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Body temperature, blood infection parameters, and outcome of thrombolysis-treated ischemic stroke patients

Authors

  • Marjaana Tiainen,

    Corresponding author
    1. Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
    • Correspondence: Marjaana Tiainen, Department of Neurology, Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland.

      E-mail: marjaana.tiainen@hus.fi

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    • †These authors contributed equally.
  • Atte Meretoja,

    1. Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
    2. Melbourne Brain Centre at the Royal Melbourne Hospital, Department of Medicine, University of Melbourne, Florey Institute of Neuroscience and Mental Health, and Department of Neurology, Royal Melbourne Hospital, Melbourne, Vic., Australia
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    • †These authors contributed equally.
  • Daniel Strbian,

    1. Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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  • Joel Suvanto,

    1. Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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  • Sami Curtze,

    1. Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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  • Perttu J. Lindsberg,

    1. Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
    2. Research Programs Unit, Molecular Neurology, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland
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  • Lauri Soinne,

    1. Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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  • Turgut Tatlisumak,

    1. Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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  • and for the Helsinki Stroke Thrombolysis Registry Group

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    • ‡The Helsinki Stroke Thrombolysis Registry further includes Ville Artto, Sari Atula, Olli Häppölä, Markku Kaste, SatuMustanoja, Katja Piironen, Jukka Putaala, Kirsi Rantanen, Tiina Sairanen, Oili Salonen, and Heli Silvennoinen.

  • Conflict of interest: A. M. received honoraria and consultant fees from Boehringer Ingelheim. L. S. has received honoraria for speaking (Boehringer Ingelheim, Pfizer, Sanofi) and consulting (Boehringer Ingelheim). T. T. received research grants from Concentric Medical, Mitsubishi Pharma, H. Lundbeck A/B, Boehringer Ingelheim, PhotoThera, BrainsGate, Schering Plough, and SanofiAventis, and is a consultant and on the Advisory Board of Boehringer Ingelheim.

Abstract

Background and Aims

Body temperature, inflammation, and infections may modify response to thrombolytic therapy. We studied their associations with clinical improvement after intravenous thrombolysis and three-month outcome.

Methods

We included 985 consecutive acute ischemic stroke patients treated with intravenous thrombolysis at the Helsinki University Central Hospital during 1995–2008. Body temperature, blood leukocyte count, and C-reactive protein levels were analyzed on arrival and at day one. Clinical improvement was defined as National Institutes of Health Stroke Scale score decrease of ≥4 points or a score of 0 at 24 h. Functional outcome was assessed at three-months with the modified Rankin Scale dichotomized at 0–2 (good) vs. 3–6 (poor). Associations were tested with multivariable logistic regression analysis.

Results

Of the baseline variables, lower C-reactive protein independently predicted clinical improvement at 24 h (odds ratio 0·94 per 5 mg/L; 95% confidence interval 0·89–1·00; P = 0·03), whereas higher leukocyte count (odds ratio 1·10 per E9/L; 1·03–1·17; P < 0·01) and C-reactive protein (odds ratio 1·07 per 5 mg/L; 1·01–1·14; P = 0·02) were associated with poor three-month outcome. When body temperature increased over the first 24 h, clinical improvement after thrombolysis was unlikely (odds ratio 0·66 per °C; 0·45–0·95; P = 0·03) and poor outcome more common (odds ratio 1·63 per °C; 1·24–2·14; P < 0·001). Elevated leukocytes at baseline increased the risk of symptomatic intracerebral hemorrhage (odds ratio 1·07 per E9/L; 1·00–1·13; P = 0·04).

Conclusion

A lower level of systemic inflammation at time of thrombolysis may be associated with clinical improvement and good outcome at three-months. Increase in body temperature during the first 24 h associates with lack of clinical improvement and worse patient outcome.

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