title: Level and value of interleukin-18 after acute ischemic stroke.
abstract: BACKGROUND
  The prognostic value of the level of interleukin (IL)-18 in patients after acute ischemic stroke (IS) has not been completely investigated. This prospective cohort study examined whether the circulating IL-18 level can predict 90-day outcome of IS.
  
  
  RESULTS
  Plasma IL-18 level was obtained from blood samples taken by venous access at 48 h following acute IS in 217 consecutive patients. Plasma IL-18 level was also evaluated in 20 healthy and 40 at-risk control subjects. Plasma levels of IL-18 and white blood cell (WBC) counts were significantly higher in IS patients than in both control groups (all p values <0.0001). Patients with high IL-18 level (>or=780 pg/ml) had significantly higher incidences of 90-day recurrent stroke and 90-day accumulative death (all p values <0.01). Univariate analysis demonstrated that IL-18 level (>or=780 pg/ml), modified Rankin scale score, WBC count, creatinine level, and coronary artery disease were significantly associated with 90-day major adverse clinical outcomes (MACO) (defined as combined 90-day recurrent stroke and 90-day mortality) (all p values <0.05). Multiple stepwise logistic regression analysis demonstrated that high IL-18 level (>or=780 pg/ml) (p<0.0001), together with creatinine level (p=0.024), were independently predictive of 90-day MACO.
  
  
  CONCLUSIONS
  Plasma IL-18 level is a major independent inflammatory predictor of 90-day MACO in IS patients. Evaluation of circulating IL-18 level might improve the prediction of unfavorable clinical outcome following IS.
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chun-Man
authors.initials: CM
authors.lastname: Yuen
authors.forename: Cheng-An
authors.initials: CA
authors.lastname: Chiu
authors.forename: Li-Teh
authors.initials: LT
authors.lastname: Chang
authors.forename: Chia-Wei
authors.initials: CW
authors.lastname: Liou
authors.forename: Cheng-Hsien
authors.initials: CH
authors.lastname: Lu
authors.forename: Ali A
authors.initials: AA
authors.lastname: Youssef
authors.forename: Hon-Kan
authors.initials: HK
authors.lastname: Yip
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood; D020382:Interleukin-18 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000097:blood*
chemical_list: D015415:Biomarkers; D020382:Interleukin-18