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Spontaneous intracranial haemorrhage in critically ill patients with malignancies

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Abstract

Purpose

Limited data are available on the intracranial haemorrhage (ICH) developed in critically ill cancer patients during their stay in the intensive care unit (ICU).

Methods

All consecutive patients who underwent brain CT for suspicion of spontaneous intracerebral haemorrhage (ICH) with acute neurologic symptoms or signs developed during their ICU stay were retrospectively evaluated to identify predictors of ICH.

Results

Over the study period, a total of 273 patients underwent brain CT scanning for suspicion of ICH, with altered mentality in 202 (74 %), seizure in 43 (16 %), and hemiparesis in 34 (13 %). However, only 49 (18 %) patients had a final diagnosis of ICH. The most common type of haemorrhage was intracerebral in 34 patients (69 %), followed by subarachnoidal haemorrhage in 17 (35 %). In multiple logistic regression analysis, anisocoric pupils or abnormal pupil reflex (adjusted OR 7.939; 95 % CI, 2.315–27.228) was an independent predictor of ICH. In addition, higher positive end-expiratory pressure (adjusted OR 1.204; 95 % CI, 1.065–1.361) was significantly associated with ICH. However, platelet count was inversely associated with ICH (adjusted OR 0.993; 95 % CI 0.988–0.999).

Conclusion

Brain CT scanning should be performed even in critically ill cancer patients, especially with risk factors and acute neurologic changes.

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Acknowledgments

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI14C0743).

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Authors and Affiliations

  1. Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Jeong-Am Ryu, Daesang Lee, Jeong Hoon Yang, Chi-Ryang Chung, Chi-Min Park, Gee Young Suh & Kyeongman Jeon

  2. Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Jeong Hoon Yang

  3. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Chi-Min Park

  4. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Gee Young Suh & Kyeongman Jeon

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  1. Jeong-Am Ryu
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  2. Daesang Lee
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Correspondence to Kyeongman Jeon.

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Ryu, JA., Lee, D., Yang, J.H. et al. Spontaneous intracranial haemorrhage in critically ill patients with malignancies. Support Care Cancer 24, 2971–2978 (2016). https://doi.org/10.1007/s00520-016-3094-5

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  • DOI: https://doi.org/10.1007/s00520-016-3094-5

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