Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression

Background Stroke-induced immunodepression is a well characterized complication of acute ischemic stroke. In experimental studies beta-blocker therapy reversed stroke-induced immunodepression, reduced infection rates and mortality. Recent, heterogeneous studies in stroke patients could not provide evidence of a protective effect of beta-blocker therapy. Aim of this study is to investigate the potential preventive effect of beta-blockers in subgroups of patients at high risk for stroke-induced immunodepression. Methods Data from a prospectively derived registry of major stroke patients receiving endovascular therapy between 2011 +/- 2017 in a tertiary stroke center (University Medical Center Go E ttingen. Germany) was used. The effect of beta-blocker therapy on pneumonia, urinary tract infection, sepsis and mortality was assessed using multivariate logistic regression analysis. Results Three hundred six patients with a mean age of 72 +/- 13 years and a median NIHSS of 16 (IQR 10.75 +/- 20) were included. 158 patients (51.6%) had pre-stroke-and continued betablocker therapy. Beta-blocker therapy did not reduce the incidence of pneumonia (OR 0.78, 95% CI 0.31 +/- 1.92, p = 0.584), urinary tract infections (OR 1.51, 0.88 +/- 2.60, p = 0.135), sepsis (OR 0.57, 0.18 +/- 1.80, p = 0.334) or mortality (OR 0.59, 0.16 +/- 2.17, p = 0.429). Strokes involving the insula and anterio-medial cortex increased the risk for pneumonia (OR 4.55, 2.41 +/- 8.56, p< 0.001) and sepsis (OR 4.13, 1.81 +/- 9.43, p = 0.001), while right hemispheric strokes increased the risk for pneumonia (OR 1.60, 0.92 +/- 2.77, p = 0.096). There was a nonsignificantly increased risk for urinary tract infections in patients with beta-blocker therapy and insula/anterio-medial cortex strokes (OR 3.12, 95% CI 0.88 +/- 11.05, p = 0.077) with no effect of beta-blocker therapy on pneumonia, sepsis or mortality in both subgroups. Conclusions In major ischemic stroke patients, beta- blocker therapy did not lower post-stroke infection rates and was associated with urinary tract infections in a subgroup with insula/anteriomedial strokes.