IngentaConnect Hyperthermia is a surrogate marker of inflammation-mediated cause...

Abstract:

. Leira R, Rodríguez-Yáñez M, Castellanos M, Blanco M, Nombela F, Sobrino T, Lizasoain I, Dávalos A, Castillo J (Hospital Clínico Universitario, Santiago de Compostela; Hospital Universitario Doctor Josep Trueta, Girona; Hospital Universitario La Princesa, Madrid; Universidad Complutense, Madrid; and Hospital Universitario Germans Trias i Pujol, Barcelona, Spain). Hyperthermia is a surrogate marker of inflammation-mediated cause of brain damage in acute ischaemic stroke. J Intern Med 2006; 260: 343-349.

The influence of temperature on the outcome observed in experimental models of ischaemic stroke has not been definitively proved in patients with stroke. Interleukin-6 (IL-6) acts as important endogenous pyrogen, and it is an important regulator of spontaneous body temperature during cerebral ischaemia. The objective of this study was to determine, during the acute phase of cerebral ischaemia, the potential relationship between proinflammatory cytokines and hyperthermia as a cause of larger cerebral infarcts. Patients and methods.

We studied 229 patients with a first-ever acute hemispheric infarction admitted within the first 24 h from onset of symptoms. On admission, axillary temperature was recorded and blood chemistry studies and cranial computed tomography were performed. We classified body temperature into two groups: hyperthermia (⩾37.5 °C) and normothermia (<37.5 °C). We determined proinflammatory markers [IL-6, tumour necrosis factor-α (TNF-α), intercellular adhesion molecule (ICAM-1) and vascular cellular adhesion molecule] on admission. Two outcome variables were evaluated: (i) infarct volume; (ii) Canadian Stroke Scale (CSS) at 3 months (CSS ⩿ 7 was considered poor outcome and CSS > 7 good outcome). Results.

Patients with hyperthermia had higher infarct volume [46.5 (9.8-78.5) cm³ vs. 19.1 (5.0-23.5) cm³; P < 0.0001], as well as poor outcome at 3 months. Plasma levels of IL-6, TNF-α and ICAM-1 were significantly higher in the group of patients with hyperthermia than in the normothermic group. There was a significant correlation between body temperature on admission and infarct volume (r = 0.302; P < 0.0001), and between proinflammatory markers (IL-6 and TNF-α) and infarct volume. A significant association was also found between proinflammatory markers (IL-6, TNF-α, and ICAM-1) and poor outcome. However, after adjustment for potential confounders, hyperthermia was not independently associated with either larger infarct volume or with poor outcome at 3 months. Conclusions.

Inflammatory mediators play a role in acute ischaemic brain damage independently of hyperthermia.

Keywords: acute stroke; cytokines; hyperthermia

Document Type: Research article

DOI: 10.1111/j.1365-2796.2006.01694.x

Affiliations: 1: Department of Neurology, Stroke Unit and Neurovascular Research Laboratory, Hospital Clínico Universitario, Santiago de Compostela 2: Stroke Unit, Department of Neurology, Hospital Universitario Doctor Josep Trueta, Girona 3: Stroke Unit, Department of Neurology, Hospital Universitario La Princesa, Madrid 4: Department of Pharmacology, Facultad de Medicina, Universidad Complutense, Madrid 5: Stroke Unit, Department of Neurology, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain