Association of White Blood Cell Count With Clinical Outcome Independent of Treatment With Alteplase in Acute Ischemic Stroke.

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 × 10 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. ClinicalTrials.gov Identifier: NCT01525290.

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Copyright © 2022 Barow, Quandt, Cheng, Gelderblom, Jensen, Königsberg, Boutitie, Nighoghossian, Ebinger, Endres, Fiebach, Thijs, Lemmens, Muir, Pedraza, Simonsen, Gerloff and Thomalla.

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EB, BC, AK, FB, NN, MEb, MEn, JF, VT, RL, KM, SP, CS, CG, and GT report grants from European Union 7th Framework Program during the conduct of the study. MEn reports grants from Bayer and fees paid to the Charité from AstraZeneca, Bayer, Boehringer Ingelheim, BMS, Daiichi Sankyo, Amgen, GSK, Sanofi, Covidien, Novartis, Pfizer and funding from DFG under Germany's Excellence Strategy – EXC-2049 – 390688087, BMBF, DZNE, DZHK, EU, Corona Foundation, and Fondation Leducq, all outside the submitted work. JF reports personal fees from Abbvie, AC Immune, Artemida, Bioclinica/Clairo, Biogen, BMS, Brainomic, Daiichi-Sankyo, Eisai, F.Hoffmann-La Roche AG, Eli Lilly, Guerbet, Ionis Pharmaceuticals, IQVIA, Janssen, Julius Clinical, Jung Diagnostics, Lysogene, Premier Research and Tau Rx, all outside the submitted work. CS reports grants from Novo Nordisk Foundation and Health Research Foundation of Central Denmark Region outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.