title: Systemic Inflammatory Response Syndrome Predicts Severity of Stroke and Outcome.
abstract: BACKGROUND
  This study was undertaken to evaluate the frequency of systemic inflammatory response syndrome (SIRS) at admission and its correlation with clinical and radiological severity of stroke and outcome.
  
  
  METHODS
  Two hundred consecutive stroke patients within 48 hours of ictus were prospectively included, and their clinical details including Glasgow Coma Scale (GCS), National Institutes of Health Stroke Scale (NIHSS), and feature of raised intracranial tension were noted. Computed tomography/magnetic resonance imaging finding included stroke type, location, size, midline shift, herniation, and intraventricular hemorrhage score. SIRS was noted on days 1, 2, 7, and 15. Death and outcome at 3 months were based on modified Rankin Scale (mRS) score.
  
  
  RESULTS
  Seventy-five (37.5%) had infraction and 125(62.5%) intracranial hemorrhage (ICH). SIRS was present in 120 (60%) patients: all the features in 56 (28%), 3 in 48 (24%), and 2 in 16 (8%). The presence of SIRS decreased with time: on the second day in 57%, seventh day in 43%, and 15th day in 21% of patients. Admission SIRS correlated with the GCS score (P < .001), NIHSS score (P < .001), volume of ICH (P < .001), infarction size (P < .001), hypernatremia (P = .001), and respiratory paralysis (P < .001). Thirty-one (15.5%) patients died, and 30 (97%) of them had SIRS. At 3 months, 110 (55%) patients had poor outcome (mRS >2) and of them 90 (82%) had SIRS (P < .001). On multivariate regression analysis, the number of SIRS criteria (P = .16) was not significantly related to 3-month outcome and death but independently related to NIHSS score at admission (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.22-1.56; P < .001), GCS score (OR = 1.32; 95% CI = 1.01-1.71; P = .04), and duration of hospitalization (OR = 1.07; 95% CI = 1.01-1.15; P = .03).
  
  
  CONCLUSIONS
  SIRS at presentation is a useful marker for clinicoradiological severity of stroke but not an independent marker of death and disability.
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. Electronic address: jayanteek@yahoo.com.
authors.forename: Jayantee
authors.initials: J
authors.lastname: Kalita
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Jogendra
authors.initials: J
authors.lastname: Bastia
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Sanjeev K
authors.initials: SK
authors.lastname: Bhoi
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Usha K
authors.initials: UK
authors.lastname: Misra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Stroke; death; infarction; intracerebral hemorrhage; outcome; systemic inflammatory response syndrome