| Objectives: To observe the distribution and fluctuation of peripheral leukocyte count in the acute stage of stroke. To determine factors that influence admission leukocytosis. To evaluate the relationship between peripheral leukocyte count and outcomes of stroke.Materials and methods: 1.We prospectively registered consecutive cases of acute stroke at the neurological wards of the West China Hospital, Sichuan University from Jan. 01, 2005 to Feb.01, 2007. Patients of ischemic and hemorrhagic stroke within 24 hours of symptom onset were included. Leukocyte count and differential count on admission or the next morning were measured.When total count exceeded 10.0×10~9/L, blood routine examination was rechecked on about 3rd and 6th day from onset. Other clinical information influencing total count level and stroke prognosis were also collected, then outcomes including death,disability and recurrence were followed up at the end of 3rd, 6th and 12th month after the onset of stroke. 2.Horizontal distribution and dynamic fluctuation of leukocyte count were observed and analyzed.Then elevation of leucocyte count(defined as its count≥10×10~9/L)was analyzed in relation to age, sex, vascular risk factor, stroke type, stroke severity, etc by using univariate and multivariate logistical regression to evaluate the influencing factors for leukocytosis.The statistic model was also used to determine the relations between leucocyte count and stroke prognosis by controlling other possible influencing factors.Results.1. 587 cases of acute stroke within 24h from onset were included. Among them 411 cases were ischemic stroke (70.0%) and 176 cases were hemorrhagic stroke(30.0%). The range of admission white blood cell count was from 2.4×10~9/L to 26.7×10~9/L. Median was observed as 7.60×10~9/L. Quartile was 6.00×10~9/L-9.88×l0~9/L.The difference of count between ischemic stroke and hemorrhagic stroke was significant (P=0.025). The number of stroke patients with leukocyte count≥10×10~9/L was 141. Its percentage was 24%. Percentage of leukocytosis in hemorrhagic stroke was significantly larger than that in ischemic stroke (31.3% vs. 20.9%, P=0.008).39 cases with leucocytosis but without infection at admission and during hospital-stay were observed and we found that leucocyte count level was lowered obviously to almost normal range(median was 8.87×10~9/L,quartile was 7.01×10~9/L-9.74×10~9/L) on about 3rd day (P＜0.05). The trend still existed on the 6th day althouth without much significance (P=0.054). 2. After multivariate logistic regression, the independent influencing factors of leukocytosis were infection at admission (OR4.94,95%CI 2.610-9.350), time between symptom onset and admission (OR1.19, 95%CI 1.009-1.402),NIHSS at admission (OR 2.361, 95%CI 1.781-3.130) and age (OR 0.964, 95%CI 0.949-0.979). 3. Univariate analysis showed that elevation of leukocyte total count and differential count (neutrophil count and lymphocyte count) increased risk of death at 1st and 3rd month,and death/disability at 3rd month (P＜0.05). Besides, reduction of lymphocyte count also had a higher risk of death/disability at 3rd month when compared with count in normal range (P=0.007).But multivariate analysis found abnormal level of leukocyte count and differential count did not give an independent impact on short-term outcomes.Conclusion: 1.Leukocytosis (≥10.0×10~9/L) at admission happened in 24% cases in acute stage of stroke. Its percentage in hemorrhagic stroke was significantly larger than that in ischemic stroke.The high level of leukocyte count without influence of infection could cut down on about the 3rd day. 2. Independent predictors of leukocytosis were age, time between symptom onset and admission, infection at admission and NIHSS at admission. 3. Elevation of leukocyte total count and differential count (neutrophil count and lymphocyte count) increased risk of death at 1st and 3rd month,and death/disability at 3rd month. Reduction of lymphocyte count increased risk of death/disability at 3rd month. But none of them gave an independent impact on short-term outcomes.
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