If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  Interleukin-6 Has Prognostic Significance in Acute Brain Ischaemia By Chris Berrie BOLOGNA, ITALY -- June 3, 2005 -- High plasma levels of the inflammatory marker interleukin (IL) 6 are associated with worse neurological deficits and poor long-term functional outcome in patients with acute brain ischaemia, according to a study presented here May 26th at the European Stroke Conference (ESC). "Inflammation plays a critical role in the pathogenesis of atherothrombosis as well as in acute brain ischaemia, and inflammatory markers are elevated in acute brain ischaemia," said David Tanne, MD, Principal Investigator and Head, Stroke Centre, Department of Neurology, Sheba Medical Centre, Tel Hashomer, Israel. To study the associations between plasma levels of inflammatory markers and the severity and long-term outcome following acute brain ischaemia, Dr. Tanne and colleagues obtained blood samples from 73 consecutive patients with acute brain ischaemia (36% women; mean age, 63.0 years) within 36 hours of symptom onset. Patients had full clinical assessments at hospitalisation, before and at discharge and during follow-up, according to their National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Stroke Impact Scale-16 (SIS-16). Patients with evidence of infection or inflammatory disease were excluded from the study. The range of potential inflammatory markers that were assessed at baseline using high-sensitivity enzyme linked immunosorbent assay (ELISA) kits were IL-6, IL-10, soluble intercellular adhesion molecule (sICAM-1) and CD40 ligand (CD40L). The analyses were performed blinded to the clinical data. The only one of these inflammatory markers to show any association with stroke severity or outcome was IL-6, and it was associated with increasing age, body temperature and white blood cell counts. The positive correlation of IL-6 with stroke severity at baseline was seen as mean plasma concentrations of NIHSS 0-5 (n = 44), 2.7; NIHSS 6-15 (n = 15), 6.1; NIHSS >15 (n = 13) 9.4 (P < .0001). These strong correlations were maintained between IL-6 and NIHSS scores throughout the initial days in hospital (days 1-2, P < .001; days 4-5, P < .001) and at discharge (P < .0001). At a median follow-up of 10 months (range, 8-15 months), the odds ratios (ORs) for the IL-6 tertiles (lower, middle, upper) as a function of NIHSS scores >5 versus </=5 increased greatly (unadjusted ORs, 1, 3.8, 11.0; age adjusted ORs, 1, 2.9, 7.3; respectively). Baseline IL-6 was also associated with functional outcomes at discharge (mRS 0, n = 11, 2.9; mRS 1-2, n = 39, 3.3; mRS 3-4, 4.5; and mRS 5 or death, n = 11, 11.2 (P < .0001). Similarly, at the same 10-month follow-up, the ORs for the IL-6 tertiles (lower, middle, upper) as a function of mRS scores (>/=2 vs. <2) increased (unadjusted ORs, 1, 1.4, 3.3; age adjusted ORs, 1, 1.0, 2.0; respectively), as did those for the SIS-16 (</=85 vs. >85) (unadjusted ORs, 1, 1.4, 4.1; age adjusted ORs, 1, 1.2, 3.1; respectively). Although the logistic regression analysis with further adjustment for stroke severity diminished these associations, IL-6 remained associated with stroke severity (NIHSS >10; adjusted OR, 1.34; P = .001) and poor functional outcome (mRS >2; odds ratio, 1.19; P = .007; per 1.0 pg/mL change). There were no significant associations identified with early neurological deterioration. Dr. Tanne said that the hope is that this plasma marker will assist in the risk stratification of patients with acute ischaemic stroke.
[Study title: "Prognostic Significance of Interleukin-6 in Acute Brain Ischaemia." Oral Session 1A, Abstract 11]
|
