The Lymphocyte Depletion in Patients with Acute Ischemic Stroke Associated with Poor Neurologic Outcome

Abstract

Cep Juli,1,2 Henhen Heryaman,1 Arnengsih Nazir,1 Eng-Tat Ang,3 Irma Ruslina Defi,4 Uni Gamayani,2 Nur Atik5 1Doctoral Program, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia; 2Department of Neurology, Dr. Hasan Sadikin General Hospital, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia; 3Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 4Department of Physical Medicine and Rehabilitation, Dr. Hasan Sadikin General Hospital, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia; 5Department of Biomedical Sciences, Faculty of Medicine, Padjadjaran University, Bandung, IndonesiaCorrespondence: Nur AtikDepartment of Biomedical Sciences, Faculty of Medicine, Padjadjaran University, Bandung, IndonesiaEmail [email protected]: Inflammation plays an important role and is involved in all stages of acute ischemic stroke. One of these stages involves the recruitment of leukocytes from the peripheral circulation into the ischemic tissue. Lymphocytes as a subtype of leukocytes are important mediators and can become a predictor of neurological outcome. Several studies have been conducted regarding the correlation between differential lymphocyte counts and acute ischemic stroke. Most of these studies analyzed lymphocyte ratio to other leukocyte subtypes such as neutrophils and monocytes. This study specifically observed the role of lymphocytes as an indicator of the inflammatory response in patients with acute ischemic stroke. This study aimed to observe the correlation among risk factors, infarct location, leukocyte counts, lymphocyte value and neurologic output in acute ischemic stroke patients.Patients and Methods: We observed and analyzed 193 patients’ data from medical record which met the inclusion and exclusion criteria with a diagnosis of acute ischemic stroke at the Department of Neurology of Dr. Hasan Sadikin General Bandung. Data were then analysed using appropriate statistical tests.Results: Most patients have more than one risk factor with a leukocyte count of less than 10,000 cell/mm3. Infarct was mostly located in subcortical area (basal ganglia), with moderate average NIHSS values at admission and at discharge. The number of lymphocytes decreased in the subject group with more than 10,000 cell/mm3 leukocytes. Subsequently, data were analyzed using Spearman’s test and there was a correlation between NIHSS on admission and lymphocyte depletion.Conclusion: The lymphocyte depletion in patients with leukocytosis is a predictor of poor NIHSS.Keywords: ischemic stroke, lymphocyte depletion, poor neurologic outcome

Keywords

• ischemic stroke
• lymphocyte depletion
• poor neurologic outcome