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

Tam, Alan; Ilodigwe, Don; Mocco, J; Mayer, Stephan A.; Kassell, Neal F.; Ruefenacht, Daniel; Schmiedek, Peter; Weidauer, Stephan; Pasqualin, A.; Macdonald, R. Loch

doi:10.1007/s12028-010-9402-x

Cited by 103 publications

(55 citation statements)

References 40 publications

(56 reference statements)

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“…10 Other studies found SIRS to be common after SAH and predictive of poor clinical outcome. 8,31,36 The magnitude of the changes in brain volume was small, but it is in the ranges measured reproducibly in other studies and that were of clinical importance. 7,30,37 Brain volumes decreased approximately 0.3% per year in healthy aging humans.…”

Section: Discussionmentioning

confidence: 51%

“…Variables possibly associated with global brain atrophy that were included were demographics (age, sex), medical history (history of hypertension, diabetes, smoking, and ischemic heart disease, and development of SIRS), 31 clinical characteristics on admission (WFNS grade, mean arterial blood pressure), radiological factors (aneurysm location and size, angiographic vasospasm, hydrocephalus [measured by ventriculocranial ratio], intraventricular hemorrhage, intracerebral hemorrhage, aneurysm securing procedure), and medical complications during hospitalization (episodes of CPP < 60 mm Hg, seizures, antiepileptic drug use, CSF drainage [external ventricular or lumbar drainage or lumbar puncture], permanent CSF diversion, angiographic vasospasm, and DIND). Systemic inflammatory response syndrome was defined as a patient with at least 2 of the variables included in SIRS on any day, up to 4 days after SAH; these variables were 1) temperature > 38°C (fever) or < 36°C (hypothermia); 2) leukocyte count > 12,000 (leu-kocytosis) or < 4000 (leukopenia); 3) heart rate > 90 beats per minute (tachycardia); and 4) respiratory rate > 20 per minute (tachypnea).…”

Section: Clinical Outcomesmentioning

confidence: 99%

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Impact of global cerebral atrophy on clinical outcome after subarachnoid hemorrhage

Tam

Kapadia

Ilodigwe

et al. 2013

JNS

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Object Atrophy in specific brain areas correlates with poor neuropsychological outcome after subarachnoid hemorrhage (SAH). Few studies have compared global atrophy in SAH with outcome. The authors examined the relationship between global brain atrophy, clinical factors, and outcome after SAH. Methods This study was a post hoc exploratory analysis of the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) trial, a randomized, double-blind, placebo-controlled trial of 413 patients with aneurysmal SAH. Patients with infarctions or areas of encephalomalacia on CT, and those with large clip/coil artifacts, were excluded. The 97 remaining patients underwent CT at baseline and 6 weeks, which was analyzed using voxel-based volumetric measurements. The percentage difference in volume between time points was compared against clinical variables. The relationship with clinical outcome was modeled using univariate and multivariate analysis. Results Older age, male sex, and systemic inflammatory response syndrome (SIRS) during intensive care stay were significantly associated with brain atrophy. Greater brain atrophy was significantly associated with poor outcome on the modified Rankin scale (mRS), severity of deficits on the National Institutes of Health Stroke Scale (NIHSS), worse executive functioning, and lower EuroQol Group–5D (EQ-5D) score. Adjusted for confounders, brain atrophy was not significantly associated with Mini-Mental State Examination and Functional Status Examination scores. Brain atrophy was not associated with angiographic vasospasm or delayed ischemic neurological deficit. Conclusions Worse mRS score, NIHSS score, executive functioning, and EQ-5D scores were associated with greater brain atrophy and older age, male sex, and SIRS burden. These data suggest outcome is associated with factors that cause global brain injury independent of focal brain injury.

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Section: Discussionmentioning

confidence: 51%

Section: Clinical Outcomesmentioning

confidence: 99%

Impact of global cerebral atrophy on clinical outcome after subarachnoid hemorrhage

Tam

Kapadia

Ilodigwe

et al. 2013

JNS

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“…15 It has also been shown previously using the CONSCIOUS-1 database that systemic inflammatory response syndrome after SAH is associated with a poor outcome. 16 Systemic inflammatory response syndrome was defined as 2 of the following 4 variables: hypothermia/fever, tachycardia, tachypnea, and leukocytosis or leukopenia. To our knowledge, the current study is the first to demonstrate a significant association between circulating neutrophil levels and patient phenotypes associated with poor neurological outcome in a large clinical cohort using data-driven methodology.…”

Section: Discussionmentioning

confidence: 99%

Patient Phenotypes Associated With Outcomes After Aneurysmal Subarachnoid Hemorrhage

Ibrahim

Morgan

Macdonald

2014

Stroke

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Background and Purpose-Predictors of outcome after aneurysmal subarachnoid hemorrhage have been determined previously through hypothesis-driven methods that often exclude putative covariates and require a priori knowledge of potential confounders. Here, we apply a data-driven approach, principal component analysis, to identify baseline patient phenotypes that may predict neurological outcomes. Methods-Principal component analysis was performed on 120 subjects enrolled in a prospective randomized trial of clazosentan for the prevention of angiographic vasospasm. Correlation matrices were created using a combination of Pearson, polyserial, and polychoric regressions among 46 variables. Scores of significant components (with eigenvalues >1) were included in multivariate logistic regression models with incidence of severe angiographic vasospasm, delayed ischemic neurological deficit, and long-term outcome as outcomes of interest. Results-Sixteen significant principal components accounting for 74.6% of the variance were identified. A single component dominated by the patients' initial hemodynamic status, World Federation of Neurosurgical Societies score, neurological injury, and initial neutrophil/leukocyte counts was significantly associated with poor outcome. Two additional components were associated with angiographic vasospasm, of which one was also associated with delayed ischemic neurological deficit. The first was dominated by the aneurysm-securing procedure, subarachnoid clot clearance, and intracerebral hemorrhage, whereas the second had high contributions from markers of anemia and albumin levels. Conclusions-Principal

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“…This could explain the dissociation between preventing any aVSP and improving outcomes in prior clinical trials. 19,20 Another possible explanation for this dissociation is that multifactorial processes drive aSAH complications such as cerebral infarction and delayed ischemic neurological deficits, 9,11,12,17 so improving outcomes may require combination therapy targeting aVSP plus other pathophysiological mechanisms.…”

Section: Macdonald Et Al Quality Of Life and Healthcare Burden Of Vasmentioning

confidence: 99%

Quality of Life and Healthcare Resource Use Associated With Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Macdonald

Hunsche²,

Schüler³

et al. 2012

Stroke

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Background and Purpose— In this analysis of data from a large clinical trial in aneurysmal subarachnoid hemorrhage, the impact of angiographic vasospasm (aVSP) on specific patient outcomes and inpatient healthcare resource use was assessed. Methods— This was a post hoc analysis of exploratory end points collected for 409 patients with aneurysmal subarachnoid hemorrhage in the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) trial. Central reviewers graded severity of aVSP as none, mild, moderate, or severe based on comparison of catheter angiograms obtained at baseline and 7 to 11 days after aneurysmal subarachnoid hemorrhage. Assessments of cognitive status (Mini-Mental State Examination) and patient-relevant outcomes (EuroQol total score and visual analog scale and Functional Status Examination) were administered at Week 12. The relationship between severity of aVSP and these end points as well as inpatient healthcare resource use (intensive care, general ward, and total hospital lengths of stay) was assessed using univariate and multivariate analyses. Results— Cognitive status and all patient-relevant outcome measures varied significantly ( P <0.0001) with severity of aVSP (mean for severe aVSP versus no aVSP, respectively: Mini-Mental State Examination, 18.0 versus 27.6; EuroQol total, 0.38 versus 0.74; EuroQol visual analog scale, 50.9 versus 75.5; Functional Status Examination, 20.5 versus 11.7). A significant inverse relationship with severity of aVSP was observed for total hospital days ( P =0.008) and days in the intensive care unit ( P <0.0001). On average, patients with severe aVSP stayed in the hospital 5 days longer than those with no aVSP. Conclusions— Severe aVSP is associated with poor cognition, worse patient-relevant outcomes, and greater inpatient healthcare resource use. Future studies assessing new aVSP treatments should include outcome measures that evaluate quality of recovery among survivors.

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

Abstract: 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.

Cited by 103 publications

References 40 publications

Impact of global cerebral atrophy on clinical outcome after subarachnoid hemorrhage

Impact of global cerebral atrophy on clinical outcome after subarachnoid hemorrhage

Patient Phenotypes Associated With Outcomes After Aneurysmal Subarachnoid Hemorrhage

Quality of Life and Healthcare Resource Use Associated With Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage

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