WJNS  Vol.3 No.4 , November 2013
Impact of urinary tract and pulmonary infection on mortality after intracerebral hemorrhage in Brazzaville

Objective: To evaluate the impact of urinary tract and pulmonary infection on mortality after cerebral hemorrhage. Method: We conducted at the University Hospital of Brazzaville, a cross-sectional study from January to August2012 inthe emergency department, neurology and intensive care unit. It included patients admitted for cerebral hemorrhage confirmed by CT-scan. A statistical analysis by logistic regression was carried out to evaluate the correlation between infection and death. Result: Among total of 261 patients for stroke, 82 admitted for cerebral hemorrhage (31.4%). The mean age was 55 ± 11 years (range 26 to 83 years). The sex ratio men/women was 1.7. Hypertension was the most important risk factor to 80.5%. The average intake in neurology time was 28 ± 13 hours. The average time for completion of the CT-scan was 2.4 ± 2 days. Thirty-eight (46.3%) patients had a fever linked to an infectious cause from the third day of hospitalization. The most frequent infectious complications were sepsis (n = 16%; 42%), pulmonary infection (n = 14%; 37%) and urinary tract infection (n = 8%; 21%). Specific mortality of infection was 31.7% (n = 26). The multivariate analysis showed a positive correlation between the occurrence of infection and mortality (p = 0.002), specifically between sepsis and mortality (p = 0.0004), and an association between the time of admission late in neurology and the occurrence of infectious complications (p = 0.0001). Conclusion: Infection is one of the dreaded complications of cerebral hemorrhage. It is often associated with delayed care in specialized areas, and is thereby a preventable cause of death.

Cite this paper
Ossou-Nguiet, P. , Ellenga-Mbolla, B. , Odzebe, A. , Otiobanda, G. , Gankama, T. , Obondzo-Aloba, K. and Gombet, T. (2013) Impact of urinary tract and pulmonary infection on mortality after intracerebral hemorrhage in Brazzaville. World Journal of Neuroscience, 3, 246-249. doi: 10.4236/wjns.2013.34033.
[1]   Benatru, I., Rouaud, O., Durier, J., Contegal, F., Couvreur, G., Bejot, Y., et al. (2006) Stable stroke incidence rates but improved case fatality in Dijon, France, from 1985 to 2004. Stroke, 37, 1674-1679. http://dx.doi.org/10.1161/01.STR.0000226979.56456.a8

[2]   Gebel, J.M. and Broderick, J.P. (2000) Intracerebral hemorrhage. Neurologic Clinics, 18, 419-438. http://dx.doi.org/10.1016/S0733-8619(05)70200-0

[3]   Copenhaver, B.R., Hsia, A.W., Merino, J.G., Burgess, R.E., Fifi, J.T., Davis, L., et al. (2008) Racial differencies in microbleeds prevalency in intracerebral haemorrhage primaire. Neurology, 71, 1176-1182. http://dx.doi.org/10.1212/01.wnl.0000327524.16575.ca

[4]   Rincon, F., Lyden, P. and Mayer, S.A. (2012) The Epidemiology of intracerebral Hemorrhage in the United States from 1979 to 2008. Springer Science, 77, 524-532.

[5]   Gage, B.F., Yan, Y., Milligan, P.E., Waterman, A.D., Culverhouse, R., Rich, M.W., et al. (2006) Clinical classification schemes for predicting hemorrhage: Results from the National Registry of Atrial Fibrillation (NRAF). American Heart Journal, 151, 713-719. http://dx.doi.org/10.1016/j.ahj.2005.04.017

[6]   Adoukonou, T.A., Vallat, J.M., Joubert, J., Macian, F., Kabore, R., Magy, L., et al. (2010) Prise en charge des accidents vasculaires cérébraux en Afrique subsaharienne. Revue Neurologique, 166, 882-893. http://dx.doi.org/10.1016/j.neurol.2010.06.004

[7]   Fogelholm, R., Murros, K., Rissanen, A. and Avikainen, S. (2005) Long term survival after primary intracerebral haemorrhage: A retrospective population based study. Journal of Neurology, Neurosurgery & Psychiatry, 76, 1534-1538. http://dx.doi.org/10.1136/jnnp.2004.055145

[8]   Grillo, P., Velly, L. and Bruder, N. (2006) Accidents vasculaires cérébraux hémorragiques: Nouveautés de prise en charge. Annales Francaises d'Anesthésie et de Réanimation, 25, 868-873. http://dx.doi.org/10.1016/j.annfar.2006.03.030

[9]   Schwarz, S., Hafner, K., Aschoff, A. and Schwab, S. (2000) Incidence and prognostic significance of fever following intracerebral hemorrhage. Neurology, 54, 354-361. http://dx.doi.org/10.1212/WNL.54.2.354

[10]   Westendorp, W.F., Nederkoorn, P.J., Vermeij, J.D., Dijkgraaf, M.G. and Van de Beek, D. (2011) Post-stroke infection: A systematic review and meta-analysis. BMC Neurology, 11, 110. http://dx.doi.org/10.1186/1471-2377-11-110

[11]   Sagui, E. (2007) Les accidents vasculaires cérébraux en Afrique subsaharienne. Médecine Tropicale, 6, 596-600.

[12]   Sène Diouf, F., Mapoure, N.Y., Ndiaye, M., Mbatchou Ngahane, H.B., Touré, K., Thiam, A., et al. (2008) Pronostic des hémorragies intracérébrales avec coma dans une unité de neuroréanimation tropicale. Médecine Tropicale, 68, 606-610.

[13]   Kim, K.-H. (2009) Predictors of 30-day mortality and 90-day functional recovery after primary intracerebral hemorrhage: Hospital based multivariate analysis in 585 patients. Journal of Korean Neurosurgical Society, 45, 341-349. http://dx.doi.org/10.3340/jkns.2009.45.6.341

[14]   Thorogood, M., Connor, M.D., Kewando-Hundt, G., Tollman, S. and Ngoma, B. (2004) SASPI project team. Secondary prevention of stroke-results from the Southern Africa stroke prevention initiative (SASPI) study. Bulletin of the World Health Organization, 82, 503-508.

[15]   Emsley, H.C. and Hopkins, S.J. (2008) Acute ischemic stroke and infection: Recent and emerging concepts. The Lancet Neurology, 7, 341-353. http://dx.doi.org/10.1016/S1474-4422(08)70061-9

[16]   Vermeij, F.H., Scholte, O.P., Reimer, W.J., de Man, M.P., Van Oostenbrugge, R.J., Franke, C.L., et al. (2009) Strokeassociated infection is an independent risk factor for poor outcome after acute ischemic stroke: Data from the Netherlands stroke survey. Cerebrovascular Diseases, 27, 465-471. http://dx.doi.org/10.1159/000210093

[17]   De Herdt, V., Dumont, F., Henon, H., Derambre, P., Vonck, K., Leys, D., et al. (2011) Early seizures in intracerebral hemorrhage. Neurology, 77, 1794-1800. http://dx.doi.org/10.1212/WNL.0b013e31823648a6

[18]   Balami, J.S. and Buchan, A.M. (2012) Complications of intracerebral haemorrhage. The Lancet Neurology, 11, 101-118. http://dx.doi.org/10.1016/S1474-4422(11)70264-2

[19]   Commichau, C., Scarmeas, N. and Mayer, S.A. (2003) Risk factors for fever in the neurologic intensive care unit. Neurology, 60, 837-841. http://dx.doi.org/10.1212/01.WNL.0000047344.28843.EB

[20]   Mayer, S.A., Kowalski, R.G., Presciutti, M., Ostapkovich, N.D., McGann, E., Fitzsimmons, B.F., et al. (2004) Clinical trial of a novel surface cooling systemfor fever control in neurocritical care patients. Critical Care Medicine, 32, 2508-2515. http://dx.doi.org/10.1097/01.CCM.0000147441.39670.37