Stroke is accompanied by local inflammatory response and systemic immunosuppression. Immunosuppression markers are associated with the occurrence of medical complications (infections), whereas inflammatory markers are associated with worse functional prognosis. This prospective study tries to validate in acute stroke patients the prognostic usefulness of a panel of immune biomarkers that have previously been associated with various clinical outcomes. The identification of beneficial and harmful immune responses in cerebral ischemia will allow the prediction of the clinical course of the patients and will be helpful in designing immunomodulatory therapeutic strategies for acute stroke.
Stroke is accompanied by local inflammatory response and systemic immunosuppression. Immunosuppression markers are associated with the occurrence of medical complications (infections), whereas inflammatory markers are associated with worse functional prognosis. This prospective study tries to validate in acute stroke patients the prognostic usefulness of a panel of immune biomarkers that have previously been associated with various clinical outcomes. The immune biomarkers will be assessed at admission, at day 1 after admission and at day 90. The assessed immune biomarker panel includes: * Serum cortisol levels. * Serum interleukin (IL)-10 levels. * Proportion of circulating B lymphocytes (CD3-CD19+ cells). * Monocyte surface expression of TLR4, HLA-DR, CD86, and VLA-4. * Ex - vivo production of tumor necrosis factor (TNF)-α in monocytes after stimulation with LPS. * Proportion of each of the circulating monocyte subpopulations (CD14highCD16-, CD14highCD16+, and CD14dimCD16+). The identification of beneficial and harmful immune responses in cerebral ischemia will allow the prediction of the clinical course of the patients and will be helpful in designing immunomodulatory therapeutic strategies for acute stroke.
Study Type
OBSERVATIONAL
Enrollment
132
Functional Unit of Cerebrovascular Diseases, Hospital Clínic of Barcelona
Barcelona, Barcelona, Spain
Predictive immune score for favorable outcome
To establish a predictive immune score for functional outcome. Favorable outcome is defined as a modified Rankin Scale (mRS) score of \<3 at day 90+-15 after stroke
Time frame: 90 +-15 days after onset of symptoms
Predictive immune score for stroke associated infection
To establish a predictive score for stroke associated infection (SAI) based on immune biomarkers. Stroke associated infection is defined as: body temperature \> 37.7ºC and symptoms of infection (cough, dyspnea, pleuritic pain, dysuria), or leukocytosis \>11000, leukopenia \<4000, pulmonary infiltrates in chest X-ray or positive cultures for a pathogen.
Time frame: 7 days after onset of symptoms
Predictive immune score for ischemic progression
To establish a predictive score for ischemic progression based in a panel of immune biomarkers. Ischemic progression is defined as an increase of ≥4 points in the National Institutes of Health Stroke Scale(NIHSS) score in the absence of bleeding in the CT scan.
Time frame: 7 days after onset of symptoms
Predictive immune score for functional outcome over the entire mRS
To establish a predictive score for functional outcome based in a panel of immune biomarkers and using shift analysis of the entire mRS
Time frame: 90 +-15 days after onset of symptoms
Localization and stroke volume analysis
To investigate the influence of the localization and stroke volume on the occurrence of a stroke associated infection and on neurological outcome
Time frame: SAI within 7 days and neurological outcome after 3 months after onset of symptoms
Insular cortex involvement and infarct volume
To investigate the influence of insular cortex involvement and infarct volume on the occurrence of a SAI and on the neurological outcome after 3 months
Time frame: SAI within 7 days and and on the neurological outcome after 3 months
Infection and functional outcome after ischemic stroke
To assess the independent effect of SAI over the functional outcome at 3 months
Time frame: SAI within 7 days after onset of symptoms and neurological outcome after 3 months
Thrombolysis, immune biomarkers and SAI
To assess the effect of thrombolytic treatment over changes in the immune biomarker panel and over the occurrence of SAI
Time frame: SAI within 7 days after onset of symptoms
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