Acute systemic inflammatory response syndrome in subarachnoid hemorrhage.
OBJECTIVE
Systemic inflammatory response syndrome (SIRS) without infection is a well-known phenomenon that accompanies various acute cerebral insults. We sought to determine whether the initial SIRS score was associated with outcome in subarachnoid hemorrhage (SAH).


METHODS
In 103 consecutive patients with SAH, the occurrence of SIRS was assessed according to the presence of >/=2 of the following: temperature of <36 degrees C or >38 degrees C, heart rate of >90 bpm, respiratory rate of >20 breaths/min, and white blood cell count of <4000/mm(3) or >12 000/mm(3). SIRS criteria and other prognostic parameters were evaluated as predictors of dichotomous Glasgow Outcome Scale score.


RESULTS
SIRS was highly related to poor clinical grade (Hunt and Hess clinical grading scale), a large amount of SAH on CT (Fisher CT group), and high plasma glucose concentration on admission. By univariate analysis, the occurrence of SIRS was associated with higher mortality and morbidity rates than was the nonoccurrence (P<0.001). Among individual SIRS criteria, heart rate (P=0.003), respiration rate (P=0.003), and white blood cell count (P=0.03) were significant outcome predictors. By multivariate logistic regression analysis, the presence of SIRS independently predicted outcome. SIRS carried an increased risk of subsequent intracranial complications such as vasospasm and normal pressure hydrocephalus, as well as systemic complications.


CONCLUSIONS
In SAH patients, SIRS on admission reflected the extent of tissue damage at onset and predicted further tissue disruption, producing clinical worsening and, ultimately, a poor outcome.
Yoshimoto
Y
Y
Department of Neurosurgery, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama, Japan. yhyoshi@dokkyomed.ac.jp
Tanaka
Y
Y
Hoya
K
K
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D002648:Child; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D023261:Glasgow Outcome Scale; D006339:Heart Rate; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000453:epidemiology; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012119:Respiration; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000453:epidemiology*; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed
D001786:Blood Glucose