(Stroke. 2000;31:2325.)
© 2000 American Heart Association, Inc.
Original Contributions |
Proinflammatory Cytokines and Early Neurological Worsening in Ischemic Stroke
From the Institut Clínic Malalties Sistema Nerviós, IDIBAPS, Hospital Clínic, Barcelona (N.V., A.C.); Neurology Service, Hospital Clínico Universitario, Santiago de Compostela (J.C.); and Neurology Service, Hospital Universitario Doctor Josep Trueta, Girona, Spain (A.D.).
Correspondence to Ángel Chamorro, MD, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain. E-mail chamorro{at}medicina.ub.es
Background and Purpose—The
mechanisms for clinical deterioration in patients with ischemic
stroke are not completely understood. Several proinflammatory
cytokines are released early after the onset of brain
ischemia, but it is unknown whether inflammation predisposes to
neurological deterioration. We assessed the implication of interleukin
(IL)-6 and tumor necrosis factor (TNF)-
in early neurological
worsening in ischemic stroke.
Methods—Two hundred thirty-one patients consecutively admitted
with first-ever ischemic cerebral infarction within the first
24 hours from onset were included. Neurological worsening was defined
when the Canadian Stroke Scale (CSS) score fell at least 1 point during
the first 48 hours after admission. IL-6 and TNF- were determined in
plasma and cerebrospinal fluid (CSF; n=81) obtained on admission.
Results—Eighty-three patients (35.9%) deteriorated within the
first 48 hours. IL-6 in plasma (>21.5 pg/mL; OR 37.7, CI 11.9 to
118.8) or in CSF (>6.3 pg/mL; OR 13.1, CI 2.2 to 77.3) were
independent factors for early clinical worsening, with multiple
logistic regression. The association was statistically significant in
all ischemic stroke subtypes as well as in subjects with
cortical or subcortical infarctions. IL-6 in plasma was highly
correlated with body temperature, glucose, fibrinogen, and infarct
volume. CSF and plasma concentrations of TNF- were also higher in
patients who deteriorated, but the differences observed did not remain
significant on multivariate analysis.
Conclusions—In addition to participating in the acute-phase response that follows focal cerebral ischemia, IL-6 levels on admission are associated with early clinical deterioration. The association between IL-6 and early neurological worsening prevails without regard to the initial size, topography, or mechanism of the ischemic infarction.
Key Words: interleukins • prognosis • stroke • tumor necrosis factor
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