RT Journal Article
SR Electronic
T1 Inflammatory and stress markers predicting pneumonia, outcome, and etiology in patients with stroke
JF Neurology - Neuroimmunology Neuroinflammation
JO Neurol Neuroimmunol Neuroinflamm
FD Lippincott Williams & Wilkins
SP e692
DO 10.1212/NXI.0000000000000692
VO 7
IS 3
A1 Hotter, Benjamin
A1 Hoffmann, Sarah
A1 Ulm, Lena
A1 Montaner, Joan
A1 Bustamante, Alejandro
A1 Meisel, Christian
A1 Meisel, Andreas
YR 2020
UL http://nn.neurology.org/content/7/3/e692.abstract
AB Objective Prognosis of stroke is negatively affected by complications, in particular stroke-associated pneumonia (SAP). We hypothesized that inflammatory and stress biomarkers predict SAP during hospitalization and outcome 3 months after stroke.Methods We pooled the clinical data of 2 acute stroke studies with identical assessment: the STRoke Adverse outcome is associated WIth NoSoKomial Infections (STRAWINSKI) and PREDICT studies. Measurement of biomarkers (ultrasensitive procalcitonin [PCTus]; midregional pro-adrenomedullin; midregional pro-atrial natriuretic peptide [MRproANP]; ultrasensitive copeptin [CPus]; C-terminal pro-endothelin) was performed from serum samples drawn on the first 4 days of hospital admission.Results The combined cohort consists of 573 cases with available backup samples to perform the analysis. SAP was associated with increased admission and maximum levels of all biomarkers. Furthermore, all biomarkers were associated with death and correlated with functional outcome 3 months after stroke. The multivariate logistic regression model retained ultrasensitive CPus and PCTus beyond clinical risk factors for predicting SAP, improving the receiver operating characteristic area under the curve (AUC) from 0.837 to 0.876. In contrast, the biomarkers did not improve the prediction of death and functional outcome in the multivariate model. Cardioembolic strokes were significantly associated with higher values of all biomarkers, whereas discrimination was best for MRproANP (AUC = 0.811 for maximum value).Conclusions The tested biomarkers are associated with SAP and poor functional outcome. However, these biomarkers only slightly improve prediction of SAP and do not improve long-term outcome prediction over clinical parameters. MRproANP showed the best discrimination for identifying cardioembolic stroke, warranting further studies to confirm our finding.Clinical trial registration clinicaltrials.gov NCT01264549 and NCT01079728.ANP=atrial natriuretic peptide; AUC=area under the curve; COPD=chronic obstructive pulmonary disease; CPus=ultrasensitive copeptin; CTproET=C-terminal pro-endothelin; MRproANP=midregional pro-ANP; mRS=modified Rankin Scale; NI=no infection; NIHSS=NIH Stroke Scale; NPV=negative predictive value; PCT=procalcitonin; PCTus=ultrasensitive procalcitonin; PPV=positive predictive value; ROC=receiver operating characteristic; SAP=stroke-associated pneumonia; STRAWINSKI=STRoke Adverse outcome is associated WIth NoSoKomial Infections; UTI=urinary tract infection