Department of Neurology, University of Heidelberg, Heidelberg, Germany.
Int J Stroke. 2013 Dec;8(8):639-44. doi: 10.1111/j.1747-4949.2012.00822.x. Epub 2012 May 28.
Infections are common complications in patients with acute ischemic stroke; however, the pathophysiology of the stroke-induced immunodepression is still under debate. Although it has been shown that increased mortality and longer hospital stay are associated with the presence of poststroke infections, it remains unclear if early poststroke infections occurring in the first seven-days have an effect on the overall functional outcome.
Aim of our study was to identify the frequency of poststroke infections in thrombolysed stroke patients and to analyze their effect on the outcome after three-months.
From 1998 to 2011, all patients in our institution undergoing thrombolysis for acute ischemic stroke were included into a prospective database. Baseline variables, clinical, radiographic, and laboratory data were collected prospectively. Outcome measures included symptomatic intracerebral hemorrhage per European-Australasian Acute Stroke Study II criteria, mortality, and modified Rankin Scale at three-months. Logistic regression models were used to identify independent predictors for poor outcome where appropriate.
One thousand sixteen patients were included; of them, 36·3% had an infection during the first week. Pneumonia (9·6%) and urinary tract infections (5·4%) were most frequent. Severity of stroke (P < 0·0001), infarct size (P < 0·0001), atrial fibrillation (P = 0·005), and cardio embolic cause of stroke (P < 0·0001) were associated with infections. Age (odds ratio 1·089, 95% confidence interval 1·064-1·115, P < 0·0001), severity of stroke (odds ratio 1·111, 95% confidence interval 1·073-1·149; P < 0·0001) history of diabetes (odds ratio 0·555. 95% confidence interval 0·357-0·864; P = 0·009), infarct size (odds ratio 4·256 95% confidence interval 2·697-6·745; P < 0·0001), infections (odds ratio 1·548, 95% confidence interval 1·008-2·376; P = 0·046), and symptomatic intracerebral hemorrhage were independent predictors for poor outcome after three-months.
In our cohort of thrombolysed stroke patients, poststroke infections were frequent in patients with severe cardio embolic stroke, a large infarct, and a longer hospital stay; those patients have a higher risk of infection and a poorer functional outcome after three-months. This risk increases after occurrence of symptomatic intracerebral hemorrhage. Prevention of infection with antibiotic therapy or other prophylactic treatment could potentially lead to a better functional outcome and further randomized studies on this aspect are needed.
感染是急性缺血性脑卒中患者的常见并发症；然而，中风引起的免疫抑制的病理生理学仍存在争议。虽然已经表明，中风后感染的存在与死亡率增加和住院时间延长有关，但目前尚不清楚中风后 7 天内发生的早期感染是否会对整体功能结果产生影响。
本研究的目的是确定溶栓治疗的缺血性脑卒中患者中风后感染的频率，并分析其对 3 个月后的结果的影响。
1998 年至 2011 年，我院所有接受急性缺血性脑卒中溶栓治疗的患者均纳入前瞻性数据库。前瞻性收集基线变量、临床、影像学和实验室数据。结局指标包括根据欧洲-澳大利亚急性脑卒中研究 II 标准定义的症状性颅内出血、死亡率和 3 个月时改良 Rankin 量表评分。在适当的情况下，使用逻辑回归模型确定不良结局的独立预测因素。
共纳入 1016 例患者；其中，36.3%的患者在第 1 周内发生感染。最常见的是肺炎（9.6%）和尿路感染（5.4%）。卒中严重程度（P<0.0001）、梗死灶大小（P<0.0001）、心房颤动（P=0.005）和心源性栓塞性卒中（P<0.0001）与感染有关。年龄（比值比 1.089，95%置信区间 1.064-1.115，P<0.0001）、卒中严重程度（比值比 1.111，95%置信区间 1.073-1.149；P<0.0001）、糖尿病史（比值比 0.555，95%置信区间 0.357-0.864；P=0.009）、梗死灶大小（比值比 4.256，95%置信区间 2.697-6.745；P<0.0001）、感染（比值比 1.548，95%置信区间 1.008-2.376；P=0.046）和症状性颅内出血是 3 个月后不良结局的独立预测因素。
在我们溶栓治疗的缺血性脑卒中患者队列中，严重的心源性栓塞性卒中、较大的梗死灶和较长的住院时间与卒中后感染有关；这些患者感染风险更高，3 个月后的功能结局更差。在发生症状性颅内出血后，这种风险会增加。抗生素治疗或其他预防性治疗以预防感染可能会导致更好的功能结局，因此需要进一步进行这方面的随机研究。
