Please use this identifier to cite or link to this item:
Title: Association of White Blood Cell Count With Clinical Outcome Independent of Treatment With Alteplase in Acute Ischemic Stroke.
Austin Authors: Barow, Ewgenia;Quandt, Fanny;Cheng, Bastian;Gelderblom, Mathias;Jensen, Märit;Königsberg, Alina;Boutitie, Florent;Nighoghossian, Norbert;Ebinger, Martin;Endres, Matthias;Fiebach, Jochen B;Thijs, Vincent N ;Lemmens, Robin;Muir, Keith W;Pedraza, Salvador;Simonsen, Claus Z;Gerloff, Christian;Thomalla, Götz
Affiliation: Neurology
Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany..
The Florey Institute of Neuroscience and Mental Health
Hospices Civils de Lyon, Service de Biostatistique, Lyon, France..
Department of Stroke Medicine, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France..
Centrum für Schlaganfallforschung Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany..
Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany..
Department of Neurology, University Hospitals Leuven, Leuven, Belgium..
Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, United Kingdom..
Department of Radiology, Institut de Diagnostic per la Image (IDI), Girona, Spain..
Department of Neurology, Aarhus University Hospital, Aarhus, Denmark..
Université Lyon 1, Villeurbanne, France..
Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France..
Medical Park Berlin Humboldtmühle, Klinik für Neurologie, Berlin, Germany..
German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen), Berlin, Germany..
German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Berlin, Germany..
Department of Neurosciences, Experimental Neurology, University of Leuven, Leuven, Belgium..
Laboratory of Neurobiology, Center for Brain & Disease Research, Leuven, Belgium..
Issue Date: 13-Jun-2022
Date: 2022
Publication information: Frontiers in neurology 2022; 13: 877367
Abstract: Higher white blood cell (WBC) count is associated with poor functional outcome in acute ischemic stroke (AIS). However, little is known about whether the association is modified by treatment with intravenous alteplase. WAKE-UP was a randomized controlled trial of the efficacy and safety of magnetic resonance imaging [MRI]-based thrombolysis in unknown onset stroke. WBC count was measured on admission and again at 22-36 h after randomization to treatment (follow-up). Favorable outcome was defined by a score of 0 or 1 on the modified Rankin scale (mRS) 90 days after stroke. Further outcome were stroke volume and any hemorrhagic transformation (HT) that were assessed on follow-up CT or MRI. Multiple logistic regression analysis was used to assess the association between outcome and WBC count and treatment group. Of 503 randomized patients, WBC count and baseline parameters were available in 437 patients (μ = 64.7 years, 35.2% women) on admission and 355 patients (μ = 65.1 years, 34.1% women) on follow-up. Median WBC count on admission was 7.6 × 109/L (interquartile range, IQR, 6.1-9.4 × 109/L) and 8.2 × 109/L (IQR, 6.7-9.7 × 109/L) on follow-up. Higher WBC count both on admission and follow-up was associated with lower odds of favorable outcome, adjusted for age, National Institutes of Health (NIH) Stroke Scale Score, temperature, and treatment (alteplase vs. placebo, adjusted odds ratio, aOR 0.85, 95% confidence interval [CI] 0.78-0.94 and aOR 0.88, 95% CI 0.79-0.97). No interaction between WBC count and treatment group was observed (p = 0.11). Furthermore, WBC count on admission and follow-up was significantly associated with HT (aOR 1.14, 95% CI 1.05-1.24 and aOR 1.13, 95% CI 1.00-1.26). Finally, WBC count on follow-up was associated with larger stroke volume (aOR 2.57, 95% CI 1.08-6.07). Higher WBC count is associated with unfavorable outcome, an increased risk of HT, and larger stroke volume, independent of treatment with alteplase. Whether immunomodulatory manipulation of WBC count improves stroke outcome needs to be tested. Identifier: NCT01525290.
DOI: 10.3389/fneur.2022.877367
ORCID: 0000-0002-6614-8417
Journal: Frontiers in neurology
PubMed URL: 35769368
PubMed URL:
ISSN: 1664-2295
Type: Journal Article
Subjects: WAKE-UP
clinical outcome
ischemic stroke
treatment effect
white blood cell count (WBC)
Appears in Collections:Journal articles

Show full item record

Page view(s)

checked on May 28, 2024

Google ScholarTM


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.