High natural killer cell number might identify stroke patients at risk of developing infections.
OBJECTIVE
To investigate early changes in leukocyte subsets and autonomic function as predictors of the development of poststroke infections.


METHODS
We assessed the time course of leukocyte subsets in the blood of 59 patients with acute ischemic stroke. We divided the patients into 2 groups: those who developed infections during the first 7 days after stroke onset and those who did not. We measured urinary norepinephrine and epinephrine concentrations and pulse rate variability indices within 24 hours of admission.


RESULTS
We found that the number of circulating natural killer (NK) cells within the first hours after stroke was higher in stroke patients who developed infections (mean 435 cells/mL; 95% confidence interval [CI] 321-588) than in stroke patients who did not develop infections (mean 236 cells/mL; 95% CI 186-300; p = 0.001). This was followed by a decrease in all lymphocyte subsets from admission to day 1, varying between 22% and 40%, which was not seen in patients without poststroke infection (mean increase varied between 2% and 23%; all p < 0.005). In the group that developed infections, pulse rate variability revealed a decreased high frequency component. These findings all remained significant after adjustment for age and stroke volume.


CONCLUSIONS
High circulating NK cell count within the first hours after ischemic stroke onset followed by a drop in all lymphocyte subsets identified patients who developed infections and may be caused by a sympathovagal imbalance with sympathetic overweight. These findings need to be validated in larger studies.
Departments of Neurology (S.D.R., A.D.V., J.D.K.), Radiology (A.-M.V.B.), Hematology (M.D.W.), and Biostatistics and Medical Informatics (D.C., R.B.), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium; and Department of Neurology (J.D.K.), Universitair Medisch Centrum Groningen, the Netherlands.
Sylvie
S
De Raedt
Departments of Neurology (S.D.R., A.D.V., J.D.K.), Radiology (A.-M.V.B.), Hematology (M.D.W.), and Biostatistics and Medical Informatics (D.C., R.B.), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium; and Department of Neurology (J.D.K.), Universitair Medisch Centrum Groningen, the Netherlands.
Aurelie
A
De Vos
Departments of Neurology (S.D.R., A.D.V., J.D.K.), Radiology (A.-M.V.B.), Hematology (M.D.W.), and Biostatistics and Medical Informatics (D.C., R.B.), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium; and Department of Neurology (J.D.K.), Universitair Medisch Centrum Groningen, the Netherlands.
Anne-Marie
AM
Van Binst
Departments of Neurology (S.D.R., A.D.V., J.D.K.), Radiology (A.-M.V.B.), Hematology (M.D.W.), and Biostatistics and Medical Informatics (D.C., R.B.), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium; and Department of Neurology (J.D.K.), Universitair Medisch Centrum Groningen, the Netherlands.
Marc
M
De Waele
Departments of Neurology (S.D.R., A.D.V., J.D.K.), Radiology (A.-M.V.B.), Hematology (M.D.W.), and Biostatistics and Medical Informatics (D.C., R.B.), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium; and Department of Neurology (J.D.K.), Universitair Medisch Centrum Groningen, the Netherlands.
Danny
D
Coomans
Departments of Neurology (S.D.R., A.D.V., J.D.K.), Radiology (A.-M.V.B.), Hematology (M.D.W.), and Biostatistics and Medical Informatics (D.C., R.B.), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium; and Department of Neurology (J.D.K.), Universitair Medisch Centrum Groningen, the Netherlands.
Ronald
R
Buyl
Departments of Neurology (S.D.R., A.D.V., J.D.K.), Radiology (A.-M.V.B.), Hematology (M.D.W.), and Biostatistics and Medical Informatics (D.C., R.B.), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium; and Department of Neurology (J.D.K.), Universitair Medisch Centrum Groningen, the Netherlands.
Jacques
J
De Keyser