OBJECTIVE Patients with subarachnoid hemorrhage (SAH) usually have prolonged hospitalizations due to the need to closely monitor their neurological status. Therefore, these patients have higher risk of experiencing hospital-acquired complications (HACs), which can complicate their clinical course and recovery. However, there is no evidence on the impact of HACs of long-term clinical outcomes. We aimed to identify if HACs are independent risk factors for poor clinical outcomes at 12-18 months of follow-up. PATIENTS AND METHODS Retrospective analysis of 323 patients with SAH diagnosis from 2013 until June 2018. We collected patient-related factors (age, sex, body mass index (BMI), ethnicity), comorbidities (hypertension, smoke status, diabetes, coronary heart diseases, prothrombotic diseases and hypercholesterolemia), clinical variables (Hunt-Hess grade, modified Fisher grade, treatment, delayed cerebral ischemia), aneurysm characteristics (location, size) and HACs (pneumonia, deep vein thrombosis (DVT), urinary tract infection (UTI), external ventricular drainage (EVD) infections, sepsis, hyponatremia and acute respiratory distress syndrome). Poor outcomes were defined as mRS ≥ 3. RESULTS 204 patients were included in the primary analysis. 82 (40.2%) experienced one or more HACs during their hospital course. Patients that developed HACs have significantly increased ICU (12.1 ± 6.6 vs 24.3 ± 23.6, p < .001) and hospital (18.7 ± 14.2 vs 35.3 ± 26.3, p < .001) length of stays. Moreover, patients with HACs had significant higher rates of delayed cerebral ischemia, non-routine discharge and poor outcomes at 90 days. 177 patients had complete follow-ups at 12-18 months, HACs were independent risk factors for poor functional outcomes at 12-18 months after adjusting for demographic, comorbidities and clinical variables [OR = 3.205, 95% CI 1.231-8.347, p < 0.001]. CONCLUSIONS HACs are an independent risk factor of sustaining poor clinical outcomes 12-18 months after a SAH. Furthermore, HACs are significantly related with the occurrence of DCI, with non-routine discharge and 90-day poor functional outcomes.

中文翻译：

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医院获得性并发症对蛛网膜下腔出血后长期临床结局的影响

目的 蛛网膜下腔出血 (SAH) 患者通常需要长期住院治疗，因为需要密切监测他们的神经系统状态。因此，这些患者发生医院获得性并发症 (HAC) 的风险更高，这会使他们的临床病程和康复复杂化。然而，没有证据表明 HAC 对长期临床结果的影响。我们旨在确定 HAC 是否是 12-18 个月随访时临床结果不佳的独立危险因素。患者和方法 对 2013 年至 2018 年 6 月诊断为 SAH 的 323 名患者进行回顾性分析。我们收集了患者相关因素（年龄、性别、体重指数 (BMI)、种族）、合并症（高血压、吸烟状况、糖尿病、冠心病） 、血栓前疾病和高胆固醇血症），临床变量（Hunt-Hess 分级、改良 Fisher 分级、治疗、迟发性脑缺血）、动脉瘤特征（位置、大小）和 HAC（肺炎、深静脉血栓形成 (DVT)、尿路感染 (UTI)、心室外引流 (EVD) ) 感染、败血症、低钠血症和急性呼吸窘迫综合征)。不良结局被定义为 mRS ≥ 3。结果 204 名患者被纳入主要分析。82 (40.2%) 人在住院期间经历了一种或多种 HAC。发生 HAC 的患者在 ICU (12.1 ± 6.6 vs 24.3 ± 23.6, p < .001) 和住院 (18.7 ± 14.2 vs 35.3 ± 26.3, p < .001) 的住院时间显着增加。此外，HAC 患者在 90 天时延迟脑缺血、非常规出院和不良结局的发生率显着更高。177 名患者在 12-18 个月时进行了完整的随访，在调整人口统计学、合并症和临床变量后，HAC 是 12-18 个月功能预后不良的独立危险因素 [OR = 3.205，95% CI 1.231-8.347，p < 0.001]。结论 HAC 是 SAH 后 12-18 个月维持不良临床结果的独立危险因素。此外，HAC 与 DCI 的发生、非常规出院和 90 天不良功能结局显着相关。