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. 2022 Jul 26:15:4239-4249.
doi: 10.2147/JIR.S368183. eCollection 2022.

Pulmonary Tuberculosis-Related Ischemic Stroke: A Retrospective Case Control Study

Yunfei Wei #  1   2 , Shiting Tang #  1 , Zhouhua Xie  3 , Yaoqin He  3 , Yunli Zhang  4 , Yiju Xie  5 , Shijian Chen  1 , Liuyu Liu  1 , Yayuan Liu  1 , Zhijian Liang  1
Affiliations

Pulmonary Tuberculosis-Related Ischemic Stroke: A Retrospective Case Control Study

Yunfei Wei et al. J Inflamm Res. .

Abstract

Objective: There have been only a few studies of ischemic stroke in patients with pulmonary tuberculosis (pTB). This study aimed to explore the clinical features and the underlying pathogenesis of pulmonary tuberculosis-related ischemic stroke (TBRIS).

Methods: Active pulmonary tuberculosis patients with acute ischemic stroke (without conventional vascular risk factors) were recruited as the TBRIS group. Patients who solely had active pulmonary tuberculosis were recruited as the control group (pTB group). Clinical data were collected, and multiple logistic regression analysis was applied to analyze the independent risk factors for TBRIS.

Results: A total of 179 TBRIS patients and 179 pTB patients were enrolled. Most (56.42%) of the TBRIS patients experienced the ischemic stroke events within 3 months after the diagnosis of tuberculosis. The multiple logistic regression analysis revealed that an increased mean platelet volume; elevated plasma D-dimer, C-reactive protein, and serum ferritin levels; and an increased monocyte percentage were independent risk factors for TBRIS. The AUC of the identification model was 0.778, with a sensitivity of 70.30% and a specificity of 78.90%.

Conclusion: The findings in the present study suggested that most of the TBRIS patients experienced ischemic stroke within 3 months after the diagnosis of tuberculosis. And the more intensive immune response to the tuberculosis infection in the TBRIS group contributed to the initiation of platelet activation and to the development of a hypercoagulable state, which were attributed to the pathogenesis of TBRIS. Index of TBRIS equaling to 0.3234 facilitates clinicians to identify the pTB patients who were at higher risk for TBRIS, and allow physicians to take further effective measures to prevent ischemic stroke in patients with pTB. However, our findings will need to be confirmed by further studies.

Keywords: independent risk factor; ischemic stroke; pathogenesis; pulmonary tuberculosis; tuberculosis-related ischemic stroke.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart for the screening of patients with pulmonary tuberculosis-related ischemic stroke. TBRIS: pulmonary tuberculosis-related ischemic stroke pTB: pulmonary tuberculosis.
Figure 2
Figure 2
Temporal map between the course of pulmonary tuberculosis and the onset of ischemic stroke. formula image: Ischemic stroke onset before pulmonary tuberculosis diagnosis formula image: Ischemic stroke onset after pulmonary tuberculosis diagnosis.
Figure 3
Figure 3
Typical neuroimage of a patient with acute ischemic stroke and active pulmonary tuberculosis. Images are from a male in his 50s who had acute ischemic stroke without conventional stroke risk factors and who was initially diagnosed with active pulmonary tuberculosis during the treatment of ischemic stroke. Six MRI diffusion-weighted images (picture A–F) show multiple high-signal lesions in multiple arterial regions of the brain. Two pictures of computed tomography angiography (picture G and H) show normal cerebral vessels.
Figure 4
Figure 4
Analysis of the ROC curve and the area under the curve.
See this image and copyright information in PMC

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