The Stress-Immune Response in Acute Hyperglycemic Stroke

Abstract

Diabetic and hyperglycemic stroke patients have worse clinical outcome, higher mortality rates, larger infarcts, and more severe neurological disability than euglycemic individuals. The reasons for the worse outcome in diabetes are poorly understood, but may not be fully explained by hyperglycemia alone. The objective of this prospective clinical study was to explore whether there is an association between the stress-immune response and clinical outcomes in the hyperglycemic state. Circulating immune cells including neutrophils, monocytes, B-cells and subpopulations of T-lymphocytes were measured over 96 hours post stroke in both hyperglycemic and euglycemic patients. Cortisol and C-reactive protein (CRP) were measured daily over 4 days in the acute post-stroke phase. Short- and long-term neurological outcomes were assessed by the NIH stroke scale, modified Ranking scale and discharge disposition. Discharge dispositions were captured at discharge and 90 days post stroke. Data on infection rates and all course mortality were collected during the hospital stay and at 3 months follow up. Hyperglycemic stroke patients had worse clinical outcomes, more in-hospital infections, less favorable discharge dispositions and higher mortality rates. Hyperglycemic individuals had higher cortisol and CRP levels, higher peripheral neutrophil concentrations and suppressed lymphocyte levels compared to their euglycemic counterparts. Our data suggests an altered stress-immune response in the hyperglycemic state following acute ischemic stroke which could contribute to the poor clinical outcome in this high risk group. Key words Key words: Diabetes, hyperglycemia, ischemic stroke, lymphocytes, neutrophils