The role of stroke-induced immunosuppression as a predictor of functional outcome in the neurorehabilitation setting

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

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