Plasma endotoxin activity rises during ischemic stroke and is associated with worse short-term outcome.
BACKGROUND
Activation of Toll-like receptor 4 (TLR4) contributes to brain injury and poor outcome after cerebral ischemia. The expression of this receptor on monocytes is increased in patients with acute ischemic stroke. Endotoxin is an endogenous ligand for TLR4. The aim of our study was to determine if plasma endotoxin activity is increased in stroke patients and correlates with functional outcome.


METHODS
We included 88 patients with ischemic stroke (median age: 71, 56.8% men) and 59 age-matched controls. Plasma endotoxin activity and level of proteins regulating endotoxin interaction with TLR4 (LPS binding protein - LBP and sCD14) were measured in blood samples taken at day 1 (within 24h after stroke symptoms onset), 3 and 6. Short-term functional outcome was assessed at day 14 using modified Rankin Scale. Unfavourable outcome was defined as modified Rankin Scale score>2.


RESULTS
Compared to controls, stroke patients had higher plasma endotoxin activity on day 1 (median: 0.39 vs 0.32EU/mL, P=0.03) as well as higher LBP (median: 18.7 vs 11.5μg/mL, P<0.01) and sCD14 level (median: 1330 vs 1070ng/mL, P<0.01). Plasma LPS activity and levels of LBP and sCD14 significantly rose during stroke. Higher LPS activity measured on day 6 was associated with unfavourable outcome (OR: 3.94, 95%CI: 1.03-15.02, P=0.04, adjusted for age and stroke severity).


CONCLUSIONS
Plasma endotoxin activity rises during ischemic stroke and is associated with worse short-term outcome.
['Klimiec|Elzbieta|E|', 'Pera|Joanna|J|', 'Chrzanowska-Wasko|Joanna|J|', 'Golenia|Aleksandra|A|', 'Slowik|Agnieszka|A|', 'Dziedzic|Tomasz|T|']
D000209:Acute-Phase Proteins D000368:Aged D002545:Brain Ischemia D002352:Carrier Proteins D004731:Endotoxins D005260:Female D006801:Humans D018950:Lipopolysaccharide Receptors D008297:Male D008562:Membrane Glycoproteins D008875:Middle Aged D018709:Statistics, Nonparametric D020521:Stroke D013997:Time Factors
Endotoxin Ischemic stroke Outcome Inflammation