Biomarkers of immune capacity, infection and inflammation are associated with poor outcome and mortality after stroke - the PREDICT study.
Acute-Phase Proteins
Aged
Aged, 80 and over
Atrial Fibrillation
/ complications
Biomarkers
/ blood
Brain Ischemia
/ blood
Carrier Proteins
/ blood
Diabetes Mellitus
Female
Germany
HLA-DR Antigens
/ blood
Humans
Immune Tolerance
Inflammation
/ complications
Interleukin-10
/ blood
Interleukin-6
/ blood
Male
Membrane Glycoproteins
/ blood
Middle Aged
Pneumonia
/ etiology
Prospective Studies
Spain
Stroke
/ blood
Time Factors
Tumor Necrosis Factor-alpha
/ blood
Biomarkers
Ischemic stroke
Mortality
Outcome
Journal
BMC neurology
ISSN: 1471-2377
Titre abrégé: BMC Neurol
Pays: England
ID NLM: 100968555
Informations de publication
Date de publication:
03 Jul 2019
03 Jul 2019
Historique:
received:
01
02
2018
accepted:
23
06
2019
entrez:
5
7
2019
pubmed:
5
7
2019
medline:
5
11
2019
Statut:
epublish
Résumé
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. 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. 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. 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. www.clinicaltrials.gov, NCT01079728 , March 3, 2010.
Sections du résumé
BACKGROUND
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
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
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
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
BACKGROUND
www.clinicaltrials.gov, NCT01079728 , March 3, 2010.
Identifiants
pubmed: 31269910
doi: 10.1186/s12883-019-1375-6
pii: 10.1186/s12883-019-1375-6
pmc: PMC6607590
doi:
Substances chimiques
Acute-Phase Proteins
0
Biomarkers
0
Carrier Proteins
0
HLA-DR Antigens
0
IL10 protein, human
0
IL6 protein, human
0
Interleukin-6
0
Membrane Glycoproteins
0
Tumor Necrosis Factor-alpha
0
lipopolysaccharide-binding protein
0
Interleukin-10
130068-27-8
Banques de données
ClinicalTrials.gov
['NCT01079728']
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
148Subventions
Organisme : Bundesministerium für Forschung und Technologie
ID : 01EO0801
Organisme : Deutsche Forschungsgemeinschaft
ID : Exc257
Organisme : FP7 Ideas: European Research Council
ID : 201024
Organisme : Open Access Publishing Fund of University of Tübingen
ID : none
Organisme : Universitätsklinikum Tübingen
ID : 2459-0-0
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