ASSOCIATION BETWEEN ISCHEMIC STROKE AND NEUTROPHIL COUNT. A PROSPECTIVE OBSERVATIONAL STUDY.

Abstract

Background: Ischemic stroke remains a leading cause of mortality and long-term disability worldwide, with inflammation playing a pivotal role in its pathogenesis. Neutrophils, key mediators of the innate immune response, have been increasingly implicated in exacerbating brain injury through proinflammatory mechanisms. This study investigates the prognostic significance of peripheral blood neutrophil counts in relation to stroke severity and functional outcomes in acute ischemic stroke patients.

Objective: To evaluate the association between admission neutrophil counts and the severity of ischemic stroke, and to explore the potential of neutrophil levels as a prognostic biomarker in clinical practice.

Methods: A prospective observational study was conducted at the Department of Neurology, Pakistan Institute of Medical Sciences (PIMS), Islamabad. A total of 114 adult patients with radiologically confirmed acute ischemic stroke were enrolled within 24 hours of symptom onset. Neutrophil counts were obtained from complete blood counts at admission. Stroke severity was assessed using the NIH Stroke Scale (NIHSS), and functional outcomes were measured at discharge using the modified Rankin Scale (mRS). Multivariate logistic regression was performed to evaluate associations while adjusting for age, gender, hypertension, and diabetes.

Results: Severe stroke (NIHSS ≥16) was observed in 71% of patients with high neutrophil counts (≥8000 cells/µL), compared to 39% in those with normal levels (p = 0.005). Severe disability (mRS ≥4) was significantly more common in the high neutrophil group (37% vs. 14%, p = 0.009). Multivariate analysis confirmed high neutrophil count as an independent predictor of severe stroke (adjusted OR: 3.45, 95% CI: 1.62–7.32, p = 0.001).

Conclusion: Elevated neutrophil counts are significantly associated with greater stroke severity and poorer functional outcomes, supporting their role as a potential prognostic biomarker in ischemic stroke. These findings warrant further research into neutrophil-targeted therapies to improve stroke prognosis.