on February 20, 2003
Published online before print February 20, 2003, doi: 10.1161/01.STR.0000057976.53301.69
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Submitted on April 17, 2002
From the Hospital Clínic (N.V., A.C.), Clinical Institute of Nervous System Diseases, Instituto Investigaciones Biomédicas August Pi i Sunyer, Barcelona; Hospital Clínic Universitario (J.C.), Santiago de Compostela; Hospital Universitario Doctor Josep Trueta (A.D.), Girona; Centre Estudis Epidemiològics sobre la SIDA de Catalunya (A.E.), University Hospital Germans Trías i Pujol, Badalona; and Department of Pharmacology and Toxicology (A.M.P.); Instituto Investigaciones Biomédicas Consejo Superior Investigaciones Científicas, Barcelona, Spain. * To whom correspondence should be addressed. E-mail: chamorro{at}medicina.ub.es.
Background--Mechanisms involved in stroke progression are incompletely understood. Ischemic brain injury is characterized by acute local inflammatory response mediated by cytokines. Anti-inflammatory cytokines act in a feedback loop to inhibit continued proinflammatory cytokine production. We assessed the implication of interleukin (IL)-10 and IL-4 in deteriorating ischemic stroke. Methods--Two hundred thirty-one patients with ischemic stroke within the first 24 hours from onset were included. Neurological worsening was defined when the Canadian Stroke Scale score fell at least 1 point during the first 48 hours after admission. Anti-inflammatory cytokines were determined in plasma obtained on admission. Results--Eighty-three patients (35.9%) worsened within the first 48 hours after stroke onset. Significantly lower concentrations of IL-10 were found in patients with neurological worsening (P<0.05), but IL-4 levels were similar in patients with or without deterioration. Lower plasma concentrations of IL-10 (<6 pg/mL) were associated with clinical worsening on multivariate analysis (odds ratio=3.1, 95% CI=1.1 to 8.9) independently of hyperthermia, hyperglycemia, or neurological condition on admission. Further analysis disclosed that early worsening was independently associated with lower IL-10 plasma levels in patients with subcortical infarcts or lacunar stroke but not in patients with cortical lesions. Conclusions--Anti-inflammatory cytokine IL-10 is associated with the early clinical course of patients with acute ischemic stroke, especially in patients with small vessel disease or subcortical infarctions.
Revised on September 25, 2002
Accepted on September 27, 2002
Levels of Anti-Inflammatory Cytokines and Neurological Worsening in Acute Ischemic Stroke
Nicolás Vila MD;
Key words: cytokines • inflammation • interleukin-4 • interleukin-10 • neuroprotection • stroke, ischemic
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