Systemic biomarker associated with poor outcome after futile reperfusion

Hervella P, Sampedro-Viana A et al.  Eur J Clin Invest. 2024 Feb 15:e14181. doi: 10.1111/eci.14181. Online ahead of print. PMID: 38361320

Background: Successful recanalization does not lead to complete tissue reperfusion in a considerable percentage of ischemic stroke patients. This study aimed to identify biomarkers associated with futile recanalization. Leukoaraiosis predicts poor outcomes of this phenomenon. Soluble tumour necrosis factor-like weak inducer of apoptosis (sTWEAK), which is associated with leukoaraiosis degrees, could be a potential biomarker.
Methods: This study includes two cohorts of ischemic stroke patients in a multicentre retrospective observational study. Effective reperfusion, defined as a reduction of ≥8 points in the National Institutes of Health Stroke Scale (NIHSS) within the first 24 h, was used as a clinical marker of effective reperfusion.

Funding; Spanish Ministry of Science and Innovation (SAF2017- 84267-R), PDC2021-121455-I00, Xunta de Galicia (Axencia Galega de Innovación: IN607A2022–03), Instituto de
Salud Carlos III (ISCIII) (PI17/00540, PI17/01103), ISCIII/PI21/01256/Co-financed by the European Union, Spanish Research Network on Cerebrovascular Diseases RETICS-INVICTUS PLUS (RD16/0019/0001 and RD16/0019/0003), RICORS-ICTUS (Cerebrovascular diseases) RD21/0006/0003 and RD21/0006/0011. DTS/00103 (Desarrollo Tecnológico en Salud del ISCIII) M. BazarraBarreiros is a PFIS Researcher (FI22/00200) of Instituto de Salud Carlos III. T. Sobrino (CPII17/00027), F. Campos (CPII19/00020) and R. Iglesias-Rey (CP22/00061) from the Miguel Servet Program of Instituto de Salud Carlos III. Sponsors did not participate in the study design, collection, analysis, or interpretation of the data, or in writing the report.

Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapy

Rabaneda-Lombarte N, Faura J, Ezcurra-Díaz G et al. Front Neurol. 2024 Feb 28;15:1358628. doi: 10.3389/fneur.2024.1358628. eCollection 2024. PMID: 38497035


Objective: The modified Centers for Disease Control and Prevention (mCDC) criteria have been proposed for diagnosing and managing stroke-associated pneumonia (SAP). The objective was to investigate the impact of SAP on stroke outcome depending on whether or not it conforms to mCDC criteria. Our secondary objective was to identify the responsible factors for antibiotic initiation in stroke patients.
Methods: We conducted a prospective, multicenter, observational study of ischemic stroke patients with moderate to severe stroke (NIHSS≥4) admitted within 24  h. For 7 days, mCDC criteria were assessed daily, and infections and antibiotics were recorded. Pneumonias were divided into those fulfilling mCDC criteria (mCDC-SAP) or not (other pneumonias, OPn). The effect of each type of pneumonia on 3-month outcome was evaluated in separated logistic regression models. Factors associated with antibiotic initiation were explored using a random forest analysis.
Results: Of the 342 patients studied, infections were diagnosed in 72 (21.6%), including 39 (11.7%) cases of pneumonia. Of them, 25 (7.5%) fulfilled mCDC criteria. Antibiotics were used in 92% of mCDC-SAP and 64.3% of OPn. In logistic regression analysis, mCDC-SAP, but not OPn, was an independent predictor of poor outcome [OR, 4.939 (1.022–23.868)]. The random forest analysis revealed that fever had the highest importance for antibiotic initiation. Interpretation: The mCDC criteria might be useful for detecting clinically
relevant SAP, which is associated with poor outcomes. Isolated signs of infection were more important for antibiotic initiation than compliance with pre-defined criteria. Therefore, adherence to mCDC criteria might result in antibiotic saving without compromising clinical outcome.

Funding: The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Study supported by Fundació La Marató de TV3 (201706-30-31), Instituto de Salud Carlos III (PI17/02130 and PI21/00949), co-financed by the Fondo Europeo de Desarrollo Regional. Some centres take part in Spanish Stroke Research Network RICORS-ICTUS (RD21/0006/0024, RD21/0006/0007 and RD21/0006/0015)