Interleukin 10, monocytes and increased risk of early infection in ischaemic stroke.
OBJECTIVE
The pathophysiology of stroke-associated infection (SAI) is uncertain. The cytokine profile and peripheral white cell response were assessed in patients with or without SAI.


METHODS
The incidence of SAI was assessed in 110 patients with ischaemic stroke allocated antibiotic prophylaxis or placebo within 24 h of clinical onset. Peripheral white cell counts, interleukin (IL)6, tumour necrosis factor (TNF)alpha and IL10 were measured in plasma.


RESULTS
17 (15%) patients developed infection and showed time-dependent increases of total white cell count, neutrophils, monocytes, lymphocytes, IL6 and IL10, whereas TNFalpha and the TNFalpha/IL10 ratio decreased. In logistic regression, IL10 (odds ratio (OR) 1.08, 95% confidence interval (CI) 1.01 to 1.16), monocyte count (OR 1.42, 95% CI 1.08 to 1.87) and National Institute for Health Stroke Survey score on admission (OR 1.17, 95% CI 1.05 to 1.31) were independent predictors of systemic infection.


CONCLUSIONS
SAI is associated with stroke severity, excessive IL10-mediated response and an increased number of circulating monocytes. These results support the finding that acute ischaemic brain injury triggers a blood-borne anti-inflammatory response that decreases the antimicrobial drive of the immune system.
Chamorro
A
A
Stroke Unit, Hospital Clínic and Institut d'Investigacions Biomédiques August Pi i Sunyer, University of Barcelona, Hospital Clínic, 08036 Barcelona, Spain. achamorro@ub.edu
Amaro
S
S
Vargas
M
M
Obach
V
V
Cervera
A
A
Torres
F
F
Planas
A M
AM
D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D002545:Brain Ischemia / Q000150:complications* / Q000382:microbiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D016753:Interleukin-10 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D016017:Odds Ratio; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000382:microbiology*
D016753:Interleukin-10