The Lymphocyte Depletion in Patients with Acute Ischemic Stroke Associated with Poor Neurologic Outcome

Overview

Journal Int J Gen Med

Publisher Dove Medical Press

Specialty General Medicine

Date 2021 May 21

PMID 34017192

Citations 14

Authors

Cep Juli

Henhen Heryaman

Arnengsih Nazir

Eng-Tat Ang

Irma Ruslina Defi

Uni Gamayani

Nur Atik

Affiliations

Soon will be listed here.

Abstract

Purpose: Inflammation plays an important role and is involved in all stages of acute ischemic stroke. One of these stages involves the recruitment of leukocytes from the peripheral circulation into the ischemic tissue. Lymphocytes as a subtype of leukocytes are important mediators and can become a predictor of neurological outcome. Several studies have been conducted regarding the correlation between differential lymphocyte counts and acute ischemic stroke. Most of these studies analyzed lymphocyte ratio to other leukocyte subtypes such as neutrophils and monocytes. This study specifically observed the role of lymphocytes as an indicator of the inflammatory response in patients with acute ischemic stroke. This study aimed to observe the correlation among risk factors, infarct location, leukocyte counts, lymphocyte value and neurologic output in acute ischemic stroke patients.

Patients And Methods: We observed and analyzed 193 patients' data from medical record which met the inclusion and exclusion criteria with a diagnosis of acute ischemic stroke at the Department of Neurology of Dr. Hasan Sadikin General Bandung. Data were then analysed using appropriate statistical tests.

Results: Most patients have more than one risk factor with a leukocyte count of less than 10,000 cell/mm. Infarct was mostly located in subcortical area (basal ganglia), with moderate average NIHSS values at admission and at discharge. The number of lymphocytes decreased in the subject group with more than 10,000 cell/mm leukocytes. Subsequently, data were analyzed using Spearman's test and there was a correlation between NIHSS on admission and lymphocyte depletion.

Conclusion: The lymphocyte depletion in patients with leukocytosis is a predictor of poor NIHSS.

Citing Articles

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Data-Driven Analysis Reveals Cortical Infarction Patterns Correlated With Inflammation and Prognosis: A Retrospective, Multicenter Cohort Study.

Wang W, Ding L, Zhang M.Eng Q, Jing J, Jiang Y, Meng X J Am Heart Assoc. 2024; 13(12):e033616.

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References

Meder G, Switonska M, Pleszka P, Palacz-Duda V, Dzianott-Pabijan D, Sokal P . Endovascular Treatment of Stroke Caused by Carotid Artery Dissection. Brain Sci. 2020; 10(11). PMC: 7692463. DOI: 10.3390/brainsci10110800. View

Raggi P, Genest J, Giles J, Rayner K, Dwivedi G, Beanlands R . Role of inflammation in the pathogenesis of atherosclerosis and therapeutic interventions. Atherosclerosis. 2018; 276:98-108. DOI: 10.1016/j.atherosclerosis.2018.07.014. View

Renna N, de Las Heras N, Miatello R . Pathophysiology of vascular remodeling in hypertension. Int J Hypertens. 2013; 2013:808353. PMC: 3736482. DOI: 10.1155/2013/808353. View

Halkes P, Kappelle L, van Gijn J, van Wijk I, Koudstaal P, Algra A . Large subcortical infarcts: clinical features, risk factors, and long-term prognosis compared with cortical and small deep infarcts. Stroke. 2006; 37(7):1828-32. DOI: 10.1161/01.STR.0000226993.88307.ff. View

Kwakkel G, Veerbeek J, van Wegen E, Nijland R, Harmeling-van der Wel B, Dippel D . Predictive value of the NIHSS for ADL outcome after ischemic hemispheric stroke: does timing of early assessment matter?. J Neurol Sci. 2010; 294(1-2):57-61. DOI: 10.1016/j.jns.2010.04.004. View

Vila N, Castillo J, Davalos A, Esteve A, Planas A, Chamorro A . Levels of anti-inflammatory cytokines and neurological worsening in acute ischemic stroke. Stroke. 2003; 34(3):671-5. DOI: 10.1161/01.STR.0000057976.53301.69. View

Arboix A, AliO J . Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis. Curr Cardiol Rev. 2011; 6(3):150-61. PMC: 2994107. DOI: 10.2174/157340310791658730. View

Powers W, Rabinstein A, Ackerson T, Adeoye O, Bambakidis N, Becker K . 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018; 49(3):e46-e110. DOI: 10.1161/STR.0000000000000158. View

Maestrini I, Strbian D, Gautier S, Haapaniemi E, Moulin S, Sairanen T . Higher neutrophil counts before thrombolysis for cerebral ischemia predict worse outcomes. Neurology. 2015; 85(16):1408-16. PMC: 4626239. DOI: 10.1212/WNL.0000000000002029. View

10.

Sacco R, Kasner S, Broderick J, Caplan L, Connors J, Culebras A . An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013; 44(7):2064-89. PMC: 11078537. DOI: 10.1161/STR.0b013e318296aeca. View

11.

Switonska M, Piekus-Slomka N, Slomka A, Sokal P, Zekanowska E, Lattanzi S . Neutrophil-to-Lymphocyte Ratio and Symptomatic Hemorrhagic Transformation in Ischemic Stroke Patients Undergoing Revascularization. Brain Sci. 2020; 10(11). PMC: 7690817. DOI: 10.3390/brainsci10110771. View

12.

Virella G, Lopes-Virella M . The role of the immune system in the pathogenesis of diabetic complications. Front Endocrinol (Lausanne). 2014; 5:126. PMC: 4115589. DOI: 10.3389/fendo.2014.00126. View

13.

Siniscalchi A, Gallelli L, Malferrari G, Pirritano D, Serra R, Santangelo E . Cerebral stroke injury: the role of cytokines and brain inflammation. J Basic Clin Physiol Pharmacol. 2014; 25(2):131-7. DOI: 10.1515/jbcpp-2013-0121. View

14.

Yaghi S, Elkind M . Lipids and Cerebrovascular Disease: Research and Practice. Stroke. 2015; 46(11):3322-8. PMC: 4624572. DOI: 10.1161/STROKEAHA.115.011164. View

15.

Watson J, Jones H, Banks J, Whiting P, Salisbury C, Hamilton W . Use of multiple inflammatory marker tests in primary care: using Clinical Practice Research Datalink to evaluate accuracy. Br J Gen Pract. 2019; 69(684):e462-e469. PMC: 6582449. DOI: 10.3399/bjgp19X704309. View

16.

Wang Z, He D, Zeng Y, Zhu L, Yang C, Lu Y . The spleen may be an important target of stem cell therapy for stroke. J Neuroinflammation. 2019; 16(1):20. PMC: 6352449. DOI: 10.1186/s12974-019-1400-0. View

17.

Ren H, Liu X, Wang L, Gao Y . Lymphocyte-to-Monocyte Ratio: A Novel Predictor of the Prognosis of Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2017; 26(11):2595-2602. DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.019. View

18.

Adams Jr H, Biller J . Classification of subtypes of ischemic stroke: history of the trial of org 10172 in acute stroke treatment classification. Stroke. 2015; 46(5):e114-7. DOI: 10.1161/STROKEAHA.114.007773. View

19.

Wilck N, Ludwig A . Targeting the ubiquitin-proteasome system in atherosclerosis: status quo, challenges, and perspectives. Antioxid Redox Signal. 2014; 21(17):2344-63. DOI: 10.1089/ars.2013.5805. View

20.

Vila N, Castillo J, Davalos A, Chamorro A . Proinflammatory cytokines and early neurological worsening in ischemic stroke. Stroke. 2000; 31(10):2325-9. DOI: 10.1161/01.str.31.10.2325. View