Immuno-inflammatory and thrombotic/fibrinolytic variables associated with acute ischemic stroke diagnosis

Accumulating evidence suggests that inflammation plays an important role in the development of acute cerebrovascular disease. The aim of this study is to evaluate the predictive value of a series of candidate serum immuno-inflammatory and thrombotic/fibrinolitic molecules towards diagnosis of acute ischemic stroke.

We enrolled 120 consecutive patients with a diagnosis of acute ischemic stroke and 123 consecutive hospitalized control patients without a diagnosis of acute ischemic stroke. We evaluated plasma levels of IL-1beta, TNF-beta, IL-6 and IL-10, E-selectin, P-selectin, sICAM-1 and sVCAM-1 as markers of immuno-inflammatory activation, vWF plasma levels as a marker of endothelial dysfunction, TPA antigen and PAI-1 plasma levels as a marker of a prothrombotic state.

TNF-alpha, PAI-1 and TPA on bivariate logistic regression were highly correlated to stroke diagnosis. Among the other variables maintained in the final model ILbeta, Selectin E, were significantly associated with acute ischemic stroke diagnosis, whereas IL-6, VICAM-1, ICAM-1 and neutrophil percentage showed only a slight or no association with stroke diagnosis. Furthermore, only the continuous values of TNF-alpha, PAI-1 and TPA showed a significant predictive value and likelihood ratio, with an area under the ROC curve of 98.6%, 97.1% and 99.9%, respectively.

Our findings could suggest the high diagnostic power of these immuno-inflammatory and thrombotic/fibrinolytic variables in patients with acute ischemic stroke. Although our results are encouraging, additional studies are needed to establish the validity of this approach.