RT Journal Article
SR Electronic
T1 Higher neutrophil counts before thrombolysis for cerebral ischemia predict worse outcomes
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 1408
OP 1416
DO 10.1212/WNL.0000000000002029
VO 85
IS 16
A1 Maestrini, Ilaria
A1 Strbian, Daniel
A1 Gautier, Sophie
A1 Haapaniemi, Elena
A1 Moulin, Solène
A1 Sairanen, Tiina
A1 Dequatre-Ponchelle, Nelly
A1 Sibolt, Gerli
A1 Cordonnier, Charlotte
A1 Melkas, Susanna
A1 Leys, Didier
A1 Tatlisumak, Turgut
A1 Bordet, Régis
YR 2015
UL http://n.neurology.org/content/85/16/1408.abstract
AB Objective: To determine whether higher neutrophil counts before IV recombinant tissue plasminogen activator (rtPA) administration in ischemic stroke (IS) patients are associated with symptomatic intracerebral hemorrhages (sICH) and worse outcomes at 3 months.Methods: Blood samples for leukocyte, neutrophil, and lymphocyte counts were drawn before IV rtPA administration in IS patients included in the cohorts of Lille and Helsinki. The primary endpoint was sICH (European Cooperative Acute Stroke–II definition). Secondary endpoints were death and excellent (modified Rankin Scale [mRS] score 0–1 or equal to prestroke mRS) and good (mRS score 0–2 or equal to prestroke mRS) outcomes at 3 months.Results: We included 846 patients (median age 71 years; 50.8% men). The neutrophil count and neutrophil to lymphocyte ratio (NLR) were independently associated with the 4 endpoints: sICH (adjusted odds ratio [adjOR] for an increase of 1,000 neutrophils = 1.21 and adjOR 1.11, respectively), death (adjOR 1.16 and adjOR 1.08), and excellent (adjOR 0.87 and adjOR 0.85) and good (adjOR 0.86 and adjOR 0.91) outcomes. The total leukocyte count was not associated with any of the 4 endpoints. The best discriminating factor for sICH was NLR ≥4.80 (sensitivity 66.7%, specificity 71.3%, likelihood ratio 2.32). Patients with NLR ≥4.80 had a 3.71-fold increased risk for sICH (95% confidence interval adjOR: 1.97–6.98) compared to patients with NLR <4.80.Conclusions: Higher neutrophil counts and NLR are independently associated with sICH and worse outcome at 3 months. The identification of mediators of this effect could provide new targets for neuroprotection in patients treated by rtPA.adjOR=adjusted odds ratio; CI=confidence interval; ECASS=European Cooperative Acute Stroke Study; MMP-9=matrix metalloproteinase–9; mRS=modified Rankin Scale; NIHSS=NIH Stroke Scale; NLR=neutrophil to lymphocyte ratio; rtPA=recombinant tissue plasminogen activator; sICH=symptomatic intracerebral hemorrhage