Inflammatory response after stroke-A clinical observation study.

BACKGROUND

Body temperature and peripheral blood inflammatory markers are often elevated in acute stroke. Whether the increase in inflammatory markers is caused by the stroke itself or is attributable to a complication, is incompletely understood. This uncertainty may hamper the diagnosis and treatment of infections. We aimed to describe the dynamics of inflammatory parameters in a cohort of stroke patients free from complications.

METHODS

Acute stroke patients were prospectively included within 48 h of symptom onset and monitored through daily questions of symptoms and clinical examinations to detect complications. Inflammatory parameters in blood and body temperature were measured daily for up to ten days and the 97.5th percentile calculated. Values were compared with paired t-test to measurements at a 90-day follow up.

RESULTS

70 stroke patients were included. 51 of them were considered complication-free and sampled for a total of 282 days. Body temperature, CRP and WBC were all significantly elevated the first days after stroke, compared to 90-days post stroke. Mean body temperature was highest at 24-48h at 37.1°C, mean WBC was highest at 0-24h at 8.1 × 10^9/L, compared to 36.7°C and 6.0 × 10^9/L at the 90-day follow-up (p-values < 0.01). Median CRP peaked at 7.0 mg/L 120-144 h after stroke, compared to 0.9 mg/L at follow-up (p-value < 0.01).

CONCLUSIONS

Acute stroke may cause mildly elevated levels of CRP, WBC and body temperature. Except for WBC during the first 24h, higher levels (such as CRP > 50mg/L, WBC > 11 × 10^9/L or body temp > 38°C) are very uncommon (< 2.5%) and are likely to reflect a complication.