Background and purpose The blood–brain barrier (BBB) not only provides a physical obstruction but also recruits and activates neutrophils in cases of infection. Hemorrhagic or ischemic stroke reportedly induces the disruption of the BBB. However, few studies have reported a correlation between the incidence of meningitis in patients with a history of stroke. This study tested the hypothesis that patients with a history of stroke may be more vulnerable to meningitis. Methods Stroke and age-matched comparison ( n ?=?29,436 and 87,951, respectively) cohorts were recruited from the Taiwan National Health Insurance database (2000–2011). Correlations between the two cohorts were evaluated by Cox proportional hazard regression model, Kaplan–Meier curve, and log-rank tests. Results The incidence of meningitis was higher in the stroke cohort compared to that in the comparison cohort [hazard ratio (HR), 2.89; 95% confidence interval (CI), 2.23–3.74, p ?0.001]. After adjusting for age, sex, and comorbidities, the estimated HR in the stroke cohort was 2.55-fold higher than that in the comparison cohort (CI, 1.94–3.37; p ?0.001). Notably, patients who had experienced hemorrhagic stroke had a higher incidence rate of meningitis than those with a history of ischemic stroke, except for patients older than 75?years (incidence rates in hemorrhagic/ischemic stroke patients, 3.14/1.48 in patients younger than 45?years, 1.52/0.41 in 45- to 64-year group, 1.15/0.90 in 65- to 74-year group, 0.74/0.93 in patients older than 75?years). Moreover, stroke patients who had undergone head surgery had the highest meningitis risk (adjusted HR, 8.66; 95% CI, 5.55–13.5; p ?0.001) followed by stroke patients who had not undergone head surgery (adjusted HR, 2.11; 95% CI, 1.57–2.82; p ?0.001). Conclusion Our results indicated that stroke patients have higher risks of meningitis. Compromised BBB integrity in stroke patients may lead to increased vulnerability to infectious pathogens. In summary, our study provided new evidence of the clinical relationship between stroke and meningitis, and our findings suggest the need for precautions to prevent meningitis in stroke patients.
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机译:背景和目的血脑屏障(BBB)不仅会造成身体阻塞,而且在感染的情况下还会募集并激活中性粒细胞。据报道,出血性或缺血性中风会诱发血脑屏障破坏。但是,很少有研究报道脑卒中患者脑膜炎的发病率之间存在相关性。这项研究检验了有中风病史的患者可能更容易患脑膜炎的假设。方法从台湾国民健康保险数据库(2000-2011年)中收集卒中和年龄匹配的比较(分别为n = 29,436和87,951)。通过Cox比例风险回归模型,Kaplan-Meier曲线和对数秩检验对两个队列之间的相关性进行了评估。结果中风组脑膜炎的发生率高于比较组[危险比(HR),2.89; 95%置信区间(CI),2.23-3.74,p 0.001]。在对年龄,性别和合并症进行调整后,中风队列的估计HR比比较队列的高2.55倍(CI,1.94-3.37; p <0.001)。值得注意的是,经历过出血性中风的患者脑膜炎的发生率高于具有缺血性中风病史的患者,但年龄大于75岁的患者除外(出血/缺血性中风患者的发生率,小于45岁的患者为3.14 / 1.48。年,在45至64岁组中为1.52 / 0.41,在65至74岁组中为1.15 / 0.90,在75岁以上患者中为0.74 / 0.93)。此外,接受头部手术的中风患者发生脑膜炎的风险最高(HR调整后为8.66; 95%CI为5.55-13.5; p <0.001),其次是未经头部手术的脑卒中(调整后HR为2.11; 95%CI,1.57–2.82; p 0.001)。结论我们的结果表明,中风患者罹患脑膜炎的风险更高。脑卒中患者的血脑屏障完整性受损可能导致感染性病原体的脆弱性增加。总之,我们的研究提供了中风与脑膜炎之间临床关系的新证据,我们的发现表明需要采取预防措施来预防中风患者的脑膜炎。
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