Systemic Inflammatory Response Depends on Initial Stroke Severity but Is Attenuated by Successful Thrombolysis

Abstract Background The occurrence of systemic inflammatory response syndrome (SIRS) is associated with poor outcomes after ischemic stroke, and the inflammatory response can be significantly attenuated by successful reperfusion, while the SIRS in patients with acute large vessel occlusion stroke (ALVOS) who underwent endovascular treatment (EVT) remain unclear. We aimed to investigate the occurrence rate, predictors, and clinical outcomes of SIRS in patients with ALVOS after EVT. Methods We retrospectively collected EVT data of patients with ALVOS from July 2014 to August 2019 in our center. SIRS in the absence of infection was defined as the presence of ≥2 of the following: (1) heart rate >90 (2) body temperature >38°C or <36°C, (3) white blood cells >12 000/mm or <4000/mm or >10% bands for >24 h or (4) respiratory rate >20. Favorable outcome was defined as obtaining a 90-day modified Rankin Scale (mRS) score ≤2. Results Among the 262 patients who received EVT, 92 (35.1%) developed SIRS, 88 (95.7%) of whom developed SIRS in the first two days after EVT. Patients who developed SIRS had a reduced favorable outcome (OR, 4.112 [95% CI, 1.705–9.920]; P=0.002) and higher mortality (OR, 25.236 [95% CI, 8.578–74.835]; P<0.001) at 90 days. Greater SIRS burden was positively correlated with NIHSS scores at discharge and mRS scores at 90 days (r=0.249, P=0.017; r=0.230, P=0.027). The development of SIRS in patients with ALOVS who underwent EVT was associated with neutrophilic leukocytosis, hyperglycemia, higher admission NIHSS scores, and worse collateral circulation. Conclusions Patients with SIRS had higher odds of poor functional outcomes and higher mortality at 90 days in the EVT-treatment setting. The severity of the inflammatory response was positively correlated with the clinical outcomes of patients. Clinically relevant associations with SIRS were neutrophilic leukocytosis, hyperglycemia and baseline stroke severity, but favorable collateral circulation was a protective factor against SIRS.

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Abstract TP359: Admission Systemic Inflammatory Response Syndrome and Outcome Following Intracerebral Hemorrhage in a Multicenter Study

Stroke ◽

10.1161/str.47.suppl_1.tp359 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Amelia K Boehme ◽

Mary Comeau ◽

Carl Langefeld ◽

Aaron Lord ◽

Charles Moomaw ◽

...

Keyword(s):

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Intracerebral Hemorrhage ◽

Vital Signs ◽

Systemic Inflammatory Response ◽

Stroke Severity ◽

Chi Square ◽

Lower Baseline ◽

Poor Outcomes ◽

Ich Score

Background and Purpose: Systemic Inflammatory Response Syndrome (SIRS) has been shown to predict outcomes after intracerebral hemorrhage (ICH) in a single-center cohort. We hypothesized that SIRS would predict outcomes in a multicenter multi-ethnic cohort of ICH patients. Methods: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a multi-center observational study of ICH among whites, blacks, and Hispanics. SIRS on admission was defined according to standard criteria as 2 or more of the following: (1) body temperature 38°C, (2) heart rate > 90 beats per minute, (3) respiratory rate > 20/minute, or (4) white blood cell count 12,000/mm3. Patients were excluded if they died within 72 hours of admission, or if missing vital signs or laboratory tests did not allow for assessment of SIRS on admission. Associations of SIRS with baseline characteristics, infection, and poor outcomes (modified Rankin Scale 3-6) at discharge and 3 months were assessed using t-tests, chi-square, and logistic regression. Results: Of 2411 patients included, 340 (14%) met SIRS criteria at admission. Patients with SIRS were younger (58.0 vs. 62.3 years; p<.0001) and more likely to have intraventricular hemorrhage (IVH) (52.9% vs. 36.5%; p<.0001), higher baseline ICH volume (25.2 vs. 17.4; p<.0001), and lower baseline Glasgow Coma Score (GCS; 10.7 vs. 13.1; p<.0001). SIRS was not associated with subsequent infection (OR 1.40, 95%CI 0.84-2.34). In unadjusted analyses, SIRS was associated with poor outcome at discharge (OR 2.0, 95%CI 1.5-2.7) and 3-months (OR 1.8, 95%CI 1.4-2.3). In patients with milder ICH (ICH score 0-2), SIRS was associated with poor mRS at discharge and 3 months, but SIRS was not related to outcomes for patients with baseline ICH score 3-5. After adjusting for age, IVH, ICH volume, GCS, ICH location, and pre-onset mRS, SIRS was no longer associated with poor outcomes. Conclusions: SIRS at admission is an indicator of stroke severity and thus a predictor of poor functional outcome, but not infection, after ICH. Further study is needed to better understand systemic inflammation after ICH.

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