Department of Neurology, University Hospital, Jakubowskiego 2 Str., 30-688 Krakow, Poland.
Department of Neurology, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688 Krakow, Poland.
J Stroke Cerebrovasc Dis. 2021 Feb;30(2):105525. doi: 10.1016/j.jstrokecerebrovasdis.2020.105525. Epub 2020 Dec 15.
The impact of contracting stroke-associate infection (SAI) that requires antibiotic treatment after an acute ischemic stroke (AIS) treated with alteplase remains unclear. We studied the profiles of SAI in patients with AIS treated with alteplase toward identifying predictive factors and prognostic implications at 90 days post-stroke.
We analyzed 33 parameters readily available within 24 hours after AIS: demographics, risk factors, and several clinical and biochemical parameters. Outcome measures were mRS ≤ 2 and mortality 90 days post-stroke.
83 (23.6%) of 352 patients developed SAI. Multivariate logistic regression analysis showed that atrial fibrillation, mRS above 0 pre-stroke, lower delta NIHSS (the difference between NIHSS score measured upon admission and 24 hours after later), CRP≥10 mg/L, and elevated WBC count affected SAI risk (model including CRP levels and WBC count) and atrial fibrillation, mRS above 0 pre-stroke, lower delta NIHSS, HT, and elevated fibrinogen levels affected SAI risk (model excluding CRP levels and WBC count). 231 patients (74.1%) had mRS ≤ 2 at day 90. Multivariate logistic regression analysis showed that younger age, no hypertension, mRS=0 pre-stroke, higher delta NIHSS, no HT, no SAI, and CRP<10 mg/L, were associated with mRS≤2 at day 90. 54 (15.3%) patients died within 90 days. Multivariate logistic regression analysis showed that pre-stroke mRS>0, lower delta NIHSS, HT, CRP≥10 mg/L, lower triglyceride levels affected the risk of death within 90 days.
Several markers available within 24 hours post-stroke were predictive of SAI that requires antibiotic treatment. SAI affects long-term outcome but not mortality.
阿替普酶治疗急性缺血性脑卒中（AIS）后并发需要抗生素治疗的感染（SAI）的影响尚不清楚。我们研究了阿替普酶治疗的 AIS 患者的 SAI 特征，以确定 90 天后的预测因素和预后意义。
我们分析了 AIS 后 24 小时内可获得的 33 个参数：人口统计学、危险因素和几个临床及生化参数。结局指标为 mRS≤2 和 90 天后的死亡率。
352 例患者中 83 例（23.6%）发生 SAI。多变量逻辑回归分析显示，房颤、卒中前 mRS 评分＞0、NIHSS 差值较低（入院时 NIHSS 评分与 24 小时后 NIHSS 评分的差值）、CRP≥10mg/L 和白细胞计数升高均影响 SAI 风险（包含 CRP 水平和白细胞计数的模型），房颤、卒中前 mRS 评分＞0、NIHSS 差值较低、高血压和纤维蛋白原水平升高影响 SAI 风险（不包含 CRP 水平和白细胞计数的模型）。90 天时 231 例（74.1%）患者 mRS≤2。多变量逻辑回归分析显示，年龄较小、无高血压、卒中前 mRS=0、NIHSS 差值较高、无高血压、无 SAI、CRP＜10mg/L 与 90 天时 mRS≤2 相关。90 天内 54 例（15.3%）患者死亡。多变量逻辑回归分析显示，卒中前 mRS＞0、NIHSS 差值较低、高血压、CRP≥10mg/L、甘油三酯水平较低均影响 90 天内的死亡风险。
卒中后 24 小时内的多个标志物可预测需要抗生素治疗的 SAI。SAI 影响长期预后，但不影响死亡率。
