Neurology, Vol 50, Issue 6 1722-1728, Copyright © 1998 by American Academy of Neurology

ARTICLES

Persistent inflammatory response in stroke survivors

NB Beamer, BM Coull, WM Clark, DP Briley, M Wynn and G Sexton
Department of Neurology, Arizona Health Sciences Center, Tucson 85724- 5023, USA.

OBJECTIVE: Goals were to determine how long acute-phase markers remain elevated after ischemic stroke and how marker levels relate to stroke risk factors, stroke mechanism, and subsequent vascular events. METHODS: Fibrinogen (FIB), C-reactive protein (CRP), leukocytes (WBC), neutrophils (PMN), interleukin-6, and interleukin-1 receptor antagonist were measured at stroke onset and at 6 weeks, 6 months, and 1 year after enrollment, or until a vascular event occurred in 136 acute ischemic stroke patients, 76 patients with comparable risk factors for stroke, and 48 age-balanced healthy subjects. RESULTS: Multivariate logistic analysis showed that prior stroke and FIB level predicted new events in stroke patients (p < 0.04 for both), whereas congestive heart failure (p < 0.02) and creatinine level (p < 0.006) were predictive in at-risk patients. After controlling for infection, FIB, CRP, and PMN levels at baseline were higher in at-risk but not in stroke patients with recurrent events (p < 0.05 for all). At 1 year, FIB levels remained elevated in event-free stroke survivors compared with levels in the risk and control groups (p < 0.001 for both). FIB also remained higher in stroke survivors who had atheroembolism (AE) compared with non-AE stroke survivors (381+/-72 versus 342+/-78 mg/dL, p < 0.02). Peripheral vascular disease was an independent predictor (p < 0.0001) of longitudinal FIB in stroke survivors. Of note, both WBC and PMN levels were chronically elevated in patients with stroke risk factors and in stroke survivors (p < 0.0001 for both) compared with healthy elderly subjects. CONCLUSIONS: Most acute-phase markers decline gradually after stroke, but FIB remains significantly elevated and is associated with increased risk for recurrent vascular events.

This article has been cited by other articles:

				S. Sen, A. Hinderliter, P. K. Sen, J. Simmons, V. A. LeGrys, J. Beck, S. Offenbacher, K. Moss, and S. M. Oppenheimer Association of Leukocyte Count With Progression of Aortic Atheroma in Stroke/Transient Ischemic Attack Patients Stroke, November 1, 2007; 38(11): 2900 - 2905. [Abstract] [Full Text] [PDF]

				H. Tsukui, A. Abla, J. J. Teuteberg, D. M. McNamara, M. A. Mathier, L. M. Cadaret, and R. L. Kormos Cerebrovascular accidents in patients with a ventricular assist device J. Thorac. Cardiovasc. Surg., July 1, 2007; 134(1): 114 - 123. [Abstract] [Full Text] [PDF]

				C. L. Carty, P. Heagerty, K. Nakayama, E. C. McClung, J. Lewis, D. Lum, E. Boespflug, C. McCloud-Gehring, B. R. Soleimani, J. Ranchalis, et al. Inflammatory Response After Influenza Vaccination in Men With and Without Carotid Artery Disease Arterioscler. Thromb. Vasc. Biol., December 1, 2006; 26(12): 2738 - 2744. [Abstract] [Full Text] [PDF]

				P. Htun, S. Fateh-Moghadam, B. Tomandl, R. Handschu, K. Klinger, K. Stellos, C. Garlichs, W. Daniel, and M. Gawaz Course of Platelet Activation and Platelet-Leukocyte Interaction in Cerebrovascular Ischemia Stroke, September 1, 2006; 37(9): 2283 - 2287. [Abstract] [Full Text] [PDF]

				W. M. Clark Adiponectin: Spectator or Player? Stroke, September 1, 2005; 36(9): 1919 - 1920. [Full Text] [PDF]

				S. P. Efstathiou, D. I. Tsioulos, A. G. Tsiakou, Y. E. Gratsias, A. V. Pefanis, and T. D. Mountokalakis Plasma Adiponectin Levels and Five-Year Survival After First-Ever Ischemic Stroke Stroke, September 1, 2005; 36(9): 1915 - 1919. [Abstract] [Full Text] [PDF]

				L. S. Ritter, K. M. Stempel, B. M. Coull, and P. F. McDonagh Leukocyte-Platelet Aggregates in Rat Peripheral Blood After Ischemic Stroke and Reperfusion Biol Res Nurs, April 1, 2005; 6(4): 281 - 288. [Abstract] [PDF]

				E Di Angelantonio, M Fiorelli, D Toni, M L Sacchetti, S Lorenzano, A Falcou, M V Ciarla, M Suppa, L Bonanni, G Bertazzoni, et al. Prognostic significance of admission levels of troponin I in patients with acute ischaemic stroke J. Neurol. Neurosurg. Psychiatry, January 1, 2005; 76(1): 76 - 81. [Abstract] [Full Text] [PDF]

				P. M. Rothwell, S. C. Howard, D. A. Power, S. A. Gutnikov, A. Algra, J. van Gijn, T. G. Clark, M. F.G. Murphy, C. P. Warlow, and for the Cerebrovascular Cohort Studies Collaborati Fibrinogen Concentration and Risk of Ischemic Stroke and Acute Coronary Events in 5113 Patients With Transient Ischemic Attack and Minor Ischemic Stroke Stroke, October 1, 2004; 35(10): 2300 - 2305. [Abstract] [Full Text] [PDF]

				T. Dziedzic, A. Slowik, A. Szczudlik, M. Schwaninger, A. Grau, and D. Acalovschi Interleukin-6 and Stroke: Cerebral Ischemia Versus Nonspecific Factors Influencing Interleukin-6 * Response Stroke, December 1, 2003; 34 (12): e229 - e230. [Full Text] [PDF]

				P. J. Lindsberg and A. J. Grau Inflammation and Infections as Risk Factors for Ischemic Stroke Stroke, October 1, 2003; 34(10): 2518 - 2532. [Abstract] [Full Text] [PDF]

				A. A. Albert, C. J. Beller, J. A. Walter, B. Arnrich, U. P. Rosendahl, H. Priss, and J. Ennker Preoperative high leukocyte count: a novel risk factor for stroke after cardiac surgery Ann. Thorac. Surg., May 1, 2003; 75(5): 1550 - 1557. [Abstract] [Full Text] [PDF]

				A. J. Grau, S. Reiners, C. Lichy, F. Buggle, A. Ruf, and B. Jilma Platelet Function Under Aspirin, Clopidogrel, and Both After Ischemic Stroke: A Case-Crossover Study * Synergistic Antiplatelet Effects of Clopidogrel and Aspirin Detected With the PFA-100 in Stroke Patients Stroke, April 1, 2003; 34(4): 849 - 854. [Abstract] [Full Text] [PDF]

				L. Marquardt, A. Ruf, U. Mansmann, R. Winter, M. Schuler, F. Buggle, H. Mayer, and A. J. Grau Course of Platelet Activation Markers After Ischemic Stroke Stroke, November 1, 2002; 33(11): 2570 - 2574. [Abstract] [Full Text] [PDF]

				M. Di Napoli and F. Papa Inflammation, Hemostatic Markers, and Antithrombotic Agents in Relation to Long-Term Risk of New Cardiovascular Events in First-Ever Ischemic Stroke Patients Stroke, July 1, 2002; 33(7): 1763 - 1771. [Abstract] [Full Text] [PDF]

				R. Pedrinelli, G. Dell'Omo, G. Penno, and M. Mariani Non-diabetic microalbuminuria, endothelial dysfunction and cardiovascular disease Vascular Medicine, November 1, 2001; 6(4): 257 - 264. [Abstract] [PDF]

				M. Di Napoli, F. Papa, and V. Bocola C-Reactive Protein in Ischemic Stroke : An Independent Prognostic Factor Stroke, April 1, 2001; 32(4): 917 - 924. [Abstract] [Full Text] [PDF]

				M. Di Napoli, F. Papa, and V. Bocola Prognostic Influence of Increased C-Reactive Protein and Fibrinogen Levels in Ischemic Stroke Stroke, January 1, 2001; 32(1): 133 - 138. [Abstract] [Full Text] [PDF]

				A. S. M. Shamsuzzaman and V. K. Somers Fibrinogen, Stroke, and Obstructive Sleep Apnea . An Evolving Paradigm of Cardiovascular Risk Am. J. Respir. Crit. Care Med., December 1, 2000; 162(6): 2018 - 2020. [Full Text]

				H. J Milionis, A. F Winder, and D. P Mikhailidis Lipoprotein (a) and stroke J. Clin. Pathol., July 1, 2000; 53(7): 487 - 496. [Abstract] [Full Text] [PDF]

				L. S. Ritter, J. A. Orozco, B. M. Coull, P. F. McDonagh, and W. I. Rosenblum Leukocyte Accumulation and Hemodynamic Changes in the Cerebral Microcirculation During Early Reperfusion After Stroke Editorial Comment Stroke, May 1, 2000; 31(5): 1153 - 1161. [Abstract] [Full Text] [PDF]

				S. Reichlin Editorial: Is Leptin a Secretion of the Brain? J. Clin. Endocrinol. Metab., July 1, 1999; 84(7): 2267 - 2269. [Full Text]

				N. B. Beamer, B. M. Coull, W. M. Clark, and M. Wynn Microalbuminuria in Ischemic Stroke Arch Neurol, June 1, 1999; 56(6): 699 - 702. [Abstract] [Full Text] [PDF]