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Dziedzic, Tomasz; Słowik, Agnieszka; Szczudlik, Andrzej

doi:10.1186/cc2828

Cited by 70 publications

(29 citation statements)

References 39 publications

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“…A number of predisposing factors are considered to account for the high incidence of bacterial pneumonia following stroke, including several factors known to facilitate aspiration, such as impaired protective reflexes, dysphagia and mechanical ventilation [4,6,25]. In addition, experimental and clinical evidence suggests that acute central nervous system injury, including stroke, directly impairs antibacterial host defence, thereby increasing susceptibility to infections [26,27,28,29]. In particular, down-regulation of systemic cellular immune responses, i.e.…”

Section: Immune and Stress Markers For The Prediction Of Post-stroke mentioning

confidence: 99%

Predicting Post-Stroke Infections and Outcome with Blood-Based Immune and Stress Markers

Meisel

Meisel²,

Harms³

et al. 2012

Cerebrovasc Dis

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About one third of early deaths and poor outcomes after acute stroke are caused by potentially preventable stroke-associated complications, especially infections. Early identification of patients at high risk of infections and poor prognosis with biomarkers might help to initiate adequate therapies and guide treatment decisions. Acute injury of the central nervous system, including stroke, disturbs the normally well-balanced interplay between the sympathetic nervous system and the immune system, thereby impairing the antibacterial immune response in stroke patients. Changes in immune and stress markers, for example a reduction in HLA-DR expression on monocytes or an increase in serum catecholamine levels, occur very early after stroke onset, explain the high susceptibility of stroke patients to bacterial infections, and are predictive of infectious complications occurring up to 2 weeks after stroke. Outcome prediction is of utmost importance for decision-making in stroke units as well as in neurological intensive care units. However, to date the accuracy of outcome prediction by physicians and clinical scoring systems is only moderate. So far, only two blood-based biomarkers have been identified as independent predictors of outcome and mortality after stroke: the stress marker copeptin and midregional pro-atrial natriuretic peptide. Careful evaluation of prognostic markers is needed to prevent the occurrence of self-fulfilling prophecy.

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Section: Immune and Stress Markers For The Prediction Of Post-stroke mentioning

confidence: 99%

Predicting Post-Stroke Infections and Outcome with Blood-Based Immune and Stress Markers

Meisel

Meisel²,

Harms³

et al. 2012

Cerebrovasc Dis

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“…In a 2001 human study, severe immune suppression was observed following severe TBI. Eighteen to seventy-two hours after head trauma, the numbers of circulating T-cells, T-helper cells, T-suppressor [92,93] and NK cells were reduced while the B-lymphocyte count remained normal [92]. There was also an increase in CD4+/CD45+ T cells [10,93].…”

Section: Introductionmentioning

confidence: 99%

“…Eighteen to seventy-two hours after head trauma, the numbers of circulating T-cells, T-helper cells, T-suppressor [92,93] and NK cells were reduced while the B-lymphocyte count remained normal [92]. There was also an increase in CD4+/CD45+ T cells [10,93]. The immune regulatory functions within the CNS following TBI, for example, microglia and astrocyte activation lead to antigen presentation to T-cells that alters their cytokine response and this may contribute to TBI pathology.…”

Section: Introductionmentioning

confidence: 99%

New perspectives on central and peripheral immune responses to acute traumatic brain injury

Das

Mohapatra

2012

J Neuroinflammation

228

182

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Traumatic injury to the brain (TBI) results in a complex set of responses involving various symptoms and long-term consequences. TBI of any form can cause cognitive, behavioral and immunologic changes in later life, which underscores the problem of underdiagnosis of mild TBI that can cause long-term neurological deficits. TBI disrupts the blood–brain barrier (BBB) leading to infiltration of immune cells into the brain and subsequent inflammation and neurodegeneration. TBI-induced peripheral immune responses can also result in multiorgan damage. Despite worldwide research efforts, the methods of diagnosis, monitoring and treatment for TBI are still relatively ineffective. In this review, we delve into the mechanism of how TBI-induced central and peripheral immune responses affect the disease outcome and discuss recent developments in the continuing effort to combat the consequences of TBI and new ways to enhance repair of the damaged brain.

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“…Although aspiration due to a decreased level of consciousness may explain the development of pneumonia among some patients, research also suggests that catecholamines released as a result of brain injury-induced sympathetic activation may modulate cells of the immune system and induce systemic immunosuppression [15-20]. While this immune suppression may protect the brain from further inflammatory damage, it may also increase susceptibility to infection among those with acquired brain injury [16,17,19]. …”

Section: Introductionmentioning

confidence: 99%

Incidence, prevalence, and occurrence rate of infection among adults hospitalized after traumatic brain injury: study protocol for a systematic review and meta-analysis

et al. 2013

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BackgroundInfection occurs commonly among patients hospitalized after traumatic brain injury (TBI) and has been associated with increased intensive care unit and hospital lengths of stay and an elevated risk of poor neurological outcome and mortality. However, as many relevant published studies to date have varied in the type and severity of TBI among included patients as well as in their design (randomized versus non-randomized), risk of bias, and setting (hospital ward versus intensive care unit), their reported estimates of infection occurrence vary considerably. Thus, the purpose of this systematic review and meta-analysis is to estimate the incidence, prevalence, and occurrence rate of infection among patients hospitalized after TBI.Methods/DesignWe will search electronic bibliographic databases (MEDLINE, EMBASE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews) from their first available date as well as personal files, reference lists of included articles, and conference proceedings. Two investigators will independently screen titles and abstracts and select cohort studies, cross-sectional studies, and randomized controlled trials involving adults hospitalized after TBI that reported estimates of cumulative incidence, incidence rate, prevalence, or occurrence rate of infection for inclusion in the systematic review. These investigators will also independently extract data and assess risk of bias. We will exclude studies with fewer than ten patients; experimental groups allocated to treatment with antibiotics, glucocorticoids, immunosuppressants, barbiturates, or hypothermia; and studies focused on military/combat-related TBI. Pooled estimates of cumulative incidence, incidence rate, prevalence, and occurrence rate will be calculated using random effects models. We will also calculate I2 and Cochran Q statistics to assess for inter-study heterogeneity and conduct stratified analyses and univariate meta-regression to determine the influence of pre-defined study-level covariates on our pooled estimates.DiscussionThis study will compile the world literature regarding the epidemiology of infection among adults hospitalized after TBI. A better understanding of the role of infection will be helpful in the development of guidelines for patient management. This protocol has been registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42013005146).

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Untitled

Cited by 70 publications

References 39 publications

Predicting Post-Stroke Infections and Outcome with Blood-Based Immune and Stress Markers

Predicting Post-Stroke Infections and Outcome with Blood-Based Immune and Stress Markers

New perspectives on central and peripheral immune responses to acute traumatic brain injury

Incidence, prevalence, and occurrence rate of infection among adults hospitalized after traumatic brain injury: study protocol for a systematic review and meta-analysis

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