Boehme Amelia K, Comeau Mary E, Langefeld Carl D, Lord Aaron, Moomaw Charles J, Osborne Jennifer, James Michael L, Martini Sharyl, Testai Fernando D, Woo Daniel, Elkind Mitchell S V
Department of Neurology (A.K.B., M.S.V.E.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Wake Forest University (M.E.C., C.D.L.), NC; Department of Neurology (A.L.), New York University School of Medicine; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati, OH; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Baylor University, Houston, TX (S.M.); and University of Illinois Chicago (F.D.T.).
Neurol Neuroimmunol Neuroinflamm. 2017 Dec 22;5(2):e428. doi: 10.1212/NXI.0000000000000428. eCollection 2018 Mar.
Systemic inflammatory response syndrome (SIRS) may be related to poor outcomes after intracerebral hemorrhage (ICH).
The Ethnic/Racial Variations of Intracerebral Hemorrhage study is an observational study of ICH in whites, blacks, and Hispanics throughout the United Sates. SIRS was defined by standard criteria as 2 or more of the following on admission: (1) body temperature <36°C or >38°C, (2) heart rate >90 beats per minute, (3) respiratory rate >20 breaths per minute, or (4) white blood cell count <4,000/mm or >12,000/mm. The relationship among SIRS, infection, and poor outcome (modified Rankin Scale [mRS] 3-6) at discharge and 3 months was assessed.
Of 2,441 patients included, 343 (14%) met SIRS criteria at admission. Patients with SIRS were younger (58.2 vs 62.7 years; < 0.0001) and more likely to have intraventricular hemorrhage (IVH; 53.6% vs 36.7%; < 0.0001), higher admission hematoma volume (25.4 vs 17.5 mL; < 0.0001), and lower admission Glasgow Coma Scale (GCS; 10.7 vs 13.1; < 0.0001). SIRS on admission was significantly related to infections during hospitalization (adjusted odds ratio [OR] 1.36, 95% confidence interval [CI] 1.04-1.78). In unadjusted analyses, SIRS was associated with poor outcomes at discharge (OR 1.96, 95% CI 1.42-2.70) and 3 months (OR 1.75, 95% CI 1.35-2.33) after ICH. In analyses adjusted for infection, age, IVH, hematoma location, admission GCS, and premorbid mRS, SIRS was no longer associated with poor outcomes.
SIRS on admission is associated with ICH score on admission and infection, but it was not an independent predictor of poor functional outcomes after ICH.
全身炎症反应综合征（SIRS）可能与脑出血（ICH）后的不良预后相关。
脑出血的种族/民族差异研究是一项针对美国各地白人、黑人和西班牙裔脑出血患者的观察性研究。SIRS按照标准标准定义为入院时出现以下2项或更多情况：（1）体温<36°C或>38°C，（2）心率>90次/分钟，（3）呼吸频率>20次/分钟，或（4）白细胞计数<4000/mm或>12000/mm。评估了SIRS、感染与出院时及3个月时不良预后（改良Rankin量表[mRS]评分为3 - 6）之间的关系。
在纳入的2441例患者中，343例（14%）入院时符合SIRS标准。SIRS患者更年轻（58.2岁对62.7岁；P<0.0001），更可能发生脑室内出血（IVH；53.6%对36.7%；P<0.0001），入院时血肿体积更大（25.4 mL对17.5 mL；P<0.0001），入院时格拉斯哥昏迷量表（GCS）评分更低（10.7对13.1；P<0.0001）。入院时的SIRS与住院期间的感染显著相关（校正比值比[OR]为1.36，95%置信区间[CI]为1.04 - 1.78）。在未校正分析中，SIRS与脑出血后出院时（OR为1.96，95% CI为1.42 - 2.70）及3个月时（OR为1.75，95% CI为1.35 - 2.33）的不良预后相关。在针对感染、年龄、IVH、血肿位置、入院GCS及病前mRS进行校正的分析中，SIRS不再与不良预后相关。
入院时的SIRS与入院时的ICH评分及感染相关，但它并非脑出血后功能不良预后的独立预测因素。
