Leukocyte subtypes and adverse clinical outcomes in patients with acute ischemic cerebrovascular events

Anxin Wang; Kehua Quan; Xue Tian; Yingting Zuo; Xia Meng; Pan Chen; Hao Li; Yongjun Wang

doi:10.21037/atm-20-7931

Leukocyte subtypes and adverse clinical outcomes in patients with acute ischemic cerebrovascular events

Ann Transl Med. 2021 May;9(9):748. doi: 10.21037/atm-20-7931.

Authors

Anxin Wang^{1

2}, Kehua Quan^{1

2}, Xue Tian^{1

2}, Yingting Zuo^{1

2}, Xia Meng^{1

2}, Pan Chen^{1

2}, Hao Li^{1

2}, Yongjun Wang^{1

2}

Affiliations

¹ China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Abstract

Background: Our study aimed to evaluate whether the effects on adverse clinical outcomes, defined as death, recurrent stroke, and poor functional outcomes, differed by leukocyte subtype in patients with acute ischemic cerebrovascular events, including both ischemic stroke and transient ischemic attack (TIA).

Methods: We derived data from the Third China National Stroke Registry (CNSR-III). The counts and percentages of each leukocyte subtype were collected within the first 24 hours after admission. Enrolled patients were classified into four groups by the quartiles of each leukocyte subtype count or percentage. Hazard ratios (HRs) or odds ratios (ORs) and their 95% confidence intervals (CIs) of adverse clinical outcomes were calculated, with the lowest quartile group as the reference category. We used C statistics, integrated discrimination improvement (IDI), and the net reclassification index (NRI) to evaluate each leukocyte subtype's incremental predictive value beyond conventional risk factors.

Results: A total of 14,174 patients were enrolled. Higher counts of leukocytes, neutrophils, and monocytes were associated with elevated risks of adverse clinical outcomes. In contrast, higher counts of lymphocytes and eosinophils were related to reduced risks of adverse clinical outcomes. Meanwhile, basophil counts seemed to not correlate with adverse clinical outcomes. Furthermore, there were also significant associations between the percentages of leukocyte subtypes and adverse clinical outcomes.

Conclusions: Leukocyte subtypes had different relationships with adverse clinical outcomes at 3-month and 1-year follow-up in patients with acute ischemic cerebrovascular events and could slightly increase the predictive value compared with the conventional model.

Keywords: Leukocyte; ischemic stroke; outcome; transient ischemic attack (TIA).