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Ma J, Xie H, Yuan C, Shen J, Chen J, Chen Q, Liu J, Tong Q, Sun J. The gut microbial signatures of patients with lacunar cerebral infarction. Nutr Neurosci 2024; 27:620-636. [PMID: 37538045 DOI: 10.1080/1028415x.2023.2242121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND Emerging evidence revealed that gut microbial dysbiosis is involved in the pathogenesis of multiple neurological diseases, but there is little available data on the relationship between gut microbiota and lacunar cerebral infarction (LCI). METHODS Fecal samples from acute LCI patients (n = 65) and matched healthy controls (n = 65) were collected. The compositions and potential functions of the gut microbiota were estimated. RESULTS The results showed that there were significant gut microbial differences between LCI and control groups. Patients with LCI had higher abundances of genus Lactobacillus, Streptococcus, Veillonella, Acidaminococcus, Bacillus, Peptoclostridium, Intestinibacter, Alloscardovia and Cloacibacillus but lower proportions of genus Agathobacter and Lachnospiraceae_UCG-004. Investigating further these microbes such as Lactobacillus and Veillonella were correlated with clinical signs. Moreover, we found that 9 gene functions of gut microbiota were different between LCI patients and controls, which were associated with amino acid metabolism and inflammatory signal transduction. Notably, four optimal microbial markers were determined, and the combination of Streptococcus, Lactobacillus, Agathobacter, Lachnospiraceae_UCG-004 and the three risk factors achieved an area under the curve (AUC) value of 0.854 to distinguish LCI from controls. CONCLUSION These findings revealed the characterizing of gut microbiota in LCI patients and provided potential microbial biomarkers for clinical diagnosis of LCI.
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Affiliation(s)
- Jiaying Ma
- Department of Geriatrics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Huijia Xie
- Department of Geriatrics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Chengxiang Yuan
- Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jie Shen
- Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jiaxin Chen
- Department of Geriatrics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Qionglei Chen
- Department of Geriatrics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jiaming Liu
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Qiuling Tong
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jing Sun
- Department of Geriatrics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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2
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Marta-Enguita J, Rubio-Baines I, Aymerich N, Herrera M, Zandio B, Mayor S, Roncal C, Mendioroz M, Orbe J, Muñoz R. Analysis of the prognostic value of emergency blood tests in ischaemic stroke. Neurologia 2022:S2173-5808(22)00176-6. [PMID: 36402398 DOI: 10.1016/j.nrleng.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study aims to evaluate the prognostic value of emergency blood test results in patients with acute ischaemic stroke. METHODS We evaluated 592 prospectively patients with neuroimaging-confirmed ischaemic stroke admitted to our stroke unit between 2015 and 2018. We gathered emergency blood test results and calculated the neutrophil-to-lymphocyte ratio and the neutrophil-to-platelet ratio (neutrophils × 1.000/platelets). The association between blood test results and functional prognosis (as measured with the modified Rankin Scale) and such complications as haemorrhagic transformation was evaluated by logistic regression analysis. The additional predictive value of blood test parameters was assessed with receiver operating characteristic curves and the net reclassification index. RESULTS An neutrophil-to-lymphocyte ratio ≥ 3 at admission was associated with a two-fold increase in the risk of functional dependence at 3 months (OR: 2.24; 95% CI: 1.35-3.71) and haemorrhagic transformation (OR: 2.11; 95% CI: 1.09-4.05), while an neutrophil-to-lymphocyte ratio ≥ 3.86 resulted in an increase of 2.4 times in the risk of mortality at 3 months (OR: 2.41; 95% CI: 1.37-4.26) after adjusting for the traditional predictors of poor outcomes. Patients with neutrophil-to-platelet ratio ≥ 32 presented 3 times more risk of haemorrhagic transformation (OR: 3.17; 95% CI: 1.70-5.92) and mortality at 3 months (OR: 3.07; 95% CI: 1.69-5.57). Adding these laboratory parameters to standard clinical-radiological models significantly improved discrimination and prognostic accuracy. CONCLUSIONS Basic blood test parameters provide important prognostic information for stroke patients and should therefore be analysed in combination with standard clinical and radiological parameters to optimise ischaemic stroke management.
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Affiliation(s)
- J Marta-Enguita
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; Laboratorio Aterotrombosis, CIMA-Universidad de Navarra, Pamplona, Spain; Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain
| | - I Rubio-Baines
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - N Aymerich
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain
| | - M Herrera
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain
| | - B Zandio
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain
| | - S Mayor
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - C Roncal
- Laboratorio Aterotrombosis, CIMA-Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; CIBERCV, ISCIII, Madrid, Spain
| | - M Mendioroz
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain; Laboratorio de Neuroepigénetica, NavarraBiomed, Pamplona, Spain
| | - J Orbe
- Laboratorio Aterotrombosis, CIMA-Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain
| | - R Muñoz
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain.
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3
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Marta-Enguita J, Rubio-Baines I, Aymerich N, Herrera M, Zandio B, Mayor S, Roncal C, Mendioroz M, Orbe J, Muñoz R. Análisis del valor pronóstico de la analítica urgente en el ictus isquémico. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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4
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Endres M, Moro MA, Nolte CH, Dames C, Buckwalter MS, Meisel A. Immune Pathways in Etiology, Acute Phase, and Chronic Sequelae of Ischemic Stroke. Circ Res 2022; 130:1167-1186. [PMID: 35420915 DOI: 10.1161/circresaha.121.319994] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Inflammation and immune mechanisms are crucially involved in the pathophysiology of the development, acute damage cascades, and chronic course after ischemic stroke. Atherosclerosis is an inflammatory disease, and, in addition to classical risk factors, maladaptive immune mechanisms lead to an increased risk of stroke. Accordingly, individuals with signs of inflammation or corresponding biomarkers have an increased risk of stroke. Anti-inflammatory drugs, such as IL (interleukin)-1β blockers, methotrexate, or colchicine, represent attractive treatment strategies to prevent vascular events and stroke. Lately, the COVID-19 pandemic shows a clear association between SARS-CoV2 infections and increased risk of cerebrovascular events. Furthermore, mechanisms of both innate and adaptive immune systems influence cerebral damage cascades after ischemic stroke. Neutrophils, monocytes, and microglia, as well as T and B lymphocytes each play complex interdependent roles that synergize to remove dead tissue but also can cause bystander injury to intact brain cells and generate maladaptive chronic inflammation. Chronic systemic inflammation and comorbid infections may unfavorably influence both outcome after stroke and recurrence risk for further stroke. In addition, stroke triggers specific immune depression, which in turn can promote infections. Recent research is now increasingly addressing the question of the extent to which immune mechanisms may influence long-term outcome after stroke and, in particular, cause specific complications such as poststroke dementia or even poststroke depression.
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Affiliation(s)
- Matthias Endres
- Klinik für Neurologie mit Experimenteller Neurologie (M.E., C.H.N., A.M.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,Center for Stroke Research Berlin (M.E., C.H.N., C.D., A.M.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,Excellence Cluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,German Center for Neurodegenerative Diseases, Partner Site Berlin, Germany (M.E.).,German Centre for Cardiovascular Research, Partner Site Berlin, Germany (M.E., C.H.N.)
| | - Maria A Moro
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (M.A.M.).,Departamento de Farmacología yToxicología, Unidad de Investigación Neurovascular, Universidad Complutense de Madrid, Madrid, Spain (M.A.M.).,Instituto Universitario de Investigación en Neuroquímica, UCM, Madrid, Spain (M.A.M.).,Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (M.A.M.)
| | - Christian H Nolte
- Klinik für Neurologie mit Experimenteller Neurologie (M.E., C.H.N., A.M.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,Center for Stroke Research Berlin (M.E., C.H.N., C.D., A.M.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,German Centre for Cardiovascular Research, Partner Site Berlin, Germany (M.E., C.H.N.)
| | - Claudia Dames
- Center for Stroke Research Berlin (M.E., C.H.N., C.D., A.M.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,Institute for Medical Immunology (C.D.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Marion S Buckwalter
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (M.S.B.).,Wu Tsai Neurosciences Institute, Stanford University, CA (M.S.B.)
| | - Andreas Meisel
- Klinik für Neurologie mit Experimenteller Neurologie (M.E., C.H.N., A.M.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,Center for Stroke Research Berlin (M.E., C.H.N., C.D., A.M.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,NeuroCure Clinical Research Center (A.M.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
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5
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Tollitt J, Allan SM, Chinnadurai R, Odudu A, Hoadley M, Smith C, Kalra PA. Does previous stroke modify the relationship between inflammatory biomarkers and clinical endpoints in CKD patients? BMC Nephrol 2022; 23:38. [PMID: 35042473 PMCID: PMC8767689 DOI: 10.1186/s12882-021-02625-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Chronic kidney disease (CKD) is an independent risk factor for stroke. Stroke is also an independent risk factor for worse CKD outcomes and inflammation may contribute to this bidirectional relationship. This study aims to investigate inflammatory biomarkers in patients with non-dialysis CKD (ND-CKD) with and without stroke.
Methods
A propensity matched sample from > 3000 Salford Kidney Study (SKS) patients, differentiated by previous stroke at study recruitment, had stored plasma analyzed for interleukin- 6 (IL-6), Von Willebrand Factor (VWF) and C-reactive protein (CRP). Multivariable cox regression analysis investigated associations between inflammation and death, end-stage renal disease (ESRD) and future non-fatal cardiovascular events (NFCVE).
Results
A total of 157 previous stroke patients were compared against 162 non-stroke patients. There were no significant differences in inflammatory biomarkers between the two groups. Previous stroke was associated with greater mortality risk, hazard ratio (HR) (95% CI) was 1.45 (1.07–1.97). Higher inflammatory biomarker concentrations were independently associated with death but not ESRD or NFCVE in the total population. For each 1 standard deviation (SD) increase in log IL-6, VWF and CRP, the HR for all-cause mortality were 1.35 (1.10–1.70), 1.26 (1.05–1.51) and 1.34 (1.12–1.61), respectively. CRP retained its independent association (HR 1.47 (1.15–1.87)) with death in the stroke population.
Conclusion
Previous stroke is an important determinant of mortality. However, the adverse combination of stroke and ND-CKD does not seem to be driven by higher levels of inflammation detected after the stroke event. Biomarkers of inflammation were associated with worse outcome in both stroke and non-stroke ND-CKD patients.
Trial registration
15/NW/0818.
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6
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Faura J, Bustamante A, Miró-Mur F, Montaner J. Stroke-induced immunosuppression: implications for the prevention and prediction of post-stroke infections. J Neuroinflammation 2021; 18:127. [PMID: 34092245 PMCID: PMC8183083 DOI: 10.1186/s12974-021-02177-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
Stroke produces a powerful inflammatory cascade in the brain, but also a suppression of the peripheral immune system, which is also called stroke-induced immunosuppression (SIIS). The main processes that lead to SIIS are a shift from a lymphocyte phenotype T-helper (Th) 1 to a Th2 phenotype, a decrease of the lymphocyte counts and NK cells in the blood and spleen, and an impairment of the defense mechanisms of neutrophils and monocytes. The direct clinical consequence of SIIS in stroke patients is an increased susceptibility to stroke-associated infections, which is enhanced by clinical factors like dysphagia. Among these infections, stroke-associated pneumonia (SAP) is the one that accounts for the highest impact on stroke outcome, so research is focused on its early diagnosis and prevention. Biomarkers indicating modifications in SIIS pathways could have an important role in the early prediction of SAP, but currently, there are no individual biomarkers or panels of biomarkers that are accurate enough to be translated to clinical practice. Similarly, there is still no efficient therapy to prevent the onset of SAP, and clinical trials testing prophylactic antibiotic treatment and β-blockers have failed. However, local immunomodulation could open up a new research opportunity to find a preventive therapy for SAP. Recent studies have focused on the pulmonary immune changes that could be caused by stroke similarly to other acquired brain injuries. Some of the traits observed in animal models of stroke include lung edema and inflammation, as well as inflammation of the bronchoalveolar lavage fluid.
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Affiliation(s)
- Júlia Faura
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Bustamante
- Stroke Unit, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain.
| | - Francesc Miró-Mur
- Systemic Autoimmune Research Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Stroke Research Program, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville & Department of Neurology, Hospital Universitario Virgen de la Macarena, Seville, Spain
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7
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Gradek-Kwinta E, Czyzycki M, Lopatkiewicz AM, Klimiec-Moskal E, Slowik A, Dziedzic T. Lipopolysaccharide binding protein and sCD14 as risk markers of stroke-associated pneumonia. J Neuroimmunol 2021; 354:577532. [PMID: 33676085 DOI: 10.1016/j.jneuroim.2021.577532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/02/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
To determine the utility of lipopolysaccharide binding protein (LBP) and soluble CD14 (sCD14) as risk markers of stroke-associated pneumonia (SAP). We included 331 stroke patients. The plasma levels of LBP (median: 19.4 vs 15.3 μg/mL, P < 0.01) and sCD14 (median: 1.5 vs 1.4 μg/mL, P = 0.04) were elevated in SAP. In multivariate analysis, a higher level of LBP (OR: 1.09, 95%CI: 1.05-1.13), but not sCD14 (OR: 2.16, 0.94-4.97), was associated with SAP. The addition of LBP or sCD14 to the clinical model did not improve its discriminatory ability. Our results suggest the modest value of studied biomarkers for SAP prediction.
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Affiliation(s)
| | - Mateusz Czyzycki
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | | | | | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Dziedzic
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
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8
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Faura J, Bustamante A, Reverté S, García-Berrocoso T, Millán M, Castellanos M, Lara-Rodríguez B, Zaragoza J, Ventura O, Hernández-Pérez M, van Eendenburg C, Cardona P, López-Cancio E, Cánovas D, Serena J, Rubiera M, Dávalos A, Montaner J. Blood Biomarker Panels for the Early Prediction of Stroke-Associated Complications. J Am Heart Assoc 2021; 10:e018946. [PMID: 33634708 PMCID: PMC8174272 DOI: 10.1161/jaha.120.018946] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Acute decompensated heart failure (ADHF) and respiratory tract infections (RTIs) are potentially life-threatening complications in patients experiencing stroke during hospitalization. We aimed to test whether blood biomarker panels might predict these complications early after admission. Methods and Results Nine hundred thirty-eight patients experiencing ischemic stroke were prospectively recruited in the Stroke-Chip study. Post-stroke complications during hospitalization were retrospectively evaluated. Blood samples were drawn within 6 hours after stroke onset, and 14 biomarkers were analyzed by immunoassays. Biomarker values were normalized using log-transformation and Z score. PanelomiX algorithm was used to select panels with the best accuracy for predicting ADHF and RTI. Logistic regression models were constructed with the clinical variables and the biomarker panels. The additional predictive value of the panels compared with the clinical model alone was evaluated by receiver operating characteristic curves. An internal validation through a 10-fold cross-validation with 3 repeats was performed. ADHF and RTI occurred in 19 (2%) and 86 (9.1%) cases, respectively. Three-biomarker panels were developed as predictors: vascular adhesion protein-1 >5.67, NT-proBNP (N-terminal pro-B-type natriuretic peptide) >4.98 and d-dimer >5.38 (sensitivity, 89.5%; specificity, 71.7%) for ADHF; and interleukin-6 >3.97, von Willebrand factor >3.67, and d-dimer >4.58 (sensitivity, 82.6%; specificity, 59.8%) for RTI. Both panels independently predicted stroke complications (panel for ADHF: odds ratio [OR] [95% CI], 10.1 [3-52.2]; panel for RTI: OR, 3.73 [1.95-7.14]) after adjustment by clinical confounders. The addition of the panel to clinical predictors significantly improved areas under the curve of the receiver operating characteristic curves in both cases. Conclusions Blood biomarkers could be useful for the early prediction of ADHF and RTI. Future studies should assess the usefulness of these panels in front of patients experiencing stroke with respiratory symptoms such as dyspnea.
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Affiliation(s)
- Júlia Faura
- Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR)Universitat Autònoma de Barcelona Barcelona Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR)Universitat Autònoma de Barcelona Barcelona Spain.,Stroke Unit Hospital Universitari Germans Trias i Pujol Barcelona Spain
| | - Silvia Reverté
- Stroke Unit Hospital Universitari Verge de la Cinta de Tortosa Tortosa Spain
| | - Teresa García-Berrocoso
- Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR)Universitat Autònoma de Barcelona Barcelona Spain
| | - Mónica Millán
- Stroke Unit Hospital Universitari Germans Trias i Pujol Barcelona Spain
| | - Mar Castellanos
- Department of Neurology Complejo Hospitalario Universitario A Coruña, A Coruña Biomedical Research Institute Spain
| | | | - Josep Zaragoza
- Stroke Unit Hospital Universitari Verge de la Cinta de Tortosa Tortosa Spain
| | - Oriol Ventura
- Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR)Universitat Autònoma de Barcelona Barcelona Spain
| | | | | | - Pere Cardona
- Stroke Unit Hospital Universitari de Bellvitge Barcelona Spain
| | | | - David Cánovas
- Department of Neurology Hospital Universitari Parc Taulí Sabadell Spain
| | - Joaquín Serena
- Stroke Unit Hospital Universitari Josep Trueta Girona Spain
| | - Marta Rubiera
- Stroke, Unit, Department of Neurology Hospital Universitari Vall d'Hebron Barcelona Spain
| | - Antoni Dávalos
- Stroke Unit Hospital Universitari Germans Trias i Pujol Barcelona Spain
| | - Joan Montaner
- Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR)Universitat Autònoma de Barcelona Barcelona Spain
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9
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Wu T, Zhang H, Tian X, Cao Y, Wei D, Wu X. Neutrophil-to-Lymphocyte Ratio Better Than High-Sensitivity C-Reactive Protein in Predicting Stroke-Associated Pneumonia in Afebrile Patients. Neuropsychiatr Dis Treat 2021; 17:3589-3595. [PMID: 34916795 PMCID: PMC8668255 DOI: 10.2147/ndt.s340189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/30/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate the association between neutrophil-to-lymphocyte ratio (NLR) and stroke-associated pneumonia (SAP) in patients with acute ischemic stroke (AIS) without fever and to clarify whether NLR has an advantage over high-sensitivity C-reactive protein (hs-CRP) in predicting SAP. PATIENTS AND METHODS A total of 434 patients with AIS without fever were assessed in this study. Multivariable analysis was used to evaluate the relationship between NLR and SAP, and the receiver operating characteristic (ROC) curve was used to compare the predictive value of NLR and hs-CRP. RESULTS Among the total patients, 18 (4.1%) developed SAP. After adjusting for confounders, NLR (adjusted odds ratio [aOR] = 1.60; 95% confidence interval [CI], 1.30-1.96; p < 0.001) remained independently associated with an increased risk of SAP. In addition, the area under the curve (AUC) of NLR (0.862 [0.826-0.893]) was higher than that of hs-CRP (0.738 [0.694-0.779]). CONCLUSION We found that compared with hs-CRP, NLR was significantly associated with the occurrence of SAP in patients with AIS without fever and showed a more effective predictive value for SAP.
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Affiliation(s)
- Ti Wu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Haipeng Zhang
- Department of Clinical Laboratory, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Xiaolin Tian
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Yang Cao
- Department of Clinical Laboratory, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Dianjun Wei
- Department of Clinical Laboratory, Hebei Yanda Hospital, Langfang, Hebei, People's Republic of China
| | - Xiangkun Wu
- Department of Clinical Laboratory, Hebei Yanda Hospital, Langfang, Hebei, People's Republic of China
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10
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Schweizer J, Bustamante A, Lapierre-Fétaud V, Faura J, Scherrer N, Azurmendi Gil L, Fluri F, Schütz V, Luft A, Boned S, Sanchez JC, Montaner J, Katan M. SAA (Serum Amyloid A): A Novel Predictor of Stroke-Associated Infections. Stroke 2020; 51:3523-3530. [PMID: 33161846 DOI: 10.1161/strokeaha.120.030064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to evaluate and independently validate SAA (serum amyloid A)-a recently discovered blood biomarker-to predict poststroke infections. METHODS The derivation cohort (A) was composed of 283 acute ischemic stroke patients and the independent validation cohort (B), of 367 patients. The primary outcome measure was any stroke-associated infection, defined by the criteria of the US Centers for Disease Control and Prevention, occurring during hospitalization. To determine the association of SAA levels on admission with the development of infections, logistic regression models were calculated. The discriminatory ability of SAA was assessed, by calculating the area under the receiver operating characteristic curve. RESULTS After adjusting for all predictors that were significantly associated with any infection in the univariate analysis, SAA remained an independent predictor in study A (adjusted odds ratio, 1.44 [95% CI, 1.16-1.79]; P=0.001) and in study B (adjusted odds ratio, 1.52 [1.05-2.22]; P=0.028). Adding SAA to the best regression model without the biomarker, the discriminatory accuracy improved from 0.76 (0.69-0.83) to 0.79 (0.72-0.86; P<0.001; likelihood ratio test) in study A. These results were externally validated in study B with an improvement in the area under the receiver operating characteristic curve, from 0.75 (0.70-0.81) to 0.76 (0.71-0.82; P<0.038). CONCLUSIONS Among patients with ischemic stroke, blood SAA measured on admission is a novel independent predictor of infection after stroke. SAA improved the discrimination between patients who developed an infection compared with those who did not in both derivation and validation cohorts. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00390962.
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Affiliation(s)
- Juliane Schweizer
- Department of Neurology, University Hospital Zurich, Switzerland (J.S., N.S., V.S., A.L., M.K.)
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain (A.B., J.F., J.M.).,Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (A.B., S.B.)
| | - Vanessa Lapierre-Fétaud
- Translational Biomarker Group, Department of Human Protein Sciences, University of Geneva, Switzerland (V.L.-F., L.A., J.-C.S.)
| | - Júlia Faura
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain (A.B., J.F., J.M.)
| | | | - Leire Azurmendi Gil
- Translational Biomarker Group, Department of Human Protein Sciences, University of Geneva, Switzerland (V.L.-F., L.A., J.-C.S.)
| | - Felix Fluri
- Department of Neurology, University Hospital Wuerzburg, Germany (F.F.)
| | - Valerie Schütz
- Department of Neurology, University Hospital Zurich, Switzerland (J.S., N.S., V.S., A.L., M.K.)
| | - Andreas Luft
- Department of Neurology, University Hospital Zurich, Switzerland (J.S., N.S., V.S., A.L., M.K.)
| | - Sandra Boned
- Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (A.B., S.B.)
| | - Jean-Charles Sanchez
- Translational Biomarker Group, Department of Human Protein Sciences, University of Geneva, Switzerland (V.L.-F., L.A., J.-C.S.)
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain (A.B., J.F., J.M.)
| | - Mira Katan
- Department of Neurology, University Hospital Zurich, Switzerland (J.S., N.S., V.S., A.L., M.K.)
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11
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Gradek-Kwinta E, Czyzycki M, Weglarczyk K, Slowik A, Siedlar M, Dziedzic T. Ex vivo synthesized cytokines as a biomarker of stroke-associated pneumonia. Clin Chim Acta 2020; 510:260-263. [DOI: 10.1016/j.cca.2020.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/28/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
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12
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Molnar T, Csuka D, Pusch G, Nagy L, Garred P, Illes Z. Associations between serum L-arginine and ficolins in the early phase of acute ischemic stroke - A pilot study. J Stroke Cerebrovasc Dis 2020; 29:104951. [PMID: 32689592 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/04/2020] [Accepted: 05/09/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Activation of both the L-arginine and the lectin pathway contributes to the pathophysiology and the outcome of acute ischemic stroke (AIS). However, the interplay between the two systems has not yet been examined. METHODS A total of 44 patients with AIS were recruited into this study. Serial measurement of serum L-arginine, asymmetric and symmetric dimethylarginine (ADMA, SDMA), and hsCRP, ficolin-2, ficolin-3, MAP-1, MASP-3 and mannose-binding lectin (MBL) were analyzed within 6 h after onset of stroke and 72 h later. Outcomes were assessed as National Institutes of Health Stroke Scale (NIHSS) worsening by 24 h, poststroke infection, and death by 1 month. RESULTS In the hyperacute stage of AIS, ficolin-3, MAP-1 and MBL were positively correlated with L-arginine within 6 h after onset of symptoms (p<0.05 respectively). Significantly lower ficolin-3 and MASP-3 levels were found at 72 h in patients, who developed post-stroke infection after day 4, when compared to patients without post-stroke infections (p=0.03 and p=0.009). At 72 hours, ficolin-3 levels negatively correlated with S100B (p=0.01). Ficolin-3 at 72 post-stroke hours remained an independent predictor of post-stroke infection, while only hsCRP was an independent predictor of 30-day mortality. CONCLUSION Early consumption of ficolin-3 is associated with complications such as post-stroke infections. In the hyperacute phase of AIS, the positive correlation between ficolins and the NO donor L-arginine may reflect the protective role of L-arginine presumably by improving the cerebral microcirculation in a prothrombotic environment induced by complement activation.
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Affiliation(s)
- Tihamer Molnar
- Department of Anaesthesiology and Intensive Care, University of Pecs, Ifjusag u. 13, Pecs 7623, Hungary.
| | - Dorottya Csuka
- 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
| | | | - Lajos Nagy
- Department of Applied Chemistry, University of Debrecen, Debrecen, Hungary.
| | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology Section 7631, Rigshospitalet University Hospital, Copenhagen, Denmark.
| | - Zsolt Illes
- Department of Neurology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
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13
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Csecsei P, Tarkanyi G, Bosnyak E, Szapary L, Lenzser G, Szolics A, Buki A, Hegyi P, Abada A, Molnar T. Risk analysis of post-procedural intracranial hemorrhage based on STAY ALIVE Acute Stroke Registry. J Stroke Cerebrovasc Dis 2020; 29:104851. [PMID: 32402722 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/24/2020] [Accepted: 03/28/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Intracranial hemorrhages (ICH) are classified as symptomatic or asymptomatic according to the presence of clinical deterioration. Here, we aimed to find predictive factors of symptomatic intracranial bleeding in a registry-based stroke research. METHODS Data of consecutive patients with acute ischemic stroke (AIS) were extracted from the prospective STAY ALIVE stroke registry. Analysis of the total population and treatment sugroups such as endovascular thrombectomy (EVT), intravenous thrombolysis (IVT), or their combination (IVT+EVT) were also done. Outcome measures were ICH, 30- and 90-day clinical outcome based on the modified Rankin Scale (mRS:0-2 as favorable outcome). The hemorrhage was captured by a non-enhanced CT of the skull within 24 h after procedure. RESULTS A total of 355 patients (mean age: 68±11; female N=177 (49.9%); EVT n=131 (36.9%); IVT n=157 (44.2%); IVT+EVT n=67 (18.9%) were included in the analysis. The total number of ICH was 47 (13%), symptomatic (sICH) 12 (3.4%) and asymptomatic (aICH) 35 (9.9%) in the whole population. NIHSS ≥15.5 at 24 post stroke hours predicted sICH with a sensitivity of 100% and a specificity of 92% (p<0.001). Furthermore, lower age, good collateral circulation on initial CT angiography and lower NIHSS score measured at 24 h independently associated with a favorable 90-day outcome, whereas baseline NIHSS and ASPECT score were not. CONCLUSION Although partial recanalization, ASPECT< 6, and poor collaterals were significantly associated with sICH, the only independent predictor was NIHSS ≥15.5 at 24 post stroke hours. This suggests a careful evaluation of patients with worsening NIHSS despite an adequate therapy.
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Affiliation(s)
- Peter Csecsei
- Department of Neurology, University of Pecs, Medical School, Ifjusag u. 13., Pecs 7623, Hungary.
| | - Gabor Tarkanyi
- Department of Neurology, University of Pecs, Medical School, Ifjusag u. 13., Pecs 7623, Hungary
| | - Edit Bosnyak
- Department of Neurology, University of Pecs, Medical School, Ifjusag u. 13., Pecs 7623, Hungary
| | - Laszlo Szapary
- Department of Neurology, University of Pecs, Medical School, Ifjusag u. 13., Pecs 7623, Hungary
| | - Gabor Lenzser
- Department of Neurosurgery, University of Pecs, Medical School, Pecs, Hungary
| | - Alex Szolics
- Department of Neurosurgery, University of Pecs, Medical School, Pecs, Hungary
| | - Andras Buki
- Department of Neurosurgery, University of Pecs, Medical School, Pecs, Hungary
| | - Peter Hegyi
- Institute for Translational Medicine, University of Pecs, Medical School, Pecs, Hungary
| | - Alan Abada
- Department of Anaesthesiology and Intensive Care, University of Pecs, Medical School, Pecs, Hungary
| | - Tihamer Molnar
- Department of Anaesthesiology and Intensive Care, University of Pecs, Medical School, Pecs, Hungary
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14
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Wang L, Li Y, Wang C, Guo W, Liu M. C-reactive Protein, Infection, and Outcome After Acute Ischemic Stroke: A Registry and Systematic Review. Curr Neurovasc Res 2020; 16:405-415. [PMID: 31738143 DOI: 10.2174/1567202616666191026122011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/10/2019] [Accepted: 09/25/2019] [Indexed: 02/08/2023]
Abstract
Background:
A number of studies have explored the prognostic role of CRP in patients
with acute ischemic stroke, however, the results have been inconclusive. The aim of our study was
to investigate the impact of infection on the association between CRP and 3-month functional outcome
by performing a registry study and systematic review.
Methods:
Patients admitted within 24 hours of acute ischemic stroke onset and had CRP measured
within 24 hours after admission were included. Patients admitted between June 2016 and December
2018 in Chengdu Stoke Registry were enrolled. The PubMed database was searched up to July
2019 to identify eligible studies. Poor outcome was defined as modified Rankin Scale scores at
3-month more than 3.
Results:
Totally, 368 patients in the registry and 18 studies involving 15238 patients in the systematic
review were included. A statistically significant association between CRP values on admission
and 3-month poor outcome in patients without infection was found, both in our registry
(CRP per 1-mg/L increment, OR 1.04, 95% CI 1.01 to 1.07, p=0.008) and meta-analysis (CRP per
1-mg/dL increment, OR 1.66 [95% CI 1.37 to 2.01, p<0.001]). In patients with infection, CRP was
not associated with a 3-month poor outcome according to registry data (OR 1.00, 95% CI 0.99 to
1.01, p=0.663) and meta-analysis (OR 1.01, 95% CI 0.99 to 1.01, p=0.128).
Conclusion:
High CRP value was independently associated with a 3-month poor outcome after
stroke in patients without infection. Further studies are required to examine the value of infection
on CRP measures and long-term functional outcomes.
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Affiliation(s)
- Lu Wang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuxiao Li
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Changyi Wang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wen Guo
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ming Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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15
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Kamtchum-Tatuene J, Jickling GC. Blood Biomarkers for Stroke Diagnosis and Management. Neuromolecular Med 2019; 21:344-368. [PMID: 30830566 PMCID: PMC6722038 DOI: 10.1007/s12017-019-08530-0] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/19/2019] [Indexed: 12/20/2022]
Abstract
Biomarkers are objective indicators used to assess normal or pathological processes, evaluate responses to treatment and predict outcomes. Many blood biomarkers already guide decision-making in clinical practice. In stroke, the number of candidate biomarkers is constantly increasing. These biomarkers include proteins, ribonucleic acids, lipids or metabolites. Although biomarkers have the potential to improve the diagnosis and the management of patients with stroke, there is currently no marker that has demonstrated sufficient sensitivity, specificity, rapidity, precision, and cost-effectiveness to be used in the routine management of stroke, thus highlighting the need for additional work. A better standardization of clinical, laboratory and statistical procedures between centers is indispensable to optimize biomarker performance. This review focuses on blood biomarkers that have shown promise for translation into clinical practice and describes some newly reported markers that could add to routine stroke care. Avenues for the discovery of new stroke biomarkers and future research are discussed. The description of the biomarkers is organized according to their expected application in clinical practice: diagnosis, treatment decision, and outcome prediction.
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Affiliation(s)
- Joseph Kamtchum-Tatuene
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, 4-120 Katz Building, 114 Street & 87 Avenue, Edmonton, AB, T6G 2E1, Canada.
| | - Glen C Jickling
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, 4-120 Katz Building, 114 Street & 87 Avenue, Edmonton, AB, T6G 2E1, Canada
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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16
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Chiu CC, Lin JM, Wu LY, Hsu TC, Tzang BS. The Beneficial Effects of Raffinee in Permanent Occulted Stroke Mice. J Med Food 2019; 22:1226-1234. [PMID: 31545135 DOI: 10.1089/jmf.2019.4438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Ischemic stroke is a major cause of disability and mortality globally. Although thrombolytic therapy is routinely adopted in cases of ischemic stroke, various alternative natural neuroprotectants are also used as effective adjuvant therapies to recover neurofunction following ischemic stroke. Raffinee, a natural fermented product with strong antioxidant and neuroprotective activities, has antiatherogenic effects in animals and has exhibited neuroprotective effects in a clinical trial by recovering motor and sensory function following spinal cord lesion. This study reveals the advantageous effects of Raffinee on PC12 cells by decreasing hypoxia-induced apoptosis in mice with permanent middle cerebral artery occlusion (pMCAO) by increasing the levels of neurotrophic factors such as S100β, reducing serum inflammatory factors such as matrix metalloproteinases (MMP)-9/MMP-2 ratio, tumor necrosis factor-α, and interleukin (IL)-6 level, and increasing IL-10 levels. Significantly reduced brain infarct volume along with a favorable survival ratio was observed for pMCAO mice that received Raffinee, suggesting a neuroprotective potential of Raffinee in cases of acute ischemic stroke by suppressing apoptosis.
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Affiliation(s)
- Chun-Ching Chiu
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan.,Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.,Department of Medical Intensive Care Unit, Changhua Christian Hospital, Changhua, Taiwan
| | - Jer-Min Lin
- Ziel Enterprise Co., Ltd., Kaohsiung, Taiwan
| | - Li-Yi Wu
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
| | - Tsai-Ching Hsu
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan.,Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan.,Immunology Research Center, Chung Shan Medical University, Taichung, Taiwan
| | - Bor-Show Tzang
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan.,Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan.,Immunology Research Center, Chung Shan Medical University, Taichung, Taiwan.,Department of Biochemistry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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17
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Lee Y, Lim J, Choi SW, Han S, Park B, Youm JY. Changes of Biomarkers before and after Antibiotic Treatment in Spinal Infection. Korean J Neurotrauma 2019; 15:143-149. [PMID: 31720268 PMCID: PMC6826089 DOI: 10.13004/kjnt.2019.15.e19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/13/2019] [Accepted: 07/25/2019] [Indexed: 11/17/2022] Open
Abstract
Objective The laboratory biomarkers used to diagnose spinal infection include white blood cell (WBC) counts, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Recently, procalcitonin (PCT) has been used as a biomarker to distinguish between bacterial infection and non-bacterial infection. We aimed to compare the changes of conventional biomarker and PCT in patients with spinal infection before and after antibiotic treatment. Methods ESR, CRP, WBC counts, and PCT were measured in 29 patients diagnosed with pyogenic spinal infection at our hospital between May 2016 and December 2018 prior to antibiotic administration. After antibiotic administration, the values were followed up for 4 weeks at 1-week intervals. Results A total of 29 patients were enrolled, with a mean age of 67.8 years, consisting of 16 men and 13 women. Twenty-five patients had lumbar infections, and 2 each had cervical and thoracic infections. The mean ESR, CRP, PCT, and WBCs decreased at week 4 of antibiotic treatment compared to their baseline values. CRP and WBCs were significantly decreased after 4 weeks of treatment compared to before treatment. The mean ESR and PCT was not statistically significant compared to pretreatment and after antibiotic treatment (p-value>0.05). Conclusion Among several biomarker, CRP and WBCs are biomarkers that can aid early evaluation of the effects of antibiotic treatment in pyogenic spondylitis. Although PCT did not have statistical significance, it can be used as a biomarker that reflects the effect of antibiotic and severity of infection.
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Affiliation(s)
- Young Lee
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea
| | - Jeongwook Lim
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea
| | - Seung-Won Choi
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea
| | - Sanghyun Han
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea
| | - Bumsoo Park
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea
| | - Jin-Young Youm
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea
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18
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Cai Z, He W, Zhuang FJ, Chen Y. The role of high high-sensitivity C-reactive protein levels at admission on poor prognosis after acute ischemic stroke. Int J Neurosci 2018; 129:423-429. [PMID: 30332913 DOI: 10.1080/00207454.2018.1538139] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Plasma high hypersensitive C-reactive protein (hs-CRP) levels are associated with risk and prognosis of vascular diseases. The clinical implications of markedly elevated hs-CRP levels are more discovered in the onset and development of stroke. The aim of this study is to determine the association of plasma hs-CRP levels on the prognosis in patients with acute ischemic stroke. METHODS Retrospective analysis of a single-center database of consecutive cases for acute cerebral infarction (ACI) from January 1 2012 to December 30 2016 was performed. Significant predictors of the dependent variable variance were identified by standard linear, univariate and multivariate, or binary logistic regression modeling. Multivariate regression analysis was introduced to investigate the relationship between plasma hs-CRP levels at admission and change in National Institutes of Health Stroke Scale (NIHSS) score at discharge. RESULTS The percentages of hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, body mass index (BMI) and chronic kidney disease were raised with the increase of hs-CRP plasma concentration at admission among all patients (p < 0.05). ACI patients with large-artery atherosclerosis had an increasing percentage with the increase of hs-CRP mean value (p < 0.05). The initial NIHSS scores, the acute infection rate and age advance also increased with the increase of hs-CRP plasma concentration at admission (p < 0.05). The ratio of neurological improvement increased with the decrease of plasma hs-CRP concentration (p < 0.05). The neurological deterioration and poor prognosis increased with the increase of plasma hs-CRP concentration (p < 0.05). CONCLUSION High plasma hs-CRP levels are associated with worse outcomes in the ACI patients. Monitoring plasma hs-CRP levels and cutting down the elevated plasma hs-CRP levels will be beneficial in screening and treatment decisions for the prognosis of acute ischemic stroke.
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Affiliation(s)
- Zhiyou Cai
- a Department of Neurology , Chongqing General Hospital University of Chinese Academy of Sciences , Chongqing , Chongqing , People's Republic of China
| | - Wenbo He
- b Department of Neurology , Renmin Hospital Hubei University of Medicine , Shiyan , Hubei Province , People's Republic of China
| | - Feng-Juan Zhuang
- b Department of Neurology , Renmin Hospital Hubei University of Medicine , Shiyan , Hubei Province , People's Republic of China
| | - Yan Chen
- b Department of Neurology , Renmin Hospital Hubei University of Medicine , Shiyan , Hubei Province , People's Republic of China
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19
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Kalra L, Smith CJ, Hodsoll J, Vail A, Irshad S, Manawadu D. Elevated C-reactive protein increases diagnostic accuracy of algorithm-defined stroke-associated pneumonia in afebrile patients. Int J Stroke 2018; 14:167-173. [PMID: 30196790 DOI: 10.1177/1747493018798527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIM Pyrexia-dependent clinical algorithms may under or overdiagnose stroke-associated pneumonia. This study investigates whether inclusion of elevated C-reactive protein as a criterion improves diagnosis. METHODS The contribution of C-reactive protein ≥30 mg/l as an additional criterion to a Centers for Disease Control and Prevention-based algorithm incorporating pyrexia with chest signs and leukocytosis and/or chest infiltrates to diagnose stroke-associated pneumonia was assessed in 1088 acute stroke patients from 37 UK stroke units. The sensitivity, specificity, and positive predictive value of different approaches were assessed using adjudicated stroke-associated pneumonia as the reference standard. RESULTS Adding elevated C-reactive protein to all algorithm criteria did not increase diagnostic accuracy compared with the algorithm alone against adjudicated stroke-associated pneumonia (sensitivity 0.74 (95% CI 0.65-0.81) versus 0.72 (95% CI 0.64-0.80), specificity 0.97 (95% CI 0.96-0.98) for both; kappa 0.70 (95% CI 0.63-0.77) for both). In afebrile patients (n = 965), elevated C-reactive protein with chest and laboratory findings had sensitivity of 0.84 (95% CI 0.67-0.93), specificity of 0.99 (95% CI 0.98-1.00), and kappa 0.80 (95% CI 0.70-0.90). The modified algorithm of pyrexia or elevated C-reactive protein and chest signs with infiltrates or leukocytosis had sensitivity of 0.94 (95% CI 0.87-0.97), specificity of 0.96 (95% CI 0.94-0.97), and kappa of 0.88 (95% CI 0.84-0.93) against adjudicated stroke-associated pneumonia. CONCLUSIONS An algorithm consisting of pyrexia or C-reactive protein ≥30 mg/l, positive chest signs, leukocytosis, and/or chest infiltrates has high accuracy and can be used to standardize stroke-associated pneumonia diagnosis in clinical or research settings. TRIAL REGISTRATION http://www.isrctn.com/ISRCTN37118456.
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Affiliation(s)
- Lalit Kalra
- 1 Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Craig J Smith
- 2 Greater Manchester Comprehensive Stroke Centre and Division of Cardiovascular Sciences, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - John Hodsoll
- 3 Biostatistics Department, NIHR Biomedical Research Centre for Mental Health and Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Andy Vail
- 4 Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Saddif Irshad
- 1 Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Dulka Manawadu
- 5 Department of Clinical Neurosciences, King's College Hospital NHS Foundation Trust, London, UK
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20
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Simats A, García-Berrocoso T, Ramiro L, Giralt D, Gill N, Penalba A, Bustamante A, Rosell A, Montaner J. Characterization of the rat cerebrospinal fluid proteome following acute cerebral ischemia using an aptamer-based proteomic technology. Sci Rep 2018; 8:7899. [PMID: 29784938 PMCID: PMC5962600 DOI: 10.1038/s41598-018-26237-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 04/20/2018] [Indexed: 11/08/2022] Open
Abstract
The limited accessibility to the brain has turned the cerebrospinal fluid (CSF) into a valuable source that may contribute to the complete understanding of the stroke pathophysiology. Here we have described the CSF proteome in the hyper-acute phase of cerebral ischemia by performing an aptamer-based proteomic assay (SOMAscan) in CSF samples collected before and 30 min after male Wistar rats had undergone a 90 min Middle Cerebral Artery Occlusion (MCAO) or sham-surgery. Proteomic results indicated that cerebral ischemia acutely increased the CSF levels of 716 proteins, mostly overrepresented in leukocyte chemotaxis and neuronal death processes. Seven promising candidates were further evaluated in rat plasma and brain (CKB, CaMK2A, CaMK2B, CaMK2D, PDXP, AREG, CMPK). The 3 CaMK2 family-members and CMPK early decreased in the infarcted brain area and, together with AREG, co-localized with neurons. Conversely, CKB levels remained consistent after the insult and specifically matched with astrocytes. Further exploration of these candidates in human plasma revealed the potential of CKB and CMPK to diagnose stroke, while CaMK2B and CMPK resulted feasible biomarkers of functional stroke outcome. Our findings provided insights into the CSF proteome following cerebral ischemia and identified new outstanding proteins that might be further considered as potential biomarkers of stroke.
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Affiliation(s)
- Alba Simats
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teresa García-Berrocoso
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Ramiro
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dolors Giralt
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Natalia Gill
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Penalba
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Rosell
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
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Makris K, Haliassos A, Chondrogianni M, Tsivgoulis G. Blood biomarkers in ischemic stroke: potential role and challenges in clinical practice and research. Crit Rev Clin Lab Sci 2018; 55:294-328. [DOI: 10.1080/10408363.2018.1461190] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Konstantinos Makris
- Clinical Biochemistry Department, KAT General Hospital, Kifissia, Athens, Greece
| | | | - Maria Chondrogianni
- Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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