Abstract
BackgroundPersistent inflammation is an important driver of disease progression and affects prognosis. Some indicators of inflammation predict short-term outcomes. The relationship between prognosis, especially mortality, and persistent inflammation in massive stroke has not been studied, and this has been the subject of our research.MethodsFrom April 1, 2017 to February 1, 2020, consecutive patients were prospectively enrolled. Clinical data, laboratory data, imaging data and follow-up infections morbidity were compared between 2 groups according to modified Rankin scale (mRS) scores (mRS < 3 and ≥ 3) at 1 month. The binomial logistic analysis was used to determine independent factors of 1-month prognosis. Short-term functional outcome, mortality and infection rates in massive stroke with and without persistent inflammation were compared.ResultsOne hundred thirty-nine patients with massive stroke were included from 800 patients. We found that admission blood glucose levels (p = 0.005), proportions of cerebral hemispheric (p = 0.001), posterior circulatory (p = 0.035), and lacunar (p = 0.022) ischemia were higher in poor outcome patients; neutrophil-to-lymphocyte ratio (odd ratio = 1.87, 95%CI 1.14–3.07, p = 0.013) and blood glucose concentrations (odd ratio = 1.34, 95%CI 1.01–1.79, p = 0.043) can independently predict the short-term prognosis in massive stroke patients. We also found that the incidence of pulmonary infection (p = 0.009), one-month mortality (p = 0.003) and adverse outcomes (p = 0.0005) were higher in patients with persistent inflammation.ConclusionsThis study suggested that persistent inflammation is associated with poor prognosis, 1-month mortality and the occurrence of in-hospital pulmonary infection and that higher baseline inflammation level predicts short-term poor outcomes in massive stroke.
Highlights
Persistent inflammation is an important driver of disease progression and affects prognosis
In the comparison of blood pressure and blood glucose, we found that admission blood glucose levels were different between the 2 groups of patients, i.e., it was higher in the poor prognosis group (5.4 mmol/L, 4.6–6.3 vs 6.6 mmol/L, 5.3–8.2, p = 0.005); no difference was found in blood pressure
Persistent inflammation and 1-month outcomes By comparing the incidence of patient outcomes including pulmonary infection, urinary tract infection, 1-month mortality and 1-month modified Rankin scale (mRS) in the group with and without persistent inflammation (Table 3), we found that the incidence of pulmonary infections (p = 0.009) as well as one-month mortality (p = 0.003) and adverse outcomes (p = 0.0005) was higher in patients with persistent inflammation than that without persistent inflammation
Summary
Persistent inflammation is an important driver of disease progression and affects prognosis. The relationship between prognosis, especially mortality, and persistent inflammation in massive stroke has not been studied, and this has been the subject of our research. A clinical scale predicting early death after stroke has been developed [2] and the usefulness of NLR in predicting poor functional outcomes has been proved in ischemic and hemorrhagic stroke [10, 11], whether systemic inflammation persisting a certain course of the disease predicts stroke mortality remains to be further explored, especially in MaS. The present prospective study aimed to evaluate the impact of persistent, systemic inflammation in MaS on short-term outcomes such as mortality and nosocomial infections including pulmonary infection
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