Abstract Details

Title Comparison of Outcomes Between the Immunocompetent and Immunocompromised in Acute Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (5:00 PM-6:00 PM)

Poster/Presentation
Number 14-005

Objective We aim to investigate the effect of immunosuppression at the time of acute ischemic stroke (AIS) by comparing outcomes between immunocompromised and immunocompetent AIS patients.

Background Acute ischemic stroke (AIS), a leading cause of morbidity and mortality in the United States, results from hypoperfusion and neuronal cell death mediated by free radicals, excitotoxicity, inflammation, necrosis, apoptosis, and autophagy. Microglia and astrocytes activate, and pro-inflammatory mediators and anti-inflammatory cytokines get released. Animal models have demonstrated poor outcomes in AIS due to the proinflammatory immune system. Immunocompromised patients may have improved outcomes.

Design/Methods Stroke database records from 1/1/16-3/1/22 were analyzed. Slicer Dicer software identified patients 18+ who experienced AIS while on selected immunomodulating agents. An immunocompromised group of 189 patients was compared to a control group of 245 patients. Differences in National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) from admission to discharge provided ΔNIHSS and ΔmRS values. Length of hospital stay, hemorrhagic transformation rate, and death rate were utilized as outcome metrics.

Results Delta NIHSS and mRS values were -0.31 and 0.48 respectively in the immunocompromised, compared to -0.91 and 0.44 respectively in the control group with (p=0.82) and (p=0.51). In cases with initial NIHSS >6, differences were still insignificant; however, there was a trend toward better outcomes: ΔNIHSS and ΔmRS –4 and 1.15 in the immunocompromised vs -1.42 and 1.48 in the control group (p=0.44) and (p=0.33). Length of stay was longer in the immunocompromised (p=0.02).

Conclusions The inflammatory response post-stroke likely contributes to cell death. Our analysis failed to demonstrate a statistically significant difference in outcome between immunocompromised and immunocompetent patients who have AIS. Considering underlying immune dysfunction often involves complications and the immunocompromised had comparable outcomes to the immunocompetent, immunomodulation may be beneficial in post-stroke care. A repeated study with a larger sample size is needed.

Authors/Disclosures
Siara M. Clos, MD (SUNY Upstate Department of Neurology) PRESENTER	Dr. Clos has nothing to disclose.
Sedat Gul, MD	Dr. Gul has nothing to disclose.
Aydan Kahriman, MD	Dr. Kahriman has nothing to disclose.
Michal Kawzowicz, MD	Mr. Kawzowicz has nothing to disclose.
Sara Abdelhafiz, MBBS	Dr. Abdelhafiz has nothing to disclose.
Adeenah Ahmed, MD	Ms. Ahmed has nothing to disclose.
Sanaea Z. Bhagwagar (SUNY Upstate Medical University)	An immediate family member of Miss Bhagwagar has received personal compensation for serving as an employee of three different biotech companies unrelated to the present submission.
Hye Cho, Medical Student	Ms. Cho has nothing to disclose.
Brendan Daly, Medical Student	Mr. Daly has nothing to disclose.
Dan Draytsel	Mr. Draytsel has nothing to disclose.
Romario Gibson, MD	Dr. Gibson has nothing to disclose.
Heidi Hindsley, MD, PA	Ms. Hindsley has nothing to disclose.
Ryan Kimmis, MD (University of Iowa Hospitals and Clinics)	Dr. Kimmis has nothing to disclose.
Makenzie L. Kramer	Ms. Kramer has nothing to disclose.
Justin Lui	Mr. Lui has nothing to disclose.
Hesham Masoud, MD (Department of Neurology)	Dr. Masoud has nothing to disclose.
Corey A. McGraw, MD (Upstate Medical University)	The institution of Dr. McGraw has received research support from Novartis. The institution of Dr. McGraw has received research support from F. Hoffmann - La Roche. The institution of Dr. McGraw has received research support from Genentech. The institution of Dr. McGraw has received research support from Neurona Therapeutics. The institution of Dr. McGraw has received research support from Instituto Grifols, S.A..

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