Introduction: Studies suggest that an elevated inflammatory profile is associated with increased stroke incidence and worse post-stroke outcome. It is unclear if an elevated inflammatory profile on admission is a useful prognostic marker of poor outcome after stroke, a reflection of a more severe stroke, or a marker of infection or the comorbidities that caused the stroke.
Hypothesis: We hypothesized that elevated acute phase reactants (APRs) are associated with poor outcome post-stroke, independent of stroke severity and infection.
Methods: The study used a prospectively collected clinical database of 755 patients admitted for ischemic or hemorrhagic stroke. APRs studied included erythrocyte sedimentation rate (ESR), glucose, platelets, and white blood cell count. Outcome was assessed at discharge using a dichotomous modified Rankin Scale (mRS) score of 3-6 (poor outcome) vs. 0-2 (good outcome), and was evaluated in multivariate logistic regression. Analyses were adjusted for NIHSS, age, sex, race, hypertension, diabetes, and use of antithrombotic medication, and were further stratified by presence/ absence of diabetes, infection (via urinalysis), and by race.
Results: Elevated ESR (OR: 1.16, 95% CI: 1.00-1.33) and glucose (OR: 1.04 per 10 mg/dL, 95% CI: 1.00-1.09), were each associated with poor outcome, independent of stroke severity (NIHSS). Even in non-diabetics, elevated glucose was associated with 15% non-significantly higher odds of poor outcome per 10 mg/dL (95% CI: 0.998-1.34). However, subgroup analysis of those without infection showed no association between APRs and poor outcome. In race-stratified models, glucose level was significantly associated with poor outcome in African Americans (OR: 1.13, 95% CI: 1.01-1.26), but not in other races.
Conclusion: Our study shows that ESR is associated with poor outcome after stroke, independently of stroke severity, and that elevated glucose may be associated with increased odds of poor outcome in non-diabetic or African American ischemic stroke patients. Glucose and ESR may play a role in determining prognosis of stroke patients, and therefore point to a potential target for improving outcome of stroke patients.