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Impact of Systemic Inflammatory Response Syndrome on Vasospasm, Cerebral Infarction, and Outcome After Subarachnoid Hemorrhage: Exploratory Analysis of CONSCIOUS-1 Database

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Abstract

Background

Systemic inflammatory response syndrome (SIRS) may develop after aneurysmal subarachnoid hemorrhage (SAH). We investigated factors associated with SIRS after SAH, whether SIRS was associated with complications of SAH such as vasospasm, cerebral infarction, and clinical outcome, and whether SIRS could contribute to a difference in outcome between patients treated by endovascular coiling or neurosurgical clipping of the ruptured aneurysm.

Methods

This was exploratory analysis of 413 patients in the CONSCIOUS-1 study. SIRS was diagnosed if the patient had at least 2 of 4 variables (hypothermia/fever, tachycardia, tachypnea, and leukocytosis/leukopenia) within 4 days of admission. Clinical outcome was measured on the Glasgow outcome scale 3 months after SAH. The relationship between clinical and radiologic variables and SIRS, angiographic vasospasm, delayed ischemic neurologic deficit (DIND), cerebral infarction, vasospasm-related infarction, and clinical outcome were modeled with uni- and multivariable analyses.

Results

63% of patients developed SIRS. Many factors were associated with SIRS in univariate analysis, but only poor WFNS grade and pneumonia were independently associated with SIRS in multivariable analysis. SIRS burden (number of SIRS variables per day over the first 4 days) was associated with poor outcome, but not with angiographic vasospasm, DIND, or cerebral infarction. The method of aneurysm treatment was not associated with SIRS.

Conclusion

SIRS was associated with poor outcome but not angiographic vasospasm, DIND, or cerebral infarction after SAH in the CONSCIOUS-1 data. There was no support for the notion that neurosurgical clipping is associated with a greater risk of SIRS than endovascular coiling.

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Acknowledgments

Actelion Pharmaceuticals, Ltd., was the sponsor of the CONSCIOUS-1 trial. No financial support was provided for the exploratory analysis described in this article; the data analysis and writing are the work of the authors.

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Authors and Affiliations

  1. Division of Neurosurgery, St. Michael’s Hospital, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada

    Alan K. H. Tam, Don Ilodigwe, Jay Mocco, Stephan Mayer, Neal Kassell, Daniel Ruefenacht, Peter Schmiedek, Stephan Weidauer, Alberto Pasqualin & R. Loch Macdonald

  2. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Alan K. H. Tam, Don Ilodigwe, Jay Mocco, Stephan Mayer, Neal Kassell, Daniel Ruefenacht, Peter Schmiedek, Stephan Weidauer, Alberto Pasqualin & R. Loch Macdonald

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  1. Alan K. H. Tam
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Correspondence to R. Loch Macdonald.

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Tam, A.K.H., Ilodigwe, D., Mocco, J. et al. Impact of Systemic Inflammatory Response Syndrome on Vasospasm, Cerebral Infarction, and Outcome After Subarachnoid Hemorrhage: Exploratory Analysis of CONSCIOUS-1 Database. Neurocrit Care 13, 182–189 (2010). https://doi.org/10.1007/s12028-010-9402-x

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