Prediction of Stroke-associated Pneumonia

Conditions

Ischemic Stroke

Keywords

ischemic stroke, stroke-associated pneumonia, prediction, immune and infection parameters

Brief summary

Stroke-associated pneumonia (SAP) constitutes a clinically relevant complication of stroke, because it increases the mortality and has a negative impact on the neurological prognosis of the patient. An early identification of patients at risk for SAP allowing an early initiation of antiinfective therapy may improve the prognosis. To date, no reliable prediction models or clinical scores for stroke-associated pneumonia exist. Recently, it was shown that parameters indicating an impaired immune function are associated with the subsequent occurrence of SAP and could therefore be used as predictors for SAP. This study will develop and prospectively validate a prognostic score to predict SAP based on clinical parameters. Furthermore, the study examines the prognostic properties of selected immune and infectious parameters for the prediction and diagnosis of SAP. The study will further address the question whether these infectious and immune parameters predict the 3-month-outcome. In a subgroup of patients, MRI parameters on stroke size and localization will be assessed to investigate whether these parameters might allow prediction of SAP or the 3-month-outcome.

Benjamin Hotter, Sarah Hoffmann, Lena Ulm, Christian Meisel, Alejandro Bustamante et al. (9 authors)

Stroke2020-12-0737 citations

10.1161/strokeaha.120.031884

Inflammatory and stress markers predicting pneumonia, outcome, and etiology in patients with stroke

Benjamin Hotter, Sarah Hoffmann, Lena Ulm, Joan Montaner, Alejandro Bustamante et al. (7 authors)

Neurology Neuroimmunology & Neuroinflammation2020-02-2642 citations

10.1212/nxi.0000000000000692

Biomarkers of immune capacity, infection and inflammation are associated with poor outcome and mortality after stroke - the PREDICT study

Annerose Mengel, Lena Ulm, Benjamin Hotter, Hendrik Harms, Sophie K. Piper et al. (10 authors)

BMC Neurology2019-07-0345 citations

10.1186/s12883-019-1375-6

IL-6 Plasma Levels Correlate With Cerebral Perfusion Deficits and Infarct Sizes in Stroke Patients Without Associated Infections.

Hotter B, Hoffmann S, Ulm L, Meisel C, Fiebach JB, Meisel A.

2019-02-1546 citations

10.3389/fneur.2019.00083

Interventions

None listed

Study design

Observational model

CASE_ONLY

Time perspective

PROSPECTIVE

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

No

Inclusion criteria

* ischemic stroke in the anterior (ACA, MCA) and posterior cerebral circulation (PCA, BA) of any severity * stroke onset within the last 36h * age ≥ 18 * consent by the patient or the legal representative

Exclusion criteria

* intracranial hemorrhage * signs of infection at admission (clinical / paraclinical) * pre-existing dysphagia * mechanical ventilation at admission * participation in an interventional trial

Design outcomes

Primary

Measure	Time frame	Description
Predictive score for SAP based on clinical parameters assessed within 36h after stroke onset	SAP within 7 days after onset of symptoms (stroke)	To establish a predictive score for SAP based on clinical parameters assessed within 36h after stroke onset
Predictive properties of immune parameters (IL6, IL10, mHLA-DR) or infection parameters (PCT) for the occurrence of a SAP within 7 days after stroke onset	SAP within 7 days after onset of symptoms (stroke)	To evaluate of the predictive properties of immune parameters (IL6, IL10, mHLA-DR) or infection parameters (PCT) for the occurrence of a SAP within 7 days after stroke onset

Secondary

Measure	Time frame	Description
Localization and stroke volume analysis	SAP within 7 days and neurological outcome after 3 months after onset of symptoms (stroke)	To investigate the influence of the localization and stroke volume on the occurrence of a SAP and on neurological outcome
Predictive properties of immune parameters (IL6, IL8, IL10, mHLA-DR, MBL, monocytic cytokine secretion after ex vivo stimulation, C5a) and infection parameters (PCT, LBP) for the occurence of a SAP	SAP within 7 days after onset of symptoms (stroke)	To evaluate of the predictive properties of immune parameters (IL6, IL8, IL10, mHLA-DR, MBL, monocytic cytokine secretion after ex vivo stimulation, C5a) and infection parameters (PCT, LBP) for the occurence of a SAP
Predictive properties of immune parameters (IL6, IL8, IL10, mHLA-DR, MBL, monocytic cytokine secretion after ex vivo stimulation, C5a) and infection parameters (PCT, LBP) for the neurological outcome	Neurological outcome 3 months after onset of symptoms (stroke)	To evaluate of the predictive properties of immune parameters (IL6, IL8, IL10, mHLA-DR, MBL, monocytic cytokine secretion after ex vivo stimulation, C5a) and infection parameters (PCT, LBP) for the neurological outcome
Transcriptome analyses	SAP within 7 days and neurological outcome after 3 months after onset of symptoms (stroke)	To perform transcriptome analyses to identify new biomarkers which may predict the occurence of a SAP or the 3-month neurological outcome
Influence of insular cortex involvement and infarct volume on the occurrence of a SAP within 7 days and and on the neurological outcome after 3 months	SAP within 7 days after onset of symptoms (stroke) and neurological outcome after 3 months	To investigate the influence of insular cortex involvement and infarct volume on the occurrence of a SAP within 7 days after stroke onset and on the neurological outcome after 3 months
Plasma levels of acetylcholinesterase	within 7 days after onset of symptoms (stroke)	To investigate the parasympathetic influence on the immune function after stroke by measuring plasma levels of acetylcholinesterase

Countries

Germany, Spain

Outcome results