Systemic Inflammatory Response Syndrome and Outcomes in Ischemic Patients Treated with Endovascular Treatment

Figures & data

Figure 1 Inclusion flow chart.

Table 1 Demographics and Baseline and Outcome Characteristics Stratified by SIRS

	All Patients (n=256)	Non-SIRS (n=165)	SIRS (n=91)	P-value	Odds Ratio (95% CI)	P-value
Age, mean (SD), y	68.1 (11.6)	67.9 (11.7)	68.4 (11.7)	0.787
Male, n (%)	139 (54.3)	86 (52.1)	53 (58.2)	0.347
Hypertension	180 (70.3)	106 (64.2)	74 (81.3)	0.004
Diabetes mellitus	43 (16.8)	23 (13.9)	20 (22.0)	0.100
Clinical characteristics, median (IQR)
Baseline NIHSS score	16 (13–19)	14 (12–18)	18 (15–20)	<0.001	1.115 (1.022–1.217)	0.014
Baseline ASPECT score	8 (8–10)	9 (8–10)	8 (8–9)	0.006
Stroke cause, n (%)
LAA	84 (32.8)	59 (35.8)	25 (27.5)	0.195
Cardioembolic	141 (55.1)	84 (50.9)	57 (62.6)
Undetermined or other	31 (12.1)	22 (13.3)	9 (9.9)
Occlusion site, n (%)
ICA	107 (41.8)	62 (37.6)	45 (49.5)	0.065
MCA	149 (58.2)	103 (62.4)	46 (50.5)
OTP, median (IQR)	260 (210–300)	270 (212–300)	255 (210–300)	0.411
Bridging therapy, n (%)	32 (12.5)	23 (13.9)	9 (9.9)	0.348
Collateral score, n (%)
Grade 0	58 (22.7)	21 (12.7)	37 (40.7)	<0.001	Reference
Grade 1	99 (38.7)	63 (38.2)	36 (39.6)		0.346 (0.153–0.783)	0.011
Grade 2	99 (38.7)	81 (49.1)	18 (19.8)		0.225 (0.093–0.545)	0.001
mTICI, 2b/3, n (%)	187 (73.0)	125 (75.8)	62 (68.1)	0.188
Independence at 90 days, n (%)	113 (44.1)	100 (60.6)	13 (14.3)	<0.001
Mortality at 90 days, n (%)	64 (25.0)	10 (6.1)	54 (59.3)	<0.001
Laboratory examination
FBG*(mmol/L), mean (SD)	7.4 (3.5)	6.5 (2.6)	8.9 (4.4)	<0.001	1.140 (1.036–1.256)	0.007
Leucocytes, 109/L	10.2 (8.3–13.3)	9.4 (7.9–11.3)	13.7 (10.8–17.2)	<0.001
Neutrophils,109/L	8.7 (6.8–11.6)	7.7 (6.5–9.5)	12.0 (9.4–15.2)	<0.001	1.367 (1.219–1.534)	<0.001
Lymphocytes, 109/L	0.9 (0.7–1.3)	1.0 (0.7–1.4)	0.8 (0.6–1.2)	0.011

Note: *Missing data in six patients.

Abbreviations: SIRS, systemic inflammatory response syndrome; ASPECT, Alberta Stroke Program Early CT; ICA, internal carotid artery; LAA, large-artery atherosclerosis; mTICI, modified thrombolysis in cerebral infarction; ICA, internal carotid artery; MCA, middle cerebral artery; NIHSS, National Institutes of Health Stroke Scale; OTP, symptom onset to groin puncture time; FBG, fasting blood glucose.

Figure 2 Odds ratios (OR) of the development of systemic inflammatory response syndrome (SIRS) in all enrolled patients.

Table 2 Comparison of the Variables Stratified by Outcome in the Overall Cohort

	Favorable Outcome (n=113)	Poor Outcome (n=143)	P-value	Odds Ratio (95% CI)	P-value
Age, mean (SD), y	65.7 (11.2)	69.9 (11.8)	0.004
Male, n (%)	70 (61.9)	69 (48.3)	0.029	2.043 (0.984–4.242)	0.055
Medical history, n (%)
Hypertension	75 (66.4)	105 (73.4)	0.220
Diabetes mellitus	12 (10.6)	31 (21.7)	0.019
Clinical characteristics, median (IQR)
Baseline NIHSS score	14 (12–18)	17 (14–20)	<0.001
Baseline ASPECT score	9 (8–10)	8 (8–9)	<0.001	0.680 (0.491–0.942)	0.020
Stroke cause, n (%)
LAA	50 (44.2)	34 (23.8)	<0.001
Cardioembolic	47 (41.6)	94 (65.7)
Undetermined or other	16 (14.2)	15 (10.5)
Occlusion site, n (%)
ICA	33 (29.2)	74 (51.7)	<0.001	2.663 (1.287–5.514)	0.008
MCA	80 (70.8)	69 (48.3)		Reference
OTP, median (IQR)	270 (224–303)	250 (210–300)	0.208
Bridging therapy, n (%)	16 (14.2)	16 (11.2)	0.475
Collateral score, n (%)
Grade 0	8 (7.1)	50 (35.0)	<0.001	Reference
Grade 1	38 (33.6)	61 (42.7)		0.344 (0.119–0.994)	0.049
Grade 2	57 (59.3)	32 (22.4)		0.115 (0.038–0.343)	<0.001
mTICI, 2b/3, n (%)	98 (86.7)	89 (62.2)	<0.001	0.223 (0.095–0.525)	0.001
SIRS, n (%)	13 (11.5)	78 (54.5)	<0.001	4.112 (1.705–9.920)	0.002
Laboratory examination
FBG* (mmol/L), mean (SD)	6.1 (2.2)	8.4 (4.0)	<0.001
Leucocytes, 109/L	9.3 (7.9–11.3)	11.8 (8.9–14.8)	<0.001
Neutrophils,109/L	7.7 (6.4–9.5)	10.1 (7.4–12.7)	<0.001	1.171 (1.032–1.328)	0.015
Lymphocytes, 109/L	1.1 (0.7–1.4)	0.8 (0.6–1.2)	0.005

Note: *Missing data in six patients.

Abbreviations: SIRS, systemic inflammatory response syndrome; ASPECT, Alberta Stroke Program Early CT; ICA, internal carotid artery; LAA, large-artery atherosclerosis; mTICI, modified thrombolysis in cerebral infarction; ICA, internal carotid artery; MCA, middle cerebral artery; NIHSS, National Institutes of Health Stroke Scale; OTP, symptom onset to groin puncture time; FBG, fasting blood glucose.

Figure 3 Distribution of mRS scores at 90 days according to the presence of systemic inflammatory response syndrome (SIRS).