Impact of systemic inflammatory response syndrome on vasospasm, cerebral infarction, and outcome after subarachnoid hemorrhage: exploratory analysis of CONSCIOUS-1 database.
BACKGROUND
Systemic inflammatory response syndrome (SIRS) may develop after aneurysmal subarachnoid hemorrhage (SAH). We investigated factors associated with SIRS after SAH, whether SIRS was associated with complications of SAH such as vasospasm, cerebral infarction, and clinical outcome, and whether SIRS could contribute to a difference in outcome between patients treated by endovascular coiling or neurosurgical clipping of the ruptured aneurysm.


METHODS
This was exploratory analysis of 413 patients in the CONSCIOUS-1 study. SIRS was diagnosed if the patient had at least 2 of 4 variables (hypothermia/fever, tachycardia, tachypnea, and leukocytosis/leukopenia) within 4 days of admission. Clinical outcome was measured on the Glasgow outcome scale 3 months after SAH. The relationship between clinical and radiologic variables and SIRS, angiographic vasospasm, delayed ischemic neurologic deficit (DIND), cerebral infarction, vasospasm-related infarction, and clinical outcome were modeled with uni- and multivariable analyses.


RESULTS
63% of patients developed SIRS. Many factors were associated with SIRS in univariate analysis, but only poor WFNS grade and pneumonia were independently associated with SIRS in multivariable analysis. SIRS burden (number of SIRS variables per day over the first 4 days) was associated with poor outcome, but not with angiographic vasospasm, DIND, or cerebral infarction. The method of aneurysm treatment was not associated with SIRS.


CONCLUSIONS
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.
Tam
Alan K H
AK
Division of Neurosurgery, St. Michael's Hospital, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
Ilodigwe
Don
D
Mocco
Jay
J
Mayer
Stephan
S
Kassell
Neal
N
Ruefenacht
Daniel
D
Schmiedek
Peter
P
Weidauer
Stephan
S
Pasqualin
Alberto
A
Macdonald
R Loch
RL
D000328:Adult; D002544:Cerebral Infarction / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D019992:Databases as Topic; D004146:Dioxanes / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005334:Fever / Q000453:epidemiology; D006801:Humans; D007035:Hypothermia / Q000453:epidemiology; D007964:Leukocytosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010919:Placebos; D011725:Pyridines / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D044022:Receptor, Endothelin A / Q000187:drug effects / Q000502:physiology; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013449:Sulfonamides / Q000627:therapeutic use*; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology*; D013610:Tachycardia / Q000453:epidemiology; D013777:Tetrazoles / Q000627:therapeutic use*; D017211:Treatment Failure; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery
D004146:Dioxanes; D010919:Placebos; D011725:Pyridines; D011743:Pyrimidines; D044022:Receptor, Endothelin A; D013449:Sulfonamides; D013777:Tetrazoles; C109641:clazosentan