title: Systemic Inflammatory Response Syndrome and Outcomes in Intracerebral Hemorrhage.
abstract: To identify the patients at greatest odds for systemic inflammatory response syndrome (SIRS) and examine the association between SIRS and outcomes in patients presenting with intracerebral hemorrhage (ICH).
  
  
  
  We retrospectively reviewed consecutive patients presenting to a tertiary care center from 2008 to 2013 with ICH. SIRS was defined according to standard criteria as 2 or more of the following: (1) body temperature <36 or >38 °C, (2) heart rate >90 beats per minute, (3) respiratory rate >20, or (4) white blood cell count <4000/mm(3) or >12,000/mm(3) or >10 % polymorphonuclear leukocytes for >24 h in the absence of infection. The outcomes of interest, discharge modified Rankin Scale (mRS 4-6), death, and poor discharge disposition (discharge anywhere but home or inpatient rehab) were assessed using logistic regression.
  
  
  
  A total of 249 ICH patients met inclusion criteria and 53 (21.3 %) developed SIRS during their hospital stay. A score was developed (ranging from 0 to 3) to identify patients at greatest risk for developing SIRS. Adjusting for stroke severity, SIRS was associated with mRS 4-6 (OR 5.25, 95 %CI 2.09-13.2) and poor discharge disposition (OR 3.74, 95 %CI 1.58-4.83) but was not significantly associated with death (OR 1.75, 95 %CI 0.58-5.32). We found that 33 % of the effect of ICH score on poor functional outcome at discharge was explained by the development of SIRS in the hospital (Sobel 2.11, p = 0.03).
  
  
  
  We observed that approximately 20 % of patients with ICH develop SIRS, and that patients with SIRS were at increased risk of having poor functional outcome at discharge.
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA. akb2188@cumc.columbia.edu.|Department of Neurology, Gertrude Sergievsky Center, Columbia University, 710 W 168th Street, Room 612, New York, NY, 10032, USA. akb2188@cumc.columbia.edu.
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.affiliation: Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.|Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
authors.forename: Angela N
authors.initials: AN
authors.lastname: Hays
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
authors.forename: Kimberly P
authors.initials: KP
authors.lastname: Kicielinski
authors.affiliation: Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
authors.forename: Kanika
authors.initials: K
authors.lastname: Arora
authors.affiliation: Division of Neurocritical Care, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Niren
authors.initials: N
authors.lastname: Kapoor
authors.affiliation: Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lyerly
authors.affiliation: Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
authors.forename: Alissa
authors.initials: A
authors.lastname: Gadpaille
authors.affiliation: Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
authors.forename: Harn
authors.initials: H
authors.lastname: Shiue
authors.affiliation: Geriatric Research Education and Clinical Center (GRECC), Birmingham VA Medical Center, Birmingham, AL, 35233, USA.|Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35249, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Albright
authors.affiliation: Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
authors.forename: David
authors.initials: D
authors.lastname: Miller
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Harrigan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology*; D055815:Young Adult
keywords: Epidemiology; Inflammation; Intracerebral hemorrhage; Stroke; Systemic inflammatory response syndrome