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White blood cell count is an independent predictor of outcomes after acute ischaemic stroke
Author(s) -
Furlan J. C.,
Vergouwen M. D. I.,
Fang J.,
Silver F. L.
Publication year - 2014
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12233
Subject(s) - medicine , confounding , stroke (engine) , white blood cell , ischaemic stroke , odds ratio , hazard ratio , confidence interval , ischemia , mechanical engineering , engineering
Background and purpose In patients with ischaemic stroke, elevated white blood cell count ( WBC ) has been associated with stroke severity on admission and poor functional outcome. However, previous studies did not control for confounding factors. We hypothesized that higher WBC is an independent predictor of stroke severity, greater degree of disability and 30‐day mortality after acute ischaemic stroke. Methods Data from the R egistry of the C anadian S troke N etwork on consecutive patients with acute ischaemic stroke admitted between J uly 2003 and M arch 2008 were used. Patients were divided into groups as follows: low WBC (0.1–4 × 10 −9 /l), normal WBC (4.1–10 × 10 −9 /l) and high WBC (10.1–40 × 10 −9 /l). Primary outcome measures were the frequency of moderate/severe strokes on admission ( C anadian N eurological S cale ≤ 8), greater degree of disability at discharge (modified Rankin score 3–6) and 30‐day mortality. Regression analyses were performed adjusting for confounders. Results In total, 8829 patients were included. After adjustment for major potential confounders, every 1 × 10 −9 /l increase in WBC was associated with stroke severity on admission [odds ratio ( OR ) 1.09; 95% CI 1.07–1.10; P < 0.0001), disability at discharge ( OR 1.04; 95% CI 1.02–1.06; P = 0.0005) and 30‐day mortality (hazard ratio 1.07; 95% CI 1.05–1.08; P < 0.0001). The K aplan– M eier curves indicate that elevated WBC is associated with higher mortality after acute ischaemic stroke ( P = 0.001). Conclusions In patients with acute ischaemic stroke, higher WBC on admission is an independent predictor of stroke severity on admission, greater degree of disability at discharge and 30‐day mortality. These results reinforce the need for further studies focused on immunomodulation therapy targeting inflammatory response following acute ischaemic stroke.