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Critical Care |

Acute Respiratory Distress Syndrome Following Spontaneous Non-subarachnoid Intracranial Hemorrhage

Holly Keyt, MD; Colin Son, MD
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University of Texas Health Science Center, San Antonio, TX


Chest. 2015;148(4_MeetingAbstracts):176A. doi:10.1378/chest.2280533
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Abstract

SESSION TITLE: ARDS Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Non-subarachnoid hemorrhagic stroke is a neurological disease of considerable incidence. It carries significant morbidity and mortality risks; the latter largely associated with post stroke, acquired conditions. Subarachnoid hemorrhage and neurotrauma have previously been identified as risk factors for ARDS. Despite this no previous work has assessed spontaneous non-subarachnoid intracranial hemorrhage as a risk factor for ARDS.

METHODS: We reviewed the National Inpatient Sample (NIS), the largest all payer database in the United States, to assess the concurrence of hemorrhagic stroke and ARDS. The database includes a random sample of twenty percent of all U.S. acute care hospital discharges totally approximately 8 million records per annum. We queried the database for years 2010-2012 for all adult discharges with an ICD-9 code of 431, 432.0, 432.1 or 432.9 corresponding to spontaneous non-subarachnoid intracranial hemorrhages. Cases of ARDS were identified by those patients concurrently with ICD-9 codes of 518.5 or 518.82 and ventilatory requirements based on ICD-9 codes 96.70, 96.71 or 96.72.

RESULTS: 114,715 acute hospitalizations following adult hemorrhagic stroke were identified. 21,992 (19.2%) of these met our search criteria for ARDS compared to 2.1% amongst all adult hospitalizations. The development of post stroke ARDS significantly increased the risk of in hospital mortality from 13.3% to 49.4% (p<0.001). The in hospital mortality in these patients was also significantly higher than in other patients meeting search criteria for ARDS, 49.4% versus 29.7% (p<0.001). This significance persisted even following linear regression controlling for patient age, number of diagnoses, median income by zip code and the provided illness severity measure.

CONCLUSIONS: Spontaneous non-subarachnoid intracranial hemorrhage is a risk factor for the development of ARDS. The development of ARDS significantly increases in hospital mortality in these patients and the combination of hemorrhagic stroke and ARDS is particularly potent as compared to the development of ARDS following other admission diagnoses.

CLINICAL IMPLICATIONS: Our findings further reiterate a relationship between acute cerebral insult and ARDS. Further investigation, especially on the ideal treatment of these complex patients, is warranted.

DISCLOSURE: The following authors have nothing to disclose: Holly Keyt, Colin Son

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