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

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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Abstract TP151: Association of Splenic Contraction And Development of Systemic Inflammatory Response Syndrome After Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.tp151 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Alicia M Zha ◽

Bhargav Tippinayani ◽

Jaskaren Randhawa ◽

Nicole J Pariseau ◽

Farhaan S Vahidy ◽

...

Keyword(s):

Ischemic Stroke ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Care Center ◽

Tertiary Care ◽

Systemic Inflammatory Response ◽

Secondary Brain Injury ◽

Stroke Patients

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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Abstract 23: The Systemic Inflammatory Response Syndrome Following Cardiac Surgery

Circulation ◽

10.1161/circ.116.suppl_16.ii_928 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Niall S MacCallum ◽

Sarah E Gordon ◽

Gregory J Quinlan ◽

Timothy W Evans ◽

Simon J Finney

Keyword(s):

Cardiac Surgery ◽

Length Of Stay ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Systemic Inflammation ◽

Systemic Inflammatory Response ◽

Icu Stay ◽

Prolonged Icu Stay ◽

Post Cardiac Surgery ◽

Sirs Criteria

The systemic inflammatory response syndrome (SIRS) is the leading cause of morbidity & mortality in the critically ill. It is associated with a 50% reduction in 5 year life expectancy. SIRS is defined as 2 of the following criteria: heart rate >90, respiratory rate >20 or pCO 2 <4.3kPa, temperature <36 or >38°C, white cell count <4 or >12 x10 9 /l. These criteria are used to stratify patients for specific therapies & in research to define interventional groups. Cardiac surgery is associated with systemic inflammation. The validity of the SIRS criteria have never been formally evaluated post cardiac surgery. We undertook to describe the incidence of SIRS post cardiac surgery & relate this to outcome. Methods: We retrospectively analysed prospectively collected data from 2764 consecutive admissions following cardiac surgery (coronary bypass grafting 1425, valve surgery 763, combined procedure 252, other 324). The number of criteria met simultaneously within 1 hour epochs was recorded for the entire admissions. Results: 96.4%, 57.9% & 12.2% of patients met at least 2, 3 or 4 criteria respectively within 24hrs of admission. The temperature criterion was least often fulfilled. ICU mortality was 2.67%. Length of stay exceeded 3 days in 18.5% of patients. The capacity of the criteria to predict mortality & prolonged ICU stay is presented in the table . Discussion: Nearly all patients fulfilled the standard 2 criteria definition of SIRS within 24hrs of admission. This definition does not adequately define the subgroup of patients with greater systemic inflammation, mortality or length of stay. Thus, some clinical manifestations of inflammation are very common following cardiac surgery, although not necessarily prognostic. By contrast, the presence of 3 or more criteria was more discriminatory of death & prolonged ICU stay. We propose that 3 or more SIRS criteria is a more appropriate threshold that defines those patients with clinically significant inflammation post cardiac surgery.

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Antimicrobial utilization pattern in Systemic Inflammatory Response Syndrome positive septicemia: a prospective study in an apex hospital in South Delhi

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20190665 ◽

2019 ◽

Vol 8 (3) ◽

pp. 557

Author(s):

Anwer Habib ◽

Razi Ahmad

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

High Risk Patient ◽

Systemic Inflammatory Response ◽

Early Initiation ◽

Source Of Infection ◽

Sepsis And Septic Shock ◽

Sirs Criteria

Background: Despite significant advances in critical care, mortality and morbidity in severe sepsis and septic shock remain high, this may be explained by the fact that in sepsis bacterial infection triggers the innate immune response, setting in motion a cascade of pro-inflammatory and anti-inflammatory cytokines leading to what we recognize as the systemic inflammatory response syndrome (SIRS). It has been thought that this self-propagating cascade drives the progression to severe sepsis and septic shock with increasing degrees of cellular injury and end-organ dysfunction, therefor early initiation of empirical antimicrobial agent is crucial and life-saving atleast in high risk patient. This study aimed to see the outcome (recover or mortality) of patients diagnosed by using SIRS criteria.Methods: Total of 105 patients of suspected sepsis fulfilling SIRS criteria (SIRS ≥2), were included in study. Study population were administered appropriate empirical antimicrobial depending on the source of infection and followed till the final outcome (complete recovery or death).Results: Out of 105 patients included in study based on SIRS criteria, 87 (82.85%) were confirmed to be having septicemia on further evaluation. In majority of patient primary source of infection were respiratory tract (44.76%) and most commonly employed and effective empirical antimicrobial were a combination piperacillin with tazobactum and amikacin (40%). 92.39% patients recovered with empirical antimicrobial, with total in-hospital mortality rate of 7.61%.Conclusions: Early initiation of appropriate antimicrobial by using SIRS as an indicator for the early diagnosis of septicemia is crucial in the management of septicemia and prevention of development of severe sepsis, septic shock.

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Abstract 3275: Early Neurological Improvement After Intravenous Thrombolysis in Acute Stroke Predicts Long-Term Functional Outcome

Stroke ◽

10.1161/str.43.suppl_1.a3275 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Leonard L Yeo ◽

Liang Shen ◽

Ben Wakerley ◽

Aftab Ahmad ◽

Kay W Ng ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Symptom Onset ◽

Functional Outcomes ◽

Treatment Time ◽

Favorable Outcome ◽

Stroke Patients ◽

Neurological Improvement ◽

Iv Tpa

Background: Intravenously administered tissue plasminogen activator (IV-TPA) remains the only approved therapeutic agent for arterial recanalization in acute ischemic stroke (AIS). Wide variations in the rates and timing of neurological recovery are observed in thrombolyzed patients. While all IV-TPA treated patients are routinely evaluated for neurological recovery at 24-hours, considerable improvement occurs in some cases within 2-hours of treatment initiation. We evaluated whether early neurological improvement at 2-hours after IV-TPA bolus (ENI-2) can predict functional outcomes in thrombolyzed AIS patients at 3-months. Methods: Data for consecutive stroke patients treated with IV-TPA within 4.5 hours of symptom-onset during 2007-2010 were prospectively entered in the thrombolyzed registry maintained at our tertiary care center. Data were collected for demographic characteristics, vascular risk factors, stroke subtypes and blood pressure levels before IV-TPA bolus. National Institute of Health Stroke Scale (NIHSS) scores were obtained before IV-TPA bolus and at 2-hours. ENI-2 was defined as a reduction in NIHSS score by more than 10-points from baseline score or an absolute score of 4-points or less at 2-hours after IV-TPA bolus. Functional outcomes at 3-months were determined by modified Rankin scale (mRS). Data were analyzed by SPSS 19.0. Results: Of the 2238 AIS patients admitted during the study period, 240 (11%) received IV-TPA within 4.5-hours of symptom-onset. Median age was 65yrs (range 19-92), 63% males, median NIHSS 17points (range 3-35) and median onset-to-treatment time 149 minutes. Overall, 122 (50.8%) patients achieved favorable functional outcome (mRS 0-1) at 3-months. Factors associated with favorable outcome at 3-months on univariable analysis were younger age, female gender, presence of atrial fibrillation, baseline NIHSS, onset-to-treatment time (OTT) and ENI-2. However, multivariable analysis demonstrated NIHSS at onset (OR per 1-point increase 0.907, 95%CI 0.848-0.969) and ENI-2 (OR 4.926 95%CI 1.66-15.15) as independent predictors of favorable outcome at 3-months. Conclusion: Early Neurological improvement at 2-hours after IV-TPA bolus is a strong predictor of the functional outcome at 3-months in acute ischemic stroke patients.

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Elevated total homocysteine predicts in-hospital pneumonia and poor functional outcomes in acute ischemic stroke

10.21203/rs.2.22904/v1 ◽

2020 ◽

Author(s):

Shoujiang You ◽

Lixuan Wang ◽

Huaping Du ◽

Danni Zheng ◽

Chongke Zhong ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Fold Increase ◽

Short Term ◽

Thcy Level ◽

Poor Outcome ◽

Total Homocysteine ◽

The Impact

Abstract Background The impact of elevated total homocysteine (tHcy) on functional outcomes and pneumonia after acute ischemic stroke (AIS) is still not well understood. We investigated the association between tHcy levels upon hospital admission and in-hospital short-term outcomes in AIS patients. Methods A total of 2,084 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included in the present study. We divided patients into 4 groups according to their level of admission tHcy: Q1 (<9.70 umol/L), Q2 (9.70-12.3 umol/L), Q3 (12.3-16.9 umol/L), and Q4 (≥16.9 umol/L). Logistic regression models were used to estimate the effect of tHcy on the short-term outcomes, including in-hospital pneumonia, all cause in-hospital mortality and poor outcome upon discharge (modified Rankin Scale score ≥3) in AIS patients. Results During hospitalization, 332 patients (15.9%) had pneumonia, 57 patients (2.7%) died from all causes and 784 (37.6%) patients experienced poor outcome at discharge. The risk of in-hospital pneumonia was significantly higher in patients with highest tHcy level (Q4) compared to those with lowest (Q1) (adjusted odds ratio [OR] 1.55; 95% confidence interval [CI], 1.03-2.33; P -trend =0.019). The highest tHcy level (Q4) was associated with a 3.35-fold and 1.50-fold increase in the risk of in-hospital mortality(adjusted OR 3.35; 95% CI, 1.11–10.13; P -trend =0.015) and poor outcome upon discharge(adjusted OR 1.50; 95% CI, 1.06–2.12; P -trend =0.044) in comparison to Q1 after adjustment for potential covariates including pneumonia. Subgroup analyses further confirmed a significant association between higher tHcy levels and a high risk of short-term outcomes. Conclusions Having a high admission tHcy level was independently associated with in-hospital pneumonia, all cause in-hospital mortality and poor outcome upon discharge in AIS patients. Moreover, the association between higher tHcy and poor functional outcome was not modified by pneumonia.

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