Ilaria Maestrini1, Daniel Strbian1, Sophie Gautier1, Elena Haapaniemi1, Solène Moulin1, Tiina Sairanen1, Nelly Dequatre-Ponchelle1, Gerli Sibolt1, Charlotte Cordonnier1, Susanna Melkas1, Didier Leys2, Turgut Tatlisumak1, Régis Bordet1. 1. From the Departments of Neurology (I.M., S.G., S. Moulin, N.D.-P., C.C., D.L., R.B.) and Pharmacology (S. Moulin, N.D.-P., C.C., D.L.), INSERM U 1171, University of Lille, UDSL; CHU Lille (S.G., R.B.), France; "Sapienza" University of Rome (I.M.), Italy; and the Department of Neurology (D.S., E.H., T.S., G.S., S. Melkas, T.T.), Helsinki University Central Hospital, Finland. 2. From the Departments of Neurology (I.M., S.G., S. Moulin, N.D.-P., C.C., D.L., R.B.) and Pharmacology (S. Moulin, N.D.-P., C.C., D.L.), INSERM U 1171, University of Lille, UDSL; CHU Lille (S.G., R.B.), France; "Sapienza" University of Rome (I.M.), Italy; and the Department of Neurology (D.S., E.H., T.S., G.S., S. Melkas, T.T.), Helsinki University Central Hospital, Finland. didier.leys@univ-lille2.fr.
Abstract
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.
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.
Authors: D Strbian; A Meretoja; F J Ahlhelm; J Pitkäniemi; P Lyrer; M Kaste; S Engelter; T Tatlisumak Journal: Neurology Date: 2012-02-07 Impact factor: 9.910
Authors: D Strbian; T Sairanen; A Meretoja; J Pitkäniemi; J Putaala; O Salonen; H Silvennoinen; M Kaste; T Tatlisumak Journal: Neurology Date: 2011-06-29 Impact factor: 9.910
Authors: Daniel Strbian; Stefan Engelter; Patrik Michel; Atte Meretoja; Lucka Sekoranja; Frank J Ahlhelm; Satu Mustanoja; Igor Kuzmanovic; Tiina Sairanen; Nina Forss; Maria Cordier; Philippe Lyrer; Markku Kaste; Turgut Tatlisumak Journal: Ann Neurol Date: 2012-05 Impact factor: 10.422
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Authors: Grant C O'Connell; Madison B Treadway; Connie S Tennant; Noelle Lucke-Wold; Paul D Chantler; Taura L Barr Journal: Transl Stroke Res Date: 2018-03-17 Impact factor: 6.829
Authors: Yvonne Couch; Naveed Akbar; Simon Davis; Roman Fischer; Alex M Dickens; Ain A Neuhaus; Annette I Burgess; Peter M Rothwell; Alastair M Buchan Journal: Stroke Date: 2017-05-23 Impact factor: 7.914