Pre-Stroke Use of Beta-Blockers Does Not Lower Post-Stroke Infection Rate: An Exploratory Analysis of the Preventive Antibiotics in Stroke Study

Westendorp, Willeke F.; Vermeij, Jan-Dirk; Brouwer, Matthijs C.; Roos, Yvo B.W.E.M.; Nederkoorn, Paul J.; Beek, Diederik van de

doi:10.1159/000450926

Cited by 33 publications

(41 citation statements)

References 15 publications

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“…Sellars and colleagues [12] found that NIHSS score more than 6 is predictive of post-stroke pneumonia. Also, these findings were consistent with the study carried out by Westendrop and colleagues [13].…”

Section: Discussionsupporting

confidence: 93%

Detection of airway protective level of the cough reflex in acute stroke patients

Belal

Selim

fotouh

et al. 2020

Egypt J Neurol Psychiatry Neurosurg

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Background: The most common respiratory complications in cerebrovascular strokes were respiratory infection, pulmonary edema, acute lung injury (ALI) acute respiratory distress syndrome (ARDS) and pulmonary embolism (PE). The inhalation cough challenge facilitates the quantification of cough. Objectives: To detect the level of cough reflex that is enough to protect against respiratory infection in stroke patients, and to identify predictors of post-stroke respiratory infection. Patients and methods: One hundred and one of cerebrovascular stroke patients were assessed in the first week of symptoms by National Institutes of Health Stroke Scale (NIHSS) Arabic version, Mann Assessment of Swallowing Ability (MASA), cough challenge test, cough flow meter, and A2DS2 score. Then, follow up after 1 week. Results: Post-stroke respiratory infection was higher in older patients and those who were not working. Respiratory infection was significantly associated with high A2DS2 and NIHSS score (p value < 0.001). A highly significant increase in the levels of the inflammatory markers was detected in patients with a respiratory infection. Eighty percent of stroke patients with no cough developed a respiratory infection. The Mann total scores and the peak cough flow were lower in patients who had a respiratory infection. Conclusion: Preserved cough reflex is essential in preventing aspirations and consequent respiratory infections.

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Section: Discussionsupporting

confidence: 93%

Detection of airway protective level of the cough reflex in acute stroke patients

Belal

Selim

fotouh

et al. 2020

Egypt J Neurol Psychiatry Neurosurg

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“…7 Similarly, in another study, pre-stroke treatment with BB in ischemic stroke or ICH was not independently associated with mortality at 3-month, however it was associated with increased infection and pneumonia rates. 13 In a very large study using data from a national registry, pre-stroke treatment with BB had no effect on 1-month mortality after ischemic stroke or ICH. 12 Dziedzic and colleagues have shown that pre-and on-stroke treatment with BB was associated with a decrease in 1-month mortality after ischemic stroke and driven by a reduction in cardiovascular death.…”

Section: Discussionmentioning

confidence: 98%

“…Westendorp and colleagues included in their analysis both ischemic stroke and ICH patients and again, after adjustment for various baseline characteristics, no effect on 3-month unfavorable functional outcome (including death) was found. 13 Considering the evidence on post-stroke infection and BB, 23 we also identified patients in whom BB were prescribed on-stroke. In studies of ICH 6 and ischemic stroke, 7 on-stroke BB treatment showed a reduction in 1-month mortality and 3-month mortality, respectively, along with a reduction in pneumonia rate.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that pre-and on-stroke use of BB was associated with less severe stroke 4 and reduced mortality, 5-7 but results have been inconsistent. [8][9][10][11][12][13] In 2006, the National Institute for Health and Care Excellence (NICE) removed BBs from its first-line antihypertensive regimens 14 and the Eighth Joint National Committee (JNC 8) reaffirmed this approach in 2014. 15 Still, many patients are prescribed BB as an antihypertensive medication, either as monotherapy, as part of a multi drug combination, or for concomitant indications.…”

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confidence: 99%

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Pre admission treatment with Beta‐blockers in hypertensive patients with acute stroke and 3‐month outcome—Data from a national stroke registry

Eizenberg

Grossman

Tanné

et al. 2018

J of Clinical Hypertension

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Cerebrovascular disease is a leading cause of morbidity and mortality worldwide, 1 with hypertension being its most important modifiable risk factor. Landmark studies have shown that lowering blood pressure decreased rates of stroke incidence and mortality. 2 However, not all anti-hypertensive agents were found to be equally effective in preventing stroke. Comparative studies and meta-analyses have demonstrated that beta-blockers (BB) provide less protection against stroke compared with other anti-hypertensive agents. 3 On the other hand, stroke is associated with dysregulation of the autonomous nervous system with subsequent derangements of the cardiovascular, endocrine, and immune systems. Several studies have shown that pre-and on-stroke use of BB was associated with less severe stroke 4 and reduced mortality, 5-7 but results have been inconsistent. [8][9][10][11][12][13] In 2006 published data on the effect of pre-stroke treatment with BB on ischemic stroke severity, disability or death at discharge, and 1 month mortality. 16 The present study is aimed at exploring the effect of prestroke treatment with BB on ischemic stroke and intracerebral hemorrhage (ICH) outcomes 3 months after stroke. | METHODS | Study setting and participantsThe National Acute Stroke Israeli Survey (NASIS) registry is an ongo- The impact of beta-blockers (BB) treatment on stroke outcome is unclear. We used data from a prospective national stroke registry to assess the associations between use of BB and poor outcome 3 months after stroke. Using the National Acute StrokeIsraeli (NASIS) registry, we identified 1126 patients with ischemic stroke and intracerebral hemorrhage with pre-stroke hypertension treatment, who were followed for 3-months. Functional outcome and mortality at 3-month were compared by use of BB, adjusting for demographics and clinical factors. Pre-stroke use of BB was reported by 615 (54.6%) patients. Users of BB showed higher rates of atrial fibrillation, heart disease, statin use, cancer, and severe stroke. Adjusted odds-ratios (ORs, 95% CI) for BB users compared with non-users 3 months after stroke were 0.86 (0.49-1.52) for mortality and 1.07 (0.76-1.50) for Barthel Index ≤60. In conclusion, treatment with BB is not associated with 3-month poor outcome in hypertensive patients.

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“…Previous studies involving humans, however, were inconclusive. Some described a protective effect of beta-blockers regarding infection rates [ 13 – 15 ], others showed a negative effect of beta-blockers with higher rates of adverse events [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression

et al. 2018

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BackgroundStroke-induced immunodepression is a well characterized complication of acute ischemic stroke. In experimental studies beta-blocker therapy reversed stroke-induced immunodepression, reduced infection rates and mortality. Recent, heterogeneous studies in stroke patients could not provide evidence of a protective effect of beta-blocker therapy. Aim of this study is to investigate the potential preventive effect of beta-blockers in subgroups of patients at high risk for stroke-induced immunodepression.MethodsData from a prospectively derived registry of major stroke patients receiving endovascular therapy between 2011–2017 in a tertiary stroke center (University Medical Center Göttingen. Germany) was used. The effect of beta-blocker therapy on pneumonia, urinary tract infection, sepsis and mortality was assessed using multivariate logistic regression analysis.ResultsThree hundred six patients with a mean age of 72 ± 13 years and a median NIHSS of 16 (IQR 10.75–20) were included. 158 patients (51.6%) had pre-stroke- and continued beta-blocker therapy. Beta-blocker therapy did not reduce the incidence of pneumonia (OR 0.78, 95% CI 0.31–1.92, p = 0.584), urinary tract infections (OR 1.51, 0.88–2.60, p = 0.135), sepsis (OR 0.57, 0.18–1.80, p = 0.334) or mortality (OR 0.59, 0.16–2.17, p = 0.429). Strokes involving the insula and anterio-medial cortex increased the risk for pneumonia (OR 4.55, 2.41–8.56, p<0.001) and sepsis (OR 4.13, 1.81–9.43, p = 0.001), while right hemispheric strokes increased the risk for pneumonia (OR 1.60, 0.92–2.77, p = 0.096). There was a non-significantly increased risk for urinary tract infections in patients with beta-blocker therapy and insula/anterio-medial cortex strokes (OR 3.12, 95% CI 0.88–11.05, p = 0.077) with no effect of beta-blocker therapy on pneumonia, sepsis or mortality in both subgroups.ConclusionsIn major ischemic stroke patients, beta-blocker therapy did not lower post-stroke infection rates and was associated with urinary tract infections in a subgroup with insula/anterio-medial strokes.

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Pre-Stroke Use of Beta-Blockers Does Not Lower Post-Stroke Infection Rate: An Exploratory Analysis of the Preventive Antibiotics in Stroke Study

Cited by 33 publications

References 15 publications

Detection of airway protective level of the cough reflex in acute stroke patients

Detection of airway protective level of the cough reflex in acute stroke patients

Pre admission treatment with Beta‐blockers in hypertensive patients with acute stroke and 3‐month outcome—Data from a national stroke registry

Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression

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