Neutrophil Count is an Accurate Differential Diagnostic Biomarker in Stroke Versus Transient Ischemic Attack

Abstract

BACKGROUNDDifferential diagnosis of transient ischemic attack (TIA) versus acute ischemic stroke (AIS) is difficult, and neuroimaging with magnetic resonance imaging (MRI) is the only definitive method to confirm AIS. In a typical stoke page imaging protocol, patients initially receive a non‐contrast computed tomography (CT) scan to potentially confirm the presence of infarct, but more importantly, to rule out intracranial hemorrhage in order to administer tissue plasminogen activator (tPA). While this CT is rapid and appropriate for tPA decision‐making, approximately 60–70 percent of AIS cases, later confirmed with MRI, are initially CT‐negative. Further, it is even more difficult to differentiate mild AIS (National Institute of Health Stroke Scale < 5) from TIA, and the decision whether to treat mild AIS with tPA is currently controversial, making this differential diagnosis even more critical. Thus, the objective of this study was to determine if neutrophil count could assist in the accurate differential diagnosis of TIA versus mild AIS.METHODSWe performed a retrospective chart review of a random sample of 100 patients discharged from a local hospital with a discharge diagnosis of TIA. From the initial sample of 100 patients, 54 met inclusion criteria for this study. In addition, we matched a sample of 54 mild AIS patients and 54 control subjects for comparison. An independent samples T test was used to detect mean differences in neutrophil count, and logistic regression to determine the odds ratios for differential diagnosis.RESULTSUpon admission, neutrophil count is significantly higher in mild AIS (6.52 ±0.34 × 103 cells/uL) compared to TIA (5.35 ±0.26 × 103 cells/uL) (p =.042). Further, at a specificity of 82 percent, mild AIS patients are 3.1 times more likely to have a neutrophil count >6.52 compared to TIA (p=.021).CONCLUSIONSNeutrophil count is a simple, easy to interpret biomarker that can differentiate stroke from TIA with greater accuracy than CT scan. As such, neutrophil count may be used to assist in the decision to administer tPA to mild AIS.Support or Funding InformationNo funding was received for this project.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.