Crtical Care and Shock Journal

Incidence of circulatory shock after spontaneous intracerebral hemorrhage and impact on case-fatality: a multi-center cohort study

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Overview

Abstract
Objective: The epidemiology of circulatory shock after spontaneous intracerebral hemorrhage (ICH) is unknown. We sought to determine its incidence, risk factors, and effect on case-fatality.
Design: Retrospective multi-center cohort study.
Setting: 83 ICUs in the United States from 2003-2008.
Patients: Subjects with ICH >17 years of age admitted to an ICU. Shock was defined as sustained systolic blood pressure <90 mmHg for ≥1 hour despite vasopressors.
Interventions: None.
Measurements and results: A total of 4,192 ICH patients. Median age was 67 yrs (IQR 54-77), 2221 (53%) were male, and 3030 (75%) were white. Median APACHE-II score was 15 (interquartile-range [IQR] 11-21) and Glasgow Coma Scale (GCS) was 11 (IQR 6-14). Incidence of shock after ICH was 5% (212/4192). Case-fatality was 72% among shock vs. 30% without shock (p<0.0001). In multi-variable analysis the following were associated with increased case-fatality: age (OR 1.01, 95%CI:1.01-1.02), DNR status (OR 1.8, 95%CI:1.3-2.6), GCS<8 (OR 11.4, 95%CI:8.4-15.4), GCS 8-12 (OR 2.1, 95%CI:1.5-2.9), mechanical ventilation (OR 2.0, 95%CI:1.6-2.5), organ dysfunction (OR 1.7, 95%CI:1.4-2.0), spontaneous hypothermia (OR 7.3, 95%CI:2.8-19.3), APACHE ≥15 (OR 2.9, 95%CI:2.2-3.7), and shock (OR 1.9, 95%CI:1.2-3.0). EVD placement was associated with survival (OR 0.8, 95%CI:0.6-0.9).
Conclusion: Circulatory shock after ICH is rare and associated with increased case-fatality.

Lauren Ng, Michelle Ghobrial, James Peoples, Syed Omar Shah, Matthew Vibbert, Jacqueline Urtecho, M. Kamran Athar, Barak Bar, Jack Jallo, Carissa C. Pineda, Diana Tzeng, Rodney Bell, Fred Rincon

Lauren Ng, Michelle Ghobrial, James Peoples, Syed Omar Shah, Matthew Vibbert, Jacqueline Urtecho, M. Kamran Athar, Barak Bar, Jack Jallo, Carissa C. Pineda, Diana Tzeng, Rodney Bell, Fred Rincon

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