Markers of infection and inflammation are associated with post-thrombectomy mortality in acute stroke

• Published in: Clinical neurology and neurosurgery Vol. 222; p. 107467
• Main Authors: Irvine, Hannah, Krieger, Penina, Melmed, Kara R., Torres, Jose, Croll, Leah, Zhao, Amanda, Lord, Aaron, Ishida, Koto, Frontera, Jennifer, Lewis, Ariane
• Format: Journal Article
• Language: English
• Published: Assen Elsevier B.V 01.11.2022; Elsevier Limited
• Subjects: Antibiotics; Blood; Coronaviruses; COVID-19; Cytokines; Edema; Fever; Infection; Infections; Inflammation; Ischemia; Leukocytes (neutrophilic); Mortality; Neutrophils; Patients; Pneumonia; Severe acute respiratory syndrome coronavirus 2; Stroke; Tumor necrosis factor-TNF; White blood cell; Infection; Stroke; Antibiotics; Fever; White blood cell; Neutrophils
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2022.107467

We explored the relationship between markers of infection and inflammation and mortality in patients with acute ischemic stroke who underwent thrombectomy. We performed retrospective chart review of stroke patients who underwent thrombectomy at two tertiary academic centers between December 2018 and November 2020. Associations between discharge mortality, WBC count, neutrophil percentage, fever, culture data, and antibiotic treatment were analyzed using the Wilcoxon rank sum test, Student’s t-test, and Fisher’s exact test. Independent predictors of mortality were identified with multivariable analysis. Analyses were repeated excluding COVID-positive patients. Of 248 patients who underwent thrombectomy, 41 (17 %) died prior to discharge. Mortality was associated with admission WBC count (11 [8–14] vs. 9 [7–12], p = 0.0093), admission neutrophil percentage (78 % ± 11 vs. 71 % ± 14, p = 0.0003), peak WBC count (17 [13–22] vs. 12 [9–15], p < 0.0001), fever (71 % vs. 27 %, p < 0.0001), positive culture (44 % vs. 15 %, p < 0.0001), and days treated with antibiotics (3 [1–7] vs. 1 [0–4], p < 0.0001). After controlling for age, admission NIHSS and post-thrombectomy ASPECTS score, mortality was associated with admission WBC count (OR 13, CI 1.32–142, p = 0.027), neutrophil percentage (OR 1.03, CI 1.0–1.07, p = 0.045), peak WBC count (OR 301, CI 24–5008, p < 0.0001), fever (OR 24.2, CI 1.77–332, p < 0.0001), and positive cultures (OR 4.24, CI 1.87–9.62, p = 0.0006). After excluding COVID-positive patients (n = 14), peak WBC count, fever and positive culture remained independent predictors of mortality. Markers of infection and inflammation are associated with discharge mortality after thrombectomy. Further study is warranted to investigate the causal relationship of these markers with clinical outcome. •White blood cell count, neutrophil percentage and fever are associated with mortality after mechanical thrombectomy for ischemic stroke.•Documented infection during hospitalization as measured by positive urine, sputum or blood culture is associated with mortality after thrombectomy.•Markers of infection and inflammation predict mortality after thrombectomy irrespective of COVID-19 status.