Persistent Leukocytosis: A Persistent Problem for Stroke Patients (P06.229)

Abstract

Objective: To determine the clinical significance of persistent versus transient leukocytosis in acute ischemic stroke (AIS). Background Transient but significant elevation in white cell counts have been described after status epilepticus, head trauma, and spinal cord injury, independent of steroid administration or infection.Leukocytosis may be secondary to alpha adrenergic stimuli, endogenous corticosteroid increase, or a combination of the two. Design/Methods: Patients who presented with AIS to our center within 48hrs of symptom onset between 7/2008 and 6/2010 were retrospectively identified by chart review. Patients were included if they had leukocytosis on admission (defined as WBC count >11,000/μl based on laboratory reference range). Demographics, NIHSS scores, leukocyte counts, length of stay (LOS), disposition, and good functional outcome (mRS 0-2) were compared in patients with persistent (still elevated 48hrs after admission) vs. transient (resolved Results: Of the 438 patients screened, 49 had leukocytosis on admission; (mean age 61.5, median admission NIHSS 9, mean LOS 8.5 days, and median discharge mRS 3). 24 (49%) had persistent leukocytosis. When compared to patients with transient leukocytosis, baseline NIHSS was significantly higher in the persistent leukocytosis group (p=0.0476), and the mean LOS was significantly longer (p=0.044). More people with transient leukocytosis had a good functional outcome (44% vs 16%, p=0.006). After adjusting for NIHSS, persistent leukocytosis was not an independent predictor of good functional outcome (OR=2.5, 95%CI 0.562-10.7, p=0.2322). NIHSS correlated significantly with persistence of leukocytosis (r=0.306, p=0.0044). Conclusions: Persistent leukocytosis, present in half of patients with AIS, is associated with higher baseline NIHSS scores, longer LOS, and poorer functional outcomes. Persistent leukocytosis is tightly linked with baseline stroke severity and may serve as a predictor of poor patient outcomes the setting of AIS. Disclosure: Dr. Boehme has nothing to disclose. Dr. Kumar has nothing to disclose. Dr. Gillette has received research support from the Infectious Disease Society of America. Dr. Siegler has nothing to disclose. Dr. Albright has nothing to disclose. Dr. Martin-Schild has nothing to disclose.