• Aaron S Lord, Carl D Langefeld, Padmini Sekar, Charles J Moomaw, Neeraj Badjatia, Anastasia Vashkevich, Jonathan Rosand, Jennifer Osborne, Daniel Woo, and Mitchell S V Elkind.
• 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.
• Stroke. 2014 Dec 1;45(12):3535-42.

Background And PurposeRisk 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.MethodsWe 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).ResultsAmong 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).ConclusionsThere are identifiable risk factors for infection after ICH, and infections predict poor outcomes.© 2014 American Heart Association, Inc.

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