Abstract WMP76: Predictors of Systemic Inflammatory Response in Acute Ischemic Stroke Patients Treated with IV tPA

Abstract

Background: Systemic Inflammatory Response Syndrome (SIRS) is a generalized inflammatory state in which cytokines are elevated. SIRS in the setting of AIS has been associated with poor outcomes. However, no study to date has investigated what predicts SIRS in AIS patients treated with tPA. Methods: Consecutive patients were retrospectively reviewed for evidence of SIRS during their admission. SIRS was defined as the presence of two or more: fever >38° C, HR >90, respiratory rate >20 and WBC <4 or >12. Patients diagnosed with infection (via positive culture) were excluded as well as those with evidence of pneumonia or UTI on admission. 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 cut-off of ≥65% or area under the curve (AUC) ≥0.6. Results: Out of 212 patients, 44 had evidence of SIRS (21%). Patients with SIRS were more likely to be Black (61% vs 54%; p=0.011), had lower median total cholesterol at baseline (143 vs.167 mg/dL; p=0.0207), and had a nonsignificant difference on prior history of stroke (51% vs. 35%; p=0.0810). Ranging from 0-6, the SIRS prediction score consists of Black race (2 points), history of hypertension (1 point), history of prior stroke (1 point) and admission total cholesterol < 200 (2 points). As shown in Figure 1, 80% of patients with a SIRS score ≥4 have SIRS. Patients with a SIRS score ≥ 4 were 3 times as likely to develop SIRS when compared to patients with a score of ≤ 3 (OR=2.815, 95% CI 1.43-5.56, p=0.0029). Conclusion: In our sample of IV tPA treated 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.