Infection is common after spontaneous intracerebral hemorrhage (ICH) and contributes to morbidity. VHA differences have been appreciated in infected patients within non-ICH populations. Here, we investigate the relationship between baseline coagulopathy in patients admitted for ICH and risk for subsequent infection.

Consecutively admitted spontaneous ICH patients were enrolled in a single-center prospective observational cohort-study and underwent viscoelastic hemostatic assay (Rotational Thromboelastometry: ROTEM) testing at admission. Patients with death or withdrawal of care within 24 hours were excluded. The primary exposure variables were ROTEM measurements of clot strength (maximum clot firmness: MCF). The primary outcome was any infection (pneumonia, bacteremia, urinary tract infection, C. Difficile colitis, ventriculitis, cellulitis) within 30 days of admission, with specific infections defined by clinical diagnostic criteria. Regression models assessed relationships of ROTEM parameters with infection, adjusted for baseline severity via ICH Score.

Of 73 patients assessed, 35(48%) experienced infection within 30 days of admission, with most frequent diagnoses being urinary tract infection (32%) and pneumonia (29%). Patients with and without infection had similar baseline stroke severity (ICH Score median [IQR] 2[1–3] vs 2[1–3], p=0.08). Logistic regression showed that greater fibrinogen assay clot strength (FIBTEM MCF) was associated with infection (adjusted OR 1.08[1.02–1.15], p=0.01). When defined as a binary exposure variable, FIBTEM MCF above the reference level (>24 mm) similarly related to increased odds of infection (adjusted OR 3.5[1.2–11.7], p=0.03).

Our findings suggest that hypercoagulable features related to elevated fibrinogen contribution to clotting are detectable on VHAs and may predict infection risk after ICH. Future work is needed to assess the generalizability and underlying mechanisms of these associations, and to determine whether VHAs can provide risk stratification strategies or insights into preventative treatment approaches for post-ICH infectious complications.