Cytokine-induced inflammation and long-term stroke functional outcome

Inflammatory reactions are involved in the pathogenesis of cerebral ischemi a, Cytokines exacerbate brain ischemic injury by several mechanisms and the y activate the synthesis of acute-phase reactants. We evaluated the associa tion between cytokine-induced inflammation and functional outcome in 41 pat ients with acute ischemic stroke. Blood samples for interleukin-1 receptor antagonist (IL-1ra), erythrocyte sedimentation rate (ESR), c-reactive prote in (CRP) and polymorphonuclear leukocyte (PMNL) count were taken within 48 h from stroke onset. Functional outcome was assessed at six months with the Modified Rankin Scale. Patients with a Rankin score greater than or equal to 3 were classified as dependent outcome. The effect of inflammatory varia bles on outcome was analyzed by logistic regression. Mathew score < 75 on a dmission, atrial fibrillation, non-lacunar infarct size, ESR > 13 mm/h in m en or > 20 mm/h in women, PMNL count > 8.10(9)/1, CRP > 0.8 mg/dl and IL-1r a > 500 pg/ml were associated with dependent outcome. On multiple logistic regression, severe stroke on admission, non-lacunar infarct size and ESR re main in the predictive model of outcome with a sensitivity and specificity of 76 and 80%, respectively. This study suggests that in addition to clinic al evaluation and neuroimaging, measurement of ESR may be useful for the ea rly detection of stroke patients with poor long-term functional outcome. (C ) 1999 Elsevier Science B.V. All rights reserved.