Different prognostic value of white blood cell subtypes in patients with acute cerebral infarction

doi:10.1016/j.atherosclerosis.2012.02.042

Atherosclerosis

Volume 222, Issue 2, June 2012, Pages 464-467

https://doi.org/10.1016/j.atherosclerosis.2012.02.042 Get rights and content

Abstract

Objective

We aimed to investigate the relationship of each white blood cells (WBC) subtype with neurologic severity and outcome in acute stroke.

Methods

We included 779 patients with first-ever acute cerebral infarction within 72 h after symptom onset. We investigated the association between counts for WBC subtypes in peripheral blood at admission and (1) initial stroke severity; (2) early change in stroke severity within one week; and (3) functional outcome at three months.

Results

Higher total WBC and neutrophil counts were associated with more severe stroke at admission (p < 0.001). In contrast, lower lymphocyte counts were associated with a lesser improvement during the first week after admission (p < 0.05) and with poor functional outcome at three months (OR = 0.706 per 1000 lymphocyte counts/mm³, p = 0.020).

Conclusions

Our study merits further investigation on the role of each WBC subtype in ischemic injury and different prognostic value of WBC subtypes measured at admission in acute stroke.

Highlights

► Neutrophil and lymphocyte counts, which were measured at admission in patients with acute cerebral infarction, had different predictive values. ► Higher total WBC and neutrophil counts were associated with more severe stroke at admission. ► Lower lymphocyte counts were associated with poor neurologic improvement in early phase and worse long-term functional outcome.

Introduction

White blood cells (WBC) are divided into neutrophils, eosinophils, basophils, lymphocytes and monocytes. Each subtype has a different inflammatory and immunologic function and may contribute differently to the pathophysiology of atherosclerosis and cerebrovascular and cardiovascular diseases [1], [2], [3]. However, prognostic value of each WBC subtypes in acute cerebral infarction is unknown. We investigated the relationship of total WBC counts and those of each WBC subtype at admission with initial stroke severity, early neurologic outcome, and long-term functional outcome in acute cerebral infarction.

Section snippets

Study design and participants

This was a hospital-based retrospective and observational study. The candidates were 1219 patients admitted from November 2008 to March 2011 with a first-ever acute cerebral infarction and registered in the Yonsei Stroke Registry [4]. We only enrolled patients who visited a hospital within 72 h of symptom. We excluded patients admitted with transient ischemic attack or history of previous stroke and patients with conditions that could influence WBC counts at admission or outcome. Patients were

Results

A total of 795 patients with acute cerebral infarction met the inclusion criteria. mRS at three months was assessed in 779 patients (98.0%, supplementary figure). The mean age of included patients was 65.54 ± 12.88 years, of which 60.8% were male (Table 1). The NIHSS score was assessed in all patients (100%) at day 0, 753 patients (96.6%) at day 1, 766 patients (98.3%) at day 3, and 736 patients (94.5%) at day 7. The median initial NIHSS score was 3 (interquartile range 1–7). Poor functional

Discussion

The harmful effects of WBC, mainly neutrophil, in acute stroke are well known [6], [7]. However, previous clinical trials inducing leukopenia or blocking the infiltration of leukocytes to the brain failed to show any clinical benefit or led to an increase in infection and poor clinical outcome [6], [8]. We showed that the effect of WBC on the neurologic outcome in acute cerebral infarction was differed by the WBC subtype. Increased total WBC counts and neutrophil counts were associated with

Conclusions

We showed that neutrophil and lymphocyte counts, which were measured at admission in acute cerebral infarction, have different predictive values for prognosis. While higher total WBC and neutrophil counts were associated with more severe initial stroke, lower lymphocyte counts were associated with poor neurologic improvement in early phase and worse long-term functional outcome. Our findings suggest that further investigation is needed to better understand the role of each WBC subtype in

Funding sources

This work was supported by a grant from the Korea Healthcare Technology Research and Development Project, Ministry of Health, Welfare, and Family Affairs, Republic of Korea (A102065).

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Short communicationDifferent prognostic value of white blood cell subtypes in patients with acute cerebral infarction

Abstract

Objective

Methods

Results

Conclusions

Highlights

Introduction

Section snippets

Study design and participants

Results

Discussion

Conclusions

Funding sources

Blood

Lancet Neurology

Experimental Neurology

American Heart Journal

The American Journal of Cardiology

Atherosclerosis

Journal of the American College of Cardiology

Short communication
Different prognostic value of white blood cell subtypes in patients with acute cerebral infarction