title: Stroke-induced immune depression-a randomized case control study in Kashmiri population of North India.
abstract: BACKGROUND
  Stroke leads to transient immunedepression, which leads to increased incidence of poststroke infections. Because infection is one of the most common causes of increased mortality in patients with stroke, this study was undertaken to document immunedepression after stroke in our population.
  
  
  METHODS
  A case-controlled study wherein 39 patients with acute ischemic stroke in the age group of 18 and 60 years without any evidence of previous immunedepression were included. Interleukin 6 (IL-6) and interleukin 10 (IL-10) levels were checked in plasma in both the groups on day 3 and day 45. Also Cortisol and epinephrine levels were checked in the urine samples collected on day 3 and day 8.
  
  
  RESULTS
  No significant difference was seen between the IL-6 and the IL-10 levels in samples collected on day 3 between the controls and cases, whereas Cortisol and norepinephrine were significantly raised in samples collected on day 3 in cases who developed infection as compared with controls.
  
  
  CONCLUSIONS
  The higher levels of urinary cortisol and norepinephrine were observed in patients with stroke who developed infections, which indirectly reflected increased amount of stroke related stress. Furthermore, the levels of plasma IL-6 and IL-10 were also elevated in the same group of patients, which means transformation of immunecompetence to immunedepression, which is responsible for higher mortality. Subsequently on recovery from infection the plasma levels of interleukins and urinary cortisol and norepinephrine did not show any difference, which indirectly means recovery of the immune system on recovery from acute stage of stroke. Mortality in the patients with infection was increased than controls.
authors.affiliation: Department of Neurology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India.
authors.forename: Devinder
authors.initials: D
authors.lastname: Kumar
authors.affiliation: Department of Immunology and Molecular Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India. Electronic address: roohi_wani@yahoo.com.
authors.forename: Roohi
authors.initials: R
authors.lastname: Rasool
authors.affiliation: Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Khalid Z
authors.initials: KZ
authors.lastname: Masoodi
authors.affiliation: Department of Immunology and Molecular Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India.
authors.forename: Imtiyaz A
authors.initials: IA
authors.lastname: Bhat
authors.affiliation: Department of Neurology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India.
authors.forename: Sawan
authors.initials: S
authors.lastname: Verma
authors.affiliation: Department of Neurology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India.
authors.forename: Sheikh
authors.initials: S
authors.lastname: Saleem
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D004837:Epinephrine / Q000652:urine; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D007194:India; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008875:Middle Aged; D020521:Stroke / Q000097:blood / Q000150:complications* / Q000276:immunology* / Q000652:urine; D013997:Time Factors; D055815:Young Adult
chemical_list: D015850:Interleukin-6; D016753:Interleukin-10; D006854:Hydrocortisone; D004837:Epinephrine
keywords: IL-10; IL-6; Ischemic stroke; hypertension; urinary cortisol; urinary norepinephrine