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J Cereb Blood Flow Metab. 2017 Dec;37(12):3671-3682. doi: 10.1177/0271678X16671964. Epub 2016 Oct 14.

Stroke-induced immunodepression and dysphagia independently predict stroke-associated pneumonia - The PREDICT study.

Author information

1
1 NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany.
2
2 Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.
3
3 Department of Neurology, St.-Josefs Krankenhaus Potsdam, Germany.
4
4 Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany.
5
5 Department of Neurology, Vivantes Auguste Viktoria Klinikum, Berlin, Germany.
6
6 Department of Neurology, Unfallkrankenhaus Berlin, Germany.
7
7 Department of Neurology, Jüdisches Krankenhaus Berlin, Germany.
8
8 Center for Stroke Research (CSB), Charité - Universitätsmedizin Berlin, Germany.
9
9 Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona, Spain.
10
10 Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany.
11
11 Clinical Trial Center Würzburg, University Hospital Würzburg, Germany.
12
12 Comprehensive Heart Failure Center, University of Würzburg, Germany.
13
13 Department of Immunology, Charité - Universitätsmedizin Berlin, Germany.
14
14 Department of Immunology, Labor Berlin - Charité Vivantes GmbH, Berlin, Germany.

Abstract

Stroke-associated pneumonia is a frequent complication after stroke associated with poor outcome. Dysphagia is a known risk factor for stroke-associated pneumonia but accumulating evidence suggests that stroke induces an immunodepressive state increasing susceptibility for stroke-associated pneumonia. We aimed to confirm that stroke-induced immunodepression syndrome is associated with stroke-associated pneumonia independently from dysphagia by investigating the predictive properties of monocytic HLA-DR expression as a marker of immunodepression as well as biomarkers for inflammation (interleukin-6) and infection (lipopolysaccharide-binding protein). This was a prospective, multicenter study with 11 study sites in Germany and Spain, including 486 patients with acute ischemic stroke. Daily screening for stroke-associated pneumonia, dysphagia and biomarkers was performed. Frequency of stroke-associated pneumonia was 5.2%. Dysphagia and decreased monocytic HLA-DR were independent predictors for stroke-associated pneumonia in multivariable regression analysis. Proportion of pneumonia ranged between 0.9% in the higher monocytic HLA-DR quartile (≥21,876 mAb/cell) and 8.5% in the lower quartile (≤12,369 mAb/cell). In the presence of dysphagia, proportion of pneumonia increased to 5.9% and 18.8%, respectively. Patients without dysphagia and normal monocytic HLA-DR expression had no stroke-associated pneumonia risk. We demonstrate that dysphagia and stroke-induced immunodepression syndrome are independent risk factors for stroke-associated pneumonia. Screening for immunodepression and dysphagia might be useful for identifying patients at high risk for stroke-associated pneumonia.

KEYWORDS:

Acute stroke; immunology; infection; inflammation; macrophages

PMID:
27733675
PMCID:
PMC5718319
DOI:
10.1177/0271678X16671964
[Indexed for MEDLINE]
Free PMC Article

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