Impact of medical complications on outcome after subarachnoid hemorrhage*

Abstract

Objective: Medical complications occur frequently after subarachnoid hemorrhage (SAH). Their impact on outcome remains poorly defined. Design: Inception cohort study. Patients: Five-hundred eighty patients enrolled in the Columbia University SAH Outcomes Project between July 1996 and May 2002. Setting: Neurologic intensive care unit. Interventions: Patients were treated according to standard management protocols. Measurements and Main 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°C (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. LEARNING OBJECTIVES On completion of this article, the reader should be able to: Identify common medical complications after subarachnoid hemorrhage. Describe complications that influence outcome. Use this inofrmation in a clinical setting. Dr. Connolly has disclosed that he is/was the recipient of direct grant/research funds from the National Institutes of Health. The remaining authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to the educational activity. Wolters Kluwer has identified and resolved all faculty conflicts of interest regarding the educational activity. Visit the Critical Care Medicine Web site (www.ccmjournal.org) for information on obtaining continuing medical education credit.