The Systemic Inflammation Effect on the Ischemic Stroke Severity and Outcomes in Persons Aged from 18 to 45 Years
Introduction. Despite numerous experimental and clinical evidence of the focal and systemic inflammation (SI) influence on cerebral ischemia, the data on the systemic inflammation effect on the ischemic stroke (IS) severity and outcomes in young people are limited and contradictory. Purpose. To study the blood levels of systemic inflammation markers and its association with the severity and outcomes in IS young patients. Materials and methods. The blood markers of systemic inflammation (peripheral blood leukocytes, high sensitivity C-reactive protein - hsCRP, serum ferritin, albumin, fibrinogen) in 235 patients with IS aged from 18 to 45 years and in 50 healthy individuals of the corresponding sex and age were analyzed. The severity of neurological and functional impairments was assessed using the National Institutes of Health Stroke Scale (NIHSS), the Modified Rankin Scale (MRS), and the Bartel Index of Everyday Life. The IS outcomes, taking into account the level of functioning and mortality according to the MRS, were assessed in 1 year after the onset of the disease. Results. There was a statistically significant increase of the levels of SI blood markers (leukocytes, hsCRP, fibrinogen) and decrease of the albumin level in the IS patients if compared with the group of healthy individuals (p<0.05, respectively). The dependence of the neurological and functional severity (according to the NIHSS scale, MRS, and Bartel’s index) on the gradation of hsCRP levels in the blood serum was revealed: the most pronounced disorders were observed in the patients with SI grades “3” (hsCRP 3.0-10.0 mg/l) and “4” (hsCRP ≥10.0 mg/l) (p<0.05). The relationship between the unfavourable outcomes of IS (3-6 points on the MRS) and the levels of SI markers (increase of the leukocytes, H=49.36, p<0.0001; hsCRP, H=92.91 p <0.0001; fibrinogen, H=16.49, p=0.002 levels, and decrease of albumin levels, H=18.78, p=0.0009) was found. The threshold value of hsCRP level (4.09 mg/L) was revealed, which can be the marker of unfavourable outcome of IS in young adults (classifier sensitivity - 78.9%, specificity - 81.0%). The cumulative two- year survival without functional impairment in patients with hsCRP levels of more than 4.09 mg/L (73.9%) was significantly lower than in the subgroup with hsCRP levels less than 4.09 mg/L (96.6%), Log-Rank Test, p=0.0004.Conclusions. The results of comprehensive assessment of the SI markers in the IS patients aged from 18 to 45 years confirmed the relationship between inflammation and the severity and poor outcomes of IS in young adults. Early identification of patients with increased risk of severe course and poor outcome will improve the prevention and treatment tactics in the IS patients aged from 18 to 45 years, taking into account the precise correction of vascular risk factors and the use of anti- inflammatory strategies.