Elevated soluble intercellular adhesion molecule-1 levels are associated with poor short-term prognosis in middle-aged patients with acute ischaemic stroke

Background: There is increasing evidence that cellular adhesion molecules (CAMs) play an important role in the pathophysiology of acute ischaemic stroke. We examined the prognostic value of soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) on in-hospital mortality in patients with ischaemic stroke. Methods: We recruited 241 consecutive patients <= 65 years of age who were admitted with acute ischaemic stroke. Serum levels of sICAM-1 and sVCAM-1 were determined within 12 h from admission. Seventy-six subjects without evidence of cardiovascular disease, matched for age and sex, served as controls. Results: Patients with acute ischaemic stroke had higher sICAM levels compared to controls [ 267 (220-325) versus 200 (179-225) ng/ml, pb0.001]. Sixteen (6.6%) patients died during hospitalization. sICAM-1 and sVCAM-1 levels were significantly higher in patients who died compared to those who survived [ 370 (324-453) versus 260 (219-313) ng/ml, pb0.001 and 790 (495-985) versus 576 (494-671) ng/ml, p=0.01, respectively] but only sICAM-1 levels were independently associated with early death, after adjusting for various confounding factors. For 10 ng/ml increase in sICAM-1 levels there was a 9% higher risk of dying. Cut-off point analysis revealed that sICAM-1 levels >322 ng/ml were the optimal points that discriminated those who died from the rest of the patients. Conclusions: High sICAM-1 levels on admission are associated with early death in ischaemic middle-aged stroke patients suggesting a pathogenetic role of inflammation in the evolution of ischaemic stroke. (C) 2007 Elsevier Ireland Ltd. All rights reserved

Inflammatory markers and in-hospital mortality in acute ischaemic stroke

Background: There is substantial evidence that cerebral ischaemia triggers an inflammatory response. We examined the short-term prognostic value on mortality of C-reactive protein (CRP), interleukin-6 (IL-6) and serum amyloid A (SAA) in patients with ischaemic stroke. Methods: We recruited 203 consecutive patients, under the age of 66 years (mean age = 54.2 +/- 8.1 years, men = 132) who admitted to the Neurology Department with the diagnosis of non-haemorrhagic stroke. Patients in atrial fibrillation or with evidence of inflammatory or malignant disease were excluded. The diagnosis was confirmed with a computed tomography or magnetic resonance imaging of the brain within 24 h of admission. CRP, IL-6 and SAA levels were determined within 12 h from admission. Results: Fourteen (6.9%) patients died during hospitalization. Serum concentrations of CRP, IL-6 and SAA were significantly higher inpatients who died compared with those who survived and were independently associated with early death, after adjusting for various confounding factors. For one unit increase in IL-6, CRP and SAA there was an 18%, 14% and 9% higher risk of dying during hospitalization, respectively. Comparisons of the areas under the ROC curve showed that IL-6 had the best predictive ability. Age-adjusted cut-off point analysis showed that IL-6 levels > 13 pg/ml were the optimal point that discriminated those who died from the rest of the patients (sensitivity = 85% and specificity = 93%). Conclusions: We demonstrated that in-hospital mortality in ischaemic stroke is associated with an exacerbation of inflammatory response as it is reflected by the higher serum levels of IL-6, CRP and SAA. From the inflammatory markers high IL-6 levels had the strongest independent predictive value for in-hospital mortality. (c) 2005 Elsevier Ireland Ltd. All rights reserved

Demographic and clinical attendance characteristics of the studied population (n = 204).

<p>^aDuration since diagnosis of CIS or clinically definite MS until study enrollment.</p><p>^bIKA: Social Insurance Institute, OPAD: Insurance institute for employees of the public sector, ΟAEE: Insurance institute for freelancers. One patient had both “other public insurance” and “private insurance”.</p><p>Demographic and clinical attendance characteristics of the studied population (n = 204).</p

Health care service use related to visits to neurologists, other doctors and health professionals.

<p>Health care service use related to visits to neurologists, other doctors and health professionals.</p

Patient evaluation of the received information and help/support on multiple sclerosis.

<p>^aAny patient with missing values was excluded from analysis due to lack of information retrieval by the corresponding source.</p><p>^bAbsence of answer in the relevant field of the CRF was considered as no participation in patient union. In total, 86.27% of the study population reported participation in MS unions.</p><p>^cAbsence of answer in the relevant field of the CRF was considered as no participation in patient support program. In total, 74.02% of the study population reported participation in support programs.</p><p>Patient evaluation of the received information and help/support on multiple sclerosis.</p

Patients' medical attendance, hospitalization and laboratory requirements of the studied population (n = 204).

<p>^aNumber of patients' admissions to hospitals to counteract relapses within the last year. In this category, the visits to one-day clinics are not included.</p><p>^bThis information was missing in 7 patients.</p><p>^cThis information was missing in 2 patients.</p><p>Patients' medical attendance, hospitalization and laboratory requirements of the studied population (n = 204).</p

Observational Study Assessing Demographic, Economic and Clinical Factors Associated with Access and Utilization of Health Care Services of Patients with Multiple Sclerosis under Treatment with Interferon Beta-1b (EXTAVIA)

Multiple sclerosis (MS) results in an extensive use of the health care system, even within the first years of diagnosis. The effectiveness and accessibility of the health care system may affect patients' quality of life. The aim of the present study was to evaluate the health care resource use of MS patients under interferon beta-1b (EXTAVIA) treatment in Greece, the demographic or clinical factors that may affect this use and also patient satisfaction with the health care system. Structured interviews were conducted for data collection. In total, 204 patients (74.02% females, mean age (SD) 43.58 (11.42) years) were enrolled in the study. Analysis of the reported data revealed that during the previous year patients made extensive use of health services in particular neurologists (71.08% visited neurologists in public hospitals, 66.67% in private offices and 48.53% in insurance institutes) and physiotherapists. However, the majority of the patients (52.45%) chose as their treating doctor private practice neurologists, which may reflect accessibility barriers or low quality health services in the public health system. Patients seemed to be generally satisfied with the received health care, support and information on MS (84.81% were satisfied from the information provided to them). Patients' health status (as denoted by disease duration, disability status and hospitalization needs) and insurance institute were found to influence their visits to neurologists. Good adherence (up to 70.1%) to the study medication was reported. Patients' feedback on currently provided health services could direct these services towards the patients' expectations