| Abstract: |
: Infection is the most common complication of stroke and it is the chief cause of morbidity and mortality in the stroke survivor. Aim: This study was designed to determine the: risk factors, predictors and prognostic factors of post-stroke infection which developed early in acute ischemic stroke patients within the first week of the onset of stroke. Subjects: The study included 60 ischemic stroke patients admitted in intensive care unit (ICU) and Stroke Unit of Neurology Department, Zagazig University subdivided into: [Group I: non stroke associated infection group (nSAI); 30 patients having stroke without any criteria of infection within 7 days of stroke onset and Group II: stroke associated infection group (SAI); 30 patients having stroke with respiratory tract infection (RTI) or urinary tract infection (UTI) within 7 days], in addition to 30 healthy sex and age-matching subjects as control.Methods: All patients had detailed history taking, thorough clinical general and neurological examination, laboratory tests (Urine analysis & urine culture, blood sugar, liver function, renal function, complete blood count, erythrocyte sedimentation rate, lipid profile, serum uric acid, serum level of C-reactive protein and serum tumor necrosis factor-alpha and interleukin-10), a chest plain X-ray performed to assess RTI and brain computed tomography (CT) scan to exclude hemorrhagic stroke and to confirm ischemic stroke.Results: stroke associated infection (SAI) patients were found to be significantly older with higher baseline blood glucose level than nSAI patients. Also number of patients with tube feeding, lower conscious level, more stroke severity and more large size infarcts were significantly higher in SAI patients than that in nSAI patients. In SAI group there were significant elevation in IL-10, significant decrease in TNF-α and significant decrease in TNF-α/IL-10 ratio compared to nSAI group. We demonstrated a significant higher number of stroke patients with RTI with history of smoking and a significant higher number of stroke patients with UTI with history of hyperlipidiemia. Our study declared baseline serum level of IL-10 of more than 14.5 pg/ml and size of infarct area of more than 3.5 cm3 as the independent predictors of post-stroke infection. Our SAI patients had significantly worse clinical prognosis in comparison to nSAI patients. In SAI patients, we found significant relation between cortico-subcortical infarction, tube feeding and lower conscious level with bad prognosis. Stroke prognosis in SAI patients was positively correlated with age of patients, size of infarct area and baseline [blood glucose level, systolic blood pressure, diastolic blood pressure, total cholesterol, National Institutes of Health Stroke Scale (NIHSS), IL-10 and total leukocytic count].Conclusion: Patients with older age, tube feeding, lower conscious level, worse clinical severity on admission, large cerebral infarcts in CT scan, and increased IL-10 serum level were more susceptible to infection. Baseline serum level of IL-10 of more than 14.5 pg/ml and size of infarct area of more than 3.5 cm3 are the independent predictors of post-stroke infection. Respiratory tract infection and UTI in the first week after stroke were associated with poor stroke outcome and therefore their active prevention and management may substantially improve stroke prognosis.
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