title: Levels of anti-inflammatory cytokines and neurological worsening in acute ischemic stroke.
abstract: 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.
authors.affiliation: Hospital Clínic, Clinical Institute of Nervous System Diseases, Instituto Investigaciones Biomédicas August Pi i Sunyer, Villaroel 170, 08036 Barcelona, Spain.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Vila
authors.forename: José
authors.initials: J
authors.lastname: Castillo
authors.forename: Antonio
authors.initials: A
authors.lastname: Dávalos
authors.forename: Anna
authors.initials: A
authors.lastname: Esteve
authors.forename: Anna M
authors.initials: AM
authors.lastname: Planas
authors.forename: Angel
authors.initials: A
authors.lastname: Chamorro
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D016207:Cytokines / Q000097:blood*; D018450:Disease Progression; D025461:Feedback, Physiological; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015847:Interleukin-4 / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020521:Stroke / Q000097:blood* / Q000150:complications / Q000175:diagnosis*
chemical_list: D016207:Cytokines; D016753:Interleukin-10; D015847:Interleukin-4