Thrombolysis in stroke patients with elevated inflammatory markers

Abstract

Objective To investigate the prognostic value of white blood cell count (WBC) on functional outcome, mortality and bleeding risk in stroke patients treated with intravenous thrombolysis (IVT). Methods In this prospective multicenter study from the TRISP registry, we assessed the association between WBC on admission and 3-month poor outcome (modified Rankin Scale 3–6), mortality and occurrence of symptomatic intracranial hemorrhage (sICH; ECASS-II-criteria) in IVT-treated stroke patients. WBC was used as continuous and categorical variable distinguishing leukocytosis (WBC > 10 × 109/l) and leukopenia (WBC < 4 × 109/l). We calculated unadjusted/ adjusted odds ratios with 95% confidence intervals (OR [95% CI]) with logistic regression models. In a subgroup, we analyzed the association of combined leukocytosis and elevated C-reactive protein (CRP > 10 mg/l) on outcomes. Results Of 10,813 IVT-treated patients, 2527 had leukocytosis, 112 leukopenia and 8174 normal WBC. Increasing WBC (by 1 × 109/l) predicted poor outcome (ORadjusted 1.04[1.02–1.06]) but not mortality and sICH. Leukocytosis was independently associated with poor outcome (ORadjusted 1.48[1.29–1.69]) and mortality (ORadjusted 1.60[1.35–1.89]) but not with sICH (ORadjusted 1.17[0.94–1.45]). Leukopenia did not predict any outcome. In a subgroup, combined leukocytosis and elevated CRP had the strongest association with poor outcome (ORadjusted 2.26[1.76–2.91]) and mortality (ORadjusted 2.43[1.86–3.16]) when compared to combined normal WBC and CRP. Conclusion In IVT-treated patients, leukocytosis independently predicted poor functional outcome and death. Bleeding complications after IVT were not independently associated with leukocytosis.

Effects of admission systemic inflammatory indicators on clinical outcomes in patients with vertebrobasilar artery occlusion: insight from the PERSIST registry

“…Therefore, they could better reflect the inflammatory status than a single inflammatory cell count. Previous studies in patients with ac-LVO suggested that leukocytes, neutrophils, and NLR were associated with 90 day prognosis regardless of whether patients received EVT 28 29. In our study, the results were consistent with the above results, suggesting that the association between inflammation indicators and prognosis did not change much in posterior circulation stroke.…”

IV Thrombolysis With or Without Endovascular Treatment for Suspected Ischemic Stroke in Patients With Intracranial Tumors

“…Except for the unexpectedly high rates of ICH after IVT in patients with tumors of the pituitary region, the rates of symptomatic ICH in the other patient groups with intracranial neoplasms (Table 5) seemed to be in the upper range of the rates of symptomatic ICH reported in other studies of patients with ischemic stroke within the TRISP cooperation ranging between 4% and 6%. [14][15][16] Due to the heterogeneity of imaging modalities and lack of availability of MRI for all patients, beyond the assessment of intratumoral hemorrhage, we did not differentiate whether any ICH after IVT occurred distant from the ischemic area, which were reported in 3% of patients, with approximately half of them classified as symptomatic ICH, in a cohort with MRI available. 17 However, although limited by the overall sample size, the relatively high rate of 4% fatal ICH after IVT in patients with meningioma is striking.…”

“…For patients with meningioma or intra-axial primary brain tumors, functional outcome was comparable with that of previous analysis within the TRISP cooperation (Table 5). [14][15][16]21 The strengths of our study include the multicenter approach with a detailed characterization of clinical and imaging data of stroke patients with intracranial tumors after IVT. Compared with previous reports, we present the analysis of a large cohort of patients that is commonly excluded from clinical trials related to IVT and that does not routinely receive IVT in clinical practice neither.…”

“…In our cohort, IVT for suspected ischemic stroke in patients with intracranial tumors including brain or leptomeningeal metastasis and nonglioblastoma primary brain tumors seemed to be relatively safe with frequencies of symptomatic ICH after IVT near the upper range of frequencies reported in previous studies of patients with ischemic stroke. [14][15][16] Still, fatality of ICH in patients with meningioma seemed to be considerable, although generalization may be limited by the overall sample size. Furthermore, caution is warranted using IVT for acute ischemic stroke in patients with tumors of the pituitary region, given the high rates of ICH observed in our cohort.…”

“…In previous studies, frequencies of symptomatic ICH were between 4% and 6% in patients receiving IVT for suspected ischemic stroke. [14][15][16] Frequencies of any ICH after IVT distant from the ischemic area without ICH in the ischemic area were observed in 3% of patients, with approximately half of them classified as symptomatic ICH, in a patient cohort with MRI available. 17 The aim of this multicenter registry-based study was to assess the frequencies of symptomatic and fatal ICH after IVT, functional outcome after IVT, and clinical and imaging characteristics in patients with intracranial tumors.…”