Thrombolysis in stroke patients with elevated inflammatory markers.

Area of Science:

• Neurology
• Hematology
• Clinical Medicine

Background:

• White blood cell count (WBC) is a common biomarker.
• Its prognostic significance in acute ischemic stroke treated with intravenous thrombolysis (IVT) requires further elucidation.

Purpose of the Study:

• To determine the prognostic value of admission WBC count for functional outcome, mortality, and bleeding risk in stroke patients receiving IVT.
• To investigate the impact of leukocytosis and leukopenia on these outcomes.

Main Methods:

• Prospective multicenter study (TRISP registry) of 10,813 IVT-treated stroke patients.
• Assessed association between admission WBC (continuous and categorical: leukocytosis >10×10⁹/l, leukopenia <4×10⁹/l) and 3-month outcomes (poor functional outcome, mortality, symptomatic intracranial hemorrhage).
• Used logistic regression to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs).

Main Results:

• Increasing WBC independently predicted poor functional outcome (ORadjusted 1.04 [1.02-1.06]).
• 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 symptomatic intracranial hemorrhage (ORadjusted 1.17 [0.94-1.45]).
• Leukopenia did not predict any outcome. Combined leukocytosis and elevated CRP showed the strongest association with poor outcome and mortality.

Conclusions:

• In IVT-treated stroke patients, leukocytosis is an independent predictor of poor functional outcome and increased mortality.
• Leukocytosis is not independently associated with an increased risk of bleeding complications following IVT.