Differential Leukocyte Counts on Admission Predict Outcomes in Acute Ischemic Stroke Patients treated with Intravenous Thrombolysis.
- 2018
CONCLUSIONS: Admission differential leukocyte counts are independently associated with clinical outcomes in AIS patients treated with IVT and might represent potential inflammatory targets for adjunctive neuroprotection in this stroke subgroup. This article is protected by copyright. All rights reserved. Copyright This article is protected by copyright. All rights reserved. METHODS: Consecutive AIS patients receiving IVT were evaluated at two stroke centers. Differential leukocyte counts and neutrophil-lymphocyte ratio (NLR) were determined during initial 12 hours of admission. Efficacy outcomes involved favorable functional outcome (FFO) [mRS-scores of 0-1] and functional independence (FI) [mRS-scores of 0-2] at three months; whereas safety outcomes were symptomatic intracranial hemorrhage (sICH) and three-month mortality. OBJECTIVE: To determine the association of differential leukocyte counts on admission with efficacy and safety outcomes in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). RESULTS: Among 657 IVT-treated AIS patients, mean age was 64+/-14, 50% were female and median NIHSS was 7 points [IQR 4-13]. Lower neutrophil, leukocyte and NLR counts were observed in patients with 3-month FFO and FI, whereas higher counts were observed in patients who expired at three months. The best discriminative factor for 3-month FFO and FI were NLR<2.2 (sensitivity 51.4%, specificity 63.1%) and leukocyte <8,100/muL (sensitivity 57.5%, specificity 55.1%), respectively. After adjustment for potential confounders, NLR <2.2 was associated with higher odds of FFO (OR: 1.56; 95%CI: 1.08-2.24; p=0.018), leukocyte count <8,100/muL was associated with higher odds of 3-month FI (OR: 1.69; 95%CI: 1.11-2.57; p=0.014) and lower odds of 3-month mortality (OR: 0.31; 95%CI: 0.16-0.60; p=0.001), whereas combined neutrophil (<6,800/muL) and leukocyte (<8,100/muL) counts were associated with 3-month FI (OR: 1.73; 95%CI: 1.13-2.67; p=0.012).