Stroke & Leucocyte count

Pada suatu visite, supersivor ward kami mengomentari pemberian antibiotik pada pasien stroke dengan kecurigaan infeksi karena peningkatan jumlah leukositnya. Pada umumnya, pasien stroke akut memang cenderung mengalami peningkatan jumlah leukosit, diduga merupakan proses inflamasi akibat brain injury. Tapi juga perlu diperhatikan bahwa pasien stroke cenderung immunocompromised sehingga rentan infeksi. Lalu, kapan peningkatan jumlah leukosit mengindikasikan adanya “true-infection” pada pasien stroke akut? Bagaimana dengan pola diff-count-nya? Berapa jumlah leukosit untuk pertimbangan kita memberikan antibiotik?

“Kita bisa mengumpulkan beberapa kasus, lalu dibuat serial blood count-nya. Coba nanti kita lihat polanya,” saran beliau.

Ternyata sisi menarik blood count pada pasien stroke tidak hanya itu. Studi oleh Heikinheimo et al (2013), menyimpulkan bahwa peningkatan leukosit pada ischemic stroke di usia muda berkaitan dengan vascular disease (plus faktor risiko vaskular), severity, dan outcome stroke.

Humm, tertarik meneliti?

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Leucocyte count in young adults with first-ever ischaemic stroke: associated factors and association on prognosis
Terttu Heikinheimo*, Jukka Putaala, Elena Haapaniemi, Markku Kaste, Turgut Tatlisumak 
International Journal of Stroke. doi: 10.1111/j.1747-4949.2012.00968.x
2013

Background
Limited data exist on the associated factors and correlation of leucocyte count to outcome in young adults with first-ever ischaemic stroke.

Aims
Our objectives were to investigate factors associated with elevated leucocyte count and whether there is correlation between leucocyte count and short- and long-term outcomes.

Methods
Of our database of 1008 consecutive patients aged 15 to 49, we included those with leucocyte count measured within the first two days from stroke onset. Outcomes were three-month and long-term disability, death, and vascular events. Linear regression was used to explore baseline variables associated with leucocyte count. Logistic regression and Cox proportional models studied the association between leucocyte count and clinical outcomes.

Results
In our study cohort of 797 patients (61·7% males; mean age 41·4 years), mean leucocyte count was high: 8·8 ± 3·1 × 109 cells/L (Reference range: 3·4–8·2 × 109 cells/L). Higher leucocyte levels were associated with dyslipidaemia, smoking, peripheral arterial disease, stroke severity, and lesion size. After adjustment for age, gender, relevant risk factors, both continuous leucocyte count and the highest quartile of leucocyte count were independently associated with unfavourable three-month outcome. Regarding events in the long-term (follow-up 8·1 ± 4·2 years in survivors), no association between leucocyte count and the event risks appeared.

Conclusions
Among young stroke patients, high leucocyte count was a common finding. It was associated with vascular disease and its risk factors as well as severity of stroke, but it was also independently associated with unfavourable three-month outcome in these patients. There was no association with the long-term outcome.