Nearly 30% of adults hospitalized with intracerebral hemorrhage have a medical complication

From 2004 to 2013, adults who suffered an intracerebral hemorrhage had an increased risk of deep vein thrombosis and acute renal failure and a decreased risk of pneumonia, sepsis and mortality, according to a database analysis.

Each of the medical complications was associated with a hospital stay increasing by more than 2.5 day and costs increasing by $8,000.

The researchers found that 29 percent of patients admitted to the hospital for an intracerebral hemorrhage had at least one additional medical complication. The risk of any complication increased approximately 20 percent from 2004 to 2013.

Lead researcher Fadar Oliver Otite, MD, of the University of Miami Miller School of Medicine, and colleagues published their results online in Stroke on Feb. 22. They also presented the findings at the American Stroke Association’s International Stroke Conference in Houston.

The researchers noted that intracerebral hemorrhage accounts for 10 percent of strokes in the U.S. and is the most deadly form of stroke.

For this study, they obtained data on 575,211 intracerebral hemorrhage cases from 2004 to 2013 from the Nationwide Inpatient Sample (NIS), the largest all-payer inpatient care database in the U.S. They mentioned that the NIS comprises a 20 percent stratified random sample of U.S. hospital discharges.

The mean age of patients at hospital admission was 68.9 years old, and 49.7 percent of patients were female.

During the study, the proportion of patients with comorbid hypertension, diabetes, chronic kidney disease and baseline coagulopathy increased over time. The mean length of stay did not change during the study, but the proportion of patients transferred to skilled nursing facilities increased from 42.3 percent in 2004 to 46.9 percent in 2013.

The researchers also found that 29.3 percent of the overall group and 37.1 percent of patients with mechanical ventilation had at least one medical complication during hospitalization. They added that urinary tract infections (14.8 percent of patients), acute renal failure (8.2 percent of patients) and pneumonia (7.8 percent of patients) were the most common complications.

The most common complication in females was urinary tract infection (19.8 percent), while the most common complication in males was acute renal failure (10.6 percent).

Although the risk of acute MI was similar among men and women, the overall weighted risks of pneumonia, sepsis, deep vein thrombosis and pulmonary embolism were approximately 30 percent greater in males.

The in-hospital mortality rates were 23.8 percent in the overall group and 59.5 percent in patients needing mechanical ventilation. In addition, 61.6 percent of in-hospital deaths occurred in the first three days of admission, and 82.4 percent of all deaths occurred within the first week of hospitalization. Further, 16.4 percent of patients who died within the first week had a medical complication, while 59.7 percent of patients who died after a week had a medical complication.

In 2004, the in-hospital mortality rate was 27.8 percent, and 26 percent of patients had at least one medical complication. In 2013, the rates were 21 percent and 31.2 percent, respectively. The researchers mentioned the increase in total complication risk was mostly due to a nearly three-fold increased risk of acute renal failure from 2004 to 2013.

After adjusting for mechanical ventilation and other variables, the odds of pneumonia decreased by 4 percent per year, the odds of sepsis decreased by 3 percent and the odds of acute renal failure increased 9 percent. Further, sepsis and deep vein thrombosis were associated with the highest mean increase in length of stay and cost.

The researchers cited a few limitations of the study, including the potential for coding errors. They also did not have information on the clinical and radiological severity of intracerebral hemorrhage. In addition, they mentioned 30-day and 90-day outcomes measures could have provided more accurate information, as could information on complications that occurred subacutely after intracerebral hemorrhage admission.

“The large sample size of our study with national representation and generalizability to all [intracerebral hemorrhage] patients in the United States provides a comprehensive evaluation of the risks, associated determinants, outcomes, and importance of medical complications in [intracerebral hemorrhage] patients,” the researchers wrote. “Medical complications are frequent and pose significant threats to morbidity and mortality for [intracerebral hemorrhage] patients, and our findings should trigger increased efforts to prevent them and to lessen their burden.”