title: Lipopolysaccharide binding protein, interleukin-10, interleukin-6 and C-reactive protein blood levels in acute ischemic stroke patients with post-stroke infection.
abstract: BACKGROUND
  Ischemic stroke patients are prone to infection by stroke-induced immunodepression. We hypothesized that levels of lipopolysaccharide binding protein (LBP), interleukin-10 (IL-10), IL-6 and C-reactive protein (CRP) are early predictors for the development of stroke-associated infection.
  
  
  METHODS
  Fifty-six patients with ischemic stroke (n = 51) and transient ischemic attack (TIA) (n = 5) who presented within 6 hours after symptom onset and who were free of detectable infection on admission were included in the study. Of these, 20 developed early infections during the first week. Blood samples were taken at 6, 12, and 24 hours and at 3 and 7 days after stroke onset. Levels of LBP, Il-10, IL-6 and CRP, as well as S100B, were measured as markers of inflammation and brain damage by commercially available immunometric tests.
  
  
  RESULTS
  In the univariate analysis, levels of LBP, IL-10, IL-6 and CRP significantly differed between patients who developed an infection and those who did not. In the binary logistic regression analysis, which was adjusted for National Institutes of Health Stroke Scale (NIHSS) on admission, stroke subtype and S100B peak levels, as indicator of the extent of brain damage, IL-10 at 6 hours, CRP at 6 hours and NIHSS on admission were identified as independent predictors of infection (IL-10: P = 0.009; CRP: P = 0.018; NIHSS: P = 0.041). The area under the curve (AUC) of the receiver operating characteristic (ROC) curves in relation to the dichotomized status of the infection (infection versus no infection) was 0.74 (95% confidence interval: 0.59 to 0.88) for CRP at 6 hours, 0.76 (0.61 to 0.9) for IL-10 at 6 hours, 0.83 (0.71 to 0.94) for NIHSS on admission and 0.94 (0.88 to 1) for the combination of CRP, IL-10 and NIHSS. In a subanalysis, 16 patients with early infections were matched with 16 patients without infection according to S100B peak levels. Here, the temporal pattern of LBP, IL-10, IL-6 and CRP significantly differed between the patient groups.
  
  
  CONCLUSIONS
  Our data show that blood levels of inflammation markers may be used as early predictors of stroke-associated infection. We propose prospective studies to investigate if the calculated cut-offs of CRP, IL-10 and NIHSS might help to identify patients who should receive early preventive antibiotic treatment.
authors.affiliation: Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30623, Hannover, Germany. worthmann.hans@mh-hannover.de.
authors.forename: Hans
authors.initials: H
authors.lastname: Worthmann
authors.affiliation: Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30623, Hannover, Germany. tryc.anita@mh-hannover.de.
authors.forename: Anita B
authors.initials: AB
authors.lastname: Tryc
authors.affiliation: Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30623, Hannover, Germany. dirks.meike@mh-hannover.de.
authors.forename: Meike
authors.initials: M
authors.lastname: Dirks
authors.affiliation: Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30623, Hannover, Germany. schuppner.ramona@mh-hannover.de.
authors.forename: Ramona
authors.initials: R
authors.lastname: Schuppner
authors.affiliation: Department of Clinical Chemistry, Hannover Medical School, Carl-Neuberg-Str. 1, 30623, Hannover, Germany. brand.korbinian@mh-hannover.de.
authors.forename: Korbinian
authors.initials: K
authors.lastname: Brand
authors.affiliation: Department of Computer Science, Ostfalia University of Applied Sciences, Am Exer 2, 38302, Wolfenbuettel, Germany. Frank.Klawonn@helmholtz-hzi.de.|Biostatistics, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany. Frank.Klawonn@helmholtz-hzi.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Klawonn
authors.affiliation: Department of Clinical Chemistry, Hannover Medical School, Carl-Neuberg-Str. 1, 30623, Hannover, Germany. lichtinghagen.ralf@mh-hannover.de.
authors.forename: Ralf
authors.initials: R
authors.lastname: Lichtinghagen
authors.affiliation: Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30623, Hannover, Germany. weissenborn.karin@mh-hannover.de.|Center for Systems Neuroscience (ZSN), Buenteweg 2, 30559, Hannover, Germany. weissenborn.karin@mh-hannover.de.
authors.forename: Karin
authors.initials: K
authors.lastname: Weissenborn
mesh_terms: D000209:Acute-Phase Proteins; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism*; D002352:Carrier Proteins / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007239:Infections / Q000097:blood* / Q000150:complications; D016753:Interleukin-10 / Q000378:metabolism*; D015850:Interleukin-6 / Q000378:metabolism*; D002546:Ischemic Attack, Transient / Q000097:blood* / Q000150:complications; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood*; D008875:Middle Aged; D059906:Neuroimaging; D012372:ROC Curve; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013997:Time Factors; D000099231:Lipopolysaccharide-Binding Protein
chemical_list: D000209:Acute-Phase Proteins; D002097:C-Reactive Protein; D002352:Carrier Proteins; D016753:Interleukin-10; D015850:Interleukin-6; D008562:Membrane Glycoproteins; D000099231:Lipopolysaccharide-Binding Protein