London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 643 565 Acute stroke: emergency management, stroke units and complications Predicting chest infection after stroke- the PREDICT study S. Hoffmann1, H. Harms2, L. Ulm3, D. Nabavi4, B.M. Mackert5, I. Schmehl6, G.J. Jungehülsing7, J. Montaner8, P.U. Heuschmann9, C. Meisel10, A. Meisel11 NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, GERMA-NY1, Department of Neurology, St.-Josefs Krankenhaus Potsdam, Potsdam, GERMANY2, Neuro- Cure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, GERMANY3, Depart-ment of Neurology, Vivantes Klinikum Neukölln, Berlin, GERMANY4, Department of Neurology, Vivantes Auguste Viktoria Klinikum, Berlin, GERMANY5, Department of Neurology, Unfallkran-kenhaus Berlin, Berlin, GERMANY6, Center for Stroke Research Berlin (CSB), Charité – Univer-sitätsmedizin Berlin, Berlin, GERMANY7, Department of Neurology, Hospital Vall d´Hebron Bar-celona, Spain, Barcelona, SPAIN8, Institute for Clinical Epidemiology and Biometry, Universtity of Würzburg, Würzburg, GERMANY9, Department of Immunology, Charité – Universitätsmedizin Berlin, Berlin, GERMANY10, Neuro- Cure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, GERMANY11 Background: Stroke-associated pneumonia (SAP) is a potentially modifiable complication after stroke showing consistent association with poor outcome. Accumulating evidence suggests that stroke is associated with temporary immunodeficiency which might facilitate increased susceptibil-ity for SAP. We investigated the predictive properties of blood based biomarkers on the occurrence of SAP. Methods: The PREDICT study is a prospective, multicentric, international study with 9 participat-ing study sites in Germany and Spain. 486 patients with ischemic stroke of any severity (NIHSS ≥ 1) and any localization (anterior+posterior circulation) were included. Blood samples in-cluding immune (IL10, TNF-a, mHLA-DR) and infection (IL6, IL8, LBP) parameters were obtained on day 1 to day 4 after stroke onset. Screening for SAP was performed up to day 7 using CDC crite-ria. Results: The last patient was included in December 2012. Interim analysis of 258 patients showed the following results: Mean age was 72.5 years, 46.5 % were female, mean NIHSS was 5.2 points. 7% of the patients suffered from SAP. All stroke patients showed signs of immunodepression as indicated by a negative mHLA-DR/LBP ratio. Patients with SAP showed significantly lower mH-LA- DR expression at day 1-4 than patients without SAP. Furthermore, patients with SAP showed significantly higher and increasing IL6 and LBP levels at day 1-4 than non-infected patients. Final analysis of the 486 included patients will be finalized until May 2013 and include a combined analy-sis of the predictive properties of biomarkers and independent clinical risk factors as identified with the A2DS2-score (presented at the ESC 2011). Conclusions: Our study supports the concept of stroke-induced immunodepression as a crucial fac-tor for the development of SAP. Selected biomarkers might facilitate early identification of patients at high-risk for SAP and help to justify intensive monitoring and tailored prophylactic measures in these patients. 566 Acute stroke: emergency management, stroke units and complications FIBRINOGEN DEPLETION AFTER I.V. THROMBOLYSIS B. Censori1, T. Partziguian2, M.R. Rottoli3, V. Bonito4, M. Sgarzi5, R. Riva6, D. Alimonti7, E. Aga-zzi8, M. Rossi9, P. Filisetti10, E. Rottoli11, O. Valoti12, M. Poloni13 Neurology Unit - Ospedale Papa Giovanni XXIII, Bergamo, ITALY1, Neurology Unit - Osped-ale Papa Giovanni XXIII, Bergamo, ITALY2, Neurology Unit - Ospedale Papa Giovanni XXIII, Bergamo, ITALY3, Neurology Unit - Ospedale Papa Giovanni XXIII, Bergamo, ITALY4, Neurology Unit - Ospedale Papa Giovanni XXIII, Bergamo, ITALY5, Neurology Unit - Ospedale Papa Giovan-ni XXIII, Bergamo, ITALY6, Neurology Unit - Ospedale Papa Giovanni XXIII, Bergamo, ITALY7, Neurology Unit - Ospedale Papa Giovanni XXIII, Bergamo, ITALY8, Neurology Unit - Ospedale Papa Giovanni XXIII, Bergamo, ITALY9,Neurology Unit - Ospedale Papa Giovanni XXIII, Berga-mo, ITALY10, Neurology Unit - Ospedale Papa Giovanni XXIII, Bergamo, ITALY11, Neurology Unit - Ospedale Papa Giovanni XXIII, Bergamo, ITALY12, Neurology Unit - Ospedale Papa Giovanni XXIII, Bergamo, ITALY13 Background. Alteplase is marketed as a fibrin-specific drug. However, cardiological trials have shown a degree of systemic lysis with therapeutic dosages. We have evaluated fibrinogen decrease after intra-venous (i-v) thrombolysis for ischemic stroke. Methods. All patients treated with i.v. al-teplase for ischemic stroke from September 2009 were considered. Fibrinogen was assessed 6 to 24 hours after thrombolysis in all patients, and before thrombolysis in a majority of cases. Results. We have studied 113 patients, with a mean age of 68.5 +/- 11.9 years. Mean interval of fibrinogen dosage from lysis was 22.1 +/- 19.5 hours. Overall, 9 patients (8.0%; 95% C.I. 3.7 to 14.6) had a decrease of fibrinogen below 150 mg%, which is the lower limit of normal, and 5 patients had a decrease of fibrinogen below 100 mg% (4.4%; 95% C.I. 1.4 to 10.0). Fifteen of 77 patients with fi-brinogen evaluation before and after thrombolysis had a decrease of at least 50% after lysis (19.5%: 95% C.I. 11.3 to 30.1). There was no association between absolute fibrinogen levels or > 50% de-crease and hemorrhage after thrombolysis. Conclusions. Thrombolysis with alteplase for stroke causes a systemic lytic state, with a frequency similar to that observed in cardiological trials. Fibrin-ogen depletion does not seem to favour brain hemorrhage, but this aspect should be evaluated with larger numbers.
Karger_ESC London_2013
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