Objective: An increased leukocyte count is positively associated with poor outcomes
and all-cause mortality in coronary heart disease, cancer, and ischemic stroke. The role of leukocyte
count in acute ischemic stroke (AIS) remains important. We aimed to investigate the association
between admission leukocyte count before thrombolysis with recombinant tissue plasminogen
activator (rt-PA) and 3-month outcomes in AIS patients.
Methods: This retrospective study included consecutive AIS patients who received intravenous
(IV) rt-PA within 4.5 h of symptom onset between January 2016 to December 2018. We assessed
outcomes, including short-term hemorrhagic transformation (HT), 3-month mortality, and functional
independence (modified Rankin Scale [mRS] score of 0–2 or 0–1).
Results: Among 579 patients who received IV rt-PA, 77 (13.3%) exhibited HT at 24 h, 43 (7.4%)
died within 3 months, and 211 (36.4%) exhibited functional independence (mRS score: 0–2). Multivariable
logistic regression revealed admission leukocyte count as an independent predictor of
good and excellent outcomes at 3 months. Each 1-point increase in admission leukocyte count increased
the odds of poor outcomes at 3 months by 7.6% (mRS score: 3–6, odds ratio [OR]: 1.076,
95% confidence interval [CI]: 1.003–1.154, p=0.041) and 7.8% (mRS score: 2–6, OR: 1.078, 95%
CI: 1.006–1.154, p=0.033). Multivariable regression analysis revealed no association between HT
and 3-month mortality. Admission neutrophil and lymphocyte count were not associated with 3--
month functional outcomes or 3-month mortality.
Conclusion: A lower admission leukocyte count independently predicts good and excellent outcomes
at 3 months in AIS patients undergoing rt-PA treatment.