Association of sepsis and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage

Franz-Simon Centner, Holger Wenz, Mariella Eliana Oster, Franz-Joseph Dally, Johannes Sauter-Servaes, Tanja Pelzer, Jochen Johannes Schoettler, Bianka Hahn, Amr Abdulazim, Katharina A.M. Hackenberg, Christoph Groden, Joerg Krebs, Manfred Thiel, Nima Etminan, Mate E. Maros
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Abstract

Background: Although sepsis and delayed cerebral ischemia (DCI) are severe complications in patients with aneurysmal subarachnoid hemorrhage (aSAH) and share pathophysiological features, their interrelation and additive effect on functional outcome is uncertain. We investigated the association of sepsis with DCI and their cumulative effect on functional outcome in patients with aSAH using current sepsis-3 definition. Methods: Patients admitted to our hospital between 11/2014-11/2018 for aSAH were retrospectively analyzed. The main explanatory variable was sepsis, diagnosed using sepsis-3 criteria. Endpoints were DCI and functional outcome at hospital discharge (modified Rankin Scale (mRS) 0-3 vs. 4-6). Propensity score matching (PSM) and multivariable logistic regressions were performed. Results: Of 238 patients with aSAH, 55 (23%) developed sepsis and 74 (31%) DCI. After PSM, aSAH patients with sepsis displayed significantly worse functional outcome (p<0.01) and longer ICU stay (p=0.046). Sepsis was independently associated with DCI (OR=2.46, 95%CI: 1.28-4.72, p<0.01). However, after exclusion of patients who developed sepsis before (OR=1.59, 95%CI: 0.78-3.24, p=0.21) or after DCI (OR=0.85, 95%CI: 0.37-1.95, p=0.70) this statistical association did not remain. Good functional outcome gradually decreased from 56% (76/135) in patients with neither sepsis nor DCI, to 43% (21/48) in those with no sepsis but DCI, to 34% (10/29) with sepsis but no DCI and to 8% (2/26) in patients with both sepsis and DCI. Conclusions: Our study demonstrates a strong association between sepsis, DCI and functional outcome in patients with aSAH and suggests a complex interplay resulting in a cumulative effect towards poor functional outcome, which warrants further studies.
动脉瘤性蛛网膜下腔出血患者败血症与延迟性脑缺血的关系
背景:尽管脓毒症和迟发性脑缺血(DCI)是动脉瘤性蛛网膜下腔出血(aSAH)患者的严重并发症,且具有共同的病理生理特征,但它们之间的相互关系以及对功能预后的叠加效应尚不确定。我们采用目前的脓毒症-3定义,研究了脓毒症与DCI的关联及其对动脉瘤性蛛网膜下腔出血患者功能预后的累积影响:我们对 2014 年 11 月至 2018 年 11 月期间我院收治的 aSAH 患者进行了回顾性分析。主要解释变量为脓毒症,诊断标准为脓毒症-3。终点为DCI和出院时的功能预后(改良Rankin量表(mRS)0-3 vs. 4-6)。进行了倾向评分匹配(PSM)和多变量逻辑回归:在238名aSAH患者中,55人(23%)出现败血症,74人(31%)出现DCI。在 PSM 后,脓毒症 aSAH 患者的功能预后明显较差(p<0.01),重症监护室住院时间较长(p=0.046)。脓毒症与 DCI 独立相关(OR=2.46,95%CI:1.28-4.72,p<0.01)。然而,在排除了DCI前(OR=1.59,95%CI:0.78-3.24,p=0.21)或DCI后(OR=0.85,95%CI:0.37-1.95,p=0.70)发生败血症的患者后,这种统计学上的关联性不再存在。良好的功能预后从既无脓毒症也无DCI患者的56%(76/135)逐渐下降到无脓毒症但有DCI患者的43%(21/48),有脓毒症但无DCI患者的34%(10/29),以及既有脓毒症又有DCI患者的8%(2/26):我们的研究表明,脓毒症、DCI 和急性脑梗死患者的功能预后之间存在密切联系,并提示存在复杂的相互作用,导致不良功能预后的累积效应,这值得进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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