AUTHOR=Vo Thao Phuong , Kristiansen Marie Hvelplund , Hasselbalch Hans Carl , Wienecke Troels 

TITLE=Elevated white blood cell counts in ischemic stroke patients are associated with increased mortality and new vascular events

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1232557

DOI=10.3389/fneur.2023.1232557

ISSN=1664-2295

ABSTRACT=Background and Purpose
High levels of White Blood Cells (WBC) in ischemic stroke have shown to increase the risk of new vascular events and mortality in short and intermediate follow-up studies, but long-term effects remain unknown. We studied whether elevated levels of WBC in ischemic stroke patients are associated with new vascular events and mortality in a 10-year follow-up period. 

Methods 
We included ischemic stroke patients hospitalized between 2011 and 2012, categorizing their WBC counts within 48 hours of stroke onset as high or normal (3.5- 8.8 x 109 mmol/L; > 8.8 x 109 mmol/L). Using Aahlen Johansen and Cox Proportional Hazard models with competing risk, we analyzed the association between WBC levels and new vascular events. Kaplan Meier and standard Cox Proportional Hazard models were used to assess the risk of all-cause mortality.


Results 
Among 395 patients (median age 69, [IQR: 63, 78], female 38,0 %), 38.5% had elevated WBC at admission. During the 10-year follow-up, 113 vascular events occurred, with 46% in patients with elevated WBC and 54% in patients with normal WBC. After adjusting for relevant factors, elevated WBC levels were independently associated with increased risk of new vascular events (HR: 1.61, CI: 1.09-2.39 P<0.05) and death (HR: 1.55, CI: 1.15-2.09, P<0.05). 

Conclusion 
Elevated WBC levels in ischemic stroke patients are linked to higher risk of new vascular event and mortality. Thus, ischemic stroke patients with elevated WBC without clinical infection needs special attention to investigate possible underlying conditions to prevent future vascular events and reduce mortality.