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Milosevich E, Demeyere N, Pendlebury ST. Infection, Inflammation, and Poststroke Cognitive Impairment. J Am Heart Assoc 2024; 13:e9130. [PMID: 38214255 PMCID: PMC10926823 DOI: 10.1161/jaha.123.033015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Infection and inflammation are dementia risk factors in population-based cohorts; however, studies in stroke are scarce. We determined the prevalence of infection after stroke and routinely measured inflammatory biomarkers during hospitalization and their associations with acute and 6-month cognitive impairment. METHODS AND RESULTS A prospective stroke cohort completed the Oxford Cognitive Screen at ≤2 weeks and 6 months after stroke. Infection, inflammatory markers (C-reactive protein, white cell count, and neutrophil/lymphocyte ratio), and systemic inflammatory response syndrome were ascertained throughout admission with electronic patient records supplemented by hand searches. Associations with acute and 6-month global and domain-specific cognitive impairment were analyzed using multivariable regression, adjusting for demographic/vascular factors and stroke severity. Among 255 patients (mean age, 73.9 [SD, 12.6] years; 46.3% women; mean education, 12.6 [SD, 3.7] years; median National Institutes of Health Stroke Scale score 5 [range, minimum-maximum, 0-30]), infection was present in 90 patients (35.3%) at mean 4.4 (SD, 6.9) days after stroke, consisting predominantly of pneumonia (47/90; 52%) and urinary tract infection (39/90; 43%). Admission white cell count was elevated in 25.1% (n=64; mean, 9.5×109/L [SD, 3.2×109/L]), C-reactive protein in 41.2% (n=105; mean, 27.5 [SD, 50.9 mg/L]), neutrophil/lymphocyte ratio in 55.7% (n=97; mean, 5.5 [SD, 4.5]), and systemic inflammatory response syndrome in 26.6% (n=53 [45.2%] positive during hospitalization). Infection was associated with acute and 6-month poststroke cognitive impairment (P<0.05adj) with stronger associations acutely for severe infection (infection+systemic inflammatory response syndrome; P=0.03adj). Acute language, executive function and attention domain impairments, and 6-month number processing impairment were associated with infection (P<0.05adj). No significant relationships were found for any biomarker and cognitive impairment. CONCLUSIONS Infection and elevations in routinely measured inflammatory biomarkers are common following stroke; however, only infection is associated with poststroke cognitive impairment, suggesting that increases in these biomarkers may be nonspecific. Infection may present a tractable target for reducing poststroke cognitive impairment.
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Affiliation(s)
- Elise Milosevich
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Nele Demeyere
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Sarah T. Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research Centre and Departments of General Medicine and GeratologyJohn Radcliffe HospitalOxfordUK
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Kostenko V, Akimov O, Gutnik O, Kostenko H, Kostenko V, Romantseva T, Morhun Y, Nazarenko S, Taran O. Modulation of redox-sensitive transcription factors with polyphenols as pathogenetically grounded approach in therapy of systemic inflammatory response. Heliyon 2023; 9:e15551. [PMID: 37180884 PMCID: PMC10171461 DOI: 10.1016/j.heliyon.2023.e15551] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/09/2023] [Accepted: 04/13/2023] [Indexed: 05/16/2023] Open
Abstract
One of the adverse outcomes of acute inflammatory response is progressing to the chronic stage or transforming into an aggressive process, which can develop rapidly and result in the multiple organ dysfunction syndrome. The leading role in this process is played by the Systemic Inflammatory Response that is accompanied by the production of pro- and anti-inflammatory cytokines, acute phase proteins, and reactive oxygen and nitrogen species. The purpose of this review that highlights both the recent reports and the results of the authors' own research is to encourage scientists to develop new approaches to the differentiated therapy of various SIR manifestations (low- and high-grade systemic inflammatory response phenotypes) by modulating redox-sensitive transcription factors with polyphenols and to evaluate the saturation of the pharmaceutical market with appropriate dosage forms tailored for targeted delivery of these compounds. Redox-sensitive transcription factors such as NFκB, STAT3, AP1 and Nrf2 have a leading role in mechanisms of the formation of low- and high-grade systemic inflammatory phenotypes as variants of SIR. These phenotypic variants underlie the pathogenesis of the most dangerous diseases of internal organs, endocrine and nervous systems, surgical pathologies, and post-traumatic disorders. The use of individual chemical compounds of the class of polyphenols, or their combinations can be an effective technology in the therapy of SIR. Administering natural polyphenols in oral dosage forms is very beneficial in the therapy and management of the number of diseases accompanied with low-grade systemic inflammatory phenotype. The therapy of diseases associated with high-grade systemic inflammatory phenotype requires medicinal phenol preparations manufactured for parenteral administration.
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Affiliation(s)
- Vitalii Kostenko
- Poltava State Medical University, Department of Pathophysiology, Ukraine
| | - Oleh Akimov
- Poltava State Medical University, Department of Pathophysiology, Ukraine
- Corresponding author.
| | - Oleksandr Gutnik
- Poltava State Medical University, Department of Pathophysiology, Ukraine
| | - Heorhii Kostenko
- Poltava State Medical University, Department of Pathophysiology, Ukraine
| | - Viktoriia Kostenko
- Poltava State Medical University, Department of Foreign Languages with Latin and Medical Terminology, Ukraine
| | - Tamara Romantseva
- Poltava State Medical University, Department of Pathophysiology, Ukraine
| | - Yevhen Morhun
- Poltava State Medical University, Department of Pathophysiology, Ukraine
| | - Svitlana Nazarenko
- Poltava State Medical University, Department of Pathophysiology, Ukraine
| | - Olena Taran
- Poltava State Medical University, Department of Pathophysiology, Ukraine
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Bian J, Guo S, Huang T, Li X, Zhao S, Chu Z, Li Z. CRP as a potential predictor of outcome in acute ischemic stroke. Biomed Rep 2023; 18:17. [PMID: 36776580 PMCID: PMC9892964 DOI: 10.3892/br.2023.1599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023] Open
Abstract
Ischemic stroke is one of the major causes of death and long-term disability worldwide. C-reactive protein (CRP) as a potential biomarker for functional outcome after acute ischemic stroke remains controversial. The aim of the present study was to examine the association between the level of CRP and functional outcome of stroke. A total of 218 consecutive patients with acute ischemic stroke within 24 h after onset were recruited for the study. Poor functional outcome was defined as a modified Rankin scale score of >2 at 3 months after stroke. The retrospective analysis was performed to investigate whether CRP within 24 h after stroke is associated with poor functional outcome at 3 months. Multivariate logistic regression analysis indicated that the CRP level (odds ratio=1.146, 95%CI: 1.012-1.297, P=0.031) was an independent risk factor for poor outcome. The receiver operating characteristics curve analysis revealed that the optimal cut-off value of CRP to distinguish favorable from poor outcome was 6.34 (area under the curve=0.829, 95%CI: 0.772-0.887, P<0.001), with 68.2% sensitivity and 85.7% specificity. Spearman correlation analysis indicated that the CRP level was positively related to the baseline National Institutes of Health Stroke Scale (NIHSS) score (r=0.551, P<0.001), fasting glucose (r=0.301, P<0.001) and age (r=0.252, P<0.001). In conclusion, a high level of CRP within 24 h after onset was associated with a poor functional outcome after the acute ischemic event. The elevation of CRP may be correlated with the baseline NIHSS score, fasting glucose and age.
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Affiliation(s)
- Jing Bian
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Siping Guo
- Department of Neurology, Suzhou Dushuhu Public Hospital, Suzhou, Jiangsu 215125, P.R. China
| | - Tingting Huang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Xiuyun Li
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Shoucai Zhao
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Zhaohu Chu
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Zibao Li
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China,Correspondence to: Dr Zibao Li, Department of Neurology, Yijishan Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui 241001, P.R. China
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Liu L, Wang A, Wang D, Guo J, Zhang X, Zhao X, Wang W. Systemic Inflammatory Response Syndrome on Admission and Clinical Outcomes After Intracerebral Hemorrhage. J Inflamm Res 2023; 16:917-926. [PMID: 36891171 PMCID: PMC9987451 DOI: 10.2147/jir.s394635] [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: 10/24/2022] [Accepted: 02/18/2023] [Indexed: 03/05/2023] Open
Abstract
Background Since studies on systemic inflammatory response syndrome (SIRS) in patients with acute intracerebral hemorrhage (ICH) are insufficient. This study investigated the associations between SIRS on admission and clinical outcomes after acute ICH. Patients and Methods The study included 1159 patients with acute spontaneous ICH from January 2014 to September 2016. In accordance with standard criteria, SIRS was defined as two or more of the following: (1) body temperature >38°C or <36°C, (2) respiratory rate >20 per minute, (3) heart rate >90 per minute, and (4) white blood cell count >12,000/μL or <4000/μL. The clinical outcomes of interest were death and major disability (defined as a modified Rankin Scale of 6 and 3-5), combined and separate at 1 month, 3 months and 1 year follow-up. Results SIRS was observed in 13.5% (157/1159) of patients and independently increased the risk of death at 1 month, 3 months, or 1 year: hazard ratio (HR) 2.532 (95% confidence interval [CI] 1.487-4.311), HR 2.436 (95% CI 1.499-3.958), HR 2.030 (95% CI 1.343-3.068), respectively (P<0.05 for all). The relationship between SIRS and ICH mortality was more pronounced in older patients or patients with larger hematoma volumes. Patients with in-hospital infections were at greater risk of major disability. The risk was enhanced when SIRS was incorporated. Conclusion The presence of SIRS at the time of admission was associated with mortality in patients with acute ICH, particularly in older patients and those with large hematomas. SIRS may exacerbate the disability caused by in-hospital infections in patients with ICH.
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Affiliation(s)
- Lijun Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Dandan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Jiahuan Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Xiaoli Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Wenjuan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
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Deng J, Li L, Cao F, Wang F, Wang H, Shi H, Shen L, Zhao F, Zhao Y. Systemic Glycemic Variation Predicts Mortality of Acute Ischemic Stroke After Mechanical Thrombectomy: A Prospective Study Using Continuous Glucose Monitoring. Front Neurol 2022; 13:817033. [PMID: 35370877 PMCID: PMC8974401 DOI: 10.3389/fneur.2022.817033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/16/2022] [Indexed: 01/01/2023] Open
Abstract
Objective We investigated the association of glycemic variation with the clinical outcomes of large vessel occlusion (LVO) induced acute ischemic stroke (AIS) after mechanical thrombectomy (MT). Methods We recruited consecutive ischemic patients with stroke. Glucose levels were assessed through continuous glucose monitoring in 70 patients with AIS who had undergone MT. Metrics including percentages of time of glucose levels above the range, the hypoglycemic range, and the time within the range, coefficient of variation, standard deviation (SD), mean of daily differences, mean amplitude of glycemic excursion, largest amplitude of glycemic excursion, high blood glucose index, and low blood glucose index. The outcomes of this observational study were in-hospital mortality, neurological improvement during hospitalization, functional independence, and mortality at follow-up (3 months). The associations of the blood glucose metrics with outcomes were analyzed. Results The average period of glucose monitoring was 3.5 days, and serum glucose was recorded 728 times after MT for each person. The glycemic variation expressed in SDs was independently associated with in-hospital mortality [odds ratio (OR): 2.8, 95% confidence interval (CI): 1.276–6.145, p = 0.01] and the 3-month mortality (OR: 2.107, 95% CI: 1.013–4.382, p = 0.046) after adjusting for potential confounders. There was no association of glycemic variation with the 3-month clinical functional independence. Conclusions Increased systemic glycemic variation was associated with higher odds of mortality of LVO-AIS after MT. Clinical Trial Registration http://www.chictr.org.cn/showproj.aspx?proj=21016, identifier: ChiCTR-OOC-17012378.
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Affiliation(s)
- Jiangshan Deng
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ling Li
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Fengya Cao
- Department of Rehabilitation Medicine, Shanghai Eighth People's Hospital, Shanghai, China
| | - Feng Wang
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hongmei Wang
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hong Shi
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Li Shen
- Clinical Research Center, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Fei Zhao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Fei Zhao
| | - Yuwu Zhao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- *Correspondence: Yuwu Zhao
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Jafari M, Katlowitz K, De la Garza C, Sellers A, Moore S, Hall H, Desai A, Singh V, Damani R. Impact of systemic inflammatory response syndrome on acute ischemic stroke patients treated with mechanical thrombectomy. J Neurol Sci 2021; 430:119988. [PMID: 34547616 DOI: 10.1016/j.jns.2021.119988] [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: 01/11/2021] [Revised: 08/12/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
AIM Systemic inflammatory response syndrome (SIRS) has been associated with poor outcomes after acute ischemic stroke (AIS). The primary goal of this study was to determine whether SIRS status on admission correlated with functional outcomes in AIS treated with mechanical thrombectomy (MT). METHODS Consecutive patients from September 2015 to April 2019 were retrospectively reviewed for SIRS on admission. SIRS was defined as the presence of ≥2 of the following: temperature < 36 °C or > 38 °C, heart rate > 90, respiratory rate > 20, and white blood cell count <4000/mm or > 12,000 mm. RESULTS Of 202 patients, 188 met inclusion criteria. 49 patients (26%) had evidence of SIRS. Neither basic patient demographics nor standard stroke risk factors predicted the development of SIRS. However, presentation with SIRS was correlated with higher rates of death (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.2-5.5) as well as lower rates of favorable functional outcomes at discharge (OR, 0.09; 95% CI, 0.02-0.40) and 3-month follow up (OR 0.12; 95% CI 0.03-0.43). These results remained significant even after adjustment for age, sex, baseline NIHSS, recanalization status, and prior co-morbidities. CONCLUSION In our sample population, SIRS was associated with worse outcomes and higher rates of mortality in AIS patients treated with MT. Recognition of key risk factors can provide better prognostication and possible future therapeutic targets.
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Affiliation(s)
- Mostafa Jafari
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Kalman Katlowitz
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Alexander Sellers
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Shawn Moore
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Hayden Hall
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Aaron Desai
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Vikramjeet Singh
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Rahul Damani
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
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