ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurocritical and Neurohospitalist Care
Gastrointestinal Dysfunction in Aneurysmal Subarachnoid Hemorrhage: Prevalence, Clinical Correlates, and Prognostic Implications in a 15-Year ICU Cohort
Provisionally accepted
- 1West China Hospital of Sichuan University, Chengdu, China
- 2West China Hospital, Sichuan University, Chengdu, China
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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 GID prevalence in aSAH, identify clinical associations, and evaluate prognostic implications. Methods We conducted a 15-year retrospective cohort study of consecutive adults with aSAH admitted to the neurological intensive care unit (NICU) at West China Hospital (October 24, 2009-June 29, 2024). GID was defined pragmatically (symptoms/signs; gastric residual volume [GRV] ≥500 mL within any calendar day after enteral nutrition initiation; gastrointestinal bleeding; or Bristol-defined diarrhea). GID occurrence was modeled using a Fine-Gray competing-risk analysis (in-hospital death as the competing event). In-hospital mortality was analyzed with multivariable logistic regression. Thirty-day survival was described by Kaplan–Meier (KM) curves. Results Among 994 patients with aSAH, GID occurred in 44.8% (445/994). Compared with non-GID patients, those with GID had higher admission heart rate and temperature and a greater proportion of Hunt-Hess 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 NT-proBNP (1576.76±3237.84 vs 1251.52± 2673.15, p = 0.023), CRP(62.64±69.30 vs 39.84±56.95, p < 0.001), IL-6(136.03± 355.40 vs 77.64±182.79, p < 0.001), and PCT(1.07±5.71 vs 0.56±2.88, p < 0.001). In 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. Conclusions In aSAH, GID is common and tracks with neurological severity, autonomic dysregulation, systemic inflammation, and resource use. Although not independently associated with mortality after adjustment, GID marks a high-risk subgroup and supports early, structured gastrointestinal supportive strategies in neurocritical care.
Keywords: aneurysmal subarachnoid Hemorrhage, Gastrointestinal dysfunction, Hunt-Hess score, Autonomic dysregulation, neurocritical care
Received: 28 Aug 2025; Accepted: 27 Nov 2025.
Copyright: © 2025 Zou, He, Wu, Xie and YIN. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: WANHONG YIN
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