Predictors of Systemic Inflammatory Response Syndrome in Ischemic Stroke Undergoing Systemic Thrombolysis with Intravenous Tissue Plasminogen Activator

Abstract

Background Systemic inflammatory response syndrome (SIRS) is an inflammatory process associated with poor outcomes in acute ischemic stroke (AIS) patients. However, no study to date has investigated predictors of SIRS in AIS patients treated with intravenous (IV) tissue plasminogen activator (tPA). Methods Consecutive patients were retrospectively reviewed for evidence of SIRS during their acute hospitalization. SIRS was defined as the presence of 2 or more of the following: (1) body temperature less than 36°C or greater than 38°C, (2) heart rate greater than 90, (3) respiratory rate greater than 20, or (4) white blood cell count less than 4000/mm or greater than 12,000/mm or more than 10% bands for more than 24 hours. Those diagnosed with an infection were excluded. A scoring system was created to predict SIRS based on patient characteristics available at the time of admission. Logistic regression was used to evaluate potential predictors of SIRS using a sensitivity cutoff of ≥65% or area under the curve of .6 or more. Results Of 212 patients, 44 had evidence of SIRS (21%). Patients with SIRS were more likely to be black (61% versus 54%; P = .011), have lower median total cholesterol at baseline (143 versus 167 mg/dL; P = .0207), and have history of previous stroke (51% versus 35%; P = .0810). Ranging from 0 to 6, the SIRS prediction score consists of African American (2 points), history of hypertension (1 point), history of previous stroke (1 point), and admission total cholesterol less than 200 (2 points). Patients with an SIRS score of 4 or more were 3 times as likely to develop SIRS when compared with patients with a score of ≤3 (odds ratio = 2.815, 95% confidence interval 1.43–5.56, P = .0029). Conclusions In our sample of IV tPA-treated AIS patients, clinical and laboratory characteristics available on presentation were able to identify patients likely to develop SIRS during their acute hospitalization. Validation is required in other populations. If validated, this score could assist providers in predicting who will develop SIRS after treatment with IV tPA.

Systemic Inflammatory Response Syndrome and Outcomes in Intracerebral Hemorrhage

“…This is supported by previous research in acute ischemic stroke and subarachnoid hemorrhage that identified strong positive associations between stroke severity and development of SIRS. (5, 24) While studies in ischemic stroke and subarachnoid hemorrhage reported that prior history of stroke hypertension, and chronic disease burden as predictors of SIRS, we did not observe this. (24-26) The influence of stroke severity on the inflammatory process suggests that SIRS in ICH patients may be related to an inflammatory reaction to the stroke itself, as opposed to pre-existing chronic inflammatory conditions.…”

“…(5, 24) While studies in ischemic stroke and subarachnoid hemorrhage reported that prior history of stroke hypertension, and chronic disease burden as predictors of SIRS, we did not observe this. (24-26) The influence of stroke severity on the inflammatory process suggests that SIRS in ICH patients may be related to an inflammatory reaction to the stroke itself, as opposed to pre-existing chronic inflammatory conditions. Further research will determine whether the score can be used to direct intervention to prevent the development of SIRS and improve ICH outcomes in the presence of SIRS.…”

Association Between Splenic Contraction and the Systemic Inflammatory Response After Acute Ischemic Stroke Varies with Age and Race

“…Patients of African American race have been found to have higher rates of non-infectious SIRS after stroke [15,26] and there is data demonstrating higher rates of infection and sepsis in African American patients [27][28][29]. African American race has also been included in a non-infectious SIRS prediction model [26]. That we did not find African American race to be an independent predictor of SIRS could represent our small sample size and our inclusion of patients who subsequently developed infections.…”

“…The data suggest that SIRS is more likely to be associated with SC in African American patients but race was not an independent predictor for the development of SIRS as seen in other studies. Patients of African American race have been found to have higher rates of non-infectious SIRS after stroke [15,26] and there is data demonstrating higher rates of infection and sepsis in African American patients [27][28][29]. African American race has also been included in a non-infectious SIRS prediction model [26].…”

High serum levels of caspase-cleaved cytokeratin-18 are associated with malignant middle cerebral artery infarction patient mortality

“…Second, that MMCAI may cause a systemic inflammatory response syndrome (SIRS), and this could activate sistemic cellular apoptosis. In fact, there are studies reporting SIRS after cerebral infarction [ 38 – 40 ], and in SIRS appears different pro-inflammatory cytokines [ 41 ] that could activate apoptosis [ 2 – 7 ].…”