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.

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.

Abstract TP151: Association of Splenic Contraction And Development of Systemic Inflammatory Response Syndrome After Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Alicia M Zha ◽  
Bhargav Tippinayani ◽  
Jaskaren Randhawa ◽  
Nicole J Pariseau ◽  
Farhaan S Vahidy ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Care Center ◽  
Tertiary Care ◽  
Systemic Inflammatory Response ◽  
Secondary Brain Injury ◽  
Stroke Patients

Background: Animal models have demonstrated the deleterious contribution that immunocytes from the spleen exert on secondary brain injury after stroke. While previous work has demonstrated that there is splenic contraction (SC) in patients with acute ischemic stroke (AIS) and intracranial hemorrhage (ICH), no clinical studies have connected the systemic inflammatory response syndrome (SIRS) with SC. We aim to associate SIRS and its individual components with SC in acute stroke Methods: This is a retrospective analysis of a previous prospective observational study where daily spleen sizes were evaluated in 178 acute stroke patients in a tertiary care center from 2010-2013. Spleen contraction was defined compared to previously established normograms of healthy volunteers from the same study. SIRS was defined as the presence of 2 or more of the following: body temperature <36 or >38C, heart rate >90 beats, respiratory rate >20, and serum white blood cell count >12,000 or <4000 mm3 in the absence of infection. SC was evaluated in patients at 24 and 72 hrs after AIS with SIRS as a primary outcome. Results: 91 patients had verified AIS without concurrent infection at admission and 70 of these patients remained inpatient at 72 hrs. SIRS was not associated with admission SC at 24hr and 72 hrs. Patients with SIRS at 24 and 72 hrs were more likely to have higher admission NIHSS. SIRS was associated with higher discharge mRS (OR 4.24, 95% CI 1.64-10.9, p=0.0028) and PEG placement (OR 3.70, 95% CI 0.95-15.11, p=0.05). 16 patients (22.9%) developed SIRS by 72hrs, only 5 of whom had SC initially. 28 patients (47%) had SIRS on admission that persisted, 12 of whom had SC. SC was not associated with SIRS at 72 hrs (OR 1.05, 95% CI 0.35-2.79, p = 0.92). 14 patients (15%) developed infections while hospitalized, of which 85% had SIRS on admission. Conclusion: Based on our initial evaluation, SC detected within 24 hrs of stroke onset is not associated with SIRS suggesting that the relationship between the two may be more complicated in humans. Consistent with prior studies, however, SIRS is associated with worse outcome. Further studies and additional time points are necessary to further clarify the role of the spleen in the development of SIRS in stroke patients.

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

scholarly journals Effect of Recanalization on Cerebral Edema in Ischemic Stroke Treated With Thrombolysis and/or Endovascular Therapy

Stroke ◽  
2020 ◽  
Vol 51 (1) ◽  
pp. 216-223 ◽  
Author(s):  
Magnus Thorén ◽  
Anand Dixit ◽  
Irene Escudero-Martínez ◽  
Zuzana Gdovinová ◽  
Lukas Klecka ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Edema ◽  
Odds Ratio ◽  
Lower Risk ◽  
Adjusted Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Secondary Outcome ◽  
Stroke Treatment ◽  
Blood Brain Barrier Disruption

Background and Purpose— A large infarct and expanding cerebral edema (CED) due to a middle cerebral artery occlusion confers a 70% mortality unless treated surgically. Reperfusion may cause blood-brain barrier disruption and a risk for cerebral edema and secondary parenchymal hemorrhage (PH). We aimed to investigate the effect of recanalization on development of early CED and PH after recanalization therapy. Methods— From the SITS-International Stroke Treatment Registry, we selected patients with signs of artery occlusion at baseline (either Hyperdense Artery Sign or computed tomography/magnetic resonance imaging angiographic occlusion). We defined recanalization as the disappearance of radiological signs of occlusion at 22 to 36 hours. Primary outcome was moderate to severe CED and secondary outcome was PH on 22- to 36-hour imaging scans. We used logistic regression with adjustment for baseline variables and PH. Results— Twenty two thousand one hundred eighty-four patients fulfilled the inclusion criteria (n=18 318 received intravenous thrombolysis, n=3071 received intravenous thrombolysis+thrombectomy, n=795 received thrombectomy). Recanalization occurred in 64.1%. Median age was 71 versus 71 years and National Institutes of Health Stroke Scale score 15 versus 16 in the recanalized versus nonrecanalized patients respectively. Recanalized patients had a lower risk for CED (13.0% versus 23.6%), adjusted odds ratio (aOR), 0.52 (95% CI, 0.46–0.59), and a higher risk for PH (8.9% versus 6.5%), adjusted odds ratio, 1.37 (95% CI, 1.22–1.55), than nonrecanalized patients. Conclusions— In patients with acute ischemic stroke, recanalization was associated with a lower risk for early CED even after adjustment for higher rate for PH in recanalized patients.

Polymorphisms in Toll-like receptor 4 and the systemic inflammatory response syndrome

2003 ◽  
Vol 31 (3) ◽  
pp. 652-653 ◽  
Author(s):  
N.J.A. Child ◽  
I.A. Yang ◽  
M.C.K. Pulletz ◽  
K. de Courcy-Golder ◽  
A.-L. Andrews ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Odds Ratio ◽  
Systemic Inflammatory Response ◽  
Minor Allele ◽  
Morbidity And Mortality ◽  
Toll Like Receptor ◽  
Toll Like Receptor 4

The systemic inflammatory response syndrome (SIRS) is a major cause of morbidity and mortality, and is thought to be due to an over-amplification of an inflammatory response. The Toll-like receptor 4 (TLR4) Asp-299→Gly polymorphism has been shown to reduce lipopolysaccharide responsiveness. We examined whether this TLR4 polymorphism is associated with severity of SIRS. A trend was found between the minor allele and mortality in SIRS (odds ratio of 4.3; P=0.076), suggesting a role for TLR4 signalling in the severity of SIRS.

Abstract TP278: Prevalence Of Systemic Inflammatory Response Syndrome and its Impact On Outcome In Acute Ischemic Stroke Patients Receiving IV tPA Therapy

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Niren Kapoor ◽  
Amelia K Boehme ◽  
Karen C Albright ◽  
Michael J Lyerly ◽  
Reza Bavarsad Shahripour ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Systemic Inflammatory Response ◽  
Short Term ◽  
Sirs Criteria ◽  
Iv Tpa

Background: Systemic Inflammatory Response Syndrome (SIRS) is a generalized inflammatory state linked to a release of various pro- and anti-inflammatory cytokines and associated with fibrin deposition, platelet aggregation, and coagulopathies. Although SIRS is associated with various inflammatory and ischemic conditions, its prevalence and impact on patients with acute ischemic stroke (AIS) has not been extensively studied. Methods: A retrospective cross sectional study was used to look at the prevalence of SIRS and its impact on outcome in AIS patients treated with IV tPA between 2009-2011 at our tertiary care center. SIRS was diagnosed if two or more of the following were present: temperature < 36°C or > 38°C, heart rate > 90/min, respiratory rate >20/min or PaCO 2 <32 mmHg and WBC count <4000/mm 3 or >12000/mm 3 or 10% bands. Patients meeting the SIRS criteria for at least 24h were included in the study. Patients with signs of active infection such as pneumonia, UTI, bacteremia, and sinusitis or deep venous thrombosis were excluded from the study. The discharge modified Rankin score (mRS) was used to compare the short-term outcomes between patients with and without SIRS. An mRS of 4-6 was used to define poor functional outcome. Results: Out of the 212 patients screened, 44 met the SIRS criteria (21%). The median NIHSS for SIRS patients was 9 (range 0-32). SIRS patients were more likely to have a longer length of stay than non-SIRS patients (5 vs. 3 days; p<0.0001). Patients with SIRS had worse functional outcomes compared to patients without SIRS (OR=2.824, 95% CI, 1.358 - 5.871, p=0.0054). Adjusting for pre-tPA NIHSS, age and race, SIRS remained a predictor of poor outcome (OR= 2.581, 95% CI, 1.163 - 5.727, p=0.0197). Presence of SIRS did not have a significant effect upon in-hospital mortality (OR=1.978, 95% CI, 0.774 - 5.057, p=0.1545). Conclusions: One out of five AIS patients treated with IV tPA developed SIRS. The presence of SIRS is associated with poor short-term functional outcomes and prolonged length of stay.

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.

Abstract 1122‐000007: Impact of Systemic Inflammatory Response Syndrome on Acute Ischemic Stroke Patients Treated with Mechanical Thrombectomy

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Mostafa Jafari ◽  
Kalman Katlowitz ◽  
Carlos De la Garza ◽  
Alexander Sellers ◽  
Shawn Moore ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Systemic Inflammatory Response ◽  
Sample Population ◽  
Poor Outcomes

Introduction : Systemic inflammatory response syndrome (SIRS) has been associated with poor outcomes after acute ischemic stroke (AIS). The primary goal of this study was to determine whether SIRS status on admission correlated with functional outcomes in AIS treated with mechanical thrombectomy (MT). Methods : Consecutive patients from September 2015 to April 2019 were retrospectively reviewed for SIRS on admission. SIRS was defined as the presence of ≥2 of the following: temperature <36°C or >38°C, heart rate >90, respiratory rate >20, and white blood cell count <4000/mm or >12 000 mm. Results : Of 202 patients, 188 met inclusion criteria. 49 patients (26%) had evidence of SIRS. Neither basic patient demographics nor standard stroke risk factors predicted the development of SIRS. However, presentation with SIRS was correlated with higher rates of death (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.2‐5.5) as well as lower rates of favorable functional outcomes at discharge (OR, 0.09; 95% CI, 0.02‐0.40) and 3‐month follow up (OR 0.12; 95% CI 0.03‐0.43). These results remained significant even after adjustment for age, sex, baseline NIHSS, recanalization status, and prior co‐morbidities. Conclusions : In our sample population, SIRS was associated with worse outcomes and higher rates of mortality in AIS patients treated with MT. Recognition of key risk factors can provide better prognostication and possible future therapeutic targets.

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