High blood pressure and inflammation are associated with poor prognosis in lacunar infarctions

Lacunar infarction has long been considered to be associated with good prognosis, however a significant percentage of these patients remain functionally dependent. In this study we sought to investigate the factors associated with poor outcome in patients with lacunar infarction. Subjects and Methods: We have performed a secondary study in 113 patients with lacunar infarctions admitted within the first 24 h of symptom onset ( mean age 70 years, 57.5% men). Blood pressure, body temperature, serum glucose levels, neurotransmitters and pro-inflammatory markers were measured at admission and during the first 72 h. Stroke severity was assessed by the Canadian Stroke Scale ( CSS). Neuroimaging evaluation was performed at admission and between days 4 and 7. Poor functional outcome was considered as a Barthel index < 85 at 3 months. Results: 36 patients ( 31.9%) had poor outcome. Older age ( p = 0.009), history of hypertension ( p = 0.005), higher body temperature ( p < 0.0001), systolic blood pressure ( SBP) ( p = 0.010), serum glucose ( p = 0.002) and interleukin- 6 ( IL- 6) ( p < 0.0001) levels, as well as lower CSS score at admission ( p < 0.0001) were all predictive factors of poor outcome in bivariate analyses. SBP at admission ( OR 2.07, CI 95% 1.04 - 3.28, p = 0.015) was the only clinical predictor on multivariate analysis. When the logistic model was further adjusted for biomarkers of inflammation and excitotoxicity, IL- 6 levels ( OR 1.09, CI 95% 1.01-1.26, p = 0.003), but not SBP, was independently associated with poor outcome. This association persisted even after adjusting for potential predictors recorded during the first 72 h of hospitalization. Conclusion: High SBP and IL- 6 levels on admission may predict poor outcome in patients with lacunar infarction. Copyright (c) 2006 S. Karger AG, Basel