title: Predictors of systemic inflammatory response syndrome in ischemic stroke undergoing systemic thrombolysis with intravenous tissue plasminogen activator.
abstract: BACKGROUND
  Systemic inflammatory response syndrome (SIRS) is an inflammatory process associated with poor outcomes in acute ischemic stroke (AIS) patients. However, no study to date has investigated predictors of SIRS in AIS patients treated with intravenous (IV) tissue plasminogen activator (tPA).
  
  
  METHODS
  Consecutive patients were retrospectively reviewed for evidence of SIRS during their acute hospitalization. SIRS was defined as the presence of 2 or more of the following: (1) body temperature less than 36°C or greater than 38°C, (2) heart rate greater than 90, (3) respiratory rate greater than 20, or (4) white blood cell count less than 4000/mm or greater than 12,000/mm or more than 10% bands for more than 24 hours. Those diagnosed with an infection were excluded. A scoring system was created to predict SIRS based on patient characteristics available at the time of admission. Logistic regression was used to evaluate potential predictors of SIRS using a sensitivity cutoff of ≥65% or area under the curve of .6 or more.
  
  
  RESULTS
  Of 212 patients, 44 had evidence of SIRS (21%). Patients with SIRS were more likely to be black (61% versus 54%; P = .011), have lower median total cholesterol at baseline (143 versus 167 mg/dL; P = .0207), and have history of previous stroke (51% versus 35%; P = .0810). Ranging from 0 to 6, the SIRS prediction score consists of African American (2 points), history of hypertension (1 point), history of previous stroke (1 point), and admission total cholesterol less than 200 (2 points). Patients with an SIRS score of 4 or more were 3 times as likely to develop SIRS when compared with patients with a score of ≤3 (odds ratio = 2.815, 95% confidence interval 1.43-5.56, P = .0029).
  
  
  CONCLUSIONS
  In our sample of IV tPA-treated AIS patients, clinical and laboratory characteristics available on presentation were able to identify patients likely to develop SIRS during their acute hospitalization. Validation is required in other populations. If validated, this score could assist providers in predicting who will develop SIRS after treatment with IV tPA.
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Niren
authors.initials: N
authors.lastname: Kapoor
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education, Birmingham, Alabama; Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities Minority Health and Health Disparities Research Center, Birmingham, Alabama.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama; Stroke Center, Birmingham VA Medical Center, Birmingham, Alabama.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lyerly
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Pawan V
authors.initials: PV
authors.lastname: Rawal
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Reza
authors.initials: R
authors.lastname: Bavarsad Shahripour
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Alvi
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Houston
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: April
authors.initials: A
authors.lastname: Sisson
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: T Mark
authors.initials: TM
authors.lastname: Beasley
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Alexandrov
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
authors.affiliation: Department of Anesthesiology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: dwmiller@uab.edu.
authors.forename: David W
authors.initials: DW
authors.lastname: Miller
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications* / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000628:therapy*; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Thrombolysis; inflammation; stroke outcome; systemic inflammatory response syndrome