A Resposta Inflamatória Sistémica está ligada com a Severidade do Edema Cerebral e Deterioração Neurológica após Recanalização em AVC isquémico

Abstract

Background and Purpose: The mechanisms by which systemic inflammation worsens clinical outcome in ischemic stroke have not been still well explored. We hypothesized that the peripheral inflammatory response augments cerebral edema (CED) and it ultimately impends neurological recovery. Methods: We analyzed consecutive patients with ischemic stroke of the anterior circulation submitted to intravenous thrombolysis (IVT) or endovascular treatment (EVT) during 2017 and 2018. We determined neutrophil-(NLR) and platelet-to-lymphocyte (PLR) ratios and the presence of Systemic Inflammatory Response Syndrome (SIRS). CED degrees were classified using the European Cooperative Acute Stroke Study (ECASS)-2 definition on CT scan at 24 hours. The clinical outcomes included early neurological deterioration (END) and functional dependence at 90 days. Ordinal and logistic regressions were used to predict the outcomes. Area Under the Curve (AUC) of Receiver Operating Characteristic curves were used to find the best cut-off values on continuous variables to predict outcomes. Results: We included 376 patients; 67% received IVT and 61% EVT. Increasing values of NLR after recanalization were associated with higher degree of CED at 24 hours (adjusted odds ratio (aOR)=1.47, 95% Confidence Interval (CI)=1.18 - 1.82, p<0.01). Moreover, NLR was also significantly associated with END (aOR=1.61, CI=1.09 - 2.38, p<0.05) and poor functional status at 90 days (aOR=1.60, CI=1.24 - 2.07, p<0.01). PLR showed similar association but NLR >6.2 was the most accurate predictor of CED and clinical outcome (AUC ~0.7, p<0.01), even after adjustment to baseline severity and excluding cases of significant hemorrhagic transformation. SIRS was associated CED severity but not clinical outcome. Conclusions: Peripheral inflammation early after recanalization is associated with increasing severity of CED, neurological deterioration and ultimately, poor functional outcome. Easily assessable pro-inflammatory indexes could be useful for patient stratification for future immunomodulation therapies.