Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression
2018 | journal article. A publication with affiliation to the University of Göttingen.
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Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression
Maier, I. L.; Becker, J. C.; Leyhe, J. R.; Schnieder, M.; Behme, D.; Psychogios, M.-N. & Liman, J. (2018)
PLoS One, 13(4) art. e0196174. DOI: https://doi.org/10.1371/journal.pone.0196174
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Details
- Authors
- Maier, Ilko L.; Becker, Johannes C.; Leyhe, Johanna Rosemarie; Schnieder, Marlena; Behme, Daniel; Psychogios, Marios-Nikos; Liman, Jan
- Abstract
- BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
- Issue Date
- 2018
- Journal
- PLoS One
- Organization
- Klinik für Neurologie ; Institut für Diagnostische und Interventionelle Neuroradiologie
- ISSN
- 1932-6203
- Language
- English