Dataset Information

Combined utility of white blood cell count and blood glucose for predicting in-hospital outcomes in acute ischemic stroke.

ABSTRACT:

Background

High white blood cell (WBC) count and high blood glucose level are risk factors for mortality and pneumonia after acute ischemic stroke (AIS). We investigated the combined effect of high WBC count and high blood glucose level on hospital admission and in-hospital mortality and pneumonia in acute AIS patients.

Methods

A total of 3124 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included in the present study. We divided patients into four groups according to their level of WBC count and blood glucose: NWNG (normal WBC count and normal glucose), NWHG (normal WBC count and higher glucose), HWNG (higher WBC count and normal glucose), and HWHG (higher WBC count and higher glucose). Cox proportional hazard model and logistic regression model were used to estimate the combined effect of WBC count and blood glucose on all-cause in-hospital mortality and pneumonia in AIS patients.

Results

HWHG was associated with a 2.22-fold increase in the risk of in-hospital mortality in comparison to NWNG (adjusted hazard ratio [HR] 2.22; 95% confidence interval [CI], 1.21-4.07; P trend = 0.003). The risk of pneumonia was significantly higher in patients with HWHG compared to those with NWNG (adjusted odds ratio [OR] 2.61; 95% CI, 1.66-4.10; P trend < 0.001). The C-statistic for the combined WBC count and blood glucose was higher than WBC count or blood glucose alone for prediction of in-hospital mortality and pneumonia (all p < 0.01).

Conclusions

High WBC count combined with high blood glucose level at admission was independently associated with in-hospital mortality and pneumonia in AIS patients. Moreover, the combination of WBC count and blood glucose level appeared to be a better predictor than WBC count or blood glucose alone.

SUBMITTER: You S

PROVIDER: S-EPMC6375165 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Publications

Combined utility of white blood cell count and blood glucose for predicting in-hospital outcomes in acute ischemic stroke.

You Shoujiang S Ou Zhijie Z Zhang Wei W Zheng Danni D Zhong Chongke C Dong Xiaofeng X Qiu Chenhong C Lu Taosheng T Cao Yongjun Y Liu Chun-Feng CF

Journal of neuroinflammation 20190214 1

<h4>Background</h4>High white blood cell (WBC) count and high blood glucose level are risk factors for mortality and pneumonia after acute ischemic stroke (AIS). We investigated the combined effect of high WBC count and high blood glucose level on hospital admission and in-hospital mortality and pneumonia in acute AIS patients.<h4>Methods</h4>A total of 3124 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included in the present study. We divided pati ...[more]

PMID: 30764852

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Project description:IntroductionHigher 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.MethodsWAKE-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.ResultsOf 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).ConclusionHigher 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.Trial registrationClinicalTrials.gov Identifier: NCT01525290.

Project description:BackgroundWhite matter hyperintensity (WMH) and brain atrophy, as imaging marker of cerebral small-vessel diseases (CSVD), have a high prevalence and strong prognostic value in stroke. We aimed to explore the association between lymphocyte count, a maker of inflammation, and WMH and brain atrophy in patients with acute ischemic stroke (AIS).MethodsA total of 727 AIS patients with lymphocyte count and brain magnetic resonance imaging data were enrolled. Participants were divided into four groups according to the quartiles of baseline lymphocyte counts. WMH is frequently divided into periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH). WMH was defined as Fazekas scale score ≥ 3; PVH was defined as periventricular Fazekas scale ≥2; DWMH was defined as deep Fazekas scale ≥2. Brain atrophy was defined as global cortical atrophy score ≥ 1. Multivariable logistic regression models were used to assess the association between lymphocyte count and WMH and brain atrophy.ResultsAmong 727 AIS, 517 (71.1%), 442 (60.8%), 459 (63.1%), 583 (80.2%) had WMH, PVH, DWMH and brain atrophy, respectively. After adjustment for potential covariates, the highest quartiles of lymphocyte counts were significantly associated with lower risk of WMH (adjusted odds ratio [aOR] 0.57, 95% confidence intervals [CI] 0.32-0.99), PVH (aOR 0.52, 95% CI 0.31-0.87), DWMH (aOR 0.53 95% CI 0.32-0.90) as well as brain atrophy (aOR 0.46, 95% CI 0.23-0.92) compared with the lowest quartiles of lymphocyte counts, respectively. Furthermore, a notable inverse association was observed between continuous lymphocyte counts and WMH, PVH, DWMH, and brain atrophy. Additionally, we found that the inverse association between baseline lymphocyte count and WMH was significant only in individuals with mild stroke.ConclusionIn patients with AIS, there was an independent and inverse association between the baseline lymphocyte count and both WMH and brain atrophy.

Dataset Information

Combined utility of white blood cell count and blood glucose for predicting in-hospital outcomes in acute ischemic stroke.

Background

Methods

Results

Conclusions

Publications

Combined utility of white blood cell count and blood glucose for predicting in-hospital outcomes in acute ischemic stroke.

Similar Datasets

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