Nowak Klaudia, Derbisz Justyna, Pęksa Jan, Łasocha Bartłomiej, Brzegowy Paweł, Slowik Joanna, Wrona Paweł, Pulyk Roman, Popiela Tadeusz, Slowik Agnieszka
Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
Department of Cardiology, Interventional Cardiology and Hypertension, University Hospital, Krakow, Poland.
Postepy Kardiol Interwencyjnej. 2020 Dec;16(4):452-459. doi: 10.5114/aic.2020.101771. Epub 2020 Dec 29.
The impact of an infection that requires antibiotic treatment (IRAT) after an acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT) remains unclear.
Here, we studied the prevalence and the profile of IRAT in patients with AIS treated with MT, aiming to identify predictive factors and prognostic implications at 90 days after stroke.
We analyzed parameters available within 24 h after AIS including demographics, risk factors, National Institutes of Health Stroke Scale (NIHSS) upon admission and 24 h later, hemorrhagic transformation (HT) on computed tomography, and several clinical and biochemical markers. The outcome measures were the modified Rankin Scale (mRS) 0-2 and 90 days post-stroke mortality.
We included 291 patients; in 184 (63.2%) patients MT was preceded by intravenous thrombolysis (IVT), and 83 (28.5%) patients developed IRAT. Multivariate analysis showed that male sex and hemorrhagic transformation on CT taken 24 h after stroke increased the risk of IRAT. We found that younger age, male sex, lower delta NIHSS, shorter time from stroke onset to groin puncture, better recanalization and a lack of hemorrhagic transformation on CT taken 24 h after stroke favorably affected outcome at day 90. Multivariate analysis showed that older age, higher delta NIHSS, unknown stroke etiology and lack of treatment with IVT were independent predictors of death up to day 90. Infection that required antibiotic treatment did not enter in the models for the studied outcome measures.
In AIS patients treated with MT, IRAT is not an independent factor that affects favorable outcome or mortality 90 days after stroke.
急性缺血性卒中（AIS）接受机械取栓（MT）治疗后，需要抗生素治疗的感染（IRAT）的影响尚不清楚。
在此，我们研究了接受MT治疗的AIS患者中IRAT的患病率和特征，旨在确定卒中后90天的预测因素和预后影响。
我们分析了AIS后24小时内可用的参数，包括人口统计学、危险因素、入院时和24小时后的美国国立卫生研究院卒中量表（NIHSS）、计算机断层扫描上的出血转化（HT）以及一些临床和生化指标。结局指标为改良Rankin量表（mRS）0 - 2分和卒中后90天死亡率。
我们纳入了291例患者；184例（63.2%）患者在MT前接受了静脉溶栓（IVT），83例（28.5%）患者发生了IRAT。多变量分析显示，男性和卒中后24小时CT上的出血转化增加了IRAT的风险。我们发现，年龄较小、男性、NIHSS差值较低、从卒中发作到股动脉穿刺的时间较短、再通较好以及卒中后24小时CT上无出血转化对90天时的结局有有利影响。多变量分析显示，年龄较大、NIHSS差值较高、卒中病因不明以及未接受IVT治疗是90天内死亡的独立预测因素。需要抗生素治疗的感染未纳入所研究结局指标的模型中。
在接受MT治疗的AIS患者中，IRAT不是影响卒中后90天良好结局或死亡率的独立因素。
