Biomarkers of immune capacity, infection and inflammation are associated with poor outcome and mortality after stroke - The PREDICT study
Mengel, A. (Universitätsklinik Tuebingen)
Ulm, L. (University of Queensland)
Hotter, B. (Charité - Universitätsmedizin Berlin)
Harms, H. (Charité - Universitätsmedizin Berlin)
Piper, S. K. (Berlin Institute of Health)
Grittner, U. (Berlin Institute of Health)
Montaner, J. (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Meisel, C. (Charité - Universitätsmedizin Berlin)
Meisel, Andreas (Charité - Universitätsmedizin Berlin)
Hoffmann, Sarah (Charité - Universitätsmedizin Berlin)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	Background: Almost 40% of stroke patients have a poor outcome at 3 months after the index event. Predictors for stroke outcome in the early acute phase may help to tailor stroke treatment. Infection and inflammation are considered to influence stroke outcome. Methods: In a prospective multicenter study in Germany and Spain, including 486 patients with acute ischemic stroke, we used multivariable regression analysis to investigate the association of poor outcome with monocytic HLA-DR (mHLA-DR) expression, interleukin 6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor alpha (TNF-alpha) and lipopolysaccharide-binding protein (LBP) as markers for immunodepression, inflammation and infection. Outcome was assessed at 3 months after stroke via a structured telephone interview using the modified Rankin Scale (mRS). Poor outcome was defined as a mRS score of 3 or higher which included death. Furthermore, a time-to-event analysis for death within 3 months was performed. Results: Three-month outcome data was available for 391 patients. Female sex, older age, diabetes mellitus, atrial fibrillation, stroke-associated pneumonia (SAP) and higher National Institute of Health Stroke Scale (NIHSS) score as well as lower mHLA-DR levels, higher IL-6 and LBP-levels at day 1 were associated with poor outcome at 3 months in bivariate analysis. Furthermore, multivariable analysis revealed that lower mHLA-DR expression was associated with poor outcome. Female sex, older age, atrial fibrillation, SAP, higher NIHSS score, lower mHLA-DR expression and higher IL-6 levels were associated with shorter survival time in bivariate analysis. In multivariable analysis, SAP and higher IL-6 levels on day 1 were associated with shorter survival time. Conclusions: SAP, lower mHLA-DR-expression and higher IL-6 levels on day one are associated with poor outcome and shorter survival time at 3 months after stroke onset. Trial registration: www. clinicaltrials. gov, NCT01079728, March 3, 2010.
Ajuts:	European Commission 201024
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Ischemic stroke ; Biomarkers ; Mortality ; Outcome
Publicat a:	BMC Neurology, Vol. 19 Núm. 1 (march 2019) , p. 148, ISSN 1471-2377

DOI: 10.1186/s12883-019-1375-6
PMID: 31269910

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