Pulmonary complications in patients with aneurysmal subarachnoid hemorrhage:risk factors and impact on outcome / 国际脑血管病杂志

ABSTRACT

Objective To investigate the risk factors for pulmonary complications in patients with aneurysmal subarachnoid hemorrhage (aSAH) and the impact on outcome.Methods Patients with aSAH admitted to the First People's Hospital of Tianmen from January 2016 to December 2017 were enrolled retrospectively.The demographic and baseline data of the patients were collected.Pulmonary complications mainly included pulmonary infection,acute lung injury,and neurogenic pulmonary edema.Clinical outcomes were assessed after 6 months using the modified Rankin scale,0-3 was defined as good outcome and ＞3 was defined as poor outcome.Multivariate logistic regression analysis was used to determine independent risk factors for pulmonary complications and poor outcome.Results A total of 230 patients with aSAH were enrolled,with an average age of 57 years,135 males and 95 females.One hundred and twenty patients (52.2％) complicated with pulmonary complications,113 of them complicated with hospital-acquired pneumonia,5 complicated with acute lung injury,and 2 complicated with neurogenic pulmonary edema.One hundred and seventy-two patients (74.8％) had good outcomes and 58 had poor outcomes.Multivariate logistic regression analysis showed that Hunt-Hess grade 3-5 (odds ratio [OR] 1.500,95％ confidence interval[CI] 1.043-2.159;P=0.029),Fisher grade 3-4 (OR 1.366,95％ CI 1.031-1.089;P=0.022),and tracheotomy or mechanical ventilation (OR 1.662,95％ CI 1.002-2.757;P =0.049) were the independent risk factors for pulmonary complications;Hunt-Hess grade 3-5 (OR 1.840,95％ CI 1.590-2.129;P ＜0.001),Fisher grade 3-4 (OR 3.522,95％ CI 3.056-4.058;P＜0.001),ventricular casting (OR 2.130,95％ CI 1.258-3.609;P=0.005),and pulmonary complications (OR 1.531,95％ CI 1.186-1.975;P=0.001) were the independent risk factors for poor outcome.Conclusions Higher Hunt-Hess and Fisher grades and tracheotomy or mechanical ventilation were associated with the increased risk of pulmonary complications in patients with aSAH.The occurrence of pulmonary complications had adverse effects on the clinical outcomes of patients.