Inflammatory marker profiles and in-hospital neurological deterioration in patients with acute minor ischemic stroke

Abstract

Aim: The aim of the study was to analyze the association between inflammatory marker profiles and in-hospital neurological deterioration (ND) in acute ischemic stroke (AIS) patients.

Methods: Data from patients with minor AIS from the Third China National Stroke Registry were analyzed. Inflammatory cytokine levels within 24 h of admission were measured. The primary outcome was in-hospital ND (an increase in National Institutes of Health Stroke Scale score ≥4 from admission to discharge). Associations were evaluated using odds ratios (ORs) and 95% confidence intervals (CIs) derived from logistic regression models. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to evaluate incremental predictive values.

Results: A total of 4031 patients (1246 women, 30.9%) with a median age of 62 years were included. In-hospital ND occurred in 121 patients (3%). Each standard-deviation increase in interleukin (IL)-6 (OR, 1.17 [95% CI, 1.06-1.31]) and high-sensitivity C-reactive protein (hsCRP) (OR, 1.43 [95% CI, 1.24-1.66]) levels was associated with increased in-hospital ND risk. Incremental predictive values for adding IL-6 (IDI, 0.012; NRI, 0.329) but not hsCRP levels to the conventional risk factors were found.

Conclusion: In minor AIS, hsCRP and IL-6 levels were associated with in-hospital ND, including IL-6 levels in prognostic models improved risk classification.

Keywords: acute ischemic stroke; cerebrovascular disease; inflammatory marker; neurological deterioration.

FIGURE 1

Dot plots based on neurological deterioration (ND) status. (A) Interleukin (IL)‐6, (B) high‐sensitivity C‐reactive protein (hsCRP), (C) lipoprotein‐associated phospholipase A2 (Lp‐PLA2) mass, (D) Lp‐PLA2 activity, (E) YKL‐40/CHI3L1, (F) IL‐1Ra, (G) IL‐6R, and (H) monocyte chemotactic protein 1 (MCP‐1).