INTRODUCTION:
Infection is a significant cause of mortality in patients with both ischemic and hemorrhagic stroke. This is thought to occur as a result of stroke-induced systemic immunosuppression (SIIS). The role of cerebral damage pre-disposing to sepsis has only been addressed in a few studies for ischemic stroke, and literature is sparse in Spontaneous Intracerebral Hemorrhage (SICH) patients who have higher mortality, greater disability and require more intensive medical care. We sought to determine identify predictors of SIIS and sepsis, so we may be able to recognize and intervene early.
METHODOLOGY:
We retrospectively analyzed 40 patients with SICH admitted to the NICU between January 2012 and January 30, 2014. We included patients with SICH. We excluded patients with multi-compartmental hemorrhage and patients lacking outcome data. Patient demographics including age, gender, location, volume of SICH, GCS, and total lymphocyte counts from days one to five of hospitalization was recorded. Data was divided into a non-infection group, where patients lacked any clinical or laboratory evidence of infections, and an infection group. Statistical analysis was performed to compare lymphocyte depletion over time between patients that developed an infection and those that did not.
RESULTS:
From the cohort of 40 patients with SICH, 20 developed an infection during their hospital course. Total lymphocyte counts were lower on all five days in the infection group compared to the non-infection group and became significant on day four of hospitalization (1 in the infection group vs. 2.1 in the non-infection group, p<0.01. Lymphopenia preceded clinical signs and symptoms of infection, which occurred in average on day 5.8 of hospitalization. Patients in the infection group had greater hemorrhage volume (32.5 ml vs. 15.5 ml) and poorer GCS scores on admission (12.7 vs. 11.8) although these differences did not reach statistical significance.
CONCLUSION:
The incidence of sepsis is high in SICH patients, and these patients have worse prognostic parameters. Our data suggests identification of lymphopenia may be a significant predictor of development of clinical infection in these patients. Future studies with larger sample sizes are warranted.
Prostaglandin E2-prostoglandin E receptor subtype 4 (EP4) signaling mediates UV irradiation-induced systemic immunosuppression
