Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 4:10:1331073.
doi: 10.3389/fsurg.2023.1331073. eCollection 2023.

Postoperative systemic inflammatory response syndrome predicts increased mortality in patients after elective craniotomy

Liyuan Peng #  1 , Qi Gan #  2 , Yangchun Xiao  3 , Jialing He  2 , Xin Cheng  2 , Peng Wang  2 , Lvlin Chen  1 , Tiangui Li  2 , Yan He  1 , Weelic Chong  4 , Yang Hai  5 , Chao You  2 , Fang Fang  2 , Yu Zhang  6
Affiliations

Postoperative systemic inflammatory response syndrome predicts increased mortality in patients after elective craniotomy

Liyuan Peng et al. Front Surg. .

Abstract

Introduction: Patients undergoing craniotomy are at high risk of perioperative morbidity and mortality due to excessive inflammatory responses. The purpose of the present study is to evaluate the prognostic utility of postoperative systemic inflammatory response syndrome (SIRS) in patients undergoing craniotomy.

Methods: We performed a retrospective cohort study of patients who underwent craniotomy between January 2011 and March 2021. SIRS was diagnosed based on two or more criteria (hypo-/hyperthermia, tachypnea, leukopenia/leukocytosis, tachycardia). We used univariate and multivariate analysis for the development of SIRS with postoperative 30-day mortality.

Results: Of 12,887 patients who underwent craniotomy, more than half of the patients (n = 6,725; 52.2%) developed SIRS within the first 7 days after surgery, and 157 (1.22%) patients died within 30 days after surgery. In multivariable analyses, SIRS (OR, 1.57; 95% CI, 1.12-2.21) was associated with 30-day mortality. Early SIRS was not predictive of 30-day mortality, whereas delayed SIRS was predictive of 30-day mortality. Abnormal white blood cell (WBC) counts contributed the most to the SIRS score, followed by abnormal body temperature, respiratory rate, and heart rate.

Conclusion: Postoperative SIRS commonly occurs after craniotomy and is an independent predictor of postoperative 30-day mortality. This association was seen only in delayed SIRS but not early SIRS. Moreover, increased WBC counts contributed the most to the SIRS score.

Keywords: craniotomy; mortality; postoperative; prognosis; systemic inflammatory response syndrome.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart.
Figure 2
Figure 2
Systemic inflammatory response syndrome (SIRS) score over the first 7 days after craniotomy. The mean (sd of the mean) daily SIRS score increased over the first 3 days and decreased thereafter. Positive individual SIRS criteria (heart rate > 90 beats per minute, temperature > 38°C or <36°C, white blood cell (WBC) > 12,000/mm3 or <4,000/mm3, and respiratory rate > 20 breaths per minute) are presented as percentages in the 7 days after surgery.
Figure 3
Figure 3
Inflammatory biomarker level after craniotomy. Mean C-reactive protein (CRP) (A), absolute neutrophil count (B), coefficient of variation of red blood cell distribution width (RDW- CV) (C), and neutrophil-lymphocyte ratio (NLR) (D) levels in patients after craniotomy according to the occurrence of systemic inflammatory response syndrome (SIRS).
Figure 4
Figure 4
A 30-day mortality among patients after craniotomy, according to the number of SIRS criteria Met. SIRS criteria 3–4 were combined. SIRS, systemic inflammatory response syndrome.
Figure 5
Figure 5
Subgroup analysis of adjusted association between SIRS positivity and 30-day mortality.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Malham GM, Souter MJ. Systemic inflammatory response syndrome and acute neurological disease. Br J Neurosurg. (2001) 15(5):381–7. 10.1080/02688690120082378 - DOI - PubMed
    1. Menger MD, Vollmar B. Surgical trauma: hyperinflammation versus immunosuppression? Langenbecks Arch Surg. (2004) 389(6):475–84. 10.1007/s00423-004-0472-0 - DOI - PubMed
    1. Margraf A, Ludwig N, Zarbock A, Rossaint J. Systemic inflammatory response syndrome after surgery: mechanisms and protection. Anesth Analg. (2020) 131(6):1693–707. 10.1213/ane.0000000000005175 - DOI - PubMed
    1. Mokart D, Merlin M, Sannini A, Brun JP, Delpero JR, Houvenaeghel G, et al. Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery. Br J Anaesth. (2005) 94(6):767–73. 10.1093/bja/aei143 - DOI - PubMed
    1. Rass V, Gaasch M, Kofler M, Schiefecker AJ, Ianosi BA, Rhomberg P, et al. Systemic inflammatory response syndrome as predictor of poor outcome in nontraumatic subarachnoid hemorrhage patients. Crit Care Med. (2018) 46(12):e1152–9. 10.1097/ccm.0000000000003429 - DOI - PubMed

LinkOut - more resources