PERSISTENT INFLAMMATORY RESPONSE IN STROKE SURVIVORS

Objective: Goals were to determine how long acute-phase markers remain elevated after ischemic stroke and how marker levels relate to stroke risk factors, stroke mechanism, and subsequent vascular events. Metho ds: Fibrinogen (FIB), C-reactive protein (CRP), leukocytes (WBC), neut rophils (PMN), interleukin-g, and interleukin-l receptor antagonist we re measured at stroke onset and at 6 weeks, 6 months, and 1 year after enrollment, or until a vascular event occurred in 136 acute ischemic stroke patients, 76 patients with comparable risk factors for stroke, and 48 age-balanced healthy subjects. Results: Multivariate logistic a nalysis showed that prior stroke and FIB level predicted new events in stroke patients (p < 0.04 for both), whereas congestive heart failure (p < 0.02) and creatinine level (p < 0.006) were predictive in at-ris k patients. After controlling for infection, FIB, CRP, and PMN levels at baseline were higher in at-risk but not in stroke patients with rec urrent events (p < 0.05 for all). At 1 year, FIB levels remained eleva ted in event-free stroke survivors compared with levels in the risk an d control groups (p < 0.001 for both). FIB also remained higher in str oke survivors who had atheroembolism (AE) compared with non-AE stroke survivors (381 +/- 72 versus 342 +/- 78 mg/dL, p < 0.02). Peripheral v ascular disease was an independent predictor (p < 0.0001) of longitudi nal FIB in stroke survivors. Of note, both WBC and PMN levels were chr onically elevated in patients with stroke risk factors and in stroke s urvivors (p < 0.0001 for both) compared with healthy elderly subjects. Conclusions: Most acute-phase markers decline gradually after stroke, but FIB remains significantly elevated and is associated with increas ed risk for recurrent vascular events.