Systemic Inflammatory Response Syndrome and Outcomes in Intracerebral Hemorrhage

Boehme, Amelia K; Hays, Angela; Kicielinski, Kimberly; Arora, Kanika; Kapoor, Niren; Lyerly, Michael; Gadpaille, Alissa; Shiue, Harn; Albright, Karen C.; Miller, David W.; Elkind, Mitchell S.V.; Harrigan, Mark R.

doi:10.1007/s12028-016-0255-9

Cited by 39 publications

(36 citation statements)

References 37 publications

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“…The association between systemic inflammation, leukocyte activation, and ICH is complex [9, 31, 32]. Our findings suggest that lymphocytes play a key role in protection against infections in ICH patients, which may have important implications for future studies.…”

Section: Discussionmentioning

confidence: 73%

Lymphopenia, Infectious Complications, and Outcome in Spontaneous Intracerebral Hemorrhage

et al. 2016

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Background Lymphopenia is increasingly recognized as a consequence of acute illness and may predispose to infections. We investigated whether admission lymphopenia (AL) is associated with increased risk of infectious complications and poor outcome in patients with spontaneous intracerebral hemorrhage (ICH). Methods We retrospectively analyzed a prospectively collected cohort of ICH patients ascertained between 1994 and 2015. We identified subjects with lymphocyte count obtained within 24 h from onset, and AL was defined as lymphocyte count < 1000/µL. Infectious complications were assessed through retrospective chart review. Association between AL, infections, and mortality was investigated using multivariable logistic regression. Results Of the 2014 patients meeting inclusion criteria, 548 (27.2%) had AL and 605 (30.0%) developed an infectious complication. Case-fatality at 90 days was 36.9%. Patients with AL had larger hematoma volumes, higher frequency of intraventricular hemorrhage, and lower Glasgow Coma Scale score on presentation (all p < 0.001). AL was independently associated with increased risk of pneumonia [odds ratio (OR) 1.97, 95% confidence interval (CI) 1.50–2.58, p < 0.001] and multiple infections (OR 1.84, 95% CI 1.24–2.71, p = 0.003). AL was also an independent predictor of 90-day mortality (OR 1.55, 95% CI 1.18–2.04, p = 0.002) after adjusting for confounders. Conclusions AL is common in ICH patients and independently associated with increased risk of infectious complications and poor outcome. Further studies will be needed to determine whether prophylactic antibiotics in ICH patients with AL can improve outcome.

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Section: Discussionmentioning

confidence: 73%

Lymphopenia, Infectious Complications, and Outcome in Spontaneous Intracerebral Hemorrhage

et al. 2016

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“…1 However, limited evidence exists regarding the influence of noninfectious systemic inflammation. 2 Experimental studies suggest that ICH induces a cytokine-driven acute-phase inflammation, which may lead to secondary brain damage and systemic inflammatory response syndrome (SIRS). 3 SIRS is frequently observed in patients with vascular diseases.…”

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confidence: 99%

“…3 SIRS is frequently observed in patients with vascular diseases. In ICH, approximately 20% of patients develop SIRS during hospital stay, 2 and a correlation between SIRS and stroke severity has been suggested. 4 Recent stroke research has focused on systemic and local inflammatory responses as novel therapeutic target (NCT03338998), 3,5 yet the association of SIRS with functional long-term outcomes after ICH remains undetermined.…”

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confidence: 99%

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

Hagen

Sembill

Sprügel

et al. 2019

Neurol Neuroimmunol Neuroinflamm

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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.

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“…As described by Boehme et al, [9] the diagnosis of systemic inflammatory response syndrome (SIRS) was made during the postoperative period. According to these criteria, at least two of the followings were required: body temperature >38.0ºC or <36.0ºC, heart rate >90/min, respiratory rate >20/min, and leucocyte count >12,000/μL or < 4,000/μL.…”

Section: Methodsmentioning

confidence: 99%

Treatment of aortic arch aneurysms: Open surgery or hybrid procedure?

Gokalp

Yilik

İner

et al. 2018

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada arkus aort anevrizmalarının tedavisinde hibrid işlem ve açık cerrahi sonuçları karşılaştırıldı.Ça lış mapla nı:Ocak 2004 -Ocak 2010 tarihleri arasında arkus aort anevrizması nedeniyle total arkus aort replasmanı yapılan 26 hasta (21 erkek, 5 kadın; ort. yaş 56.6±12.4 yıl; dağılım, 20-83 yıl) retrospektif olarak değerlendirildi. Hastalar açık konvansiyonel cerrahi grubu (grup 1, n=15) ve hibrid işlem (aynı seansta total arkus aort debranching ve endovasküler stent implantasyonu) grubu (grup 2, n=11) olarak iki gruba ayrıldı. Sağkalım oranları ve tekrar ameliyat gereksinimi gruplar arasında karşılaştırıldı. Bul gu lar:Ameliyat sonrası revizyon, ekstübasyon süresi ve drenaj miktarları açısından hibrid işlem daha iyi bulundu. Ancak sağkalım oranları, tekrar ameliyat gereksinimi ve ciddi advers kardiyovasküler olaylar açısından gruplar arasında istatistiksel olarak anlamlı bir fark yoktu.So nuç: Çalışma sonuçlarımız arkus aort anevrizması nedeniyle total arkus aort replasmanı yapılan hastalarda sağkalım ve kısa ila orta dönem sonuçlar açısından açık konvansiyonel cerrahi ve hibrid işlemin benzer olduğunu göstermektedir.Anah tarsöz cük ler: Arkus aort anevrizması; konvansiyonel açık cerrahi; hibrid işlem. ABSTRACTBackground: This study aims to compare the results of hybrid procedure and open surgery for the treatment of aortic arch aneurysms. Methods:Twenty-six patients (21 males, 5 females; mean age 56.6±12.4 years; range, 20 to 83 years) who underwent total aortic arch replacement for aortic arch aneurysm between January 2004 and January 2010 were retrospectively analyzed. The patients were divided into two groups: open conventional surgery group (group 1, n=15) and hybrid procedure (total debranching of the aortic arch and simultaneous endovascular stent) group (group 2, n=11). Survival rates and need for reoperation were compared between the groups.Results:The hybrid procedure was found to be more favorable in terms of postoperative revision, extubation period, and drainage amounts. However, there was no statistically significant difference in the survival rates, need for reoperation, and major adverse cardiovascular events between the groups. Conclusion:Our study results suggest that conventional open surgery and hybrid procedure are similar in terms of survival and short-to-mid-term results in patients undergoing total aortic arch replacement for aortic arch aneurysm.

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Systemic Inflammatory Response Syndrome and Outcomes in Intracerebral Hemorrhage

Cited by 39 publications

References 37 publications

Lymphopenia, Infectious Complications, and Outcome in Spontaneous Intracerebral Hemorrhage

Lymphopenia, Infectious Complications, and Outcome in Spontaneous Intracerebral Hemorrhage

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

Treatment of aortic arch aneurysms: Open surgery or hybrid procedure?

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