Systemic Inflammatory Response Syndrome and Outcomes in Ischemic Patients Treated with Endovascular Treatment

Abstract Background The occurrence of systemic inflammatory response syndrome (SIRS) is associated with poor outcomes after ischemic stroke, and the inflammatory response can be significantly attenuated by successful reperfusion, while the SIRS in patients with acute large vessel occlusion stroke (ALVOS) who underwent endovascular treatment (EVT) remain unclear. We aimed to investigate the occurrence rate, predictors, and clinical outcomes of SIRS in patients with ALVOS after EVT. Methods We retrospectively collected EVT data of patients with ALVOS from July 2014 to August 2019 in our center. SIRS in the absence of infection was defined as the presence of ≥2 of the following: (1) heart rate >90 (2) body temperature >38°C or <36°C, (3) white blood cells >12 000/mm or <4000/mm or >10% bands for >24 h or (4) respiratory rate >20. Favorable outcome was defined as obtaining a 90-day modified Rankin Scale (mRS) score ≤2. Results Among the 262 patients who received EVT, 92 (35.1%) developed SIRS, 88 (95.7%) of whom developed SIRS in the first two days after EVT. Patients who developed SIRS had a reduced favorable outcome (OR, 4.112 [95% CI, 1.705–9.920]; P=0.002) and higher mortality (OR, 25.236 [95% CI, 8.578–74.835]; P<0.001) at 90 days. Greater SIRS burden was positively correlated with NIHSS scores at discharge and mRS scores at 90 days (r=0.249, P=0.017; r=0.230, P=0.027). The development of SIRS in patients with ALOVS who underwent EVT was associated with neutrophilic leukocytosis, hyperglycemia, higher admission NIHSS scores, and worse collateral circulation. Conclusions Patients with SIRS had higher odds of poor functional outcomes and higher mortality at 90 days in the EVT-treatment setting. The severity of the inflammatory response was positively correlated with the clinical outcomes of patients. Clinically relevant associations with SIRS were neutrophilic leukocytosis, hyperglycemia and baseline stroke severity, but favorable collateral circulation was a protective factor against SIRS.