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Infection as a Stroke Risk Factor and Determinant of Outcome After Stroke
Elkind MSV, Boehme AK, Smith CJ, Meisel A, Buckwalter MS.. Stroke, 2020-09-08
Topic: Risk, prevention and care in population studies
Understanding the relationship between infection and stroke has taken on new urgency in the era of the coronavirus disease 2019 (COVID-19) pandemic. This association is not a new concept, as several infections have long been recognized to contribute to stroke risk. The association of infection and stroke is also bidirectional. Although infection can lead to stroke, stroke also induces immune suppression which increases risk of infection. Apart from their short-term effects, emerging evidence suggests that poststroke immune changes may also adversely affect long-term cognitive outcomes in patients with stroke, increasing the risk of poststroke neurodegeneration and dementia. Infections at the time of stroke may also increase immune dysregulation after the stroke, further exacerbating the risk of cognitive decline. This review will cover the role of acute infections, including respiratory infections such as COVID-19, as a trigger for stroke; the role of infectious burden, or the cumulative number of infections throughout life, as a contributor to long-term risk of atherosclerotic disease and stroke; immune dysregulation after stroke and its effect on the risk of stroke-associated infection; and the impact of infection at the time of a stroke on the immune reaction to brain injury and subsequent long-term cognitive and functional outcomes. Finally, we will present a model to conceptualize the many relationships among chronic and acute infections and their short- and long-term neurological consequences. This model will suggest several directions for future research.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Elkind, M. S. V., Boehme, A. K., Smith, C. J., Meisel, A., & Buckwalter, M. S. (2020). Infection as a Stroke Risk Factor and Determinant of Outcome After Stroke. Stroke. https://doi.org/10.1161/strokeaha.120.030429
Vancouver
Elkind MSV, Boehme AK, Smith CJ, Meisel A, Buckwalter MS. Infection as a Stroke Risk Factor and Determinant of Outcome After Stroke. Stroke. 2020. doi:10.1161/strokeaha.120.030429. PMID: 32897811.
BibTeX
@article{elkind2020-32897811,
author = {Elkind, M. S. V. and Boehme, A. K. and Smith, C. J. and Meisel, A. and Buckwalter, M. S.},
title = {{Infection as a Stroke Risk Factor and Determinant of Outcome After Stroke}},
journal = {Stroke},
year = {2020},
doi = {10.1161/strokeaha.120.030429},
pmid = {32897811},
url = {https://doi.org/10.1161/strokeaha.120.030429}
}
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Key findings
- Apart from their short-term effects, emerging evidence suggests that poststroke immune changes may also adversely affect long-term cognitive outcomes in patients with stroke, increasing the risk of poststroke neurodegeneration and dementia.
Why it matters
This review describes how infection can trigger stroke and how stroke can suppress the immune system and increase infection risk. It notes emerging evidence that post-stroke immune changes may worsen long-term cognitive outcomes and increase the risk of post-stroke neurodegeneration and dementia.
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Study details
- Evidence strengthLow
How this study scored 48/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Stroke) |
| Journal's citation record | 3 / 4 | Stroke: journal h-index 455 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2020 — within 10 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 254 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 31.8 citations a year over 8 year(s) since 2020 |
| Impact for its field and year | 4 / 6 | Cited 19.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 1 other studies in this library |
| Still being cited | 3 / 4 | Cited 129 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Marion S. Buckwalter: h-index 39 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Columbia University: institution h-index 1,824 (OpenAlex) |
| Multicenter collaboration | 2 / 3 | OpenAlex lists 7 institution(s) in 3 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 32897811) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 48 / 100 | — |
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