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

Abstract

<h3>Objective</h3> 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). <h3>Methods</h3> 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 &lt;36°C or &gt;38°C, respiratory rate &gt;20 per minute, heart rate &gt;90 per minute, or white blood cell count &lt;4,000/μL or &gt;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. <h3>Results</h3> 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 cm³, interquartile range [IQR 4.6–47.2 cm³] vs 7.4 cm³, IQR [2.4–18.6 cm³]; <i>p</i> &lt; 0.01), increased intraventricular hemorrhage (57.6%, n = 98/170 vs 24.8%, n = 79/319; <i>p</i> &lt; 0.01), and poorer neurologic admission status (NIH Stroke Scale score 16, IQR [7–30] vs 6, IQR [3–12]; <i>p</i> &lt; 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]; <i>p</i> = 0.025) and 12 months (OR 1.76, 95% CI [1.04–2.96]; <i>p</i> = 0.034). Increased ICH volumes on follow-up imaging (OR 1.38, 95% CI [1.01–1.89]; <i>p</i> = 0.05) and previous liver dysfunction (OR 3.01, 95% CI [1.03–10.19]; <i>p</i> = 0.04) were associated with SIRS. <h3>Conclusions</h3> 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.