title: Early neutrophilia is associated with volume of ischemic tissue in acute stroke.
abstract: OBJECTIVE
  Few data exist on the relationship between differential subpopulations of peripheral leukocytes and early cerebral infarct size in ischemic stroke. Using diffusion-weighted MR imaging (DWI), we assessed the relationship of early total and differential peripheral leukocyte counts and volume of ischemic tissue in acute stroke.
  
  
  METHODS
  All included patents had laboratory investigations and neuroimaging collected within 24 hours of stroke onset. Total peripheral leukocyte counts and differential counts were analyzed individually and by quartiles. DWI lesions were outlined using a semiautomated threshold technique. The relationship between leukocyte quartiles and DWI infarct volumes was examined using multivariate quartile regression.
  
  
  RESULTS
  173 patients met study inclusion criteria. Median age was 73 years. Total leukocyte counts and DWI volumes showed a strong correlation (Spearman rho=0.371, P<000.1). Median DWI volumes (mL) for successive neutrophil quartiles were: 1.3, 1.3, 3.2, and 20.4 (P for trend <0.001). Median DWI volumes (mL) for successive lymphocyte quartiles were: 3.2, 8.1, 1.3, and 1.5 (P=0.004). After multivariate analysis, larger DWI volume remained strongly associated with higher total leukocyte and neutrophil counts (both probability values <0.001), but not with lymphocyte count (P=0.4971). Compared with the lowest quartiles, DWI volumes were 8.7 mL and 12.9 mL larger in the highest quartiles of leukocyte and neutrophil counts, respectively.
  
  
  CONCLUSIONS
  Higher peripheral leukocyte and neutrophil counts, but not lymphocyte counts, are associated with larger infarct volumes in acute ischemic stroke. Attenuating neutrophilic response early after ischemic stroke may be a viable therapeutic strategy and warrants further study.
authors.affiliation: Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. brianhbuck@gmail.com
authors.forename: Brian H
authors.initials: BH
authors.lastname: Buck
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.forename: Oh Young
authors.initials: OY
authors.lastname: Bang
authors.forename: Susan W
authors.initials: SW
authors.lastname: Yun
authors.forename: Sidney
authors.initials: S
authors.lastname: Starkman
authors.forename: Latisha K
authors.initials: LK
authors.lastname: Ali
authors.forename: Doojin
authors.initials: D
authors.lastname: Kim
authors.forename: J Pablo
authors.initials: JP
authors.lastname: Villablanca
authors.forename: Noriko
authors.initials: N
authors.lastname: Salamon
authors.forename: Tannaz
authors.initials: T
authors.lastname: Razinia
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000276:immunology / Q000473:pathology*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D007964:Leukocytosis / Q000473:pathology*; D008214:Lymphocytes / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils / Q000473:pathology*; D020521:Stroke / Q000276:immunology / Q000473:pathology*