Association Between Splenic Contraction and the Systemic Inflammatory Response After Acute Ischemic Stroke Varies with Age and Race

Background: Animal models have demonstrated the deleterious contribution that immunocytes from the spleen exert on secondary brain injury after stroke. While previous work has demonstrated that there is splenic contraction (SC) in patients with acute ischemic stroke (AIS) and intracranial hemorrhage (ICH), no clinical studies have connected the systemic inflammatory response syndrome (SIRS) with SC. We aim to associate SIRS and its individual components with SC in acute stroke Methods: This is a retrospective analysis of a previous prospective observational study where daily spleen sizes were evaluated in 178 acute stroke patients in a tertiary care center from 2010-2013. Spleen contraction was defined compared to previously established normograms of healthy volunteers from the same study. SIRS was defined as the presence of 2 or more of the following: body temperature <36 or >38C, heart rate >90 beats, respiratory rate >20, and serum white blood cell count >12,000 or <4000 mm3 in the absence of infection. SC was evaluated in patients at 24 and 72 hrs after AIS with SIRS as a primary outcome. Results: 91 patients had verified AIS without concurrent infection at admission and 70 of these patients remained inpatient at 72 hrs. SIRS was not associated with admission SC at 24hr and 72 hrs. Patients with SIRS at 24 and 72 hrs were more likely to have higher admission NIHSS. SIRS was associated with higher discharge mRS (OR 4.24, 95% CI 1.64-10.9, p=0.0028) and PEG placement (OR 3.70, 95% CI 0.95-15.11, p=0.05). 16 patients (22.9%) developed SIRS by 72hrs, only 5 of whom had SC initially. 28 patients (47%) had SIRS on admission that persisted, 12 of whom had SC. SC was not associated with SIRS at 72 hrs (OR 1.05, 95% CI 0.35-2.79, p = 0.92). 14 patients (15%) developed infections while hospitalized, of which 85% had SIRS on admission. Conclusion: Based on our initial evaluation, SC detected within 24 hrs of stroke onset is not associated with SIRS suggesting that the relationship between the two may be more complicated in humans. Consistent with prior studies, however, SIRS is associated with worse outcome. Further studies and additional time points are necessary to further clarify the role of the spleen in the development of SIRS in stroke patients.

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Impact of systemic inflammatory response syndrome on acute ischemic stroke patients treated with mechanical thrombectomy

Journal of the Neurological Sciences ◽

10.1016/j.jns.2021.119988 ◽

2021 ◽

pp. 119988

Author(s):

Mostafa Jafari ◽

Kalman Katlowitz ◽

Carlos De la Garza ◽

Alexander Sellers ◽

Shawn Moore ◽

...

Keyword(s):

Ischemic Stroke ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Systemic Inflammatory Response ◽

Stroke Patients

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Correlation of Systemic Inflammatory Response With Infarct Volume in Acute Ischemic Stroke Patients

Stroke ◽

10.1161/01.str.0000155197.88944.ac ◽

2005 ◽

Vol 36 (2) ◽

pp. 228-229 ◽

Cited By ~ 7

Author(s):

Hedley C.A. Emsley ◽

Craig J. Smith ◽

Rachel F. Georgiou ◽

Andy Vail ◽

Pippa J. Tyrrell ◽

...

Keyword(s):

Ischemic Stroke ◽

Inflammatory Response ◽

Acute Ischemic Stroke ◽

Infarct Volume ◽

Systemic Inflammatory Response ◽

Stroke Patients

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Abstract TP278: Prevalence Of Systemic Inflammatory Response Syndrome and its Impact On Outcome In Acute Ischemic Stroke Patients Receiving IV tPA Therapy

Stroke ◽

10.1161/str.44.suppl_1.atp278 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Niren Kapoor ◽

Amelia K Boehme ◽

Karen C Albright ◽

Michael J Lyerly ◽

Reza Bavarsad Shahripour ◽

...

Keyword(s):

Ischemic Stroke ◽

Length Of Stay ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Systemic Inflammatory Response ◽

Short Term ◽

Sirs Criteria ◽

Iv Tpa

Background: Systemic Inflammatory Response Syndrome (SIRS) is a generalized inflammatory state linked to a release of various pro- and anti-inflammatory cytokines and associated with fibrin deposition, platelet aggregation, and coagulopathies. Although SIRS is associated with various inflammatory and ischemic conditions, its prevalence and impact on patients with acute ischemic stroke (AIS) has not been extensively studied. Methods: A retrospective cross sectional study was used to look at the prevalence of SIRS and its impact on outcome in AIS patients treated with IV tPA between 2009-2011 at our tertiary care center. SIRS was diagnosed if two or more of the following were present: temperature < 36°C or > 38°C, heart rate > 90/min, respiratory rate >20/min or PaCO 2 <32 mmHg and WBC count <4000/mm 3 or >12000/mm 3 or 10% bands. Patients meeting the SIRS criteria for at least 24h were included in the study. Patients with signs of active infection such as pneumonia, UTI, bacteremia, and sinusitis or deep venous thrombosis were excluded from the study. The discharge modified Rankin score (mRS) was used to compare the short-term outcomes between patients with and without SIRS. An mRS of 4-6 was used to define poor functional outcome. Results: Out of the 212 patients screened, 44 met the SIRS criteria (21%). The median NIHSS for SIRS patients was 9 (range 0-32). SIRS patients were more likely to have a longer length of stay than non-SIRS patients (5 vs. 3 days; p<0.0001). Patients with SIRS had worse functional outcomes compared to patients without SIRS (OR=2.824, 95% CI, 1.358 - 5.871, p=0.0054). Adjusting for pre-tPA NIHSS, age and race, SIRS remained a predictor of poor outcome (OR= 2.581, 95% CI, 1.163 - 5.727, p=0.0197). Presence of SIRS did not have a significant effect upon in-hospital mortality (OR=1.978, 95% CI, 0.774 - 5.057, p=0.1545). Conclusions: One out of five AIS patients treated with IV tPA developed SIRS. The presence of SIRS is associated with poor short-term functional outcomes and prolonged length of stay.

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Abstract 1122‐000007: Impact of Systemic Inflammatory Response Syndrome on Acute Ischemic Stroke Patients Treated with Mechanical Thrombectomy

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000007 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Mostafa Jafari ◽

Kalman Katlowitz ◽

Carlos De la Garza ◽

Alexander Sellers ◽

Shawn Moore ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Systemic Inflammatory Response ◽

Sample Population ◽

Poor Outcomes

Introduction : Systemic inflammatory response syndrome (SIRS) has been associated with poor outcomes after acute ischemic stroke (AIS). The primary goal of this study was to determine whether SIRS status on admission correlated with functional outcomes in AIS treated with mechanical thrombectomy (MT). Methods : Consecutive patients from September 2015 to April 2019 were retrospectively reviewed for SIRS on admission. SIRS was defined as the presence of ≥2 of the following: temperature <36°C or >38°C, heart rate >90, respiratory rate >20, and white blood cell count <4000/mm or >12 000 mm. Results : Of 202 patients, 188 met inclusion criteria. 49 patients (26%) had evidence of SIRS. Neither basic patient demographics nor standard stroke risk factors predicted the development of SIRS. However, presentation with SIRS was correlated with higher rates of death (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.2‐5.5) as well as lower rates of favorable functional outcomes at discharge (OR, 0.09; 95% CI, 0.02‐0.40) and 3‐month follow up (OR 0.12; 95% CI 0.03‐0.43). These results remained significant even after adjustment for age, sex, baseline NIHSS, recanalization status, and prior co‐morbidities. Conclusions : In our sample population, SIRS was associated with worse outcomes and higher rates of mortality in AIS patients treated with MT. Recognition of key risk factors can provide better prognostication and possible future therapeutic targets.

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