Body temperature, blood infection parameters, and outcome of thrombolysis-treated ischemic stroke patients

Background and AimsBody temperature, inflammation, and infections may modify response to thrombolytic therapy. We studied their associations with clinical improvement after intravenous thrombolysis and three-month outcome. MethodsWe included 985 consecutive acute ischemic stroke patients treated with intravenous thrombolysis at the Helsinki University Central Hospital during 1995-2008. Body temperature, blood leukocyte count, and C-reactive protein levels were analyzed on arrival and at day one. Clinical improvement was defined as National Institutes of Health Stroke Scale score decrease of 4 points or a score of 0 at 24h. Functional outcome was assessed at three-months with the modified Rankin Scale dichotomized at 0-2 (good) vs. 3-6 (poor). Associations were tested with multivariable logistic regression analysis. ResultsOf the baseline variables, lower C-reactive protein independently predicted clinical improvement at 24h (odds ratio 094 per 5mg/L; 95% confidence interval 089-100; P=003), whereas higher leukocyte count (odds ratio 110 per E9/L; 103-117; P<001) and C-reactive protein (odds ratio 107 per 5mg/L; 101-114; P=002) were associated with poor three-month outcome. When body temperature increased over the first 24h, clinical improvement after thrombolysis was unlikely (odds ratio 066 per degrees C; 045-095; P=003) and poor outcome more common (odds ratio 163 per degrees C; 124-214; P<0001). Elevated leukocytes at baseline increased the risk of symptomatic intracerebral hemorrhage (odds ratio 107 per E9/L; 100-113; P=004). ConclusionA lower level of systemic inflammation at time of thrombolysis may be associated with clinical improvement and good outcome at three-months. Increase in body temperature during the first 24h associates with lack of clinical improvement and worse patient outcome.