Systemic inflammatory response syndrome without systemic inflammation in acutely ill patients admitted to hospital in a medical emergency

1999 ◽  
Vol 96 (3) ◽  
pp. 287 ◽  
Author(s):  
Annika TAKALA ◽  
Irma JOUSELA ◽  
Klaus T. OLKKOLA ◽  
Sten-Erik JANSSON ◽  
Marjatta LEIRISALO-REPO ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Systemic Inflammation ◽  
Systemic Inflammatory Response ◽  
Medical Emergency

Systemic inflammatory response syndrome without systemic inflammation in acutely ill patients admitted to hospital in a medical emergency

1999 ◽  
Vol 96 (3) ◽  
pp. 287-295 ◽  
Author(s):  
Annika TAKALA ◽  
Irma JOUSELA ◽  
Klaus T. OLKKOLA ◽  
Sten-Erik JANSSON ◽  
Marjatta LEIRISALO-REPO ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Systemic Inflammation ◽  
Interleukin 6 ◽  
Systemic Inflammatory Response ◽  
Composite Score ◽  
C Reactive Protein ◽  
Cd11b Expression ◽  
Reactive Protein ◽  
Markers Of Inflammation

Criteria of the systemic inflammatory response syndrome (SIRS) are known to include patients without systemic inflammation. Our aim was to explore additional markers of inflammation that would distinguish SIRS patients with systemic inflammation from patients without inflammation. The study included 100 acutely ill patients with SIRS. Peripheral blood neutrophil and monocyte CD11b expression, serum interleukin-6, interleukin-1β, tumour necrosis factor-α and C-reactive protein were determined, and severity of inflammation was evaluated by systemic inflammation composite score based on CD11b expression, C-reactive protein and cytokine levels. Levels of CD11b expression, C-reactive protein and interleukin-6 were higher in sepsis patients than in SIRS patients who met two criteria (SIRS2 group) or three criteria of SIRS (SIRS3 group). The systemic inflammation composite score of SIRS2 patients (median 1.5; range 0–8, n = 56) was lower than that of SIRS3 patients (3.5; range 0–9, n = 14, P = 0.013) and that of sepsis patients (5.0; range 3–10, n = 19, P< 0.001). The systemic inflammation composite score was 0 in 13/94 patients. In 81 patients in whom systemic inflammation composite scores exceeded 1, interleukin-6 was increased in 64 (79.0%), C-reactive protein in 59 (72.8%) and CD11b in 50 (61.7%). None of these markers, when used alone, identified all patients but at least one marker was positive in each patient. Quantifying phagocyte CD11b expression and serum interleukin-6 and C-reactive protein concurrently provides a means to discriminate SIRS patients with systemic inflammation from patients without systemic inflammation.

scholarly journals Neutrophil-to-Lymphocyte Ratio Predicts Cerebral Edema and Clinical Worsening Early After Reperfusion Therapy in Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Daniela Ferro ◽  
Margarida Matias ◽  
Joana Neto ◽  
Rafael Dias ◽  
Goreti Moreira ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Systemic Inflammation ◽  
Cerebral Edema ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Reperfusion Therapy ◽  
Systemic Inflammatory Response ◽  
Early Neurological Deterioration

Background and Purpose: The mechanisms linking systemic inflammation to poor outcome in ischemic stroke are not fully understood. The authors investigated if peripheral inflammation following reperfusion therapy leads to an increase in cerebral edema (CED), thus hindering the clinical recovery. Methods: We designed a single-center study conducted at Centro Hospitalar Universitário São João between 2017 and 2019. Inclusion criteria were being adult, having an anterior circulation acute ischemic stroke, and receiving reperfusion therapy. Neutrophil-to-lymphocyte, platelet-to-lymphocyte ratios, and the systemic inflammatory response syndrome criteria were determined. The presence and grade of CED were evaluated on the computed tomography performed 24 hours following event. The clinical outcomes included early neurological deterioration and functional dependence at 90 days. Adjusted odds ratio and 95% CI were obtained by ordinal and logistic regression models. Optimal cutoff values were defined using receiver operating characteristic analysis in the training cohort and validated in an independent data set. Results: Five hundred fifty-three patients were included. Neutrophil-to-lymphocyte increased with higher degrees of CED at 24 hours (adjusted odds ratio, 1.34 [1.09–1.68], P <0.01) and was associated with early neurological deterioration (adjusted odds ratio, 1.30 [1.04–1.63], P <0.05) and poor functional status at 90 days (adjusted odds ratio, 1.79 [1.28–2.48], P <0.01). Platelet-to-lymphocyte was not associated with the outcomes. Systemic inflammatory response syndrome was related to CED due to altered white blood cell counts. Neutrophil-to-lymphocyte was the best predictor with an area under the curve around 0.7. Neutrophil-to-lymphocyte ≥7 had and accuracy, sensitivity, and specificity around 60%. Conclusions: Increased systemic inflammation is linked to the severity of CED early after reperfusion therapy in stroke. Easily obtained inflammatory markers convey early warning alerts for patients at risk of severe neurological complications with an impact on long-term functional outcome. CED quantification should be included as an end point in proof-of-concept trials in immunomodulation in stroke.

scholarly journals Systemic inflammatory response syndrome (SIRS) without systemic inflammation

Critical Care ◽  
10.1186/cc163 ◽  
1998 ◽  
Vol 2 (Suppl 1) ◽  
pp. P033
Author(s):  
A Takala ◽  
I Jousela ◽  
O Takkunen ◽  
KT Olkkola ◽  
S-E Jansson ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Systemic Inflammation ◽  
Systemic Inflammatory Response

Abstract 23: The Systemic Inflammatory Response Syndrome Following Cardiac Surgery

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Niall S MacCallum ◽  
Sarah E Gordon ◽  
Gregory J Quinlan ◽  
Timothy W Evans ◽  
Simon J Finney
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Systemic Inflammation ◽  
Systemic Inflammatory Response ◽  
Icu Stay ◽  
Prolonged Icu Stay ◽  
Post Cardiac Surgery ◽  
Sirs Criteria

The systemic inflammatory response syndrome (SIRS) is the leading cause of morbidity & mortality in the critically ill. It is associated with a 50% reduction in 5 year life expectancy. SIRS is defined as 2 of the following criteria: heart rate >90, respiratory rate >20 or pCO 2 <4.3kPa, temperature <36 or >38°C, white cell count <4 or >12 x10 9 /l. These criteria are used to stratify patients for specific therapies & in research to define interventional groups. Cardiac surgery is associated with systemic inflammation. The validity of the SIRS criteria have never been formally evaluated post cardiac surgery. We undertook to describe the incidence of SIRS post cardiac surgery & relate this to outcome. Methods: We retrospectively analysed prospectively collected data from 2764 consecutive admissions following cardiac surgery (coronary bypass grafting 1425, valve surgery 763, combined procedure 252, other 324). The number of criteria met simultaneously within 1 hour epochs was recorded for the entire admissions. Results: 96.4%, 57.9% & 12.2% of patients met at least 2, 3 or 4 criteria respectively within 24hrs of admission. The temperature criterion was least often fulfilled. ICU mortality was 2.67%. Length of stay exceeded 3 days in 18.5% of patients. The capacity of the criteria to predict mortality & prolonged ICU stay is presented in the table . Discussion: Nearly all patients fulfilled the standard 2 criteria definition of SIRS within 24hrs of admission. This definition does not adequately define the subgroup of patients with greater systemic inflammation, mortality or length of stay. Thus, some clinical manifestations of inflammation are very common following cardiac surgery, although not necessarily prognostic. By contrast, the presence of 3 or more criteria was more discriminatory of death & prolonged ICU stay. We propose that 3 or more SIRS criteria is a more appropriate threshold that defines those patients with clinically significant inflammation post cardiac surgery.

Systemic inflammatory response syndrome after major abdominal surgery

2019 ◽  
pp. 113-116
Author(s):  
Abdullah AlSomali ◽  
Abdullah Mobarki ◽  
Mohammed Almuhanna ◽  
Abdullah Alqahtani ◽  
Ziyad Alhawali ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Abdominal Surgery ◽  
Systemic Inflammatory Response ◽  
Major Abdominal Surgery
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