Inflammatory markers and in-hospital mortality in acute ischaemic stroke.
BACKGROUND
There is substantial evidence that cerebral ischaemia triggers an inflammatory response. We examined the short-term prognostic value on mortality of C-reactive protein (CRP), interleukin-6 (IL-6) and serum amyloid A (SAA) in patients with ischaemic stroke.


METHODS
We recruited 203 consecutive patients, under the age of 66 years (mean age=54.2+/-8.1 years, men=132) who admitted to the Neurology Department with the diagnosis of non-haemorrhagic stroke. Patients in atrial fibrillation or with evidence of inflammatory or malignant disease were excluded. The diagnosis was confirmed with a computed tomography or magnetic resonance imaging of the brain within 24h of admission. CRP, IL-6 and SAA levels were determined within 12h from admission.


RESULTS
Fourteen (6.9%) patients died during hospitalization. Serum concentrations of CRP, IL-6 and SAA were significantly higher in patients who died compared with those who survived and were independently associated with early death, after adjusting for various confounding factors. For one unit increase in IL-6, CRP and SAA there was an 18%, 14% and 9% higher risk of dying during hospitalization, respectively. Comparisons of the areas under the ROC curve showed that IL-6 had the best predictive ability. Age-adjusted cut-off point analysis showed that IL-6 levels >13 pg/ml were the optimal point that discriminated those who died from the rest of the patients (sensitivity=85% and specificity=93%).


CONCLUSIONS
We demonstrated that in-hospital mortality in ischaemic stroke is associated with an exacerbation of inflammatory response as it is reflected by the higher serum levels of IL-6, CRP and SAA. From the inflammatory markers high IL-6 levels had the strongest independent predictive value for in-hospital mortality.
Rallidis
Loukianos S
LS
Second Department of Cardiology, Attikon Hospital, School of Medicine, University of Athens, Athens, Greece. rallidis@ath.forthnet.gr
Vikelis
Michalis
M
Panagiotakos
Demosthenes B
DB
Rizos
Ioannis
I
Zolindaki
Maria G
MG
Kaliva
Karerina
K
Kremastinos
Dimitrios T
DT
D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D002097:C-Reactive Protein / Q000378:metabolism*; D016001:Confidence Intervals; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007249:Inflammation / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry; D011379:Prognosis; D012189:Retrospective Studies; D000685:Serum Amyloid A Protein / Q000378:metabolism*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
D015415:Biomarkers; D015850:Interleukin-6; D000685:Serum Amyloid A Protein; D002097:C-Reactive Protein