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Master Thesis

Influence de l’état inflammatoire à la phase aigüe de l’infarctus cérébral sur l’évolution thymique : modèle prédictif et perspectives d’intervention

Abstract : Introduction. Thirty percent of stroke patients will suffer from post-stroke depression (PSD), which is associated with worst outcome. Diagnosis for PSD is suboptimal. Stroke-related inflammation accounts for a substantial amount of PSD physiopathology. Routinely available inflammation biomarkers such as C-reactive protein (CRP), leukocytes count, fibrinogen and neutrophil to lymphocyte ratio (NLR) are thus explored as predictors of PSD. Objective. Primary objective was to assess the association between standard inflammation biomarkers in the acute phase of stroke and PSD at 3 months. Secondary objective was to elaborate a predictive model of PSD from clinical, biological and radiological data. Material and Methods. We performed a retrospective analysis from a monocentric cohort of stroke patient with a 3-month follow up. Serum levels of CRP, leukocytes count, fibrinogen and NLR were tested at admission and at peak during hospitalization. Mood was assessed at 3 months using the depression sub-scale of the Hospital Anxiety and Depression Scale (HADS). Association between inflammation biomarkers at baseline and HADS at 3 months was evaluated with multi-linear regression adjusted on clinical and radiological parameters. In addition, logistic predictive models of PSD at 3 months with and without inflammation biomarkers were compared. Results. Three hundred and forty eight patients were included of which 20.06% developed PSD. Multivariate analysis coefficient of determination for PSD with selected inflammation biomarkers (peak CRP, lymphocytes at baseline, NLR) was R² 0.336 (CI 95% 0.328-0.364) as compared to R² 0.334 (CI 95% 0.317-0.352) without inflammation biomarkers. Area under the curve for the Receiver Operating Characteristic curve of PSD prediction was 0.746 (CI 95% 0.592-0.803) with selected inflammation biomarkers and 0.744 (CI 95% 0.587-0.799) without. Conclusion. Some inflammation biomarkers measured in the acute phase of stroke (peak CRP, lymphocytes at baseline, NLR) are statistically but weakly associated with PSD, adding negligible value to predictive models. While these routine biomarkers suggest the implication of inflammation in PSD pathogenesis, their utility in clinical practice seems limited for the prediction of PSD, underlying the need for more specific biomarkers.
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https://dumas.ccsd.cnrs.fr/dumas-02512371
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Jean-Sébastien Liegey. Influence de l’état inflammatoire à la phase aigüe de l’infarctus cérébral sur l’évolution thymique : modèle prédictif et perspectives d’intervention. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02512371⟩

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