• Kara R Melmed, Amelia Boehme, Natasha Ironside, Santosh Murthy, Soojin Park, Sachin Agarwal, E Sander Connolly, Jan Claassen, ElkindMitchell S VMSVDepartment of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA., and David Roh.
• Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA. kara.melmed@gmail.com.
• Neurocrit Care. 2021 Feb 1; 34 (1): 85-91.

BackgroundInfection and venous thromboembolism (VTE) are associated with worse outcomes after intracerebral hemorrhage (ICH). The relationship between infection and VTE in ICH patients is unclear. We hypothesized that infection would be associated with subsequent VTE after ICH.MethodsWe retrospectively studied consecutively admitted spontaneous primary ICH patients from 2009 to 2018 surviving beyond 24 h. The primary predictor variable was infection, diagnosed prior to VTE. The primary outcome was VTE. We used multivariable logistic regression models to estimate the odds ratios and 95% confidence intervals (OR, 95% CI) for VTE risk after infection of any type, after adjusting for ICH score, length of stay and days to deep venous thrombosis (DVT) prophylaxis. Similar analysis was done to estimate the association of infection subtypes, including respiratory and urinary and blood stream infections (BSI) with VTE.ResultsThere were 414 patients (mean age 65 years, 47% female) that met were analyzed. Infection was diagnosed in 181 (44%) patients. Incident VTE was diagnosed in 36 (9%) patients, largely comprised of DVT (n = 32; 89%). Infection overall was associated with increased risk of subsequent VTE (adjusted OR 4.5, 95% CI 1.6-12.6). Respiratory (adjusted OR 5.7, 95% CI 2.8-11.7) and BSI (adjusted OR 4.0, 95% CI 1.3-11.0) were associated with future VTE. Urinary and other infections were not associated with subsequent VTE.ConclusionsInfections are associated with subsequent risk of VTE among patients with ICH. Further investigation is required to elucidate mechanisms behind this association and to improve VTE prevention after ICH.

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