title: Plasma endotoxin activity rises during ischemic stroke and is associated with worse short-term outcome.
abstract: Activation of Toll-like receptor 4 (TLR4) contributes to brain injury and poor outcome after cerebral ischemia. The expression of this receptor on monocytes is increased in patients with acute ischemic stroke. Endotoxin is an endogenous ligand for TLR4. The aim of our study was to determine if plasma endotoxin activity is increased in stroke patients and correlates with functional outcome.
  
  
  
  We included 88 patients with ischemic stroke (median age: 71, 56.8% men) and 59 age-matched controls. Plasma endotoxin activity and level of proteins regulating endotoxin interaction with TLR4 (LPS binding protein - LBP and sCD14) were measured in blood samples taken at day 1 (within 24h after stroke symptoms onset), 3 and 6. Short-term functional outcome was assessed at day 14 using modified Rankin Scale. Unfavourable outcome was defined as modified Rankin Scale score>2.
  
  
  
  Compared to controls, stroke patients had higher plasma endotoxin activity on day 1 (median: 0.39 vs 0.32EU/mL, P=0.03) as well as higher LBP (median: 18.7 vs 11.5μg/mL, P<0.01) and sCD14 level (median: 1330 vs 1070ng/mL, P<0.01). Plasma LPS activity and levels of LBP and sCD14 significantly rose during stroke. Higher LPS activity measured on day 6 was associated with unfavourable outcome (OR: 3.94, 95%CI: 1.03-15.02, P=0.04, adjusted for age and stroke severity).
  
  
  
  Plasma endotoxin activity rises during ischemic stroke and is associated with worse short-term outcome.
authors.affiliation: Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Klimiec
authors.affiliation: Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Pera
authors.affiliation: Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Chrzanowska-Wasko
authors.affiliation: Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Golenia
authors.affiliation: Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Slowik
authors.affiliation: Department of Neurology, Jagiellonian University Medical College, Krakow, Poland. Electronic address: Dziedzic@cm-uj.krakow.pl.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Dziedzic
mesh_terms: D000209:Acute-Phase Proteins; D000368:Aged; D002545:Brain Ischemia / Q000150:complications*; D002352:Carrier Proteins / Q000097:blood; D004731:Endotoxins / Q000097:blood*; D005260:Female; D006801:Humans; D018950:Lipopolysaccharide Receptors / Q000097:blood; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood; D008875:Middle Aged; D018709:Statistics, Nonparametric; D020521:Stroke / Q000097:blood* / Q000209:etiology*; D013997:Time Factors; D000099231:Lipopolysaccharide-Binding Protein
chemical_list: D000209:Acute-Phase Proteins; D002352:Carrier Proteins; D004731:Endotoxins; D018950:Lipopolysaccharide Receptors; D008562:Membrane Glycoproteins; D000099231:Lipopolysaccharide-Binding Protein
keywords: Endotoxin; Inflammation; Ischemic stroke; Outcome