Abstract
<jats:p>INTRODUCTION: Severe brain damage may result in prolonged or chronic critical illness (PCCI) representing a special clinical patient`s model. Predicting early the high risk of poor outcome of PCCI should help for in-time use of personalized treatment modalities. Immunological and genetic markers may exhibit potentially high prognostic potential may exhibit. OBJECTIVE: To determine the contribution of the AGTR1 (angiotensin II receptor type 1) rs275651 regulatory 5`-region polymorphism, the content of immune system cells and their neutrophil to lymphocyte ratio (NLR) to the outcome of PCCI in post-hemorrhagic stroke patients. MATERIALS AND METHODS: The study included 192 patients with hemorrhagic stroke in PCCI. 107 patients were admitted to the hospital with nosocomial pneumonia from other hospitals. Age was 59 (49; 67) years, Sequential Organ Failure Assessment score on the day of hospitalization was 3 (1; 4). Women constituted 43 % of the cohort. RESULTS: Neutrophil to lymphocyte ratio (NLR) higher than 4 on the fifth day of hospitalization predicted an unfavourable outcome (p = 0.0001; logrank test; Odds Ratio (OR) 6.7; 95% Confidence Interval (CI) 2.6–17.0; n = 153). Subgrouping the patients showed that the NLR value as determined on the fifth day of hospitalization predicted outcome only for patients admitted without pneumonia. For patients admitted with pneumonia, genetic variants of the angiotensin II receptor gene — AGTR1 were predictive for outcome: minor allele AGTR1 rs275651 A showed poor outcome of PCCI on the first day of hospitalisation (p = 0.037; logrank test; OR 2.6; 95% CI 0.9–7.5; n = 107). For patients admitted without pneumonia no effect of AGTR1 rs275651 genotype revealed (p = 0.76; n = 85). CONCLUSIONS: In post-hemorrhagic stroke patients in PCCI, the increased NLR value (> 4) on the fifth day of hospitalization predicts outcome of PCCI in patients admitted without pneumonia. For patients admitted with pneumonia, the genetic marker, minor allele A of AGTR1 rs275651, associates with an unfavourable outcome.</jats:p>