Systemic inflammatory response syndrome and long-term outcome after intracerebral hemorrhage. Issue 5 (September 2019)

• Record Type: Journal Article
• Authors: Hagen, Manuel; Sembill, Jochen A.; Sprügel, Maximilian I.; Gerner, Stefan T.; Madžar, Dominik; Lücking, Hannes; Hölter, Philip; Schwab, Stefan; Huttner, Hagen B.; Kuramatsu, Joji B.
• Is Part Of: Neurology. Volume 6:Issue 5(2019)
• Publication Date: 2019-09
• Subjects: Neuroimmunology -- Periodicals; Neurology -- Periodicals; 616.8
• DOI: 10.1212/NXI.0000000000000588
• Languages: English
• ISSNs: 2332-7812

Abstract

Abstract : Objective: To 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). Methods: We 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. Results: Of 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 cm 3, interquartile range [IQR 4.6–47.2 cm 3 ] vs 7.4 cm 3, IQR [2.4–18.6 cm 3 ]; 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. Conclusions: In 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.