Thrombolysis in stroke patients with elevated inflammatory markers.

Abstract

OBJECTIVE:

To investigate the prognostic value of white blood cell count (WBC) on functional outcome, mortality and bleeding risk in stroke patients treated with intravenous thrombolysis (IVT).

METHODS:

In this prospective multicenter study from the TRISP registry, we assessed the association between WBC on admission and 3-month poor outcome (modified Rankin Scale 3-6), mortality and occurrence of symptomatic intracranial hemorrhage (sICH; ECASS-II-criteria) in IVT-treated stroke patients. WBC was used as continuous and categorical variable distinguishing leukocytosis (WBC > 10 × 109/l) and leukopenia (WBC < 4 × 109/l). We calculated unadjusted/ adjusted odds ratios with 95% confidence intervals (OR [95% CI]) with logistic regression models. In a subgroup, we analyzed the association of combined leukocytosis and elevated C-reactive protein (CRP > 10 mg/l) on outcomes.

RESULTS:

Of 10,813 IVT-treated patients, 2527 had leukocytosis, 112 leukopenia and 8174 normal WBC. Increasing WBC (by 1 × 109/l) predicted poor outcome (ORadjusted 1.04[1.02-1.06]) but not mortality and sICH. Leukocytosis was independently associated with poor outcome (ORadjusted 1.48[1.29-1.69]) and mortality (ORadjusted 1.60[1.35-1.89]) but not with sICH (ORadjusted 1.17[0.94-1.45]). Leukopenia did not predict any outcome. In a subgroup, combined leukocytosis and elevated CRP had the strongest association with poor outcome (ORadjusted 2.26[1.76-2.91]) and mortality (ORadjusted 2.43[1.86-3.16]) when compared to combined normal WBC and CRP.

CONCLUSION:

In IVT-treated patients, leukocytosis independently predicted poor functional outcome and death. Bleeding complications after IVT were not independently associated with leukocytosis.

• Authors: Valerian L Altersberger, Lukas S Enz, Gerli Sibolt, Christian Hametner, Stefania Nannoni, Mirjam R Heldner, Jeffrey Stolp, Dejana R Jovanovic, Andrea Zini, Alessandro Pezzini, Susanne Wegener, Carlo W Cereda, George Ntaios, Silja Räty, Christoph Gumbinger, Miriam Heyse, Alexandros A Polymeris, Annaelle Zietz, Anna Schaufelbuehl, Davide Strambo, Giovanna Padlina, Nedelina Slavova, Marjaana Tiainen, Kati Valkonen, Twan J van Velzen, Guido Bigliardi, Predrag Stanarcevic, Mauro Magoni, Andreas Luft, Yannick Bejot, Laura Vandelli, Visnja Padjen, Paul J Nederkoorn, Marcel Arnold, Patrik Michel, Peter A Ringleb, Sami Curtze, Stefan T Engelter, Henrik Gensicke, Thrombolysis in Stroke Patients (TRISP) collaborators
• Journal: Journal of neurology (J Neurol) Vol. 269 Issue 10 Pg. 5405-5419 (Oct 2022) ISSN: 1432-1459 [Electronic] Germany
• PMID: 35622132 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2022. The Author(s).

Chemical References

• Fibrinolytic Agents

Topics

• Brain Ischemia (complications)
• Fibrinolytic Agents (adverse effects)
• Humans
• Leukocytosis
• Leukopenia (complications)
• Prospective Studies
• Stroke (complications, drug therapy, epidemiology)
• Thrombocytopenia
• Thrombolytic Therapy (adverse effects)
• Treatment Outcome