Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.
Department of Neurology, St. Bernward Hospital Hildesheim, Hildesheim, Germany.
PLoS One. 2018 Apr 25;13(4):e0196174. doi: 10.1371/journal.pone.0196174. eCollection 2018.
Stroke-induced immunodepression is a well characterized complication of acute ischemic stroke. In experimental studies beta-blocker therapy reversed stroke-induced immunodepression, reduced infection rates and mortality. Recent, heterogeneous studies in stroke patients could not provide evidence of a protective effect of beta-blocker therapy. Aim of this study is to investigate the potential preventive effect of beta-blockers in subgroups of patients at high risk for stroke-induced immunodepression.
Data from a prospectively derived registry of major stroke patients receiving endovascular therapy between 2011-2017 in a tertiary stroke center (University Medical Center Göttingen. Germany) was used. The effect of beta-blocker therapy on pneumonia, urinary tract infection, sepsis and mortality was assessed using multivariate logistic regression analysis.
Three hundred six patients with a mean age of 72 ± 13 years and a median NIHSS of 16 (IQR 10.75-20) were included. 158 patients (51.6%) had pre-stroke- and continued beta-blocker therapy. Beta-blocker therapy did not reduce the incidence of pneumonia (OR 0.78, 95% CI 0.31-1.92, p = 0.584), urinary tract infections (OR 1.51, 0.88-2.60, p = 0.135), sepsis (OR 0.57, 0.18-1.80, p = 0.334) or mortality (OR 0.59, 0.16-2.17, p = 0.429). Strokes involving the insula and anterio-medial cortex increased the risk for pneumonia (OR 4.55, 2.41-8.56, p<0.001) and sepsis (OR 4.13, 1.81-9.43, p = 0.001), while right hemispheric strokes increased the risk for pneumonia (OR 1.60, 0.92-2.77, p = 0.096). There was a non-significantly increased risk for urinary tract infections in patients with beta-blocker therapy and insula/anterio-medial cortex strokes (OR 3.12, 95% CI 0.88-11.05, p = 0.077) with no effect of beta-blocker therapy on pneumonia, sepsis or mortality in both subgroups.
In major ischemic stroke patients, beta-blocker therapy did not lower post-stroke infection rates and was associated with urinary tract infections in a subgroup with insula/anterio-medial strokes.
中风引起的免疫抑制是急性缺血性中风的一个特征性并发症。在实验研究中，β受体阻滞剂治疗逆转了中风引起的免疫抑制，降低了感染率和死亡率。最近，中风患者的异质研究未能提供β受体阻滞剂治疗具有保护作用的证据。本研究旨在探讨β受体阻滞剂在中风诱导免疫抑制高危患者亚组中的潜在预防作用。
使用德国哥廷根大学医学中心（University Medical Center Göttingen）2011-2017 年间接受血管内治疗的主要中风患者前瞻性衍生登记处的数据。使用多变量逻辑回归分析评估β受体阻滞剂治疗对肺炎、尿路感染、败血症和死亡率的影响。
纳入 306 例平均年龄 72 ± 13 岁，NIHSS中位数为 16（IQR 10.75-20）的患者。158 例（51.6%）患者有中风前和持续的β受体阻滞剂治疗。β受体阻滞剂治疗并未降低肺炎（OR 0.78，95%CI 0.31-1.92，p=0.584）、尿路感染（OR 1.51，0.88-2.60，p=0.135）、败血症（OR 0.57，0.18-1.80，p=0.334）或死亡率（OR 0.59，0.16-2.17，p=0.429）的发生率。涉及岛叶和前内侧皮质的中风增加了肺炎（OR 4.55，2.41-8.56，p<0.001）和败血症（OR 4.13，1.81-9.43，p=0.001）的风险，而右侧半球中风增加了肺炎（OR 1.60，0.92-2.77，p=0.096）的风险。β受体阻滞剂治疗和岛叶/前内侧皮质中风患者尿路感染的风险有升高趋势（OR 3.12，95%CI 0.88-11.05，p=0.077），但β受体阻滞剂治疗对肺炎、败血症或死亡率均无影响。
在主要缺血性中风患者中，β受体阻滞剂治疗并未降低中风后感染率，且与岛叶/前内侧皮质中风亚组的尿路感染有关。
