title: Infection after intracerebral hemorrhage: risk factors and association with outcomes in the ethnic/racial variations of intracerebral hemorrhage study.
abstract: OBJECTIVE
  Risk factors for infections after intracerebral hemorrhage (ICH) and their association with outcomes are unknown. We hypothesized there are predictors of poststroke infection and infections drive worse outcomes.
  
  
  METHODS
  We determined prevalence of infections in a multicenter, triethnic study of ICH. We performed univariate and multivariate analyses to determine the association of infection with admission characteristics and hospital complications. We performed logistic regression on association of infection with outcomes after controlling for known determinants of prognosis after ICH (volume, age, infratentorial location, intraventricular hemorrhage, and Glasgow Coma Scale).
  
  
  RESULTS
  Among 800 patients, infections occurred in 245 (31%). Admission characteristics associated with infection in multivariable models were ICH volume (odds ratio [OR], 1.02/mL; 95% confidence interval [CI], 1.01-1.03), lower Glasgow Coma Scale (OR, 0.91 per point; 95% CI, 0.87-0.95), deep location (reference lobar: OR, 1.90; 95% CI, 1.28-2.88), and black race (reference white: OR, 1.53; 95% CI, 1.01-2.32). In a logistic regression of admission and hospital factors, infections were associated with intubation (OR, 3.1; 95% CI, 2.1-4.5), dysphagia (with percutaneous endoscopic gastrostomy: OR, 3.19; 95% CI, 2.03-5.05 and without percutaneous endoscopic gastrostomy: OR, 2.11; 95% CI, 1.04-4.23), pulmonary edema (OR, 3.71; 95% CI, 1.29-12.33), and deep vein thrombosis (OR, 5.6; 95% CI, 1.86-21.02), but not ICH volume or Glasgow Coma Scale. Infected patients had higher discharge mortality (16% versus 8%; P=0.001) and worse 3-month outcomes (modified Rankin Scale ≥3; 80% versus 51%; P<0.001). Infection was an independent predictor of poor 3-month outcome (OR, 2.6; 95% CI, 1.8-3.9).
  
  
  CONCLUSIONS
  There are identifiable risk factors for infection after ICH, and infections predict poor outcomes.
authors.affiliation: From the Department of Neurology, New York University School of Medicine (A.S.L.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest University, Winston-Salem, NC (C.D.L.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (P.S., C.J.M., J.O., D.W.); Department of Neurology, University of Maryland School of Medicine, Baltimore (N.B.); Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston (A.V., J.R.); and Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.). Aaron.Lord@Nyumc.org.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Lord
authors.affiliation: From the Department of Neurology, New York University School of Medicine (A.S.L.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest University, Winston-Salem, NC (C.D.L.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (P.S., C.J.M., J.O., D.W.); Department of Neurology, University of Maryland School of Medicine, Baltimore (N.B.); Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston (A.V., J.R.); and Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Carl D
authors.initials: CD
authors.lastname: Langefeld
authors.affiliation: From the Department of Neurology, New York University School of Medicine (A.S.L.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest University, Winston-Salem, NC (C.D.L.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (P.S., C.J.M., J.O., D.W.); Department of Neurology, University of Maryland School of Medicine, Baltimore (N.B.); Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston (A.V., J.R.); and Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Padmini
authors.initials: P
authors.lastname: Sekar
authors.affiliation: From the Department of Neurology, New York University School of Medicine (A.S.L.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest University, Winston-Salem, NC (C.D.L.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (P.S., C.J.M., J.O., D.W.); Department of Neurology, University of Maryland School of Medicine, Baltimore (N.B.); Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston (A.V., J.R.); and Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Moomaw
authors.affiliation: From the Department of Neurology, New York University School of Medicine (A.S.L.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest University, Winston-Salem, NC (C.D.L.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (P.S., C.J.M., J.O., D.W.); Department of Neurology, University of Maryland School of Medicine, Baltimore (N.B.); Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston (A.V., J.R.); and Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Neeraj
authors.initials: N
authors.lastname: Badjatia
authors.affiliation: From the Department of Neurology, New York University School of Medicine (A.S.L.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest University, Winston-Salem, NC (C.D.L.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (P.S., C.J.M., J.O., D.W.); Department of Neurology, University of Maryland School of Medicine, Baltimore (N.B.); Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston (A.V., J.R.); and Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Anastasia
authors.initials: A
authors.lastname: Vashkevich
authors.affiliation: From the Department of Neurology, New York University School of Medicine (A.S.L.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest University, Winston-Salem, NC (C.D.L.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (P.S., C.J.M., J.O., D.W.); Department of Neurology, University of Maryland School of Medicine, Baltimore (N.B.); Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston (A.V., J.R.); and Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.affiliation: From the Department of Neurology, New York University School of Medicine (A.S.L.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest University, Winston-Salem, NC (C.D.L.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (P.S., C.J.M., J.O., D.W.); Department of Neurology, University of Maryland School of Medicine, Baltimore (N.B.); Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston (A.V., J.R.); and Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Jennifer
authors.initials: J
authors.lastname: Osborne
authors.affiliation: From the Department of Neurology, New York University School of Medicine (A.S.L.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest University, Winston-Salem, NC (C.D.L.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (P.S., C.J.M., J.O., D.W.); Department of Neurology, University of Maryland School of Medicine, Baltimore (N.B.); Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston (A.V., J.R.); and Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Woo
authors.affiliation: From the Department of Neurology, New York University School of Medicine (A.S.L.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest University, Winston-Salem, NC (C.D.L.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (P.S., C.J.M., J.O., D.W.); Department of Neurology, University of Maryland School of Medicine, Baltimore (N.B.); Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston (A.V., J.R.); and Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
mesh_terms: D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications*; D005006:Ethnicity; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors
keywords: cerebral hemorrhage; infection; outcomes assessment (health care); risk factors