Abstract T P404: The Influence Of Systemic Inflammatory Response Syndrome, In The Absence Of Infection, On The Relationship Between Intracerebral Hemorrhage Score And Outcomes
Background and Purpose: Systemic inflammatory response syndrome (SIRS) has been recognized as a risk factor for poor outcome in critically ill patients. The ICH score has been identified as a predictor of death and poor outcomes in patients with ICH. We examined the relationship between ICH score, SIRS and outcomes.
Methods: A retrospective review of patients presenting to our center from 2008-2013 with primary ICH was conducted, excluding those who were placed on comfort care. SIRS was defined as having 2 or more of the following: (1) body temperature < 36°C or > 38°C, (2) heart rate > 90, (3) respiratory rate > 20, or (4) white blood cell count < 4000/mm or > 12,000/mm or more than 10% bands for more than 24 hours. Patients with documented infections were excluded. The outcome was discharge modified-Rankin Scale (dmRS) of 4-6. A mediation analysis was conducted to assess the effect SIRS has on the relationship between ICH score and outcomes.
Results: A total of 249 ICH patients admitted to our stroke center from 2008-2013 met inclusion criteria. A total of 53 (21.3%) developed SIRS during their hospital stay. For each increase in the ICH Score, there was a 45% increase in odds of developing SIRS during hospitalization (OR 1.45, 95% 1.07-1.98, p=0.0169). SIRS was associated with an increased odds of poor functional outcome (OR 6.08, 95%CI 2.86-12.9, p<0.0001). For each increase in the ICH Score, adjusting for SIRS, there was a 2.68 fold increase in the odds of poor functional outcome (OR 2.68, 95%CI 1.82-3.96, p<0.001). Using a mediation analysis we found that 33% of the effect of ICH score on poor functional outcome at discharge explained by SIRS (Sobel 2.11, p=0.03).
Discussion: In our sample, the odds of poor outcome was significantly associated with ICH score. As expected, the prevalence of SIRS was higher in patients presenting with higher severity of illness. The results of the mediation analysis suggest that SIRS may be one mechanism by which the association of rising ICH score and worsening functional outcome can be explained. This observation raises the question of whether early intervention to prevent or treat incipient SIRS may reduce morbidity and mortality in this high-risk population.
Author Disclosures: A. Hays: None. A.K. Boehme: None. K. Kicielinski: None. K. Arora: None. N. Kapoor: None. M. Lyerly: None. D. Miller: None. M. Elkind: None. M. Harrigan: None.
- © 2015 by American Heart Association, Inc.