Amelia K Boehme1,2, Angela N Hays3,4, Kimberly P Kicielinski5, Kanika Arora3, Niren Kapoor6, Michael J Lyerly3, Alissa Gadpaille3, Harn Shiue3, Karen Albright7,8, David Miller4, Mitchell S V Elkind9,10, Mark R Harrigan5. 1. Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA. akb2188@cumc.columbia.edu. 2. Department of Neurology, Gertrude Sergievsky Center, Columbia University, 710 W 168th Street, Room 612, New York, NY, 10032, USA. akb2188@cumc.columbia.edu. 3. Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA. 4. Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA. 5. Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, 35294, USA. 6. Division of Neurocritical Care, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA. 7. Geriatric Research Education and Clinical Center (GRECC), Birmingham VA Medical Center, Birmingham, AL, 35233, USA. 8. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35249, USA. 9. Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA. 10. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.
Abstract
BACKGROUND: To 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). METHODS: We 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. RESULTS: A 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). CONCLUSION: We 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.
BACKGROUND: To 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). METHODS: We 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. RESULTS: A total of 249 ICHpatients 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). CONCLUSION: We 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.
Authors: Aaron S Lord; Carl D Langefeld; Padmini Sekar; Charles J Moomaw; Neeraj Badjatia; Anastasia Vashkevich; Jonathan Rosand; Jennifer Osborne; Daniel Woo; Mitchell S V Elkind Journal: Stroke Date: 2014-10-14 Impact factor: 7.914
Authors: Jan Claassen; David Albers; J Michael Schmidt; Gian Marco De Marchis; Deborah Pugin; Christina Maria Falo; Stephan A Mayer; Serge Cremers; Sachin Agarwal; Mitchell S V Elkind; E Sander Connolly; Vanja Dukic; George Hripcsak; Neeraj Badjatia Journal: Ann Neurol Date: 2014-05-16 Impact factor: 10.422
Authors: Amelia K Boehme; Niren Kapoor; Karen C Albright; Michael J Lyerly; Pawan V Rawal; R Bavarsad Shahripour; Reza Bavarsad Shahripour; Muhammad Alvi; J Thomas Houston; April Sisson; T Mark Beasley; Anne W Alexandrov; Andrei V Alexandrov; David W Miller Journal: Stroke Date: 2013-05-23 Impact factor: 7.914
Authors: Sean van Diepen; John P Vavalle; L Kristin Newby; Robert Clare; Karen S Pieper; Justin A Ezekowitz; Judith S Hochman; Kenneth W Mahaffey; Paul W Armstrong; Christopher B Granger Journal: Crit Care Med Date: 2013-09 Impact factor: 7.598
Authors: Sandro Marini; Andrea Morotti; Umme K Lena; Joshua N Goldstein; Steven M Greenberg; Jonathan Rosand; Christopher D Anderson Journal: Neurocrit Care Date: 2018-02 Impact factor: 3.210
Authors: Andrea Morotti; Sandro Marini; Michael J Jessel; Kristin Schwab; Christina Kourkoulis; Alison M Ayres; M Edip Gurol; Anand Viswanathan; Steven M Greenberg; Christopher D Anderson; Joshua N Goldstein; Jonathan Rosand Journal: Neurocrit Care Date: 2017-04 Impact factor: 3.210
Authors: Amelia K Boehme; Mary E Comeau; Carl D Langefeld; Aaron Lord; Charles J Moomaw; Jennifer Osborne; Michael L James; Sharyl Martini; Fernando D Testai; Daniel Woo; Mitchell S V Elkind Journal: Neurol Neuroimmunol Neuroinflamm Date: 2017-12-22
Authors: Orhan Gökalp; Levent Yılık; Hasan İner; Yüksel Beşir; Nihan Karakaş Yeşilkaya; Kazım Ergüneş; Banu Lafcı; Ali Gürbüz Journal: Turk Gogus Kalp Damar Cerrahisi Derg Date: 2018-07-03 Impact factor: 0.332