Abstract W P51: A Higher Neutrophil Count Before Thrombolysis Is Associated With Worse Outcome
Objective: to determine whether higher neutrophil counts before administration of intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) for ischemic stroke are associated with symptomatic intracerebral hemorrhages (sICH), and worse outcomes.
Methods: we conducted this study in patients treated by i.v. rt-PA in the stroke units of Lille and Helsinki. Blood samples for leukocyte, neutrophil, and lymphocyte counts were drawn before thrombolysis. The primary endpoint was sICH (ECASS-2 definition). Secondary endpoints were excellent outcome (modified Rankin Scale [mRS] 0-1), good outcome (mRS 0-2), and death at 3 months.
Results: we included 846 patients (median age: 71 years; 50.8% men). Neutrophil count was independently associated with sICH (adjusted odds ratio [adjOR] for 1,000 increase =1.21; 95% confidence interval [CI]: 1.11-1.32), death (adjOR 1.16; 95%CI: 1.08-1.24), excellent (adjOR 0.87; 95%CI: 0.82-0.93) and good (adjOR 0.86; 95%CI: 0.80-0.91) outcomes. The Neutrophil to lymphocyte ratio (NLR) was independently associated with sICH (adjOR 1.11; 95%CI: 1.06-1.17), death (adjOR 1.08; 95%CI: 1.03-1.13), excellent (adjOR 0.85; 95%CI: 0.81-0.90) and good (adjOR 0.91; 95%CI: 0.86-0.95) outcomes. Total leukocyte count was associated with none of the 4 endpoints. The best discriminating factor for sICH was a NLR ≥4.80 (sensitivity 66.7%, 95%CI 63.5%-69.9%; specificity 71.3%, 95%CI 68.3%-74.3%; likelihood ratio 2.32). Patients with NLR ≥4.80 had a 3.71-fold increased risk for sICH (95% CI adjOR: 1.97-6.98).
Conclusions: higher neutrophil counts are independently associated with sICH, death, and worse functional status at 3 months. The identification of mediators of this effect could help identifying new targets for neuroprotection in patients treated by rt-PA.
Author Disclosures: I. Maestrini: Research Grant; Significant; European Neurological Society, La Revue Neurologique. D. Strbian: None. S. Gautier: None. E. Haapaniemi: None. S. Moulin: None. T. Sairanen: None. N. Dequatre-Ponchelle: None. G. Sibolt: None. C. Cordonnier: None. S. Melkas: None. D. Leys: Research Grant; Significant; French Ministry of Health. Grant PHRC. T. Tatlisumak: Research Grant; Significant; H Lundbeck A/S, Sanofi Aventis, PhotoThera Inc, Mitsubishi Pharma, BrainsGate, Schering Plough, Bayer, Pfizer, Concentric Medical, Helsinki University Central Hospital, Sigrid Juselius Foundation, Liv och Hälsa Foundation, Biocenter Finland, Biocentrum Helsinki, European Union, Finnish Academy of Sciences, National Institutes of Health. Consultant/Advisory Board; Significant; Mitsubishi Pharma, Bayer, Pfizer, Orion Pharma, Boehringer-Ingelheim. Other; Modest; Professio Finland, University of Helsinki, Finnish Medical Association, Finnish Neurological Association, University of Donau in Krems, European Stroke Conference, European Federation of Neurological Societies Conference, European Stroke Organisation, Australia and New Zealand Stroke Society, Austrian Stroke Society, Nordic Stroke Conference, Polish Neuroscience Society, Greek Internal Medicine Society, Thrombolysis and Thrombectomy Acute Stroke Treatment Conference (TTAS), World Stroke Conference, German Psychological Society. Other; Significant; Salus Ansvar Foundation Award, Finnish Medical association Quality Award 2014. R. Bordet: None.
- © 2015 by American Heart Association, Inc.