Shruti Sonni, MD

Boehme AK, Kapoor N, Albright KC, Lyerly MJ, Rawal PV, Shahripour RB. Systemic Inflammatory Response Syndrome in Tissue-Type Plasminogen Activator–Treated Patients is Associated With Worse Short-termFunctional Outcome. Stroke. 2013

Research has shown that successful thrombolytic therapy with tPA attenuates Systemic Inflammatory Response Syndrome (SIRS) in acute stroke patients. The primary goal of this retrospective study was to determine if patients who received IV tPA and developed SIRS had a difference in functional outcomes compared to those who did not. These patients included those without diagnosed infection who had two of the following criteria: temperature <36 or >38 degrees, HR>90, RR>20, WBC <4000 or >12000/mm. Eighteen percent of patients were found to have SIRS, around 1 in 5, and it was a predictor of poor functional outcome at discharge, even after adjusting for confounders such as NIHSS, age, race and prior stroke. Interestingly, Black patients and those with lower total cholesterol at baseline were more likely to have SIRS. 

This study has an interesting result in that, despite adjusting for the known factors contributing to poor outcome in acute ischemic stroke patients, SIRS stands out as an independent predictor. One theory is that despite receiving thrombolysis, which may or may not have ultimately been “successful”, the individual components constituting SIRS have a detrimental effect on functional outcomes. However, future studies should measure inflammatory markers in patients labeled with SIRS and then correlate those levels with outcomes. The ultimate goal, of course, is to identify these patients early to try and abate poor functional outcomes.