4.6 Article

Leukocyte indicators and variations predict worse outcomes after intravenous thrombolysis in patients with acute ischemic stroke

Journal

JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM
Volume 43, Issue 3, Pages 393-403

Publisher

SAGE PUBLICATIONS INC
DOI: 10.1177/0271678X221142694

Keywords

Functional outcomes; hemorrhagic transformation; intravenous thrombolysis; leukocytes; stroke

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This study shows that leukocytes, especially leukocyte count, neutrophil count, and the NLR, are independently associated with hemorrhagic transformation (HT) and functional outcomes in stroke patients.
Leukocytes are systematic inflammation indicators related to stroke prognosis and can exhibit large dynamic waves before and after recombinant tissue plasminogen activator (r-tPA) therapy. However, additional evidence is needed to determine the prognostic significance of various leukocytes including both static and dynamic data among patients who underwent r-tPA therapy. A total of 251 patients treated with r-tPA were included; their leukocyte data were collected at two time points, and patients were followed up for three months. Analysis revealed the following findings. (i) Patients with hemorrhagic transformation (HT) and unfavorable outcomes had a higher level of leukocytes after r-tPA therapy (leukocyte count (adjusted OR (aOR) 1.191 for HT and 1.184 for unfavorable outcomes), neutrophil count (aOR 1.215 and 1.214), neutrophil-to-lymphocyte ratio (NLR; aOR 1.084 and 1.091)) and larger dynamic leukocyte changes. (ii)Among all leukocytes, the NLR after r-tPA administration demonstrated the strongest correlation with HT and unfavorable outcomes. (iii) Patients with an NLR >= 3.322 had a 3.492-fold increased risk for HT, and those with an NLR >= 5.511 had a 3.024-fold increased risk for functional outcomes. Overall, this study shows that leukocytes, especially leukocyte count, neutrophil count and the NLR, are independently associated with HT and functional outcomes in stroke patients.

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