Is stroke rehabilitation a metabolic problem?
BACKGROUND
This study looks at the impact of inflammation during the rehabilitation stage of strokes and its effect on neuro-functional recovery.


METHODS
This study investigated 94 patients suffering from strokes and admitted to rehabilitation. Anthropometric characteristics, serum proteins and inflammatory markers, plasma amino acids and neurofunction were all assessed.


RESULTS
55.3% patients had an inflammatory status (Interleukin-6 = 19.24 ± 23.01 pg ml⁻¹ vs. 4.1 ± 1.6 pg ml⁻¹ for non-inflamed subjects (p < 0.001). Inflammation was positively linked to positive proteins (alpha-1 globulin, p < 0.02) and negatively linked to negative proteins (albumin, p < 0.02; prealbumin, p < 0.01; transferrin, p < 0.05) of the acute-phase response. Inflammation was associated with low plasma concentrations of total amino acids. For the multiple logistic regression analysis, albumin (p < 0.001) and body weight maintenance (p < 0.001) were independent predictors of patient functional independence. Inflammation in dysphagic stroke (31.9%) patients was associated with more accentuated disability compared to non-inflamed dysphagics. The serum positive reactant alpha 1 globulin was the most powerful predictor of dysphagia severity (p < 0.001). At discharge, dysphagia improvement was associated with improved acute-phase negative proteins.


CONCLUSIONS
An inflammatory status may persist for most patients with strokes during the rehabiliation stage of the disease, its prevalence being higher in dysphagic compared to non-dysphagic subjects. The improvement in circulating albumin and body weight maintenance are predictors of neuro-function, even in dysphagic subjects.
Servizio di Fisiopatologia Metabolico-Nutrizionale e Nutrizione Clinica .
Roberto
R
Aquilani
Mirella
M
Boselli
Baiardi
B
Paola
Evasio
E
Pasini
Paolo
P
Iadarola
Manuela
M
Verri
Simona
S
Viglio
Annamaria
A
Condino
Federica
F
Boschi
D000328:Adult; D000510:Alpha-Globulins / Q000378:metabolism*; D001835:Body Weight; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000378:metabolism* / Q000503:physiopathology; D015850:Interleukin-6 / Q000378:metabolism*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011228:Prealbumin / Q000378:metabolism; D020127:Recovery of Function; D012709:Serum Albumin / Q000378:metabolism; D020521:Stroke / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D014168:Transferrin / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
D000510:Alpha-Globulins; D015850:Interleukin-6; D011228:Prealbumin; D012709:Serum Albumin; D014168:Transferrin; D014409:Tumor Necrosis Factor-alpha; C028184:alpha-1 serum globulin