Acute systemic inflammatory response syndrome in subarachnoid hemorrhage

Background and Purpose-Systemic inflammatory response syndrome (SIRS) witho ut infection is a well-known phenomenon that accompanies various acute cere bral insults. We sought to determine whether the initial SIRS score was ass ociated with outcome in subarachnoid hemorrhage (SAH). Methods-In 103 consecutive patients with SAH, the occurrence of SIRS was as sessed according to the presence of greater than or equal to2 of the follow ing: temperature of <36<degrees>C or >38 degreesC, heart rate of >90 bpm, r espiratory rate of >20 breaths/min, and white blood cell count of <4000/mm( 3) or > 12 000/mm(3). SIRS criteria and other prognostic parameters were ev aluated as predictors of dichotomous Glasgow Outcome Scale score. Results-SIRS was highly related to poor clinical grade (Hunt and Hess clini cal grading scale), a large amount of SAH on CT (Fisher CT group), and high plasma glucose concentration on admission. By univariate analysis, the occ urrence of SIRS was associated with higher mortality and morbidity rates th an was the nonoccurrence (P < 0.001). Among individual SIRS criteria, heart rate (P = 0.003), respiration rate (P = 0.003), and white blood cell count (P = 0.03) were significant outcome predictors. By multivariate logistic r egression analysis, the presence of SIRS independently predicted outcome. S IRS carried an increased risk of subsequent intracranial complications such as vasospasm and normal pressure hydrocephalus, as well as systemic compli cations. Conclusions-In SAH patients, SIRS on admission reflected the extent of tiss ue damage at onset and predicted further tissue disruption, producing clini cal worsening and, ultimately, a poor outcome.