Risk Factors for Hospital-Acquired Pneumonia in Hemorrhagic Stroke Patients Treated in the Intensive Care Unit

Abstract

Pneumonia is a very serious medical complication in patients with hemorrhagic stroke such as spontaneous intracerebral hemorrhage and subarachnoid hemorrhage. In the case of hemorrhagic stroke patients, hospital-acquired pneumonia increases morbidity, mortality and medical costs in addition to the already poor prognosis of hemorrhagic stroke. The purpose of this study was to identify risk factors for hospital-acquired pneumonia in hemorrhagic stroke patients treated in the intensive care unit. Methods Our study was a retrospective review of 112 hemorrhagic stroke patients treated in an intensive care unit who were hospitalized in the neurosurgery department of Gyeonsang National University Hospital from August 2019 to July 2020. The data included basic demographic data, the underlying disease, lifestyle factors, neurological evaluation results, severity of the condition and other characteristics. The radiological data and medical records of the patients were retrospectively analyzed. Results A total of 97 patients were included in the study, and 10 of them met the diagnostic criteria for hospital-acquired pneumonia. Diabetes mellitus, a high simplified acute physiology score 3 (SAPS3), a low glasgow coma scale (GCS) score, mechanical ventilation, tracheostomy, dysphagia and nasogastric tube feeding were identified as risk factors for the development of hospital-acquired pneumonia (p<0.05). Six of 10 bacterial pathogens isolated from sputum were identified as multidrug-resistant pathogens. Hospital-acquired pneumonia led to further antibiotic treatment and general deterioration, which in turn increased the intensive care unit length of stay (p<0.001). Conclusion We found that mechanical ventilation, tracheostomy, dysphagia, tube feeding, a high SAPS3, and a low GCS score were risk factors for hospital-acquired pneumonia (HAP) in hemorrhagic stroke patients. Efforts will be needed to prevent pneumonia by understanding the risk factors for HAP identified in our study.