Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression.
Stroke-induced immunodepression is a well characterized complication of acute ischemic stroke. In experimental studies beta-blocker therapy reversed stroke-induced immunodepression, reduced infection rates and mortality. Recent, heterogeneous studies in stroke patients could not provide evidence of...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2018-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC5919008?pdf=render |
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| author | Ilko L Maier Johannes C Becker Johanna Rosemarie Leyhe Marlena Schnieder Daniel Behme Marios-Nikos Psychogios Jan Liman |
| author_facet | Ilko L Maier Johannes C Becker Johanna Rosemarie Leyhe Marlena Schnieder Daniel Behme Marios-Nikos Psychogios Jan Liman |
| author_sort | Ilko L Maier |
| collection | DOAJ |
| description | Stroke-induced immunodepression is a well characterized complication of acute ischemic stroke. In experimental studies beta-blocker therapy reversed stroke-induced immunodepression, reduced infection rates and mortality. Recent, heterogeneous studies in stroke patients could not provide evidence of a protective effect of beta-blocker therapy. Aim of this study is to investigate the potential preventive effect of beta-blockers in subgroups of patients at high risk for stroke-induced immunodepression.Data from a prospectively derived registry of major stroke patients receiving endovascular therapy between 2011-2017 in a tertiary stroke center (University Medical Center Göttingen. Germany) was used. The effect of beta-blocker therapy on pneumonia, urinary tract infection, sepsis and mortality was assessed using multivariate logistic regression analysis.Three hundred six patients with a mean age of 72 ± 13 years and a median NIHSS of 16 (IQR 10.75-20) were included. 158 patients (51.6%) had pre-stroke- and continued beta-blocker therapy. Beta-blocker therapy did not reduce the incidence of pneumonia (OR 0.78, 95% CI 0.31-1.92, p = 0.584), urinary tract infections (OR 1.51, 0.88-2.60, p = 0.135), sepsis (OR 0.57, 0.18-1.80, p = 0.334) or mortality (OR 0.59, 0.16-2.17, p = 0.429). Strokes involving the insula and anterio-medial cortex increased the risk for pneumonia (OR 4.55, 2.41-8.56, p<0.001) and sepsis (OR 4.13, 1.81-9.43, p = 0.001), while right hemispheric strokes increased the risk for pneumonia (OR 1.60, 0.92-2.77, p = 0.096). There was a non-significantly increased risk for urinary tract infections in patients with beta-blocker therapy and insula/anterio-medial cortex strokes (OR 3.12, 95% CI 0.88-11.05, p = 0.077) with no effect of beta-blocker therapy on pneumonia, sepsis or mortality in both subgroups.In major ischemic stroke patients, beta-blocker therapy did not lower post-stroke infection rates and was associated with urinary tract infections in a subgroup with insula/anterio-medial strokes. |
| first_indexed | 2024-12-10T09:43:32Z |
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| id | doaj.art-e1a4935ad8014153930708e561158c93 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-10T09:43:32Z |
| publishDate | 2018-01-01 |
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| spelling | doaj.art-e1a4935ad8014153930708e561158c932022-12-22T01:53:55ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-01134e019617410.1371/journal.pone.0196174Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression.Ilko L MaierJohannes C BeckerJohanna Rosemarie LeyheMarlena SchniederDaniel BehmeMarios-Nikos PsychogiosJan LimanStroke-induced immunodepression is a well characterized complication of acute ischemic stroke. In experimental studies beta-blocker therapy reversed stroke-induced immunodepression, reduced infection rates and mortality. Recent, heterogeneous studies in stroke patients could not provide evidence of a protective effect of beta-blocker therapy. Aim of this study is to investigate the potential preventive effect of beta-blockers in subgroups of patients at high risk for stroke-induced immunodepression.Data from a prospectively derived registry of major stroke patients receiving endovascular therapy between 2011-2017 in a tertiary stroke center (University Medical Center Göttingen. Germany) was used. The effect of beta-blocker therapy on pneumonia, urinary tract infection, sepsis and mortality was assessed using multivariate logistic regression analysis.Three hundred six patients with a mean age of 72 ± 13 years and a median NIHSS of 16 (IQR 10.75-20) were included. 158 patients (51.6%) had pre-stroke- and continued beta-blocker therapy. Beta-blocker therapy did not reduce the incidence of pneumonia (OR 0.78, 95% CI 0.31-1.92, p = 0.584), urinary tract infections (OR 1.51, 0.88-2.60, p = 0.135), sepsis (OR 0.57, 0.18-1.80, p = 0.334) or mortality (OR 0.59, 0.16-2.17, p = 0.429). Strokes involving the insula and anterio-medial cortex increased the risk for pneumonia (OR 4.55, 2.41-8.56, p<0.001) and sepsis (OR 4.13, 1.81-9.43, p = 0.001), while right hemispheric strokes increased the risk for pneumonia (OR 1.60, 0.92-2.77, p = 0.096). There was a non-significantly increased risk for urinary tract infections in patients with beta-blocker therapy and insula/anterio-medial cortex strokes (OR 3.12, 95% CI 0.88-11.05, p = 0.077) with no effect of beta-blocker therapy on pneumonia, sepsis or mortality in both subgroups.In major ischemic stroke patients, beta-blocker therapy did not lower post-stroke infection rates and was associated with urinary tract infections in a subgroup with insula/anterio-medial strokes.http://europepmc.org/articles/PMC5919008?pdf=render |
| spellingShingle | Ilko L Maier Johannes C Becker Johanna Rosemarie Leyhe Marlena Schnieder Daniel Behme Marios-Nikos Psychogios Jan Liman Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression. PLoS ONE |
| title | Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression. |
| title_full | Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression. |
| title_fullStr | Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression. |
| title_full_unstemmed | Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression. |
| title_short | Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression. |
| title_sort | influence of beta blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression |
| url | http://europepmc.org/articles/PMC5919008?pdf=render |
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