Journal Article

Impact of Systemic Inflammatory Response Syndrome on Vasospasm, Cerebral Infarction, and Outcome After Subarachnoid Hemorrhage: Exploratory Analysis of CONSCIOUS-1 Database

Ruefenacht, Daniel, Ilodigwe, Don, Mocco, Jay, Mayer, Stephan, Pasqualin, Alberto, Tam, Alan K. H., Weidauer, Stephan, Kassell, Neal, Schmiedek, Peter, Macdonald, R. Loch

2010

Overview

Background Systemic inflammatory response syndrome (SIRS) may develop after aneurysmal subarachnoid hemorrhage (SAH). We investigated factors associated with SIRS after SAH, whether SIRS was associated with complications of SAH such as vasospasm, cerebral infarction, and clinical outcome, and whether SIRS could contribute to a difference in outcome between patients treated by endovascular coiling or neurosurgical clipping of the ruptured aneurysm. Methods This was exploratory analysis of 413 patients in the CONSCIOUS-1 study. SIRS was diagnosed if the patient had at least 2 of 4 variables (hypothermia/fever, tachycardia, tachypnea, and leukocytosis/leukopenia) within 4 days of admission. Clinical outcome was measured on the Glasgow outcome scale 3 months after SAH. The relationship between clinical and radiologic variables and SIRS, angiographic vasospasm, delayed ischemic neurologic deficit (DIND), cerebral infarction, vasospasm-related infarction, and clinical outcome were modeled with uni- and multivariable analyses. Results 63% of patients developed SIRS. Many factors were associated with SIRS in univariate analysis, but only poor WFNS grade and pneumonia were independently associated with SIRS in multivariable analysis. SIRS burden (number of SIRS variables per day over the first 4 days) was associated with poor outcome, but not with angiographic vasospasm, DIND, or cerebral infarction. The method of aneurysm treatment was not associated with SIRS. Conclusion SIRS was associated with poor outcome but not angiographic vasospasm, DIND, or cerebral infarction after SAH in the CONSCIOUS-1 data. There was no support for the notion that neurosurgical clipping is associated with a greater risk of SIRS than endovascular coiling.

• Publisher: Humana Press Inc,Springer Nature B.V
• Subject: Adult / Aneurysms / Cardiac arrhythmia / Cerebral Infarction - drug therapy / Cerebral Infarction - epidemiology / Cerebral Infarction - etiology / Cerebral Infarction - surgery / Clinical outcomes / Critical Care Medicine / Databases as Topic / Dioxanes - therapeutic use / Doppler effect / Double-Blind Method / Female / Fever - epidemiology / Hemorrhage / Humans / Hypothermia / Hypothermia - epidemiology / Intensive / Intensive care / Internal Medicine / Ischemia / Leukocytosis - epidemiology / Male / Medical imaging / Medicine / Medicine & Public Health / Middle Aged / Mortality / Neurology / Original Article / Patients / Placebos / Pneumonia / Pyridines - therapeutic use / Pyrimidines - therapeutic use / Receptor, Endothelin A - drug effects / Receptor, Endothelin A - physiology / Sepsis / Standard deviation / Stroke / Subarachnoid Hemorrhage - complications / Sulfonamides - therapeutic use / Systemic Inflammatory Response Syndrome - epidemiology / Tachycardia - epidemiology / Tetrazoles - therapeutic use / Treatment Failure / Treatment Outcome / Urinary tract diseases / Urinary tract infections / Urogenital system / Variables / Vasospasm, Intracranial - drug therapy / Vasospasm, Intracranial - epidemiology / Vasospasm, Intracranial - etiology / Vasospasm, Intracranial - surgery / Veins & arteries