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Multicenter Study
. 2019 Jul 3;19(1):148.
doi: 10.1186/s12883-019-1375-6.

Biomarkers of immune capacity, infection and inflammation are associated with poor outcome and mortality after stroke - the PREDICT study

A Mengel  1   2 , L Ulm  3   4 , B Hotter  3   5 , H Harms  3 , S K Piper  6   7   8 , U Grittner  6   7   8 , J Montaner  9 , C Meisel  10 , A Meisel  3   5   10 , S Hoffmann  3   10
Affiliations
Free PMC article
Multicenter Study

Biomarkers of immune capacity, infection and inflammation are associated with poor outcome and mortality after stroke - the PREDICT study

A Mengel et al. BMC Neurol. .
Free PMC article

Abstract

Background: Almost 40% of stroke patients have a poor outcome at 3 months after the index event. Predictors for stroke outcome in the early acute phase may help to tailor stroke treatment. Infection and inflammation are considered to influence stroke outcome.

Methods: In a prospective multicenter study in Germany and Spain, including 486 patients with acute ischemic stroke, we used multivariable regression analysis to investigate the association of poor outcome with monocytic HLA-DR (mHLA-DR) expression, interleukin 6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor alpha (TNF-alpha) and lipopolysaccharide-binding protein (LBP) as markers for immunodepression, inflammation and infection. Outcome was assessed at 3 months after stroke via a structured telephone interview using the modified Rankin Scale (mRS). Poor outcome was defined as a mRS score of 3 or higher which included death. Furthermore, a time-to-event analysis for death within 3 months was performed.

Results: Three-month outcome data was available for 391 patients. Female sex, older age, diabetes mellitus, atrial fibrillation, stroke-associated pneumonia (SAP) and higher National Institute of Health Stroke Scale (NIHSS) score as well as lower mHLA-DR levels, higher IL-6 and LBP-levels at day 1 were associated with poor outcome at 3 months in bivariate analysis. Furthermore, multivariable analysis revealed that lower mHLA-DR expression was associated with poor outcome. Female sex, older age, atrial fibrillation, SAP, higher NIHSS score, lower mHLA-DR expression and higher IL-6 levels were associated with shorter survival time in bivariate analysis. In multivariable analysis, SAP and higher IL-6 levels on day 1 were associated with shorter survival time.

Conclusions: SAP, lower mHLA-DR-expression and higher IL-6 levels on day one are associated with poor outcome and shorter survival time at 3 months after stroke onset.

Trial registration: www.clinicaltrials.gov, NCT01079728 , March 3, 2010.

Keywords: Biomarkers; Ischemic stroke; Mortality; Outcome.

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Conflict of interest statement

Christian and Andreas Meisel have issue of a patent on anti-infective and immunomodulatory agents used for preventive antibacterial therapy after stroke (EP1480646). As one of the co-authors, Andreas Meisel, is a section editor of this journal. The other authors report no conflict of interest.

This study was supported by Siemens Healthcare Diagnostics (collection of data).

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