Peripheral polymorphonuclear leukocyte activation as a systemic inflammatory response in ischemic stroke

2013 ◽  
Vol 34 (9) ◽  
pp. 1509-1516 ◽  
Author(s):  
Xiaoye Mo ◽  
Ting Li ◽  
Guang Ji ◽  
Wei Lu ◽  
Zhiping Hu
Keyword(s):  
Ischemic Stroke ◽  
Inflammatory Response ◽  
Polymorphonuclear Leukocyte ◽  
Systemic Inflammatory Response ◽  
Leukocyte Activation

scholarly journals Association Between Splenic Contraction and the Systemic Inflammatory Response After Acute Ischemic Stroke Varies with Age and Race

2017 ◽  
Vol 9 (5) ◽  
pp. 484-492 ◽  
Author(s):  
Alicia Zha ◽  
Farhaan Vahidy ◽  
Jaskaren Randhawa ◽  
Kaushik Parsha ◽  
Thanh Bui ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Inflammatory Response ◽  
Acute Ischemic Stroke ◽  
Systemic Inflammatory Response

scholarly journals Neutrophil-to-Lymphocyte Ratio Predicts Cerebral Edema and Clinical Worsening Early After Reperfusion Therapy in Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Daniela Ferro ◽  
Margarida Matias ◽  
Joana Neto ◽  
Rafael Dias ◽  
Goreti Moreira ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Systemic Inflammation ◽  
Cerebral Edema ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Reperfusion Therapy ◽  
Systemic Inflammatory Response ◽  
Early Neurological Deterioration

Background and Purpose: The mechanisms linking systemic inflammation to poor outcome in ischemic stroke are not fully understood. The authors investigated if peripheral inflammation following reperfusion therapy leads to an increase in cerebral edema (CED), thus hindering the clinical recovery. Methods: We designed a single-center study conducted at Centro Hospitalar Universitário São João between 2017 and 2019. Inclusion criteria were being adult, having an anterior circulation acute ischemic stroke, and receiving reperfusion therapy. Neutrophil-to-lymphocyte, platelet-to-lymphocyte ratios, and the systemic inflammatory response syndrome criteria were determined. The presence and grade of CED were evaluated on the computed tomography performed 24 hours following event. The clinical outcomes included early neurological deterioration and functional dependence at 90 days. Adjusted odds ratio and 95% CI were obtained by ordinal and logistic regression models. Optimal cutoff values were defined using receiver operating characteristic analysis in the training cohort and validated in an independent data set. Results: Five hundred fifty-three patients were included. Neutrophil-to-lymphocyte increased with higher degrees of CED at 24 hours (adjusted odds ratio, 1.34 [1.09–1.68], P <0.01) and was associated with early neurological deterioration (adjusted odds ratio, 1.30 [1.04–1.63], P <0.05) and poor functional status at 90 days (adjusted odds ratio, 1.79 [1.28–2.48], P <0.01). Platelet-to-lymphocyte was not associated with the outcomes. Systemic inflammatory response syndrome was related to CED due to altered white blood cell counts. Neutrophil-to-lymphocyte was the best predictor with an area under the curve around 0.7. Neutrophil-to-lymphocyte ≥7 had and accuracy, sensitivity, and specificity around 60%. Conclusions: Increased systemic inflammation is linked to the severity of CED early after reperfusion therapy in stroke. Easily obtained inflammatory markers convey early warning alerts for patients at risk of severe neurological complications with an impact on long-term functional outcome. CED quantification should be included as an end point in proof-of-concept trials in immunomodulation in stroke.

Abstract TP151: Association of Splenic Contraction And Development of Systemic Inflammatory Response Syndrome After Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Alicia M Zha ◽  
Bhargav Tippinayani ◽  
Jaskaren Randhawa ◽  
Nicole J Pariseau ◽  
Farhaan S Vahidy ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Care Center ◽  
Tertiary Care ◽  
Systemic Inflammatory Response ◽  
Secondary Brain Injury ◽  
Stroke Patients

Background: Animal models have demonstrated the deleterious contribution that immunocytes from the spleen exert on secondary brain injury after stroke. While previous work has demonstrated that there is splenic contraction (SC) in patients with acute ischemic stroke (AIS) and intracranial hemorrhage (ICH), no clinical studies have connected the systemic inflammatory response syndrome (SIRS) with SC. We aim to associate SIRS and its individual components with SC in acute stroke Methods: This is a retrospective analysis of a previous prospective observational study where daily spleen sizes were evaluated in 178 acute stroke patients in a tertiary care center from 2010-2013. Spleen contraction was defined compared to previously established normograms of healthy volunteers from the same study. SIRS was defined as the presence of 2 or more of the following: body temperature <36 or >38C, heart rate >90 beats, respiratory rate >20, and serum white blood cell count >12,000 or <4000 mm3 in the absence of infection. SC was evaluated in patients at 24 and 72 hrs after AIS with SIRS as a primary outcome. Results: 91 patients had verified AIS without concurrent infection at admission and 70 of these patients remained inpatient at 72 hrs. SIRS was not associated with admission SC at 24hr and 72 hrs. Patients with SIRS at 24 and 72 hrs were more likely to have higher admission NIHSS. SIRS was associated with higher discharge mRS (OR 4.24, 95% CI 1.64-10.9, p=0.0028) and PEG placement (OR 3.70, 95% CI 0.95-15.11, p=0.05). 16 patients (22.9%) developed SIRS by 72hrs, only 5 of whom had SC initially. 28 patients (47%) had SIRS on admission that persisted, 12 of whom had SC. SC was not associated with SIRS at 72 hrs (OR 1.05, 95% CI 0.35-2.79, p = 0.92). 14 patients (15%) developed infections while hospitalized, of which 85% had SIRS on admission. Conclusion: Based on our initial evaluation, SC detected within 24 hrs of stroke onset is not associated with SIRS suggesting that the relationship between the two may be more complicated in humans. Consistent with prior studies, however, SIRS is associated with worse outcome. Further studies and additional time points are necessary to further clarify the role of the spleen in the development of SIRS in stroke patients.

scholarly journals Correlation of Systemic Inflammatory Response With Infarct Volume in Acute Ischemic Stroke Patients

Stroke ◽  
2005 ◽  
Vol 36 (2) ◽  
pp. 228-229 ◽  
Author(s):  
Hedley C.A. Emsley ◽  
Craig J. Smith ◽  
Rachel F. Georgiou ◽  
Andy Vail ◽  
Pippa J. Tyrrell ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Inflammatory Response ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Systemic Inflammatory Response ◽  
Stroke Patients

scholarly journals Acute Heart Failure After Reperfused Ischemic Stroke: Association With Systemic and Cardiac Inflammatory Responses

2021 ◽  
Vol 12 ◽  
Author(s):  
Lilian Vornholz ◽  
Fabian Nienhaus ◽  
Michael Gliem ◽  
Christina Alter ◽  
Carina Henning ◽  
...  
Keyword(s):  
Heart Failure ◽  
Flow Cytometry ◽  
Ischemic Stroke ◽  
Inflammatory Response ◽  
Stroke Volume ◽  
Acute Heart Failure ◽  
Inflammatory Responses ◽  
Troponin T ◽  
Systemic Inflammatory Response ◽  
Myocardial Tissue

Patients with acute ischemic stroke (AIS) present an increased incidence of systemic inflammatory response syndrome and release of Troponin T coinciding with cardiac dysfunction. The nature of the cardiocirculatory alterations remains obscure as models to investigate systemic interferences of the brain-heart-axis following AIS are sparse. Thus, this study aims to investigate acute cardiocirculatory dysfunction and myocardial injury in mice after reperfused AIS. Ischemic stroke was induced in mice by transient right-sided middle cerebral artery occlusion (tMCAO). Cardiac effects were investigated by electrocardiograms, 3D-echocardiography, magnetic resonance imaging (MRI), invasive conductance catheter measurements, histology, flow-cytometry, and determination of high-sensitive Troponin T (hsTnT). Systemic hemodynamics were recorded and catecholamines and inflammatory markers in circulating blood and myocardial tissue were determined by immuno-assay and flow-cytometry. Twenty-four hours following tMCAO hsTnT was elevated 4-fold compared to controls and predicted long-term survival. In parallel, systolic left ventricular dysfunction occurred with impaired global longitudinal strain, lower blood pressure, reduced stroke volume, and severe bradycardia leading to reduced cardiac output. This was accompanied by a systemic inflammatory response characterized by granulocytosis, lymphopenia, and increased levels of serum-amyloid P and interleukin-6. Within myocardial tissue, MRI relaxometry indicated expansion of extracellular space, most likely due to inflammatory edema and a reduced fluid volume. Accordingly, we found an increased abundance of granulocytes, apoptotic cells, and upregulation of pro-inflammatory cytokines within myocardial tissue following tMCAO. Therefore, reperfused ischemic stroke leads to specific cardiocirculatory alterations that are characterized by acute heart failure with reduced stroke volume, bradycardia, and changes in cardiac tissue and accompanied by systemic and local inflammatory responses.

Abstract TP278: Prevalence Of Systemic Inflammatory Response Syndrome and its Impact On Outcome In Acute Ischemic Stroke Patients Receiving IV tPA Therapy

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Niren Kapoor ◽  
Amelia K Boehme ◽  
Karen C Albright ◽  
Michael J Lyerly ◽  
Reza Bavarsad Shahripour ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Systemic Inflammatory Response ◽  
Short Term ◽  
Sirs Criteria ◽  
Iv Tpa

Background: Systemic Inflammatory Response Syndrome (SIRS) is a generalized inflammatory state linked to a release of various pro- and anti-inflammatory cytokines and associated with fibrin deposition, platelet aggregation, and coagulopathies. Although SIRS is associated with various inflammatory and ischemic conditions, its prevalence and impact on patients with acute ischemic stroke (AIS) has not been extensively studied. Methods: A retrospective cross sectional study was used to look at the prevalence of SIRS and its impact on outcome in AIS patients treated with IV tPA between 2009-2011 at our tertiary care center. SIRS was diagnosed if two or more of the following were present: temperature < 36°C or > 38°C, heart rate > 90/min, respiratory rate >20/min or PaCO 2 <32 mmHg and WBC count <4000/mm 3 or >12000/mm 3 or 10% bands. Patients meeting the SIRS criteria for at least 24h were included in the study. Patients with signs of active infection such as pneumonia, UTI, bacteremia, and sinusitis or deep venous thrombosis were excluded from the study. The discharge modified Rankin score (mRS) was used to compare the short-term outcomes between patients with and without SIRS. An mRS of 4-6 was used to define poor functional outcome. Results: Out of the 212 patients screened, 44 met the SIRS criteria (21%). The median NIHSS for SIRS patients was 9 (range 0-32). SIRS patients were more likely to have a longer length of stay than non-SIRS patients (5 vs. 3 days; p<0.0001). Patients with SIRS had worse functional outcomes compared to patients without SIRS (OR=2.824, 95% CI, 1.358 - 5.871, p=0.0054). Adjusting for pre-tPA NIHSS, age and race, SIRS remained a predictor of poor outcome (OR= 2.581, 95% CI, 1.163 - 5.727, p=0.0197). Presence of SIRS did not have a significant effect upon in-hospital mortality (OR=1.978, 95% CI, 0.774 - 5.057, p=0.1545). Conclusions: One out of five AIS patients treated with IV tPA developed SIRS. The presence of SIRS is associated with poor short-term functional outcomes and prolonged length of stay.

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