Gastrointestinal dysfunction in aneurysmal subarachnoid hemorrhage: prevalence, clinical correlates, and prognostic implications from a 15-year ICU cohort study.

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%, 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.