Systemic Inflammatory Response Syndrome Predicts Severity of Stroke and Outcome

Kalita, Jayantee; Bastia, Jogendra; Bhoi, Sanjeev Kumar

doi:10.1016/j.jstrokecerebrovasdis.2015.03.057

Cited by 25 publications

(16 citation statements)

References 26 publications

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“…This is consistent with prior work that highlighted a relationship between SIRS on admission and markers of stroke severity, but not an independent association with stroke outcomes. 24 …”

Section: Discussionmentioning

confidence: 99%

Systemic inflammatory response syndrome, infection, and outcome in intracerebral hemorrhage

Boehme

Comeau

Langefeld

et al. 2018

Neurol Neuroimmunol Neuroinflamm

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Objective:Systemic inflammatory response syndrome (SIRS) may be related to poor outcomes after intracerebral hemorrhage (ICH).Methods:The Ethnic/Racial Variations of Intracerebral Hemorrhage study is an observational study of ICH in whites, blacks, and Hispanics throughout the United Sates. SIRS was defined by standard criteria as 2 or more of the following on admission: (1) body temperature <36°C or >38°C, (2) heart rate >90 beats per minute, (3) respiratory rate >20 breaths per minute, or (4) white blood cell count <4,000/mm3 or >12,000/mm3. The relationship among SIRS, infection, and poor outcome (modified Rankin Scale [mRS] 3–6) at discharge and 3 months was assessed.Results:Of 2,441 patients included, 343 (14%) met SIRS criteria at admission. Patients with SIRS were younger (58.2 vs 62.7 years; p < 0.0001) and more likely to have intraventricular hemorrhage (IVH; 53.6% vs 36.7%; p < 0.0001), higher admission hematoma volume (25.4 vs 17.5 mL; p < 0.0001), and lower admission Glasgow Coma Scale (GCS; 10.7 vs 13.1; p < 0.0001). SIRS on admission was significantly related to infections during hospitalization (adjusted odds ratio [OR] 1.36, 95% confidence interval [CI] 1.04–1.78). In unadjusted analyses, SIRS was associated with poor outcomes at discharge (OR 1.96, 95% CI 1.42–2.70) and 3 months (OR 1.75, 95% CI 1.35–2.33) after ICH. In analyses adjusted for infection, age, IVH, hematoma location, admission GCS, and premorbid mRS, SIRS was no longer associated with poor outcomes.Conclusions:SIRS on admission is associated with ICH score on admission and infection, but it was not an independent predictor of poor functional outcomes after ICH.

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“…This is consistent with prior work that highlighted a relationship between SIRS on admission and markers of stroke severity, but not an independent association with stroke outcomes. 24 …”

Section: Discussionmentioning

confidence: 99%

Systemic inflammatory response syndrome, infection, and outcome in intracerebral hemorrhage

Boehme

Comeau

Langefeld

et al. 2018

Neurol Neuroimmunol Neuroinflamm

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“…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 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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BackgroundThere have been found apoptotic changes in brain tissue samples from humans after cerebral ischemia. Caspase-cleaved cytokeratin (CCCK)-18 could appears in blood during apoptosis. High circulating levels of CCCK-18 have been associated with a poor prognosis in patients with cerebral process, such as traumatic brain injury and spontaneous cerebral hemorrhage. However, they have not been explored in patients with ischemic stroke. Thus, the aim of this study was to determine whether there is an association between serum CCCK-18 levels and mortality in patients with severe malignant middle cerebral artery infarction (MMCAI).MethodsThis was an observational, prospective and multicentre study. We included patients with severe MMCAI. We considered MMCAI as severe when Glasgow Coma Scale (GCS) was lower than 9. We measured serum CCCK-18 levels at the diagnosis moment of the severe MMCAI.ResultsWe found that non-surviving severe MMCAI patients (n = 33) showed lower GCS and platelet count, and higher serum CCCK-18 levels than survivor ones (n = 33). We found an area under the curve (AUC) of serum CCCK-18 levels to predict 30-day mortality of 82% (95% CI = 71%–91%; p < 0.001). In the multiple logistic regression analysis was found that serum CCCK-18 levels were associated with 30-day mortality (OR = 1.023; 95% CI = 1.010–1.037; p = 0.001) after to control for platelet count and GCS.ConclusionsTo our knowledge, this is the first series reporting data on serum CCCK-18 levels in ischemic stroke patients. The novel findings of our study were that non-surviving severe MMCAI patients had higher serum CCCK-18 levels than surviving patients, and that there is an association between high serum CCCK-18 levels and MMCAI patients mortality.

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“…Peripheral blood is also used as a biomarker for systemic inflammatory response. This was found to be associated with the clinical and radiological severity of sICH [ 33 ]. In addition, lymphocytes induce cellular and humoral immune responses, which play an important role in host defense against pathogens.…”

Section: Discussionmentioning

confidence: 99%

The use of neutrophil to lymphocyte ratio as a predictor for clinical outcomes in spontaneous intracerebral hemorrhage

Fang

et al. 2017

Oncotarget

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ObjectiveNeutrophil to lymphocyte ratio (NLR) is used as an independent predictor for clinical outcomes in cancers, cardiovascular disorders and ischemic stroke. The prognostic role of NLR in spontaneous intracerebral hemorrhage (sICH) is still controversial. The aim of this report is to conduct a meta-analysis to evaluate the prognostic significance NLR in patients with sICH.Materials and MethodsAll related articles were searched on PubMed, EMBASE, Cochrane Central Register of Controlled Trials followed the PRISMA flow diagram. The quality of eligible studies were evaluated and the related data were extracted by two reviewers independently. The end points included the mortality and poor outcomes and subgroup analyses were performed.ResultsFive studies with 1944 subjects were included and had acceptable quality. The high NLR had a higher risk of in-hospital mortality (OR: 0.97; 95% CI: 0.94–0.99, p = 0.02) and 90-day mortality (OR: 2.43; 95% CI: 1.01–5.83, p = 0.047); without association with the poor outcomes (OR: 1.17; 95% CI: 0.93–1.47, p = 0.18). After subgroup analyses, the high NLR correlated with an increased 90-day mortality in the high cut-off group (OR: 1.56; 95% CI: 1.15–2.13, p = 0.005). The high NLR additionally predicts poor outcomes in smaller hematoma group (OR: 1.16; 95% CI: 1.01–1.32, p = 0.04) and the high cut-off group (OR: 2.20; 95% CI: 1.54–3.14, p < 0.001).ConclusionsThe high NLR was significantly associated with in-hospital and 90-day mortality in patients with sICH. The NLR with cut-off of 7.5 had statistically significant potential for predicting mortality and poor outcomes, regardless of country, time of laboratory test and hematoma volumes.

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Systemic Inflammatory Response Syndrome Predicts Severity of Stroke and Outcome

Cited by 25 publications

References 26 publications

Systemic inflammatory response syndrome, infection, and outcome in intracerebral hemorrhage

Systemic inflammatory response syndrome, infection, and outcome in intracerebral hemorrhage

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

The use of neutrophil to lymphocyte ratio as a predictor for clinical outcomes in spontaneous intracerebral hemorrhage

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