Systemic inflammatory response syndrome, infection, and outcome in intracerebral hemorrhage.
Systemic inflammatory response syndrome, infection, and outcome in intracerebral hemorrhage.
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DOI：
10.1212/nxi.0000000000000428
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发表时间：
2018-03
期刊：
影响因子：
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通讯作者：
Elkind MSV
中科院分区：
文献类型：
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作者：
Boehme AK;Comeau ME;Langefeld CD;Lord A;Moomaw CJ;Osborne J;James ML;Martini S;Testai FD;Woo D;Elkind MSV
全身炎症反应综合征（SIRS）可能与脑出血（ICH）后不良结局有关。脑出血的种族/人种差异研究是一项在美国白人、黑人和西班牙裔中进行的ICH观察性研究。SIRS通过标准定义为入院时以下两项或更多项：（1）体温<36°C或>38°C，（2）心率>90次/分钟，（3）呼吸率>20次/分钟，或（4）白色血细胞计数<4，000/mm 3或> 12，000/mm 3。评估了出院时和3个月时SIRS、感染和不良结局（改良兰金量表[mRS] 3-6）之间的关系。在纳入的2，441例患者中，343例（14%）在入院时符合SIRS标准。SIRS患者年龄较轻（58.2 vs 62.7岁; p < 0.0001），更可能发生脑室内出血（IVH; 53.6% vs 36.7%; p < 0.0001），入院血肿体积较高（25.4 vs 17.5 mL; p < 0.0001）和较低的入院格拉斯哥昏迷评分（GCS; 10.7 vs 13.1; p < 0.0001）。入院时的SIRS与住院期间的感染显著相关（校正比值比[OR] 1.36，95%置信区间[CI] 1.04-1.78）。在未校正的分析中，SIRS与ICH后出院时（OR 1.96，95% CI 1.42-2.70）和3个月（OR 1.75，95% CI 1.35-2.33）的不良结局相关。在校正了感染、年龄、IVH、血肿位置、入院GCS和病前mRS的分析中，SIRS不再与不良结局相关。入院时的SIRS与入院时的ICH评分和感染相关，但不是ICH后不良功能结局的独立预测因素。
Systemic inflammatory response syndrome (SIRS) may be related to poor outcomes after intracerebral hemorrhage (ICH). 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. 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. 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.