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Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage
Published on: August 30, 2020
Gastrointestinal dysfunction in aneurysmal subarachnoid hemorrhage: prevalence, clinical correlates, and prognostic
Tongjuan Zou1,2, Hao He1,2, You Wu1,2
1Department of Critical Care Medicine, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Background:
Gastrointestinal dysfunction (GID) is increasingly recognized in neurocritical care, but disease-specific epidemiology, associated clinical factors, and outcomes in aneurysmal subarachnoid hemorrhage (aSAH) remain insufficiently characterized. We aimed to quantify the prevalence of GID in patients with aSAH, identify its clinical associations, and evaluate its prognostic implications.
Methods:
We conducted a 15-year retrospective cohort study involving consecutive adults with aSAH who were admitted to the neurological intensive care unit (NICU) at West China Hospital (24 October 2009-29 June 2024). GID was defined pragmatically as the presence of the following symptoms/signs: gastric residual volume [GRV] ≥ 500 mL on any calendar day after enteral nutrition initiation, gastrointestinal bleeding, or Bristol-defined diarrhea. GID occurrence was modeled using Fine-Gray competing-risk analysis (with in-hospital death as the competing event). In-hospital mortality was analyzed using multivariable logistic regression. Thirty-day survival was described by Kaplan-Meier (KM) curves.
Results:
Among the 994 patients with aSAH, GID occurred in 44.8% (445/994). Compared to non-GID patients, those with GID had higher admission heart rates and temperature levels, along with a greater proportion having a Hunt-Hess (HH) score ≥4 (43% vs. 20%, p < 0.001). Patients with GID had significantly longer ICU (18.5 ± 14.8 vs. 6.2 ± 5.7 days) and hospital stays (26.5 ± 20.5 vs. 12.7 ± 8.4 days) and higher in-hospital mortality (37% vs. 22%, p < 0.001). The GID group also had higher levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) (1576.76 ± 3237.84 vs. 1251.52 ± 2673.15, p = 0.023), C-reactive protein (CRP) (62.64 ± 69.30 vs. 39.84 ± 56.95, p < 0.001), interleukin-6 (IL-6) (136.03 ± 355.40 vs. 77.64 ± 182.79, p < 0.001), and procalcitonin (PCT) (1.07 ± 5.71 vs. 0.56 ± 2.88, p < 0.001). In the multivariable Fine-Gray competing-risk analysis, nasojejunal tube use, arrhythmia, target temperature management, HH ≥ 4, and GI drug exposure were associated with a higher subdistribution hazard of GID. KM curves showed lower unadjusted 30-day survival in the GID group (log-rank p < 0.0001). GID was not independently associated with in-hospital mortality in multivariable analyses.
Conclusion:
In aSAH, GID is common and correlates with neurological severity, autonomic dysregulation, systemic inflammation, and resource use. Although GID is not independently associated with mortality after adjustment, it identifies a high-risk subgroup and supports early, structured gastrointestinal supportive strategies in neurocritical care.
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