Objective:

We aim to investigate the effect of immunosuppression at the time of acute ischemic stroke (AIS) by comparing outcomes between immunocompromised and immunocompetent AIS patients.  

Background:

Acute ischemic stroke (AIS), a leading cause of morbidity and mortality in the United States, results from hypoperfusion and neuronal cell death mediated by free radicals, excitotoxicity, inflammation, necrosis, apoptosis, and autophagy. Microglia and astrocytes activate, and pro-inflammatory mediators and anti-inflammatory cytokines get released. Animal models have demonstrated poor outcomes in AIS due to the proinflammatory immune system. Immunocompromised patients may have improved outcomes. 

Design/Methods:

Stroke database records from 1/1/16-3/1/22 were analyzed. Slicer Dicer software identified patients 18+ who experienced AIS while on selected immunomodulating agents. An immunocompromised group of 189 patients was compared to a control group of 245 patients. Differences in National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) from admission to discharge provided ΔNIHSS and ΔmRS values. Length of hospital stay, hemorrhagic transformation rate, and death rate were utilized as outcome metrics.  

Results:

Delta NIHSS and mRS values were -0.31 and 0.48 respectively in the immunocompromised, compared to -0.91 and 0.44 respectively in the control group with (p=0.82) and (p=0.51). In cases with initial NIHSS >6, differences were still insignificant; however, there was a trend toward better outcomes: ΔNIHSS and ΔmRS –4 and 1.15 in the immunocompromised vs -1.42 and 1.48 in the control group (p=0.44) and (p=0.33). Length of stay was longer in the immunocompromised (p=0.02). 

Conclusions:

The inflammatory response post-stroke likely contributes to cell death. Our analysis failed to demonstrate a statistically significant difference in outcome between immunocompromised and immunocompetent patients who have AIS. Considering underlying immune dysfunction often involves complications and the immunocompromised had comparable outcomes to the immunocompetent, immunomodulation may be beneficial in post-stroke care. A repeated study with a larger sample size is needed.