Systemic Inflammatory Response Syndrome during Hospitalization for Intracerebral Hemorrhage Drives Poor Functional Outcome at Discharge (S39.001)

Objective: To examine the relationship between SIRS and outcomes in patients presenting with primary intracerebral hemorrhage (ICH).Background: Systemic Inflammatory Response Syndrome (SIRS) has been identified as a predictor of poor functional outcome at discharge in acute ischemic stroke patients.Methods: A retrospective review of consecutive patients presenting to a tertiary care center from 2008-2013 with primary ICH.SIRS was defined according to standard criteria as having 2 or more of the following: (1) body temperature 38°C, (2) heart rate u003e 90, (3) respiratory rate u003e 20, or (4) white blood cell count 12,000/mm or u003e 10[percnt] polymorphonuclear leukocytes for more than 24 hours. The outcome of interest was discharge modified-Rankin Scale (mRS) 4-6.Results: A total of 249 ICH patients met inclusion criteria 53 (21.3[percnt]) developed SIRS during their hospital stay. For each increase in the ICH Score, there was a 45[percnt] increase in odds of developing SIRS during hospitalization (OR 1.45, 95[percnt] 1.07-1.98, p=0.0169). SIRS was associated with an increased odds of poor functional outcome (OR 6.08, 95[percnt]CI 2.86-12.9, pu003c0.0001). For each increase in the ICH Score, adjusting for SIRS, there was a 2.68 fold increase in the odds of poor functional outcome (OR 2.68, 95[percnt]CI 1.82-3.96, pu003c0.001). Using a mediation analysis we found that 33[percnt] of the effect of ICH score on poor functional outcome at discharge was explained by SIRS (Sobel 2.11, p=0.03).Conclusions: The results of the mediation analysis suggest that SIRS may be one mechanism by which the association of rising ICH score and worsening functional outcome can be explained. The high prevalence of SIRS, in addition to the increased risk of poor outcomes, necessitates further research to determine whether early intervention in treating SIRS will reduce the poor functional outcome seen in SIRS patients. Disclosure: Dr. Boehme has nothing to disclose. Dr. Hays Shapshak has nothing to disclose. Dr. Albright has nothing to disclose. Dr. Kapoor has nothing to disclose. Dr. Kicielinski has nothing to disclose. Dr. Miller has nothing to disclose. Dr. Elkind has received personal compensation for activities with BMS-Pfizer Partnership, Janssen Pharmaceuticals, Daiichi-Sankyo, Boehringer-Ingelheim Biogen IDEC, Biotelemetry and Organon/Merk as a consultant. Dr. Elkind has received personal compensati Dr. Harrigan has nothing to disclose.