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Abstract Details

Inflammatory Markers Correlate with Functional Outcomes in Large Hemispheric Infarctions
Cerebrovascular Disease and Interventional Neurology
P2 - Poster Session 2 (8:00 AM-9:00 AM)
4-018
We hypothesize that abnormal white blood cell count (WBC)>12,000 or <4,000 on admission is associated with worse functional outcomes in patients with large hemispheric infarctions.

Large hemispheric infarctions (LHI) are associated with significant morbidity and mortality. Abnormal WBC, as surrogate for systemic inflammatory response syndrome (SIRS) markers, has been observed to directly correlate with stroke severity, but has not been explored to correlate with death or disability. 
Retrospective study of patients admitted to the neurosciences intensive care unit at a tertiary care center with diagnosis of acute ischemic stroke from 1/2012-12/2018. Inclusion criteria included admission imaging with stroke size > 2/3 middle cerebral artery (MCA) territory, with or without other vascular territory. WBC was recorded at admission, along with modified Rankin score (mRS) on admission and discharge, need for mechanical ventilation during the hospitalization, tracheostomy, and discharge disposition. Logistic regression was used for association measures.

2,318 patients were screened; 381 patients met inclusion criteria. Mean and median age of patients was 64 years old; 46.5% were male. Stroke laterality: 187 right sided LHI (49.2%), 184 left sided LHI (48.4%), and 9 bilateral LHI (2.3%); mean and median admission NIHSS 21. 205 patients (53.5%) had abnormal admission WBC count. Abnormal WBC was significantly associated with poor outcome (mRS 4-6) on discharge (OR 3.2, p<0.02, CI 1.2-8.9) and with mechanical ventilation (OR 2.3, p<0.0001, CI 1.53-3.52). Results persisted after correction for age and sex. Abnormal WBC was not associated with tracheostomy or discharge disposition.

Abnormal WBC in patients with LHI correlates with poor functional outcome at discharge and with need for mechanical ventilation during the hospitalization, but not with need for tracheostomy. Further research may identify how SIRS markers could be used to prognosticate outcomes in these patients.

Authors/Disclosures
Nandini Abburi, MD (Duke University Department of Neurology)
PRESENTER 		Dr. Abburi has nothing to disclose.
Andrea Sterenstein, MD (Rush University Medical Center) Dr. Sterenstein has nothing to disclose.
Hannah Breit, MD (University of Southern California) Dr. Breit has nothing to disclose.
Ivan Da Silva, MD Dr. Da Silva has nothing to disclose.
Sarah Song, MD, MPH, FÂ鶹´«Ã½Ó³»­ (Rush University Medical Center) Dr. Song has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Â鶹´«Ã½Ó³»­.
Sayona John, MD, FÂ鶹´«Ã½Ó³»­ (Cook County Health) Dr. John has nothing to disclose.
Lauren Koffman, DO, MS (Temple University Hospital) Dr. Koffman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Law Firm. Dr. Koffman has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Walters Kluwer.