Publications (2)5.05 Total impact
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Article: Impact of infections on long-term outcome after severe middle cerebral artery infarction.
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ABSTRACT: Post-stroke infections are the most important complications after acute stroke, accounting for almost 20% of in-hospital deaths and poor functional outcomes at discharge. Little is known about long-term effects of post-stroke infections on outcome. Here, we studied the impact of infections on long-term outcome in 64 patients which had suffered from severe middle cerebral artery infarction. Mean follow-up time in the survivors was 6.5 ± 0.9 years. Structured telephone interviews were performed to assess the patients' current functional outcome. Where re-contacting was not successful, vital status of the patients was requested at the registration office of Berlin. Multiple logistic regression analysis identified three independent risk factors associated with mortality: infections within the first 11 days after stroke, age>64 years, and female sex. Among surviving patients, functional outcome measured by Barthel Index was influenced by infections and immunocompetence measured by levels of monocytic HLA-DR expression on day 3 after stroke. In conclusion, the occurrence of post-stroke infections is the most important predictor of poor long-term outcome in this cohort of patients. Our observation warrants prospective trials on prevention or early treatment of post-stroke infections in order to improve long-term outcome after stroke.Journal of the neurological sciences 06/2012; 319(1-2):15-7. · 2.32 Impact Factor -
Article: Influence of stroke localization on autonomic activation, immunodepression, and post-stroke infection.
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ABSTRACT: Experimental and clinical data suggest that overactivation of the sympathetic nerve system (SNS) is an essential mediator of stroke-induced immunodepression, which in turn increases susceptibility to post-stroke infections. In a post hoc analysis of the PANTHERIS (Preventive Antibacterial Treatment in Acute Stroke) trial, we investigated the impact of distinct lesion patterns on SNS activation, immunodepression, and frequency of post-stroke infections. Stroke volume, stress hormone levels, and immune function were determined on day 1 after stroke onset. Stroke localization was graded using the Alberta Stroke Programme Early CT score (ASPECTS). In univariate analysis, we investigated the impact of clinical (National Institutes of Health Stroke Scale, NIHSS) and imaging stroke characteristics (lesion volume, lateralization, localization grading) on autonomous nervous system activity (norepinephrine, cortisol), immune competence (monocytic HLA-DR expression), and the frequency of post-stroke infections. In a logistic regression model, we tested for independent factors that might increase susceptibility to post-stroke infections. In a single-factor analysis, large stroke volume, lesions affecting distinct regions of the MCA cortex, and SNS activation (elevated norepinephrine levels) were associated with an impaired immune function (reduced mHLA-DR expression) and a higher susceptibility to post-stroke infections. Multivariate analysis identified increased levels of norepinephrine and infarction of the anterior MCA cortex as independent risk factors of post-stroke infections. Neither stroke severity nor stroke volume was independently associated with post-stroke infections. Apart from sympathetic activation, our data suggest that ischemic lesion in the anterior MCA cortex may be a major determinant of stroke-associated infection. This finding has to be confirmed in larger prospective studies.Cerebrovascular Diseases 11/2011; 32(6):552-60. · 2.72 Impact Factor
