title: Body temperature, blood infection parameters, and outcome of thrombolysis-treated ischemic stroke patients.
abstract: OBJECTIVE
  Body temperature, inflammation, and infections may modify response to thrombolytic therapy. We studied their associations with clinical improvement after intravenous thrombolysis and three-month outcome.
  
  
  METHODS
  We included 985 consecutive acute ischemic stroke patients treated with intravenous thrombolysis at the Helsinki University Central Hospital during 1995-2008. Body temperature, blood leukocyte count, and C-reactive protein levels were analyzed on arrival and at day one. Clinical improvement was defined as National Institutes of Health Stroke Scale score decrease of ≥4 points or a score of 0 at 24 h. Functional outcome was assessed at three-months with the modified Rankin Scale dichotomized at 0-2 (good) vs. 3-6 (poor). Associations were tested with multivariable logistic regression analysis.
  
  
  RESULTS
  Of the baseline variables, lower C-reactive protein independently predicted clinical improvement at 24 h (odds ratio 0·94 per 5 mg/L; 95% confidence interval 0·89-1·00; P = 0·03), whereas higher leukocyte count (odds ratio 1·10 per E9/L; 1·03-1·17; P < 0·01) and C-reactive protein (odds ratio 1·07 per 5 mg/L; 1·01-1·14; P = 0·02) were associated with poor three-month outcome. When body temperature increased over the first 24 h, clinical improvement after thrombolysis was unlikely (odds ratio 0·66 per °C; 0·45-0·95; P = 0·03) and poor outcome more common (odds ratio 1·63 per °C; 1·24-2·14; P < 0·001). Elevated leukocytes at baseline increased the risk of symptomatic intracerebral hemorrhage (odds ratio 1·07 per E9/L; 1·00-1·13; P = 0·04).
  
  
  CONCLUSIONS
  A lower level of systemic inflammation at time of thrombolysis may be associated with clinical improvement and good outcome at three-months. Increase in body temperature during the first 24 h associates with lack of clinical improvement and worse patient outcome.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Marjaana
authors.initials: M
authors.lastname: Tiainen
authors.forename: Atte
authors.initials: A
authors.lastname: Meretoja
authors.forename: Daniel
authors.initials: D
authors.lastname: Strbian
authors.forename: Joel
authors.initials: J
authors.lastname: Suvanto
authors.forename: Sami
authors.initials: S
authors.lastname: Curtze
authors.forename: Perttu J
authors.initials: PJ
authors.lastname: Lindsberg
authors.forename: Lauri
authors.initials: L
authors.lastname: Soinne
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001831:Body Temperature; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007249:Inflammation / Q000150:complications; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000150:complications*; D020521:Stroke / Q000150:complications* / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D002097:C-Reactive Protein
keywords: C-reactive protein; body temperature; ischemic stroke; leukocytes; outcome; thrombolysis