis. Three studies (2 meta-analyses and 1 randomized controlled trial) demonstrated that nimodipine use confers benefits (reduced morbidity and mortality) for patients with aneurysmatic subarachnoid hemorrhage. Statistically significant clinical benefits could not be demonstrated for the other drugs (clazosentan, statins, and magnesium). CONCLUSIONS Insufficient evidence is available to support the use of the triple-H therapy, clazosentan, statins, or magnesium sulfate for the prevention of cerebral vasospasm following subarachnoid hemorrhage. Nimodipine is the only preventative treatment that can be recommended.
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Affiliation(s)
- O Romero Kräuchi
- Unidad de Reanimación, Servicio de Anestesiología y Reanimacidn, Hospital Universitario Son Dureta, Palma de Mallorca.
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Abstract
BACKGROUND In the management of subarachnoid hemorrhage (SAH), the potential for early complications and the centralization of limited resources often challenge the delivery of timely neurosurgical care. We sought to determine the impact of proximity to the accepting neurosurgical centre on outcomes following aneurysmal SAH. METHODS Using administrative data, we analyzed patients undergoing treatment for aneurysmal subarachnoid hemorrhage at neurosurgical centres in Ontario between 1995 and 2004. We compared mortality for patients receiving treatment at a centre in their county (in-county) versus those treated from outside counties (out-of-county). We also examined the impact of distance from the patient's residence to the treating centre. RESULTS The mortality rates were significantly lower for in-county versus out-of-county patients (23.5% vs. 27.6%, p=0.009). This advantage remained significant after adjusting for potential confounders (HR=0.84, p=0.01). The relationship between distance from the treating centre and mortality was biphasic. Under 300 km, mortality increased with increasing distance. Over 300 km, a survival benefit was observed. CONCLUSIONS Proximity to the treating neurosurgical centre impacts survival after aneurysmal SAH. These results have significant implications for the triage of these critically ill patients.
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Teig M, Smith M. Where should patients with severe traumatic brain injury be managed? All patient should be managed in a neurocritical care unit. J Neurosurg Anesthesiol 2011; 22:357-9. [PMID: 20844380 DOI: 10.1097/ana.0b013e3181f0dada] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhang G, Zhang JH, Qin X. Effect of weekend admission on in-hospital mortality after subarachnoid hemorrhage in Chongqing China. ACTA NEUROCHIRURGICA. SUPPLEMENT 2011; 110:229-232. [PMID: 21116945 DOI: 10.1007/978-3-7091-0353-1_40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Medical resources are usually not the same throughout the week. It is reported that the mortality rate of some disease was higher in patients admitted on weekends than on weekdays. Our study will try to evaluate whether this "weekend effect" acts on in-hospital mortality rate after SAH. METHODS We performed a retrospective study of patients with SAH admitted to our hospital from January 2006-2009. Patients were classified according to their admission days. The following information, including patient demographics,living habits,systemic complications and Charlson comorbidity index, were documented. Descriptive statistics were used to assess the characteristics between patients admitted on weekends and weekdays. The comparison of mortality between the two groups was carried out by chi-square test. Multivariable regression model was used to analyze the influence of weekend admission on in-hospital mortality and adjust for potential confounders. RESULTS Weekend admission accounted for about 29% of the 183 patients with SAH. There were no differences in general characteristics between patients admitted on weekends and those on weekdays. The chi-square test showed the mortality between two groups was not significantly different (0.082). In logistic regression model, weekend admission was not an independent predictor of higher in-hospital mortality (OR 1.77, 95% CI 0.83-3.77) after SAH. CONCLUSION Weekend admission was not closely related to higher in-hospital mortality. There was no weekend effect observed in our hospital in Chongqing, China.
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Affiliation(s)
- Guanghui Zhang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, 400016, People's Republic of China
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