Predictors of systemic inflammatory response syndrome in ischemic stroke undergoing systemic thrombolysis with intravenous tissue plasminogen activator

Amelia K. Boehme, Niren Kapoor, Karen C. Albright, Michael J. Lyerly, Pawan Rawal, Reza Bavarsad Shahripour, Muhammad Alvi, J. Thomas Houston, April Sisson, T. Mark Beasley, Anne Alexandrov, Andrei Alexandrov, David W. Miller

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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.

Original languageEnglish (US)
JournalJournal of Stroke and Cerebrovascular Diseases
Volume23
Issue number4
DOIs
StatePublished - Jan 1 2014

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Systemic Inflammatory Response Syndrome
Tissue Plasminogen Activator
Stroke
Hospitalization
Cholesterol
Respiratory Rate
Body Temperature
Leukocyte Count
African Americans
Area Under Curve

All Science Journal Classification (ASJC) codes

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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Predictors of systemic inflammatory response syndrome in ischemic stroke undergoing systemic thrombolysis with intravenous tissue plasminogen activator. / Boehme, Amelia K.; Kapoor, Niren; Albright, Karen C.; Lyerly, Michael J.; Rawal, Pawan; Bavarsad Shahripour, Reza; Alvi, Muhammad; Houston, J. Thomas; Sisson, April; Beasley, T. Mark; Alexandrov, Anne; Alexandrov, Andrei; Miller, David W.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 23, No. 4, 01.01.2014.

Research output: Contribution to journalArticle

Boehme, Amelia K. ; Kapoor, Niren ; Albright, Karen C. ; Lyerly, Michael J. ; Rawal, Pawan ; Bavarsad Shahripour, Reza ; Alvi, Muhammad ; Houston, J. Thomas ; Sisson, April ; Beasley, T. Mark ; Alexandrov, Anne ; Alexandrov, Andrei ; Miller, David W. / Predictors of systemic inflammatory response syndrome in ischemic stroke undergoing systemic thrombolysis with intravenous tissue plasminogen activator. In: Journal of Stroke and Cerebrovascular Diseases. 2014 ; Vol. 23, No. 4.
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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.",
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T1 - Predictors of systemic inflammatory response syndrome in ischemic stroke undergoing systemic thrombolysis with intravenous tissue plasminogen activator

AU - Boehme, Amelia K.

AU - Kapoor, Niren

AU - Albright, Karen C.

AU - Lyerly, Michael J.

AU - Rawal, Pawan

AU - Bavarsad Shahripour, Reza

AU - Alvi, Muhammad

AU - Houston, J. Thomas

AU - Sisson, April

AU - Beasley, T. Mark

AU - Alexandrov, Anne

AU - Alexandrov, Andrei

AU - Miller, David W.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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.

AB - 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.

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DO - 10.1016/j.jstrokecerebrovasdis.2013.11.022

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JO - Journal of Stroke and Cerebrovascular Diseases

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SN - 1052-3057

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