Abstract T MP91: A Simple Systemic Inflammatory Response Syndrome Prediction Score for Patients with Intracerebral Hemorrhage

Abstract

Background and Purpose: Systemic Inflammatory Response Syndrome (SIRS) is a predictor of poor functional outcome at discharge in stroke patients. We developed a prediction score to identify patients at greatest risk for developing SIRS after admission for an intracerebral hemorrhage (ICH). Methods: Retrospective review of consecutive patients presenting to our tertiary care center from 2008-2013 with primary ICH. Patients with a documented source of infection at any point during their hospitalization were excluded. SIRS was defined as having 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% polymorphonuclear leukocytes for more than 24 hours. A prediction score was developed and adjusted for internal validation using Harrell’s Optimism method. Results: A total of 295 ICH patients met inclusion criteria. Sixty-eight (23.1%) patients developed SIRS during their hospital stay. On univariable analysis, patients with SIRS during hospitalization had a higher frequency of intubation (55.9% vs. 24.7%; p<0.0001) and SIRS in the ED (42.7% vs. 9.7%; p<0.0001), with higher median NIHSS at baseline (17 vs. 6; p<0.0001), lower median GCS at baseline (10 vs. 15; p<0.0001), higher median ICH score (2 vs. 1; p=0.0042), and greater ICH volume (18 vs. 9; p=0.0012). A score was developed ranging from 0-3 with 1 point for SIRS in the ED, 1 point for an ICH score of 2 or 3, and 2 points if the ICH score was 4 or more. The SIRS prediction score was predictive of developing SIRS during hospitalization (OR 2.86 per point from the score, 95%CI 1.94-4.21, p<0.0001; adjusted AUC 0.701). A SIRS Score of 2 or more places a patient at a 3 fold increased odds of developing SIRS during hospitalization (OR 3.05, 95%CI 1.28-6.71, p=0.0056). Discussion: Approximately 20% of patients develop SIRS during their hospitalization for ICH, and a simple scoring system identifies those patients at highest odds of developing SIRS. Further research will determine whether the score can be used direct intervention to prevent the development of SIRS and improve outcomes after ICH.