title: Early Dynamics of P-selectin and Interleukin 6 Predicts Outcomes in Ischemic Stroke.
abstract: BACKGROUND
  Thromboinflammatory molecules connect the prothrombotic state, endothelial dysfunction, and systemic/local inflammation in the acute phase of ischemic stroke.
  
  
  METHODS
  We prospectively investigated (1) serial changes in the levels of thromboinflammatory biomarkers in 76 patients with acute ischemic stroke (6, 24, and 72 hours after onset); (2) compared with 44 patients with asymptomatic severe (≥70%) carotid stenosis and 66 patients with Parkinson disease; and (3) we applied multiple regression methods, relating biological biomarkers combined with demographic data and comorbidities to poststroke infection, death, and functional outcome, and assessed the ability of the models to predict each outcome.
  
  
  RESULTS
  Interleukin 6 (IL-6) levels and change of IL-6 concentrations by 72 hours correlated with the size of tissue damage indicated by S100B titers. Levels of IL-6 and P-selectin at 72 hours were higher in patients with large-artery versus lacunar stroke. High concentration of IL-6, monocyte chemotactic protein 1, and S100B at 6 hours were associated with poststroke infections; high concentration of IL-6, S100B, and high-sensitivity C-reactive protein (hsCRP) correlated with death. Change of P-selectin from 6 to 72 hours by 1 unit increased the incidence of poststroke infections with an odds ratio of 22.7; each 100 units of IL-6 at baseline increased the odds of death by 9‰, and at 72 hours, the odds of poststroke infections by 4‰. Each unit of baseline hsCRP elevated the odds of death by 7%.
  
  
  CONCLUSIONS
  In regression models, in which biological, demographic, and comorbid factors were combined, those biological biomarkers predicted poor outcome with high accuracy, which were characterized by an increasing concentration by 72 hours. Two particular biomarkers emerged to predict outcomes besides hsCRP: early dynamic changes in the systemic levels of P-selectin and IL-6.
authors.affiliation: Department of Neurology, University of Pecs, Pecs, Hungary.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pusch
authors.affiliation: Department of Epidemiology and Biostatistics and Biodemography, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Birgit
authors.initials: B
authors.lastname: Debrabant
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, University of Pecs, Pecs, Hungary.
authors.forename: Tihamer
authors.initials: T
authors.lastname: Molnar
authors.affiliation: Department of Neurology, University of Pecs, Pecs, Hungary.
authors.forename: Gergely
authors.initials: G
authors.lastname: Feher
authors.affiliation: Department of Neurology, University of Pecs, Pecs, Hungary.
authors.forename: Viktoria
authors.initials: V
authors.lastname: Papp
authors.affiliation: Department of Neurology, University of Pecs, Pecs, Hungary.
authors.forename: Miklos
authors.initials: M
authors.lastname: Banati
authors.affiliation: Department of Neurology, University of Pecs, Pecs, Hungary.
authors.forename: Norbert
authors.initials: N
authors.lastname: Kovacs
authors.affiliation: Department of Neurology, University of Pecs, Pecs, Hungary.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Szapary
authors.affiliation: Department of Neurology, University of Pecs, Pecs, Hungary; Department of Neurology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: zsolt.illes@rsyd.dk.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Illes
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications*; D018932:Chemokine CCL2 / Q000097:blood; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood*; D012044:Regression Analysis; D064568:S100 Calcium Binding Protein beta Subunit / Q000097:blood; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D020521:Stroke / Q000097:blood* / Q000209:etiology* / Q000401:mortality; D013997:Time Factors
chemical_list: C111835:CCL2 protein, human; D018932:Chemokine CCL2; D015850:Interleukin-6; D019007:P-Selectin; D064568:S100 Calcium Binding Protein beta Subunit; C579160:S100B protein, human
keywords: Carotid stenosis; IL-6; MCP-1; P-selectin; ischemic stroke; poststroke infection