Monocyte count at onset predicts poststroke outcomes during a 90‐day follow‐up

• Published in: European journal of clinical investigation 2017-10, Vol.47 (10), p.702-710
• Main Authors: Liberale, Luca, Montecucco, Fabrizio, Bonaventura, Aldo, Casetta, Ilaria, Seraceni, Silva, Trentini, Alessandro, Padroni, Marina, Dallegri, Franco, Fainardi, Enrico, Carbone, Federico
• Format: Article
• Language: English
• Subjects: Adhesion; Adhesion molecules; Adhesion tests; Aged; Biomarkers - blood; Blood Cell Count; Brain Ischemia - blood; Brain Ischemia - mortality; Brain Ischemia - physiopathology; Brain Ischemia - therapy; Clinical trials; Cohort Studies; Computed tomography; Female; Hematology; Humans; Hypertension; inflammation; Intercellular Adhesion Molecule-1 - analysis; ischaemic stroke; Ischemia; Leukocytes; Leukocytes (neutrophilic); Logistic Models; Male; Middle Aged; Monocytes; Monocytes - physiology; Predictive Value of Tests; Prognosis; Recovery; Reperfusion; Retrospective Studies; ROC Curve; Severity of Illness Index; Smoking; Smoking - adverse effects; Statistics, Nonparametric; Stroke; Stroke - blood; Stroke - mortality; Stroke - therapy; Stroke Rehabilitation - methods; Survival Rate; Thrombolysis; Treatment Outcome
• ISSN: 0014-2972; 1365-2362
• DOI: 10.1111/eci.12795

Background Acute ischaemic stroke (AIS) triggers both systemic and neurovascular inflammation, influencing poststroke recovery. In smokers with AIS, inflammation might be further upregulated, increasing ischaemia/reperfusion injury. Here, the predictive value of leucocyte and adhesion molecules levels on poststroke outcomes was investigated. Materials and methods A total of 89 patients with AIS (n = 30 smokers and n = 59 nonsmokers) were recruited and evaluated 1, 7 and 90 days after the onset to assess stroke severity by the National Institute of Health Stroke Scale (NIHSS) score as well as clinical recovery at 90 days by the modified Rankin Scale (mRS). Lesion volume was assessed by noncontrast computed tomography. Haematological parameters, blood chemistry and soluble adhesion molecules were measured. Results Smokers experienced a more severe stroke and at a younger age with respect to nonsmokers, moreover, they had higher circulating levels of monocytes, neutrophils and soluble adhesion molecules. Baseline monocytes positively correlated with stroke severity and disability across all time points in the overall cohort. No correlation was shown between adhesion molecules and poststroke outcomes. A monocyte count >0·63 × 109/L predicted worse stroke severity (defined as NIHSS ≥5) at day 90 independently of age, hypertension, thrombolysis and active smoking in the overall cohort. Similarly, a monocyte count >0·64 × 109/L predicted poor neurological recovery at day 90 (defined as mRS > 2). Conclusions Smoker had more severe AIS and higher leucocytes and adhesion molecule levels. In the overall cohort, monocyte count was an independent predictor of worse poststroke outcome. Although larger trials are needed, monocyte count might be a cheap prognostic parameter in AIS.