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

Stroke ◽  
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.

scholarly journals Systemic inflammatory response syndrome, infection, and outcome in intracerebral hemorrhage

2017 ◽  
Vol 5 (2) ◽  
pp. e428 ◽  
Author(s):  
Amelia K. Boehme ◽  
Mary E. Comeau ◽  
Carl D. Langefeld ◽  
Aaron Lord ◽  
Charles J. Moomaw ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Intracerebral Hemorrhage ◽  
Systemic Inflammatory Response ◽  
Infection Age ◽  
Racial Variations ◽  
Poor Outcomes ◽  
Ich Score ◽  
The Relationship ◽  
Admission Glasgow Coma Scale

Objective:Systemic inflammatory response syndrome (SIRS) may be related to poor outcomes after intracerebral hemorrhage (ICH).Methods:The Ethnic/Racial Variations of Intracerebral Hemorrhage study is an observational study of ICH in whites, blacks, and Hispanics throughout the United Sates. SIRS was defined by standard criteria as 2 or more of the following on admission: (1) body temperature <36°C or >38°C, (2) heart rate >90 beats per minute, (3) respiratory rate >20 breaths per minute, or (4) white blood cell count <4,000/mm3 or >12,000/mm3. The relationship among SIRS, infection, and poor outcome (modified Rankin Scale [mRS] 3–6) at discharge and 3 months was assessed.Results:Of 2,441 patients included, 343 (14%) met SIRS criteria at admission. Patients with SIRS were younger (58.2 vs 62.7 years; p < 0.0001) and more likely to have intraventricular hemorrhage (IVH; 53.6% vs 36.7%; p < 0.0001), higher admission hematoma volume (25.4 vs 17.5 mL; p < 0.0001), and lower admission Glasgow Coma Scale (GCS; 10.7 vs 13.1; p < 0.0001). SIRS on admission was significantly related to infections during hospitalization (adjusted odds ratio [OR] 1.36, 95% confidence interval [CI] 1.04–1.78). In unadjusted analyses, SIRS was associated with poor outcomes at discharge (OR 1.96, 95% CI 1.42–2.70) and 3 months (OR 1.75, 95% CI 1.35–2.33) after ICH. In analyses adjusted for infection, age, IVH, hematoma location, admission GCS, and premorbid mRS, SIRS was no longer associated with poor outcomes.Conclusions:SIRS on admission is associated with ICH score on admission and infection, but it was not an independent predictor of poor functional outcomes after ICH.

scholarly journals Hypoalbuminemia, systemic inflammatory response syndrome, and functional outcome in intracerebral hemorrhage

2017 ◽  
Vol 41 ◽  
pp. 247-253 ◽  
Author(s):  
Mario Di Napoli ◽  
Réza Behrouz ◽  
Christopher H. Topel ◽  
Vivek Misra ◽  
Fulvio Pomero ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Systemic Inflammatory Response

scholarly journals Kadar Oksidan yang Tinggi Sebagai Faktor Risiko Terjadinya Hemolisis pada Neonatus Sepsis

Sari Pediatri ◽  
2016 ◽  
Vol 14 (3) ◽  
pp. 198
Author(s):  
Kamilah Budhi R ◽  
Asril Aminullah ◽  
Soeharyo Hadisaputro ◽  
Ag Soemantri ◽  
Suhartono Suhartono
Keyword(s):  
Vitamin E ◽  
Systemic Inflammatory Response Syndrome ◽  
Vitamin C ◽  
Inflammatory Response ◽  
Colorimetric Assay ◽  
Systemic Inflammatory Response ◽  
Chi Square

Latar belakang. Sepsis merupakan penyebab utama morbiditas dan mortalitas neonatus. Penyebab hemolisis pada neonatos meliputi: fisiologis, proses imun, stres oksidatif, aktivasi komplemen, kelainan eritrosit, enzim hemolisin. Penyebab hemolisis pada neonatus sepsis belum banyak diteliti. Tujuan. Membuktikan bahwa kadar oksidan (MDA) yang tinggi sebagai faktor risiko terjadinya hemolisis pada neonatus sepsis.Metode. Penelitian di RS Dr. Kariadi, Semarang tahun 2009, desain observasional prospektif dengannested case – controlpada 94 neonatus sepsis terdiri 47 kelompok kasus (hemolisis positif ) dan 47 kontrol (hemolisis negatif ). Diagnosis sepsis ditegakkan dengan kriteria SIRS (systemic inflammatory response syndrome)1 atau lebih, gejala klinik, pemeriksaan laboratorium atau penunjang lain. Hemolisis ditegakkan dengan metode indeks retikulosit >3, hari ke-1 dan ke-3. Pemeriksaan faktor risiko kadar MDA, GPx dengan metode spektrofotometri, vitamin C dengan metode colorimetric assay, vitamin E dengan metode ELISA, hemolisin dengan kultur darah media agar darah. Uji hipótesis menggunakan Chi-square, OR (95% Cl), Mantel-Haenszeldan regresi logistik.Hasil. Kejadian hemolisis pada neonatus sepsis 49%. Kadar MDA kelompok kasus (5,3±2,06) lebih tinggi bermakna dibanding kelompok kontrol (3,3±1,27) p=0,0001. Analisis bivariat, kadar MDA tinggi (>2,90 ng/dL) merupakan faktor risiko hemolisis pada neonatus sepsis (OR 11,6; 95% CI 2,5-54,1) Analisis multivariat, kadar MDA tinggi (> 2,90 ng/dL) dengan memperhitungkan interaksi GPx (OR 5,16; 95%CI 1,22-21,86), vitamin E (OR 5,77; 95%CI 1,49-22,26) dan vitamin C (OR 11,26:2,38-53:30) merupakan faktor risiko kejadian hemolisis pada neonatus sepsis. Hemolisin belum dapat dibuktikan Kesimpulan. Kadar oksidan (MDA) yang tinggi (>2,90 ng/dL), merupakan faktor risiko terjadinya hemolisis pada neonatus sepsis.

scholarly journals Systemic Inflammatory Response Syndrome and Outcomes in Ischemic Patients Treated with Endovascular Treatment

2020 ◽  
Author(s):  
xiangjun xu ◽  
Lili Yuan ◽  
Wenbing Wang ◽  
Junfeng Xu ◽  
Qian Yang ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Collateral Circulation ◽  
Protective Factor ◽  
Systemic Inflammatory Response ◽  
Favorable Outcome ◽  
Occurrence Rate ◽  
Stroke Severity

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.

scholarly journals Systemic inflammatory response syndrome and long-term outcome after intracerebral hemorrhage

2019 ◽  
Vol 6 (5) ◽  
pp. e588 ◽  
Author(s):  
Manuel Hagen ◽  
Jochen A. Sembill ◽  
Maximilian I. Sprügel ◽  
Stefan T. Gerner ◽  
Dominik Madžar ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Liver Dysfunction ◽  
Systemic Inflammatory Response ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Hematoma Enlargement

ObjectiveTo investigate whether the systemic inflammatory response syndrome (SIRS) without infection as surrogate of a systemic immune response is associated with poor long-term functional outcome in patients with spontaneous intracerebral hemorrhage (ICH).MethodsWe analyzed consecutive patients with spontaneous ICH from our prospective cohort study (2018–2015). SIRS was defined according to standard criteria: i.e., 2 or more of the following parameters during hospitalization: body temperature <36°C or >38°C, respiratory rate >20 per minute, heart rate >90 per minute, or white blood cell count <4,000/μL or >12,000/μL in the absence of infection. The primary outcome consisted of the modified Rankin Scale (mRS) at 3 and 12 months investigated by adjusted ordinal shift analyses. Bias and confounding were addressed by propensity score matching and multivariable regression models.ResultsOf 780 patients with ICH, 21.8% (n = 170) developed SIRS during hospitalization. Patients with SIRS showed more severe ICH compared with those without; i.e., larger ICH volumes (18.3 cm3, interquartile range [IQR 4.6–47.2 cm3] vs 7.4 cm3, IQR [2.4–18.6 cm3]; p < 0.01), increased intraventricular hemorrhage (57.6%, n = 98/170 vs 24.8%, n = 79/319; p < 0.01), and poorer neurologic admission status (NIH Stroke Scale score 16, IQR [7–30] vs 6, IQR [3–12]; p < 0.01). ICH severity-adjusted analyses revealed an independent association of SIRS with poorer functional outcome after 3 (OR 1.80, 95% CI [1.08–3.00]; p = 0.025) and 12 months (OR 1.76, 95% CI [1.04–2.96]; p = 0.034). Increased ICH volumes on follow-up imaging (OR 1.38, 95% CI [1.01–1.89]; p = 0.05) and previous liver dysfunction (OR 3.01, 95% CI [1.03–10.19]; p = 0.04) were associated with SIRS.ConclusionsIn patients with ICH, we identified SIRS to be predictive of poorer long-term functional outcome over the entire range of mRS estimates. Clinically relevant associations with SIRS were documented for previous liver dysfunction and hematoma enlargement.

Abstract P458: Systemic Inflammatory Response Syndrome is Associated With Hematoma Expansion in Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Elizabeth Carroll ◽  
Aaron Lord ◽  
Ariane Lewis ◽  
Koto Ishida ◽  
Cen Zhang ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Intracerebral Hemorrhage ◽  
Univariate Analysis ◽  
Multivariate Regression Analysis ◽  
Systemic Inflammatory Response ◽  
Vascular Lesions ◽  
Hematoma Expansion ◽  
Antibiotic Administration ◽  
Hematoma Volume

Objective: Systemic inflammatory response syndrome (SIRS) and hematoma expansion are both associated with worse outcomes after intracerebral hemorrhage (ICH), but their relationship remains unclear. We sought to determine the association between SIRS and hematoma expansion after ICH. Methods: We performed a retrospective cohort study of patients admitted to our hospital from 2013 to 2020 with primary spontaneous ICH with at least two head CTs within the first 24 hours. Patients were excluded if they had a decompressive craniectomy, intracranial vascular lesions or malignancy, or coagulopathy. Hematoma volume was measured using the ABC/2 method; hematoma expansion was defined as 6mL or 33% growth between the first and second scan. We compared patients with and without SIRS using Pearson’s χ2, students T and Wilcoxon rank sum tests. The relationship between admission SIRS and hematoma expansion was assessed using univariate and multivariate regression analysis. Results: Of 187 patients with ICH, 73 (39%; mean age 6617, 40% female) met inclusion criteria. Of those, 38 (52%) had SIRS on admission. Admission systolic blood pressure (SBP) was significantly higher in patients with SIRS compared to those without (169 [IQR 133- 205] vs 152 [125- 179] mm Hg, p= 0.02). There was no difference in mean days to first antibiotic administration (6.3 vs 5.6, p=0.78), admission platelets (227 vs 243, p= 0.38) or initial hematoma volume (23 vs 15, p=0.16). Hematoma expansion occurred in 14 patients, 11 (79%) of whom also had SIRS. A significantly greater percentage of patients with SIRS had mRS 4-6 at discharge (87 vs 67%, p=0.05). SIRS was significantly associated with hematoma expansion (OR 4.35, 95% CI 1.10-17.20, p= 0.04) on univariate analysis. The association remained statistically significant after adjusting for admission SBP, platelets, and initial hematoma volume (OR 4.54, 95% CI 1.01-20.60, p= 0.05). Conclusion: Presence of SIRS on admission is associated with hematoma expansion within the first 24 hours. Further research is needed to better understand this association, which may enable us to identify early on and treat those patients at highest risk for decompensation.

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