Is stroke rehabilitation a metabolic problem?

Brain Inj. 2014;28(2):161-73. doi: 10.3109/02699052.2013.860470.

Abstract

Background: This study looks at the impact of inflammation during the rehabilitation stage of strokes and its effect on neuro-functional recovery.

Methods: This study investigated 94 patients suffering from strokes and admitted to rehabilitation. Anthropometric characteristics, serum proteins and inflammatory markers, plasma amino acids and neurofunction were all assessed.

Results: 55.3% patients had an inflammatory status (Interleukin-6 = 19.24 ± 23.01 pg ml⁻¹ vs. 4.1 ± 1.6 pg ml⁻¹ for non-inflamed subjects (p < 0.001). Inflammation was positively linked to positive proteins (alpha-1 globulin, p < 0.02) and negatively linked to negative proteins (albumin, p < 0.02; prealbumin, p < 0.01; transferrin, p < 0.05) of the acute-phase response. Inflammation was associated with low plasma concentrations of total amino acids. For the multiple logistic regression analysis, albumin (p < 0.001) and body weight maintenance (p < 0.001) were independent predictors of patient functional independence. Inflammation in dysphagic stroke (31.9%) patients was associated with more accentuated disability compared to non-inflamed dysphagics. The serum positive reactant alpha 1 globulin was the most powerful predictor of dysphagia severity (p < 0.001). At discharge, dysphagia improvement was associated with improved acute-phase negative proteins.

Conclusions: An inflammatory status may persist for most patients with strokes during the rehabiliation stage of the disease, its prevalence being higher in dysphagic compared to non-dysphagic subjects. The improvement in circulating albumin and body weight maintenance are predictors of neuro-function, even in dysphagic subjects.

MeSH terms

  • Adult
  • Alpha-Globulins / metabolism*
  • Body Weight*
  • Deglutition Disorders / etiology
  • Female
  • Humans
  • Inflammation / metabolism*
  • Inflammation / physiopathology
  • Interleukin-6 / metabolism*
  • Logistic Models
  • Male
  • Middle Aged
  • Prealbumin / metabolism
  • Recovery of Function
  • Serum Albumin / metabolism
  • Stroke / complications
  • Stroke / metabolism*
  • Stroke / physiopathology
  • Stroke Rehabilitation
  • Transferrin / metabolism
  • Tumor Necrosis Factor-alpha / metabolism*

Substances

  • Alpha-Globulins
  • Interleukin-6
  • Prealbumin
  • Serum Albumin
  • Transferrin
  • Tumor Necrosis Factor-alpha
  • alpha-1 serum globulin