Catecholamines, infection, and death in acute ischemic stroke

Ángel Chamorro*, Sergio Amaro, Martha Vargas, Víctor Obach, Álvaro Cervera, Manuel Gómez-Choco, Ferrán Torres, Anna M. Planas

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

140 Citations (Scopus)

Abstract

Experimental studies have recently suggested that acute ischemia may facilitate the appearance of fatal infections as part of a brain-induced immunodepression syndrome. However, the mechanisms and neurological consequences of infections complicating acute ischemic stroke have received much less attention at the bedside. The incidence of infection and death after non-septic stroke was compared in this prospective study with longitudinal changes of cytokines, leukocytes, normetanephrine (NMN) and metanephrine (MN) in 75 consecutive patients. In multivariate analysis, infection, n = 13 (17%), was associated with the upper quartile of MN (OR 3.51, 95% CI 1.30-9.51), neurological impairment (NIHSS) on admission (OR 3.99, 95% CI 1.34-11.8), monocyte count (OR 1.78, 95% CI 1.13-2.79), and increased interleukin (IL)-10 (OR 1.54, 95% CI 1.00-2.38). Mortality at 3 months, n = 16 (21%), was associated with increased levels of NMN on admission (OR 2.34 95% CI 1.15-4.76), NIHSS score (OR 2.57, 95% CI 1.29-5.11), and higher IL-6 levels (OR 1.29, 95% 1.00-1.67). These findings suggest that acute ischemic stroke is associated with an early activation of the sympathetic adrenomedullar pathway that lowers the threshold of infection and increases the risk of death. Moreover, these findings are independent of the blood borne effects of pro- and anti-inflammatory cytokines, and circulating leukocytes.

Original languageAmerican English
Pages (from-to)29-35
Number of pages7
JournalJournal of the Neurological Sciences
Volume252
Issue number1
DOIs
Publication statusPublished - Jan 2007

Keywords

  • Adrenal gland
  • Cerebral ischemia
  • Infection
  • Interleukins
  • Metanephrines

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