The role of stroke-induced immunosuppression as a predictor of functional outcome in the neurorehabilitation setting
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Published:2024-04-09
Issue:1
Volume:14
Page:
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ISSN:2045-2322
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Container-title:Scientific Reports
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language:en
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Short-container-title:Sci Rep
Author:
Vaghi Gloria, Morotti Andrea, Piella Elisa Maria, Avenali Micol, Martinelli Daniele, Cristina Silvano, Allena Marta, Grillo Valentina, Corrado Michele, Bighiani Federico, Cammarota Francescantonio, Antoniazzi Alessandro, Ferrari Federica, Mazzacane Federico, Cavallini Anna, Pichiecchio Anna, Rognone Elisa, Martinis Luca, Correale Luca, Castiglia Stefano Filippo, Trabassi Dante, Serrao Mariano, Tassorelli Cristina, De Icco RobertoORCID
Abstract
AbstractStroke affects the interconnection between the nervous and immune systems, leading to a down-regulation of immunity called stroke-induced immunosuppression (SII). The primary aim of this study is to investigate SII role as a predictor of functional, neurological, and motor outcomes in the neurorehabilitation setting (NRB). We conducted a prospective observational study enrolling post-acute stroke patients hospitalized for neurorehabilitation. At NRB admission (T0) and discharge (T1), we assessed presence of SII (defined by a neutrophil-to-lymphocyte ratio ≥ 5) and we evaluated functional independence (Functional Independence Measure-FIM, Barthel Index-BI), motor performances (Tinetti Score, Hauser Ambulation Index) and neurological impairment (NIHSS). We enrolled 96 patients (45.8% females, 70.6 ± 13.9 years, 88.5% ischemic stroke). At T0, 15.6% of patients (15/96) had SII. When compared to immunocompetent patients (IC), the SII group was characterized by worse baseline functional independence, motor performances and neurological disability. The same was confirmed at T1 (FIM p = 0.012, BI p = 0.007, Tinetti p = 0.034, NIHSS p = 0.001). Neurological disability demonstrated a less pronounced improvement in SII (ΔNIHSS: SII: − 2.1 ± 2.3 vs. IC: − 3.1 ± 2.5, p = 0.035). SII group presented a higher percentage of infectious complications during the neurorehabilitation period (SII 80% vs. IC 25.9%; p = 0.001). SII may represent a negative prognostic factor in the neurorehabilitation setting. SII patients were characterized by poorer functional, motor, neurological performances and higher risk of infectious complications. ClinicaTrial registration: NCT05889169.
Funder
Ministero della Salute
Publisher
Springer Science and Business Media LLC
Reference38 articles.
1. Meisel, C., Schwab, J. M., Prass, K., Meisel, A. & Dirnagl, U. Central nervous system injury-induced immune deficiency syndrome. Nat. Rev. Neurosci. 6(10), 775–786. https://doi.org/10.1038/nrn1765 (2005). 2. Shi, K., Wood, K., Shi, F.-D., Wang, X. & Liu, Q. Stroke-induced immunosuppression and poststroke infection. Stroke Vasc. Neurol. 3(1), 34–41. https://doi.org/10.1136/svn-2017-000123 (2018). 3. van Gemmeren, T. et al. Early post-stroke infections are associated with an impaired function of neutrophil granulocytes. J. Clin. Med. 9(3), 872. https://doi.org/10.3390/jcm9030872 (2020). 4. Fu, Y., Liu, Q., Anrather, J. & Shi, F. D. Immune interventions in stroke. Nat. Rev. Neurol. 11(9), 524–535. https://doi.org/10.1038/NRNEUROL.2015.144 (2015). 5. Zahorec, R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratislava Med. J. 122(7), 474–488. https://doi.org/10.4149/BLL_2021_078 (2021).
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