Introduction: Inflammation plays a critical role in the pathophysiology of ischemia and atherosclerosis. TNFα plays a multifaceted role in stroke progression, having both protective and deleterious effects. Animal studies have shown that TNFα levels increase in cerebral tissue within the first 24 hours after experimental stroke.
Hypothesis: Expression of TNFα is related to outcomes after acute ischemic stroke. Differences in expression will be seen with respect to patient gender and other stroke characteristics.
Methods: Patients admitted to Hartford Hospital between January 2011 and March 2014 were considered for this study. Blood samples were collected within 24 hours of stroke presentation. Patients with a history of active cancer, primary or secondary neoplastic brain lesions, traumatic brain injury or intracranial hemorrhage were excluded from the study. Serum was analyzed using a multiplex human cytokine panel/Bio plex (Bio-Rad laboratories Inc.). Statistical analysis was performed using SPSS.
Results: A total of 163 ischemic stroke patients were included in the study. Outcome variables including NIH stroke scale, modified Rankin scale (mRS) at discharge, 3 months, 12 months and modified Barthel’s index (BI) were collected. Composite outcome scores were determined using the mRS and BI. A negative outcome was defined as death or BI ≤ 14 or mRS >2.There was a statistically significant difference (p=0.003) in the expression of TNFα between male - 21.74 pg/ml (15.11-30.21) and female 27.9 pg/ml (19.07-35.497) stroke patients. A significant difference (p=0.009) was observed in TNFα expression in patients with a good outcome - 22.96 pg/ml (15.69-30.85) as compared to those with a poor outcome (discharge to worse/hospice or death) - 30.78 pg/ml (22.03-35.38) post stroke.
Conclusions: Male- female sex differences are associated with changes in the post ischemic inflammatory cascade. Higher TNFα levels predict poorer outcomes post stroke. Cytokines like TNFα may serve as a potential therapeutic targets in patients with acute ischemic stroke.