Abstract Details

Title Prognostication of Outcomes in Stroke Patients Using Inflammatory Biomarkers: Findings from the Yale Post-stroke Epilepsy Research Group

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 5-010

Background

PSS are complications of intracerebral hemorrhage (ICH) linked to adverse outcomes. Animal data suggest that post-stroke inflammation contributes to epileptogenesis.

Objective

To characterize the predictive value of inflammatory plasma biomarkers in post-stroke seizures (PSS) risk and functional outcomes in PSS risk patients at 1-year follow-up.

Design/Methods

We reviewed 2015-2021 Yale New Haven Hospital ICH patients' records to collate data. A cytometric bead array determined plasma biomarker levels. We defined PSS risk as clinical seizures or EEG-recorded epileptiform discharges post-stroke and poor outcomes as Rankin scale score 3-6. We used logistic regression to analyze the association between inflammatory biomarkers, clinical variables, PSS risk, and the association of inflammatory biomarkers with poor outcomes at 1-year follow-up. We report Odds Ratio (OR) and 95% Confidence Interval (CI) for our analyses.

Results

We included 178 ICH patients, 66 with PSS risk (49% males, age 68 (48-88)) and 112 without (60% males, age 68 (59.5-76.5)), without differences in NIHSS (p=0.2). Hypertension, diabetes, antiplatelet use, deep ICH, and C-C motif chemokine ligand-2 (CCL2) were associated with decreased PSS risk. In contrast, prior TIA, lobar ICH, and ICH volume were associated with increased PSS risk in univariable analyses. Diabetes was a protective factor (OR 0.4; CI: 0.1–0.9), whereas lobar ICH (OR 6.8; CI: 3.4–13.4) was significantly associated with PSS risk in multivariable analyses. Older age, female sex, obesity, hypertension, higher ICH score and ICH volume, higher NIHSS, antihypertensive medications, and lower hemoglobin and CCL2 levels were associated with poor outcomes in univariable analyses. Lower CCL2 levels (OR 0.99; CI 0.97-0.99) were significantly associated with poor outcomes in multivariable analyses.

Conclusions

In our retrospective analyses, lower CCL2 levels predicted poor outcomes at 1-year post-stroke. No inflammatory biomarker was associated with PSS risk in this cohort. Prospective studies investigating the temporal profile of inflammatory biomarkers with PSS risk are needed.

Authors/Disclosures
Ethan Y. Wang (Yale School of Medicine) PRESENTER	Mr. Wang has nothing to disclose.
Shubham Misra, PhD (Yale University)	Dr. Misra has nothing to disclose.
Jennifer Yan	No disclosure on file
Pei Yi Chook	No disclosure on file
Yuki Kawamura	Mr. Kawamura has nothing to disclose.
Rachel Kitagawa (Yale School of Medicine)	No disclosure on file
Jennifer A. Kim, MD (Yale University School of Medicine)	Dr. Kim has nothing to disclose.
Emily J. Gilmore, MD (Yale University School of Medicine)	Dr. Gilmore has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for carpl.ai. Dr. Gilmore has received personal compensation in the range of $0-$499 for serving as a Consultant for AAN. Dr. Gilmore has received research support from NIH.
Adam De Havenon, MD, FAAN (Yale University)	Dr. De Havenon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novo Nordisk. Dr. De Havenon has stock in Certus. Dr. De Havenon has stock in TitinKM. The institution of Dr. De Havenon has received research support from NIH/NINDS. Dr. De Havenon has received publishing royalties from a publication relating to health care.
Adithya Sivaraju, MD (Yale New Haven Medical Center)	Dr. Sivaraju has nothing to disclose.
Lawrence J. Hirsch, MD, FAAN (Yale University Comprehensive Epilepsy Center)	Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Hirsch has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for marinus. The institution of Dr. Hirsch has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for UCB. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Accure. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Natus. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurelis. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Rafa Laboratories, Ltd. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Rapport Therapeutics. Dr. Hirsch has received publishing royalties from a publication relating to health care. Dr. Hirsch has received publishing royalties from a publication relating to health care. Dr. Hirsch has received personal compensation in the range of $5,000-$9,999 for serving as a Speaker with Neuropace. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Natus. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a speaker with UCB.
Guido J. Falcone, MD (Yale School of Medicine)	The institution of Dr. Falcone has received research support from NIH. The institution of Dr. Falcone has received research support from AHA.
Lauren H. Sansing, MD	Dr. Sansing has nothing to disclose.
Jessica Magid-Bernstein, MD, PhD (Yale School of Medicine)	Dr. Magid-Bernstein has nothing to disclose.
Nishant K. Mishra, MD, MBBS, PhD, FESO (Yale University)	Dr. Mishra has nothing to disclose.