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Preoperative high leukocyte count: a novel risk factor for stroke after cardiac surgery
Alexander A Albert1, Carsten J Beller, Jörg A Walter
1Clinic for Cardiothoracic Surgery, Heart Institute Lahr/Baden, Lahr, Germany. alexander.albert@heart-lahr.com
Insights
High preoperative white blood cell count (WBC) is linked to increased stroke risk after cardiac surgery. Elevated WBC also impacts stroke outcomes, suggesting interventions to lower WBC may prevent these serious complications.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Hematology
Background:
- Stroke is a severe complication following cardiac surgery.
- The association between preoperative white blood cell count (WBC) and perioperative cerebrovascular accident (CVA) remains under-investigated.
- This study aimed to explore the relationship between preoperative WBC and CVA development.
Purpose of the Study:
- To investigate the correlation between preoperative white blood cell count (WBC) and the incidence of cerebrovascular accident (CVA) in patients undergoing cardiac surgery.
- To determine if preoperative WBC levels predict the risk of perioperative stroke.
- To assess the impact of preoperative WBC on CVA clinical outcomes.
Main Methods:
- Prospective data collection from 7,483 patients undergoing coronary artery bypass grafting and/or valvular surgery.
- Preoperative and postoperative white blood cell (WBC) counts were measured.
- Preoperative WBC differentiation and logistic regression analysis were used to assess CVA risk.
Main Results:
- A total of 125 CVAs (10 TIAs, 115 strokes) were recorded.
- Patients experiencing stroke had significantly higher preoperative and postoperative WBC counts.
- Increased risk for perioperative CVA was observed starting at a preoperative WBC of 9 x 10(9)/L, with risk progressing at higher ranges.
Conclusions:
- A significant correlation exists between elevated preoperative WBC and stroke incidence during or after cardiac surgery.
- Preoperative high WBC is associated with poorer CVA clinical outcomes.
- Strategies to reduce preoperative WBC, such as managing infections, may help prevent perioperative strokes.
Background:
Stroke after cardiac surgery is a devastating complication. The relationship between white blood cell count (WBC) and perioperative cerebrovascular accident (CVA) has not been investigated. An effort was made to identify how preoperative WBC may relate to CVA development during or after cardiac surgery.
Methods:
Prospective data were collected from 7,483 patients who underwent coronary artery bypass grafting or valvular surgery or both. WBC was determined preoperatively and postoperatively. Differentiation of WBC was examined only preoperatively.
Results:
There were a total of 125 CVAs (10 transient ischemic attacks [TIAs], 115 strokes). WBC was significantly higher preoperatively and directly postoperatively in patients with stroke. Qualitative changes in preoperative WBC were also found in these patients (chi2; p < 0.001). The predictive power of the stepwise logistic regression model for CVA was greater when preoperative WBC was included. The risk for perioperative CVA increased starting at preoperative WBC of 9 x 10(9)/L (p = 0.044) and progressed in higher WBC ranges. WBC had a significant impact on CVA outcome (analysis of variance, p = 0.001).
Conclusions:
Our studies have established the correlation between high preoperative WBC and stroke during or after cardiac surgery. Furthermore, elevated preoperative WBC was related to the clinical outcome of CVA. Preoperative measures aimed at preventing or treating conditions such as infections that may cause elevated WBC may be beneficial in the prevention of stroke during or after cardiac surgery.