Systemic Inflammatory Response Syndrome on Admission and Clinical Outcomes After Intracerebral Hemorrhage

Figures & data

Figure 1 Flow chart for selection of study patients.

Abbreviations: ICH, intracerebral hemorrhage; mRS, modified Rankin Scale; IVH, intraventricular hemorrhage.

Table 1 Clinical Characteristics Between SIRS and No SIRS Group

	SIRS (n=157)	No SIRS (n=1002)	P-value
Age, years, median (IQR)	52 (42–62)	57 (49–66)	<0.0001
Male, n (%)	115 (73.3)	672 (67.1)	0.1412
History of hypertension, n (%)	106 (67.5)	685 (68.4)	0.8539
History of diabetes, n (%)	22 (14.0)	143 (14.3)	1.0000
Prior mRS	0 (0, 0)	0 (0, 0)	0.1406
Antihypertensive use, n (%)	45 (28.7)	336 (33.5)	0.2364
Smoking, n (%)	77 (49.0)	426 (42.5)	0.1409
Alcohol, n (%)	70 (44.6)	372 (37.1)	0.0776
Time from ICH to admission, n (%)			0.1230
<6 h	99 (63.1)	636 (63.5)
6–24 h	45 (28.7)	234 (23.4)
24–72 h	13 (8.3)	132 (13.2)
SBP, mmHg, median (IQR)	173 (150–193.5)	160 (144–182)	0.0004
DBP, mmHg, median (IQR)	100 (86–114)	94.5 (81–107)	0.0006
GCS score, median (IQR)	8 (6–14)	14 (12–15)	<0.0001
NIHSS score, median (IQR)	18 (12–28)	8 (3–15)	<0.0001
In-hospital infection, n (%)	88 (56.1)	234 (23.4)	<0.0001
Surgery during hospitalization, n (%)	62 (39.5)	174 (17.4)	<0.0001
Hematoma location, n (%)^a
Lobar	52 (33.8)	252 (25.3)	0.0266
Basal ganglia	68 (44.2)	492 (49.4)	0.2258
Thalamus	17 (11.0)	140 (14.1)	0.3101
Brainstem	11 (7.1)	56 (5.6)	0.4535
Cerebellum	6 (3.9)	56 (5.6)	0.3773
Intraventricular extension, n (%)^a	91 (59.1)	333 (33.4)	<0.0001
Subarachnoid extension, n (%)^a	53 (34.4)	137 (13.8)	<0.0001
Hematoma volume, mL, median (IQR)^a	34.3 (11.3–62.8)	13.0 (5.0–30.0)	<0.0001

Note: ^aAdmission non-contrast computed tomography was obtained in only 1150 patients, including 154 patients in the SIRS group and 996 patients in the No SIRS group.

Abbreviations: SIRS, systemic inflammatory response syndrome; IQR, interquartile range; ICH, intracerebral hemorrhage; SBP, systolic blood pressure; DBP, diastolic blood pressure; GCS, Glasgow Coma Scale; NIHSS, National Institutes of Health Stroke Scale; mRS, modified Rankin Scale.

Table 2 Effects of SIRS on Death and Major Disability

Outcomes	No. of Events (%)		Crude		Multivariable Analysis
	SIRS (n=157)	No SIRS (n=1002)	OR/HR (95% CI)	P-value	OR/HR (95% CI)	P-value
Death/major disability^a
1-month	128 (81.5)	519 (51.8)	4.107 (2.694–6.262)	<0.0001	1.489 (0.841–2.639)	0.1723
3-month	120 (76.4)	438 (43.7)	4.176 (2.830–6.163)	<0.0001	1.717 (0.997–2.959)	0.0514
1-year	109 (69.4)	360 (35.9)	4.050 (2.816–5.823)	<0.0001	1.943 (1.144–3.301)	0.0140
Death^b
1-month	39 (24.8)	44 (4.4)	6.493 (4.212–10.010)	<0.0001	2.532 (1.487–4.311)	0.0006
3-month	43 (27.4)	58 (5.8)	5.581 (3.753–8.301)	<0.0001	2.436 (1.499–3.958)	0.0003
1-year	49 (31.2)	100 (10.0)	3.866 (2.739–5.457)	<0.0001	2.030 (1.343–3.068)	0.0008
Major disability^a
1-month	89 (56.7)	474 (47.3)	3.127 (2.018–4.845)	<0.0001	1.393 (0.774–2.509)	0.2693
3-month	77 (49.0)	380 (37.9)	3.089 (2.043–4.668)	<0.0001	1.608 (0.913–2.833)	0.1000
1-year	60 (38.2)	260 (25.9)	3.087 (2.057–4.632)	<0.0001	1.904 (1.056–3.430)	0.0321

Notes: Adjustment for age, sex, alcohol use, systolic blood pressure, diastolic blood pressure, Glasgow Coma Scale, National Institutes of Health Stroke Scale, in-hospital infection, surgery, lobar hemorrhage, intraventricular extension, subarachnoid extension, and baseline hematoma volume. ^aAnalyzed by multivariable logistic regression models; ^banalyzed by multivariable Cox proportional hazard models.

Abbreviations: SIRS, systemic inflammatory response syndrome; OR, odds ratio; HR, hazard ratio; CI, confidence interval.

Figure 2 Subgroup analysis to evaluate the relationship of SIRS on admission and death in cerebral hemorrhage patients of different age (< 60 years or ≥ 60 years), gender, and baseline hematoma volume (<10 mL, 10–30 mL, or >30 mL). (A–C) Show the relationship at 1-month, 3-month and 1-year follow-ups.

Notes: ^aAdjustment for sex, alcohol use, systolic blood pressure, diastolic blood pressure, Glasgow Coma Scale, National Institutes of Health Stroke Scale, in-hospital infection, surgery, lobar hemorrhage, intraventricular extension, subarachnoid extension, and baseline hematoma volume; ^bAdjustment for age, alcohol use, systolic blood pressure, diastolic blood pressure, Glasgow Coma Scale, National Institutes of Health Stroke Scale, in-hospital infection, surgery, lobar hemorrhage, intraventricular extension, subarachnoid extension, and baseline hematoma volume; ^cAdjustment for age, sex, alcohol use, systolic blood pressure, diastolic blood pressure, Glasgow Coma Scale, National Institutes of Health Stroke Scale, in-hospital infection, surgery, lobar hemorrhage, intraventricular extension, and subarachnoid extension.

Abbreviations: SIRS, systemic inflammatory response syndrome; HR, hazard ratio; CI, confidence interval.

Table 3 Effects of SIRS and In-Hospital Infection on Poor Clinical Outcomes After Cerebral Hemorrhage

	No Infection or SIRS (n=768)	SIRS Only (n=69)		Infection Only (n=234)		SIRS Plus Infection (n=88)
		OR/HR (95% CI)	P-value	OR/HR (95% CI)	P-value	OR/HR (95% CI)	P-value
1-month follow-up
Death/major disability^a
Crude	Ref.	2.943 (1.739–4.981)	<0.0001	7.106 (4.880–10.347)	<0.0001	15.941 (7.269–34.960)	<0.0001
Adjusted	Ref.	1.341 (0.666–2.699)	0.4106	2.625 (1.699–4.129)	<0.0001	4.764 (1.927–11.778)	0.0007
Disabled^a
Crude	Ref.	1.975 (1.113–3.504)	0.0200	6.979 (4.773–10.205)	<0.0001	12.843 (5.791–28.481)	<0.0001
Adjusted	Ref.	1.273 (0.617–2.629)	0.5140	2.601 (1.645–4.112)	<0.0001	4.273 (1.698–10.754)	0.0020
Death^b
Crude	Ref.	9.186 (5.030–16.777)	<0.0001	2.279 (1.249–4.157)	0.0072	7.863 (4.420–13.989)	<0.0001
Adjusted	Ref.	2.484 (1.158–5.330)	0.0195	0.757 (0.376–1.524)	0.4357	1.948 (0.996–3.931)	0.0625
3-month follow-up
Death/major disability^a
Crude	Ref.	3.600 (2.146–6.040)	<0.0001	5.696 (4.092–7.927)	<0.0001	11.073 (6.033–20.325)	<0.0001
Adjusted	Ref.	1.705 (0.843–3.450)	0.1377	1.905 (1.242–2.921)	0.0031	3.301 (1.552–7.022)	0.0019
Disabled^a
Crude	Ref.	2.481 (1.401–4.394)	0.0018	5.644 (4.021–7.922)	<0.0001	8.482 (4.518–15.923)	<0.0001
Adjusted	Ref.	1.639 (0.785–3.424)	0.1886	1.872 (1.209–2.897)	0.0049	2.935 (1.337–6.447)	0.0073
Death^b
Crude	Ref.	7.335 (4.128–13.035)	<0.0001	2.444 (1.445–4.136)	0.0009	7.497 (4.454–12.617)	<0.0001
Adjusted	Ref.	2.201 (1.057–4.582)	0.0350	0.808 (0.432–1.511)	0.5050	2.114 (1.114–4.013)	0.0221
1-year follow-up
Death/major disability^a
Crude	Ref.	3.553 (2.152–5.865)	<0.0001	6.654 (4.821–9.185)	<0.0001	12.105 (6.960–21.054)	<0.0001
Adjusted	Ref.	1.757 (0.865–3.568)	0.1190	2.542 (1.678–3.852)	<0.0001	5.546 (2.705–11.372)	<0.0001
Disabled^a
Crude	Ref.	2.190 (1.179–4.067)	0.0131	6.580 (4.650–9.311)	<0.0001	10.100 (5.595–18.232)	<0.0001
Adjusted	Ref.	1.629 (0.718–3.696)	0.2434	2.643 (1.691–4.130)	<0.0001	5.880 (2.705–12.779)	<0.0001
Death^b
Crude	Ref.	5.605 (3.375–9.306)	<0.0001	2.941 (1.968–4.396)	<0.0001	5.512 (3.478–8.737)	<0.0001
Adjusted	Ref.	2.314 (1.239–4.322)	0.0085	1.117 (0.689–1.810)	0.6532	2.084 (1.186–3.662)	0.0107

Notes: Adjustment for age, sex, alcohol use, systolic blood pressure, diastolic blood pressure, Glasgow Coma Scale, National Institutes of Health Stroke Scale, surgery, lobar hemorrhage, intraventricular extension, subarachnoid extension, and baseline hematoma volume. ^aAnalyzed by multivariable logistic regression models; ^banalyzed by multivariable Cox proportional hazard models.

Abbreviations: SIRS, systemic inflammatory response syndrome; OR, odds ratio; HR, hazard ratio; CI, confidence interval.