Research Article: Inflammatory Markers and Poor Outcome after Stroke: A Prospective Cohort Study and Systematic Review of Interleukin-6

Date Published: September 8, 2009

Publisher: Public Library of Science

Author(s): William Whiteley, Caroline Jackson, Steff Lewis, Gordon Lowe, Ann Rumley, Peter Sandercock, Joanna Wardlaw, Martin Dennis, Cathie Sudlow, Fiona Mary Turnbull

Abstract: In a prospective cohort study of patient outcomes following stroke, William Whiteley and colleagues find that markers of inflammatory response are associated with poor outcomes. However, addition of these markers to existing prognostic models does not improve outcome prediction.

Partial Text: A nonspecific systemic inflammatory response occurs after both ischemic and hemorrhagic stroke, either as part of the process of brain damage or in response to complications such as deep venous thrombosis. Several studies have reported that higher levels of inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6) are associated with worse outcome after both ischemic [1] and hemorrhagic [2],[3] strokes. However, these studies often had methodological weaknesses, chiefly that they were too small, did not adequately adjust for confounders or assess the clinical utility of the measurements.

In this large cohort of stroke patients, blood markers of the acute inflammatory response were associated with poor outcome after stroke, though only IL-6 showed independent association after adjustment for confounding factors, including levels of other markers. In this cohort, the addition of IL-6 to a previously validated prognostic model added to the prediction of outcome, but by an amount that is unlikely to be useful in clinical practice. Whether or not inflammatory markers are useful in prediction of recurrent stroke [38],[39] or other vascular events is a separate question, which requires further study.



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