Dataset Information

Beyond the Brain: The Systemic Pathophysiological Response to Acute Ischemic Stroke.

ABSTRACT: Stroke research has traditionally focused on the cerebral processes following ischemic brain injury, where oxygen and glucose deprivation incite prolonged activation of excitatory neurotransmitter receptors, intracellular calcium accumulation, inflammation, reactive oxygen species proliferation, and ultimately neuronal death. A recent growing body of evidence, however, points to far-reaching pathophysiological consequences of acute ischemic stroke. Shortly after stroke onset, peripheral immunodepression in conjunction with hyperstimulation of autonomic and neuroendocrine pathways and motor pathway impairment result in dysfunction of the respiratory, urinary, cardiovascular, gastrointestinal, musculoskeletal, and endocrine systems. These end organ abnormalities play a major role in the morbidity and mortality of acute ischemic stroke. Using a pathophysiology-based approach, this current review discusses the pathophysiological mechanisms following ischemic brain insult that result in end organ dysfunction. By characterizing stroke as a systemic disease, future research must consider bidirectional interactions between the brain and peripheral organs to inform treatment paradigms and develop effective, comprehensive therapeutics for acute ischemic stroke.

SUBMITTER: Balch MHH

PROVIDER: S-EPMC7341014 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Beyond the Brain: The Systemic Pathophysiological Response to Acute Ischemic Stroke.

Balch Maria H H MHH Nimjee Shahid M SM Rink Cameron C Hannawi Yousef Y

Journal of stroke 20200531 2

Stroke research has traditionally focused on the cerebral processes following ischemic brain injury, where oxygen and glucose deprivation incite prolonged activation of excitatory neurotransmitter receptors, intracellular calcium accumulation, inflammation, reactive oxygen species proliferation, and ultimately neuronal death. A recent growing body of evidence, however, points to far-reaching pathophysiological consequences of acute ischemic stroke. Shortly after stroke onset, peripheral immunode ...[more]

PMID: 32635682

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Project description:BackgroundAcute ischemic stroke (AIS), the most common type of stroke, is a major cause of morbidity and mortality worldwide. A growing number of studies have demonstrated that inflammation is a critical mechanism in AIS. Being an easily available and effective inflammatory marker, the systemic inflammation response index (SIRI) shows a high association with mortality in patients with cancer and intracerebral hemorrhage. In this study, we evaluated the potential prognostic role of SIRI in critically ill patients with AIS.MethodsClinic data were extracted from the Medical Information Mart data for the Intensive Care IV (MIMIC-IV) database. The optimal cutoff value of SIRI was determined by X-tile software. The primary outcome was the 90-day all-cause mortality, and the secondary outcomes were 30-day and 1-year all-cause mortality of patients with AIS. Cox proportional hazards regression analyses were used to assess the association between SIRI levels and all-cause mortality, and survival curves were estimated using the Kaplan-Meier method. Furthermore, a 1:1 propensity score matching (PSM) method was performed to balance the influence of potential confounding factors.ResultsA total of 2,043 patients were included in our study. X-tile software indicated that the optimal cutoff value of the SIRI for 90-day mortality was 4.57. After PSM, 444 pairs of score-matched patients were generated. Cox proportional hazard model showed that after adjusting for possible confounders, high SIRI level (≥4.57) was independently associated with the 90-day all-cause mortality in the cohort before PSM (HR = 1.56, 95% CI: 1.30-1.89, p < 0.001) and the PSM subset (HR = 1.47, 95% CI: 1.16-1.86, p = 0.001). The survival curves showed that patients with SIRI ≥4.57 had a significantly lower 90-day survival rate in the cohort before PSM (56.7 vs. 77.3%, p < 0.001) and the PSM subset (61.0 vs. 71.8%, p = 0.001). Consistently, AIS patients with high SIRI levels (≥4.57) presented a significantly high risk of 30-day and 1-year all-cause mortality before and after PSM.ConclusionA higher SIRI (≥4.57) was associated with a higher risk of 90-day, 30-day, and 1-year mortality and was an independent risk factor of mortality in patients with acute ischemic stroke.

Dataset Information

Beyond the Brain: The Systemic Pathophysiological Response to Acute Ischemic Stroke.

Publications

Beyond the Brain: The Systemic Pathophysiological Response to Acute Ischemic Stroke.

Similar Datasets

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