• Neurocritical care · Aug 2016

    Systemic Inflammatory Response Syndrome and Outcomes in Intracerebral Hemorrhage.

    • Amelia K Boehme, Angela N Hays, Kimberly P Kicielinski, Kanika Arora, Niren Kapoor, Michael J Lyerly, Alissa Gadpaille, Harn Shiue, Karen Albright, David Miller, Mitchell S V Elkind, and Mark R Harrigan.
    • Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA. akb2188@cumc.columbia.edu.
    • Neurocrit Care. 2016 Aug 1; 25 (1): 133-40.

    BackgroundTo identify the patients at greatest odds for systemic inflammatory response syndrome (SIRS) and examine the association between SIRS and outcomes in patients presenting with intracerebral hemorrhage (ICH).MethodsWe retrospectively reviewed consecutive patients presenting to a tertiary care center from 2008 to 2013 with ICH. SIRS was defined according to standard criteria as 2 or more of the following: (1) body temperature <36 or >38 °C, (2) heart rate >90 beats per minute, (3) respiratory rate >20, or (4) white blood cell count <4000/mm(3) or >12,000/mm(3) or >10 % polymorphonuclear leukocytes for >24 h in the absence of infection. The outcomes of interest, discharge modified Rankin Scale (mRS 4-6), death, and poor discharge disposition (discharge anywhere but home or inpatient rehab) were assessed using logistic regression.ResultsA total of 249 ICH patients met inclusion criteria and 53 (21.3 %) developed SIRS during their hospital stay. A score was developed (ranging from 0 to 3) to identify patients at greatest risk for developing SIRS. Adjusting for stroke severity, SIRS was associated with mRS 4-6 (OR 5.25, 95 %CI 2.09-13.2) and poor discharge disposition (OR 3.74, 95 %CI 1.58-4.83) but was not significantly associated with death (OR 1.75, 95 %CI 0.58-5.32). We found that 33 % of the effect of ICH score on poor functional outcome at discharge was explained by the development of SIRS in the hospital (Sobel 2.11, p = 0.03).ConclusionWe observed that approximately 20 % of patients with ICH develop SIRS, and that patients with SIRS were at increased risk of having poor functional outcome at discharge.

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