Persistent inflammation worsens short-term outcomes in massive stroke patients

Abstract

Background Persistent inflammation is an important driver of disease progression and affects prognosis. Some indicators of inflammation predict short-term outcomes. The relationship between prognosis, especially mortality, and persistent inflammation in massive stroke has not been studied, and this has been the subject of our research. Methods From April 1, 2017 to February 1, 2020, consecutive patients were prospectively enrolled. Clinical data, laboratory data, imaging data and follow-up infections morbidity were compared between 2 groups according to modified Rankin scale (mRS) scores (mRS < 3 and ≥ 3) at 1 month. The binomial logistic analysis was used to determine independent factors of 1-month prognosis. Short-term functional outcome, mortality and infection rates in massive stroke with and without persistent inflammation were compared. Results One hundred thirty-nine patients with massive stroke were included from 800 patients. We found that admission blood glucose levels (p = 0.005), proportions of cerebral hemispheric (p = 0.001), posterior circulatory (p = 0.035), and lacunar (p = 0.022) ischemia were higher in poor outcome patients; neutrophil-to-lymphocyte ratio (odd ratio = 1.87, 95%CI 1.14–3.07, p = 0.013) and blood glucose concentrations (odd ratio = 1.34, 95%CI 1.01–1.79, p = 0.043) can independently predict the short-term prognosis in massive stroke patients. We also found that the incidence of pulmonary infection (p = 0.009), one-month mortality (p = 0.003) and adverse outcomes (p = 0.0005) were higher in patients with persistent inflammation. Conclusions This study suggested that persistent inflammation is associated with poor prognosis, 1-month mortality and the occurrence of in-hospital pulmonary infection and that higher baseline inflammation level predicts short-term poor outcomes in massive stroke.

Persistent hyperglycemia is a useful glycemic pattern to predict stroke mortality: a systematic review and meta-analysis

“…Consecutive patients with either ischemic or hemorrhagic stroke were screened and selected from the Stroke Unit of Shanghai Fifth People’s Hospital between April 1, 2017, and February 1, 2020. The inclusion and exclusion criteria were the same as those reported in a previous study (see Supplemental materials ) [ 18 ].…”

Neuroinflammation as a Key Driver of Secondary Neurodegeneration Following Stroke?

“…It is likely that this secondary peak in neuroinflammation is exacerbated by the concept of ‘inflammaging’. The term inflammaging alludes to the long-term condition of low-grade stimulation of the immune system, which essentially primes organisms to be more susceptible to inflammatory changes, such as those seen following stroke [ 175 , 176 ]. Suggesting that this secondary peak in neuroinflammation that is seen months after the initial insult may be exacerbated by a heightened inflammatory environment seen with ageing.…”

The Neutrophil to Lymphocyte Ratio in Poststroke Infection: A Systematic Review and Meta-Analysis

“…This systematic review included 25 studies, of which 12 were retrospective [ 10 , 12 , 14 , 18 , 22 – 25 , 28 , 30 – 32 ] and 13 were prospective [ 4 , 9 , 11 , 13 , 15 – 17 , 19 – 21 , 26 , 27 , 29 ]. Among 25 studies, 15 were included in the meta-analysis; nine were retrospective [ 10 , 14 , 22 , 24 , 25 , 28 , 30 – 32 ], and six were prospective [ 11 , 13 , 20 , 26 , 27 , 29 ].…”

“…In addition, some studies were included solely in the qualitative review [ 4 , 9 , 12 , 15 – 19 , 21 , 23 ]. The majority of them assessed the relationship between NLR and PSP [ 4 , 9 , 12 , 15 – 18 , 21 , 23 ] and reported that NLR could predict pneumonia after stroke, similar to our findings. UTI is another type of PSP whose relationship with NLR was investigated in included studies.…”