Impact of systemic inflammatory response syndrome on acute ischemic stroke patients treated with mechanical thrombectomy

Jafari, Mostafa; Katlowitz, Kalman; Garza, Carlos De la; Sellers, Alexander; Moore, Shawn; Hall, Hayden; Desai, Aaron; Singh, Vikramjeet; Damani, Rahul

doi:10.1016/j.jns.2021.119988

Cited by 4 publications

(6 citation statements)

References 22 publications

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“…Previous studies have shown that WCC, CRP, and NLR are elevated in acute stroke, particularly with greater stroke severity, larger lesion volume, poor functional outcome, and recurrent stroke, 42 , 43 and the few data available suggest that similar factors are associated with the presence of SIRS. 44 , 45 The reported prevalence of SIRS following stroke ranges from 14% to 36% on admission 44 , 45 , 46 , 47 , 48 and 22% to 53% during admission, 48 similar to the rates observed in our study (27% on admission, 45% during admission). Elevated inflammatory markers in acute stroke may also occur from chronic comorbidities, such as diabetes, hypertension, and smoking, 49 though in our study, smoking and diabetes rates were relatively uncommon.…”

Section: Discussionsupporting

confidence: 89%

Infection, Inflammation, and Poststroke Cognitive Impairment

Milosevich,

Demeyere,

Pendlebury

2024

JAHA

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Background Infection and inflammation are dementia risk factors in population‐based cohorts; however, studies in stroke are scarce. We determined the prevalence of infection after stroke and routinely measured inflammatory biomarkers during hospitalization and their associations with acute and 6‐month cognitive impairment. Methods and Results A prospective stroke cohort completed the Oxford Cognitive Screen at ≤2 weeks and 6 months after stroke. Infection, inflammatory markers (C‐reactive protein, white cell count, and neutrophil/lymphocyte ratio), and systemic inflammatory response syndrome were ascertained throughout admission with electronic patient records supplemented by hand searches. Associations with acute and 6‐month global and domain‐specific cognitive impairment were analyzed using multivariable regression, adjusting for demographic/vascular factors and stroke severity. Among 255 patients (mean age, 73.9 [SD, 12.6] years; 46.3% women; mean education, 12.6 [SD, 3.7] years; median National Institutes of Health Stroke Scale score 5 [range, minimum‐maximum, 0–30]), infection was present in 90 patients (35.3%) at mean 4.4 (SD, 6.9) days after stroke, consisting predominantly of pneumonia (47/90; 52%) and urinary tract infection (39/90; 43%). Admission white cell count was elevated in 25.1% (n=64; mean, 9.5×10 9 /L [SD, 3.2×10 9 /L]), C‐reactive protein in 41.2% (n=105; mean, 27.5 [SD, 50.9 mg/L]), neutrophil/lymphocyte ratio in 55.7% (n=97; mean, 5.5 [SD, 4.5]), and systemic inflammatory response syndrome in 26.6% (n=53 [45.2%] positive during hospitalization). Infection was associated with acute and 6‐month poststroke cognitive impairment ( P <0.05 adj ) with stronger associations acutely for severe infection (infection+systemic inflammatory response syndrome; P =0.03 adj ). Acute language, executive function and attention domain impairments, and 6‐month number processing impairment were associated with infection ( P <0.05 adj ). No significant relationships were found for any biomarker and cognitive impairment. Conclusions Infection and elevations in routinely measured inflammatory biomarkers are common following stroke; however, only infection is associated with poststroke cognitive impairment, suggesting that increases in these biomarkers may be nonspecific. Infection may present a tractable target for reducing poststroke cognitive impairment.

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Section: Discussionsupporting

confidence: 89%

Infection, Inflammation, and Poststroke Cognitive Impairment

Milosevich,

Demeyere,

Pendlebury

2024

JAHA

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“…Concurrent diagnosis of other malignant tumors that may seriously affect survival; (4). Accompanied with severe infectious diseases or liver and kidney dysfunction; (5). Severe bleeding tendency; (6).…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

“…Some domestic and foreign AIS treatment guidelines ( 4 ) recommend EVT as the first choice of treatment when intravenous thrombolysis is contraindicated or ineffective. Studies have shown that the overexpression of inflammatory factors and abnormal secretion of neurohormones in the pathogenesis of AIS aggravates the degree of neurological impairment and affects the prognosis of patients ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Risk factors of acute ischemic stroke and the role of angiotensin I in predicting prognosis of patients undergoing endovascular thrombectomy

Yang,

Li,

Huang

et al. 2024

Front. Endocrinol.

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PurposeThe interaction between the renin-angiotensin system (RAS) and the acute ischemic stroke (AIS) is definite but not fully understood. This study aimed to analyze the risk factors of AIS and explore the role of serum indicators such as angiotensin I (Ang I) in the prognosis of patients undergoing endovascular thrombectomy (EVT).Patients and methodsPatients with AIS who underwent EVT and healthy controls were retrospectively enrolled in this study, and the patients were divided into a good or a poor prognosis group. We compared Ang I, blood routine indexes, biochemical indexes, electrolyte indexes, and coagulation indexes between patients and controls. We used univariate and multivariate logistic regression analyses to evaluate possible risk factors for AIS and the prognosis of patients undergoing EVT. Independent risk factors for the prognosis of patients undergoing EVT were identified through multifactorial logistic regression analyses to construct diagnostic nomograms, further assessed by receiver operating characteristic curves (ROC).ResultsConsistent with previous studies, advanced age, high blood glucose, high D-dimer, and high prothrombin activity are risk factors for AIS. In addition, Ang I levels are lower in AIS compared to the controls. The level of Ang I was higher in the good prognosis group. Furthermore, we developed a nomogram to evaluate its ability to predict the prognosis of AIS after EVT. The AUC value of the combined ROC model (Ang I and albumin-globulin ratio (AGR)) was 0.859.ConclusionsIn conclusion, advanced age, high blood glucose, high D-dimer, and high prothrombin activity are risk factors for AIS. The combined Ang I and AGR model has a good predictive ability for the prognosis of AIS patients undergoing arterial thrombectomy.

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“…Table 1 shows the clinical characteristics of patients with or without SIRS. The former were significantly younger (52 years, IQR [42-62] versus 57 years, IQR [49-66]), had higher SBP and DBP, lower GCS scores (8, IQR [6][7][8][9][10][11][12][13][14] versus 14, IQR [12][13][14][15]), higher NIHSS scores (18, IQR [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] versus 8, IQR [3][4][5][6][7][8][9][10][11][12][13][14][15]), an increased frequency of in-hospital infection (56.1% versus 23.4%) and brain surgery (39.5% versus 17.4%) compared to the patients without SIRS (P <0.05 for all). Both groups had similar distributions of gender, history of hypertension, prior mRS, smoking, and time from ICH to admission.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“… 8 Presentation with SIRS increases the risk of death, as well as reduces the odds of favorable outcomes for ischemic stroke patients with endovascular treatment. 9 , 10 In patients treated with intravenous thrombolysis, SIRS remains an independent risk factor for adverse outcomes. 11 Besides ischemic stroke, SIRS has independently predicted subsequent complications after subarachnoid hemorrhage, such as vasospasm, normal pressure hydrocephalus, and systemic complications.…”

Section: Introductionmentioning

confidence: 99%

Systemic Inflammatory Response Syndrome on Admission and Clinical Outcomes After Intracerebral Hemorrhage

Liu¹,

Wang²,

Wang³

et al. 2023

JIR

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Background Since studies on systemic inflammatory response syndrome (SIRS) in patients with acute intracerebral hemorrhage (ICH) are insufficient. This study investigated the associations between SIRS on admission and clinical outcomes after acute ICH. Patients and Methods The study included 1159 patients with acute spontaneous ICH from January 2014 to September 2016. In accordance with standard criteria, SIRS was defined as two or more of the following: (1) body temperature >38°C or <36°C, (2) respiratory rate >20 per minute, (3) heart rate >90 per minute, and (4) white blood cell count >12,000/μL or <4000/μL. The clinical outcomes of interest were death and major disability (defined as a modified Rankin Scale of 6 and 3–5), combined and separate at 1 month, 3 months and 1 year follow-up. Results SIRS was observed in 13.5% (157/1159) of patients and independently increased the risk of death at 1 month, 3 months, or 1 year: hazard ratio (HR) 2.532 (95% confidence interval [CI] 1.487–4.311), HR 2.436 (95% CI 1.499–3.958), HR 2.030 (95% CI 1.343–3.068), respectively ( P <0.05 for all). The relationship between SIRS and ICH mortality was more pronounced in older patients or patients with larger hematoma volumes. Patients with in-hospital infections were at greater risk of major disability. The risk was enhanced when SIRS was incorporated. Conclusion The presence of SIRS at the time of admission was associated with mortality in patients with acute ICH, particularly in older patients and those with large hematomas. SIRS may exacerbate the disability caused by in-hospital infections in patients with ICH.

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Impact of systemic inflammatory response syndrome on acute ischemic stroke patients treated with mechanical thrombectomy

Cited by 4 publications

References 22 publications

Infection, Inflammation, and Poststroke Cognitive Impairment

Infection, Inflammation, and Poststroke Cognitive Impairment

Risk factors of acute ischemic stroke and the role of angiotensin I in predicting prognosis of patients undergoing endovascular thrombectomy

Systemic Inflammatory Response Syndrome on Admission and Clinical Outcomes After Intracerebral Hemorrhage

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