title: White blood cell count and clinical outcomes after intracerebral hemorrhage: The INTERACT2 trial.
abstract: BACKGROUND
  Increased inflammatory reaction can aggravate brain injury after acute intracerebral hemorrhage, but the clinical effect of such response is not fully understood. The aim of this study was to determine associations of peripheral white blood cell (WBC) count on clinical outcome among participants of the INTERACT2 study.
  
  
  METHODS
  INTERACT2 was a randomized controlled trial of early intensive (target systolic level<140 mm Hg) compared to guideline-recommended (target systolic level < 180 mm Hg) blood pressure (BP) lowering in 2839 patients with acute ICH (<6h) and elevated systolic BP (150-220 mm Hg). Blood samples were collected on admission and WBC count was measured at local laboratories. The primary outcome was death or major disability, defined by scores 3-6 on the modified Rankin Scale at 90 days. Secondary outcome was death at 90 days. Associations of baseline WBC count and outcomes were evaluated in logistic regression models. INTERACT2 is registered with http://www.clinicaltrials.gov NCT00716079.
  
  
  RESULTS
  There were 2630 participants with relevant data who were classified into quartiles of WBC counts (≤ 6.22, 6.24-7.89, 7.90-10.17, and ≥ 10.20 × 10(9)/L, respectively). Increased WBC count was associated with younger age, elevated body temperature, increased glucose level, stroke severity, larger baseline hematoma volume, and intraventricular extension. Risks of death or major disability at 90 days increased progressively with higher WBC count: frequencies of 49.9%, 52.0%, 52.3% and 58.1% for quartile groups, respectively (P=0.004 for trend). However, after adjustment for baseline clinical and imaging variables including age, sex, region, lipid lowering therapy, body temperature, glucose, systolic BP, heart rate, high NIHSS scores, volume and location of hematoma, intraventricular extension, time from onset to CT scan, and randomized treatment, the association between WBC count and primary outcome was no longer significant (P=0.426 for trend). Patients with increased WBC count had significantly higher risk of death (P=0.0003 for trend), but again the association was no longer significant after adjustment for baseline clinical and imaging variables.
  
  
  CONCLUSIONS
  Elevated WBC count on admission is not an independent prognostic variable in patients with acute ICH.
authors.affiliation: Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea; The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Sungwook
authors.initials: S
authors.lastname: Yu
authors.affiliation: The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.affiliation: The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Heeley
authors.affiliation: The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Candice
authors.initials: C
authors.lastname: Delcourt
authors.affiliation: Department of Neurology, Royal North Shore Hospital, St Leonards, University of Sydney, Sydney, Australia.
authors.forename: Martin
authors.initials: M
authors.lastname: Krause
authors.affiliation: Peking Union Medical College Hospital, Beijing, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Peng
authors.affiliation: The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia; Department of Neurology, Nanjing, Hospital affiliated to Nanjing Medical University, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.affiliation: The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia; Department of Neurology, Hebei Yutian Hospital, China.
authors.forename: Guojun
authors.initials: G
authors.lastname: Wu
authors.affiliation: The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Chen
authors.affiliation: The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia. Electronic address: canderson@georgeinstitute.org.au.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002543:Cerebral Hemorrhage / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: Clinical trial; INTERACT2; Inflammation; Intracerebral hemorrhage; Outcomes; White blood cell