Inflammatory Factors as Potential Markers of Early Neurological Deterioration in Acute Ischemic Stroke Patients Receiving Endovascular Therapy - The AISRNA Study

Qi-Wen Deng, Shi Huang, Shuo Li, Qian Zhai, Qing Zhang, Zhen-Jie Wang, Wen-Xia Chen, Huiling Sun, Min Lu, Junshan Zhou, Qi-Wen Deng, Shi Huang, Shuo Li, Qian Zhai, Qing Zhang, Zhen-Jie Wang, Wen-Xia Chen, Huiling Sun, Min Lu, Junshan Zhou

Abstract

Background and purpose: This study aimed to explore several peripheral blood-based markers related to the inflammatory response in a total of 210 patients with acute ischemic stroke (AIS) caused by large artery occlusion in the anterior circulation who received endovascular therapy (EVT) from an observational study of clinical significance of circulating non-coding RNA in acute ischemic stroke (AISRNA).

Methods: We collected baseline characteristics of 210 AIS patients participating in an observational acute stroke cohort: the AISRNA study. The following inflammatory factors were measured in these participants: interleukin-2 [IL-2], IL-4, IL-6, IL-10, tumor necrosis factor-α [TNF-α], and interferon-γ [IFN-γ]. The National Institute of Health Stroke Scale score increase of ≥4 within 24 hours after EVT defined as early neurological deterioration (END).

Results: Compared with patients without END, patients with END had a higher incidence of atrial fibrillation (P=0.012), and also had higher levels of IL-6 and IL-10 (P<0.01). Furthermore, we found that the area under the curves (AUCs) of IL-6 and IL-10 for predicting END were 0.768 (0.697-0.829), and 0.647 (0.570-0.719), respectively. Adjusting for age, sex, and atrial fibrillation, the odds ratios (ORs; 95% confidence interval) for incident END for IL-6 and IL-10 were 1.98 (1.05-6.69) and 1.18 (1.04-1.33), respectively. Additionally, we found significant changes over time in the expression levels of IL-4, IL-6, and IL-10 in patients with END compared with patients without END (P<0.05).

Conclusion: IL-6 and IL-10 levels at admission may be potential markers of END after EVT, and the time course of IL-4, IL-6, and IL-10 is correlated with stroke progression. Further larger studies are needed to confirm the current findings.

Trial registration: ClinicalTrials.gov NCT04175691. Registered November 21, 2019, https://www.clinicaltrials.gov/ct2/show/NCT04175691.

Keywords: IL-6; acute ischemic stroke; early neurological deterioration; endovascular therapy; inflammatory factors.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021 Deng et al.

Figures

Figure 1
Figure 1
Flowchart of the study patients to illustrate study screening, recruitment, and follow-up.
Figure 2
Figure 2
Discriminatory capacities of IL-6 and IL-10 for END after EVT. The area under the curves of IL-6 and IL-10 for predicting END were 0.791 (0.689–0.871), and 0.564 (0.452–0.671), respectively (P<0.001).
Figure 3
Figure 3
Time course of inflammatory factors after stroke onset (days 1 to 7). Significant changes over time were observed in the expression levels of IL-4, IL-6, and IL-10 in patients with END compared with patients without END (P<0.05). IL-4 levels peaked at day 2 and then rapidly decreased at day 3 (A). IL-6 levels were obviously increased from days 1 to 7 after EVT (B). IL-10 (C) levels also peaked at day 2 and then rapidly decreased at day 3. No significant change over time was found in the expression levels of IL-2 (D), TNF-α (E), and INF-γ (F) between patients with END and patients without END (P>0.05). *P<0.05, **P<0.01, ***P<0.001.

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