Department of Neurology, Charleston Area Medical Center, West Virginia University, Charleston, WV.
Department of Neurology, University of Tennessee Health Science Center, Memphis, TN.
Eur J Neurol. 2018 Dec;25(12):1417-1424. doi: 10.1111/ene.13741. Epub 2018 Aug 1.
To determine the association of differential leukocyte counts on admission with efficacy and safety outcomes in patients with acute ischaemic stroke (AIS) treated with intravenous thrombolysis (IVT).
Consecutive patients with AIS receiving IVT were evaluated at two stroke centers. Differential leukocyte counts and neutrophil:lymphocyte ratio (NLR) were determined during the initial 12 h of admission. Efficacy outcomes were favorable functional outcome (FFO) (modified Rankin Scale scores of 0-1) and functional independence (FI) (modified Rankin Scale scores of 0-2) at 3 months, whereas safety outcomes were symptomatic intracranial hemorrhage and 3-month mortality.
Among 657 IVT-treated patients with AIS, the mean age was 64 ± 14 years, 50% were female and median National Institutes of Health Stroke Scale score was 7 points (interquartile range, 4-13). Lower neutrophil and leukocyte counts and NLR counts were observed in patients with 3-month FFO and FI, whereas higher counts were observed in patients who died at 3 months. The best discriminative factors for 3-month FFO and FI were NLR < 2.2 (sensitivity 51.4%, specificity 63.1%) and leukocyte count <8100/μL (sensitivity 57.5%, specificity 55.1%), respectively. After adjustment for potential confounders, NLR < 2.2 was associated with higher odds of FFO [odds ratio (OR), 1.56; 95% confidence interval (CI), 1.08-2.24; P = 0.018], whereas leukocyte count <8100/μL demonstrated 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). Combined neutrophil (<6800/μL) and leukocyte (<8100/μL) counts demonstrated a strong interaction for 3-month FI (OR, 1.73; 95% CI, 1.13-2.67; P interaction = 0.012).
Differential leukocyte counts on admission were independently associated with clinical outcomes in patients with AIS treated with IVT. These inflammatory biomarkers are potential targets for adjunctive neuroprotection in this stroke subgroup.
评估入院时白细胞分类计数与接受静脉溶栓治疗的急性缺血性卒中（AIS）患者的疗效和安全性结局之间的关系。
在两个卒中中心评估接受静脉溶栓治疗的连续 AIS 患者。在入院最初 12 小时内确定白细胞分类计数和中性粒细胞/淋巴细胞比值（NLR）。3 个月时的疗效结局为良好的功能结局（改良 Rankin 量表评分 0-1）和功能独立性（改良 Rankin 量表评分 0-2），而安全性结局为症状性颅内出血和 3 个月死亡率。
在 657 例接受静脉溶栓治疗的 AIS 患者中，平均年龄为 64±14 岁，50%为女性，美国国立卫生研究院卒中量表评分中位数为 7 分（四分位距，4-13）。3 个月时具有良好功能结局和功能独立性的患者，中性粒细胞和白细胞计数以及 NLR 计数较低，而 3 个月时死亡的患者计数较高。3 个月时具有良好功能结局和功能独立性的最佳鉴别因素分别是 NLR＜2.2（敏感性 51.4%，特异性 63.1%）和白细胞计数＜8100/μL（敏感性 57.5%，特异性 55.1%）。在校正潜在混杂因素后，NLR＜2.2 与更高的良好功能结局几率相关（比值比，1.56；95%置信区间，1.08-2.24；P=0.018），而白细胞计数＜8100/μL 与 3 个月时的功能独立性几率较高相关（比值比，1.69；95%置信区间，1.11-2.57；P=0.014）和 3 个月时死亡率较低相关（比值比，0.31；95%置信区间，0.16-0.60；P=0.001）。联合中性粒细胞（＜6800/μL）和白细胞（＜8100/μL）计数与 3 个月时的功能独立性具有很强的交互作用（比值比，1.73；95%置信区间，1.13-2.67；P 交互=0.012）。
入院时的白细胞分类计数与接受静脉溶栓治疗的 AIS 患者的临床结局独立相关。这些炎症生物标志物可能是该卒中亚组辅助神经保护的潜在靶点。
