Proinflammatory reactants as determinants of stroke severity in elderly

Investigations aimed at studying of peripheral blood levels of free nitric oxide (NO) and proinflammatory cytokines IL-1beta, IL- 6 and TNF-alpha in correlation with initial ischemic lesion size and neurological dynamics during a month of acute brain ischemia. Forty two patients aged 60-75 (26 male) have been investigated. Initial neurological status, later deterioration and functional outcome were evaluated using Glasgow Coma Scale (GCS), National institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI). Patients were divided into two groups: severe stroke (GCS15, BI<16, n=25) and a moderate/mild stroke (GCS>10, NIHSSor=18, n=17). The NO concentration was detected by spectrophotometric and Electron Paramagnetic Resonance (EPR) methods. Cytokine plasma levels were determined applying the Enzyme-Linked Immuno Sorbent Assay (ELISA). Statistical evaluation was performed by SPSS. Mean values calculated using the t-paired test. Pearson correlation ad multivariate logistic regression have been applied. In the first days of stroke onset the plasma levels of IL-1beta and TNF-alpha revealed the slight negative correlation toward the functional outcome, while the elderly patients found to have the significant negative correlation of IL-6 plasma levels toward the functional outcome (p<0.01). The NO plasma concentration within 48 hours after stroke onset more profoundly was reduced in aged patients, while in less severe cases and in relatively young patients it was significantly elevated (p<0.01). The high plasma level of IL-6 in the acute phase of stroke seems to be the strong predictor of poor outcome rather for aged, than for younger patients.