The Relationship between Leukocytosis and Time to Neurodeterioration (P6.282)

Abstract

Objective: To assess the association between leukocytosis at admission and 24-hours after an acute ischemic stroke (AIS) and neurodeterioration (ND). Background: Previous research has illustrated how leukocytosis after AIS is related to poor functional outcome. A main predictor of poor functional outcome is ND. We sought to explore the relationship between leukocytosis and time to ND to identify a risk factor for a process that predicts poor functional outcome. Methods: Patients admitted to our stroke center (07/08-06/12) were retrospectively assessed. Leukocytosis was defined as WBC >11,000, ND was characterized as 蠅 2 point increase in NIHSS scale and poor functional outcome was classified as modified Rankin Scale (mRS) of 3-6. Patients were grouped into 2 categories: (1) the leukocytosis group- those who developed leukocytosis 蠅24 hours after admission and those who presented with leukocytosis and remained at 24 hours and, (2) the non-leukocytosis group- those that did not have leukocytosis and those where the leukocytosis resolved within 24 hours of admission. Results: A cohort of AIS patients (N=476) with median age 64 years, 43% female and 69% Black were assessed. Of the patients with ND (27%), median time to ND was 43 hours. In the leukocytosis group (N=84), 42 (50.6%) of them developed ND. In the non-leukocytosis group (N=312), 75 (24.5%) developed ND. Leukocytosis within 24 hours of admission is predictive of earlier time to ND (p<0.0001). Adjusting for age, stroke severity, glucose, tPA and infection, the leukocytosis group had a 2 times greater risk for developing ND (HR 2.49, 95%CI 1.61-3.84, p<0.0001). Conclusion: Having leukocytosis persist from admission to 24 hours or developing leukocytosis within 24 hours of admission is a significant predictor of early ND, which often results in poor functional outcome. Identifying such a predictor can enable physicians to identify those at risk for ND and subsequent poor functional outcomes. Future studies are needed to identify if interventions targeting leukocytosis may improve outcome after stroke.

Disclosure: Dr. Boehme has nothing to disclose. Dr. Siegler has nothing to disclose. Dr. Albright has received research support from The Agency for Healthcare Research and Quality, and the National Institute on Minority Health and Health Disparities. Dr. George has received research support from Tulane University School of Medicine. Dr. Monlezun, Jr has nothing to disclose. Dr. Friedant has nothing to disclose. Dr. Gouse has nothing to disclose. Dr. Beasley has nothing to disclose. Dr. Martin-Schild has nothing to disclose.