Impact of medical complications on outcome after subarachnoid hemorrhage.
OBJECTIVE
Medical complications occur frequently after subarachnoid hemorrhage (SAH). Their impact on outcome remains poorly defined.


METHODS
Inception cohort study.


METHODS
Five-hundred eighty patients enrolled in the Columbia University SAH Outcomes Project between July 1996 and May 2002.


METHODS
Neurologic intensive care unit.


METHODS
Patients were treated according to standard management protocols.


RESULTS
Poor outcome was defined as death or severe disability (modified Rankin score, 4-6) at 3 months. We calculated the frequency of medical complications according to prespecified criteria and evaluated their impact on outcome, using forward stepwise multiple logistic regression after adjusting for known predictors of poor outcome. Thirty-eight% had a poor outcome; mortality was 21%. The most frequent complications were temperature>38.3 degreesC (54%), followed by anemia treated with transfusion (36%), hyperglycemia>11.1 mmol/L (30%), treated hypertension (>160 mm Hg systolic; 27%), hypernatremia>150 mmol/L (22%), pneumonia (20%), hypotension (<90 mm Hg systolic) treated with vasopressors (18%), pulmonary edema (14%), and hyponatremia<130 mmol/L (14%). Fever (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-3.4; p=.02), anemia (OR, 1.8; 95% CI, 1.1-2.9; p=.02), and hyperglycemia (OR, 1.8; 95% CI, 1.1-3.0; p=.02) significantly predicted poor outcome after adjustment for age, Hunt-Hess grade, aneurysm size, rebleeding, and cerebral infarction due to vasospasm.


CONCLUSIONS
Fever, anemia, and hyperglycemia affect 30% to 54% of patients with SAH and are significantly associated with mortality and poor functional outcome. Critical care strategies directed at maintaining normothermia, normoglycemia, and prevention of anemia may improve outcome after SAH.
Wartenberg
Katja E
KE
Clinical Neuropsychology, New York Presbyterian Hospital, and Stroke and Critical Care, Columbia University, New York, NY, USA.
Schmidt
J Michael
JM
Claassen
Jan
J
Temes
Richard E
RE
Frontera
Jennifer A
JA
Ostapkovich
Noeleen
N
Parra
Augusto
A
Connolly
E Sander
ES
Mayer
Stephan A
SA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000209:etiology; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome