Response of Salivary Stress Markers in Conscious and Unconscious Patients with Acute Ischemic Stroke

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Background and Purpose: Several salivary markers have been utilized to evaluate acute or chronic psychological stress in various conditions. However, the clinical utility of these biomarkers in acute stroke patients remains uncertain. The aim of this study was to investigate changes in salivary stress markers related to acute stroke, both in conscious and unconscious patients, to assess the feasibility of using salivary stress markers in acute stroke patients.
Subjects and Methods: A total of 27 patients with acute ischemic stroke (AIS) as shown on diffusion magnetic resonance imaging (MRI) (mean age, 67.7 ± 12.9 years; 19 males, 70.4%) and 11 control subjects were studied. Saliva was collected from patients with AIS within 24 hours after onset (Day-1), followed by serial collection at Day-4 and Day-7 using a polymer roll saturation method. Salivary concentrations of immunoglobulin A (IgA), cortisol, alpha-amylase, and dehydroepiandrosterone (DHEA) were measured by the enzyme-linked immunosorbent assay. The patients were divided into two groups based on their level of consciousness as evaluated by the National Institutes of Health Stroke Scale (NIHSS) on admission: the alert group (n=20) and the unconscious group (n=7). Motor activity on Day-1 was classified into three categories: in bed, sitting out of bed, and higher motor activity. A multiple linear regression model was used to determine independent factors associated with changes in salivary stress markers.
Results: Salivary IgA and cortisol in patients with AIS at Day-1 were significantly higher than in controls (p=0.004 in IgA; p=0.002 in cortisol), and salivary amylase at Day-1 was significantly lower (p=0.049). Salivary IgA was significantly correlated with the NIHSS score (r=0.534, p=0.004) and with initial infarct volume as determined by diffusion MRI (r=0.606, p=0.001). There were no significant serial changes in any of the salivary stress markers. Multiple linear regression analyses demonstrated that motor activity levels in patients without consciousness disturbance was significantly associated with salivary IgA levels.
Conclusions: This exploratory study demonstrated the potential utility of salivary IgA in acute ischemic stroke patients. Further studies are warranted to explore the relationship between salivary IgA and the impact of psychological stress on acute ischemic stroke patients.