The Effect Of Statins Therapy On Functional Outcomes In Patients With Infection After Acute Ischemic Stroke

Background Stroke is one of the leading causes of chronic disability and death in the world,the incidence of which gradually increase along with the increase of age.As the population aging in our country,the incidence of cerebrovascular disease is getting higher and higher and brings heavy burden to patients and families.Due to the complex interaction among the nerve system -body fluid-immune system,and the imbalance of homeostasis after stroke, both of which increase the risk of post-stroke infection especially.Infection is one of the most common complications of stroke, which have major impact on 30-day mortality after stroke. Studies suggest that ischemic brain damage leads to immune suppression,which causes systemic infection,and about one-third of patients develop early infections mostly involving the respiratory and urinary tract. Statins are a kind of hydroxy methyl two acyl Co A reductase inhibitors, mainly including atorvastatin, rosuvastatin, pravastatin, simvastatin, fluvastatin and so on, and the enzyme is the rate limiting enzyme in cholesterol synthetase,through which statins decrease cholesterol synthesis, reduce the level of low density lipoprotein cholesterol, and finally can significantly reduce the incidence and mortality of cardiovascular and cerebrovascular events. Studies have demonstrated that statins is the cornerstone in the treatment of cardiovascular and cerebrovascular diseases.Large scale clinical trials suggested that statins is the only drug that can reverse atherosclerosis,in addition to their lipid-lowering properties,statins have many other pleiotropia fuctions,including potent immunomodulatory effects,which can inhibit the expression of inflammatory cytokines and have inhibitory effects in each stage of inflammatory process. Currengtly the effect of statins on post-stroke infection is unclear,This study discusses the effect of statins therapy on infection after acute ischemic stroke, in order to provide basis for clinical prevention and treatment of effect of statins therapy on infection after acute ischemic stroke.Purpose To investigate the the effect of statins therapy on functional outcomes in patients with infection after acute ischemic stroke. ischemic stroke.Methods All patients met the diagnostic criteria made at the fourth national Cerebrovascular Disease Conference held in 1995,and the head of Computer tomography(CT)and/or Magnetic resonance imaging(MRI)examination confirmed the diagnosis of acute ischemic stroke.Patients with known history of stroke, thrombolytic treatment,ongoing therapy for malignancy, known history of Human Immunodeficiency Virus(HTV),hepatitis B or C, history of brain tumor, anemia (hematocrit less than 35 on admission),and those taking immunosuppressive medications were excluded. According to wether taking statin before the onset of acute ischemic stroke,patients are divided into statin treatment group and non statin treatment group.Statin treatment group enrolled 135 cases, and treatment time was 2 to 153 weeks before the onset of the stroke; while the non statin treatment group enrolled 80 cases and with no statin treatments before the onset of the disease. All the patients were recorded general condition, stroke risk factors, Oxfordshire Community Stroke Project (OCSP) type of stroke, neural function defect scores at admission, infection type, Modified Rankin Scale(mRS)and Barthel Index(BI) at 0 months,0.5 months and 3 months after the onset of disease. Static-analysis was taken by SPSS version 22.0 for windows software. p value< 0.05(2-tailed) was considered statistically significant.Results A total of 215 cases were included in the study period, among which 135 cases were statin treatment group, included 50 cases were infected,80 cases were non statin treatment group, included 30 cases were infecte. Comparison between the statin treatment group and non statin treatment group using independent sample t test screening for differences in the distribution of quantitative indicators and chi-square test for differences in the distribution of qualitative indicators, we observed that only the p value of total anterior circulation infarct (TACI) subgroups in both compared groups is<0.05,which had statistical significance.There were no significant statistic difference in age, gender, histories of hypertension,diabetes,atrial fibrillation,chronic obstructive pulmonary disease (COPD),congestive heart failure,abuses of smoking and alcohol,National Institutes of Health Stroke Scale (NIHSS) at admission,Glasgow Coma Scale (GCS), speech disorders at admisson,number of damaged cerebral lobe,affected cerebral lobe,the incidence of infection after stroke,type of infection,length of stay between two groups.Comparison between the statin treatment infection group and non statin treatment infection group,using independent sample t test screening for differences in the distribution of quantitative indicators and chi-square test for differences in the distribution of qualitative indicators, we observed that there were no significant statistic difference in baseline data between two groups.Using rank sum test for mRS score at 0 months,0.5 months and 3 months after the onset of disease,and multivariate analysis of variance for BI at 0 months,0.5 months and 3 months after the onset of disease,we found that mRS score and BI were significantly different (p< 0.05) at three time points after the onset of the disease.It means that statin therapy before the onset of acute ischemic stroke can improve the prognosis of patients with acute ischemic stroke.Conclusion The results suggest that:1.Statin therapy before the onset of acute ischemic stroke can improve the ability of daily life and social life in patients with infection after acute ischemic stroke,thus improving the functional outcomes of those patients.2.The incidence of pulmonary infection in total anterior circulation infarct subgroup in statin treatment group may be lower than the nonstatin treatment group.