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Neurol Neuroimmunol Neuroinflamm. 2015 Feb 12;2(2):e71. doi: 10.1212/NXI.0000000000000071. eCollection 2015 Apr.

High natural killer cell number might identify stroke patients at risk of developing infections.

Neurology(R) neuroimmunology & neuroinflammation

Sylvie De Raedt, Aurelie De Vos, Anne-Marie Van Binst, Marc De Waele, Danny Coomans, Ronald Buyl, Jacques De Keyser

Affiliations

  1. Departments of Neurology (S.D.R., A.D.V., J.D.K.), Radiology (A.-M.V.B.), Hematology (M.D.W.), and Biostatistics and Medical Informatics (D.C., R.B.), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium; and Department of Neurology (J.D.K.), Universitair Medisch Centrum Groningen, the Netherlands.

PMID: 25738168 PMCID: PMC4335818 DOI: 10.1212/NXI.0000000000000071

Abstract

OBJECTIVE: To investigate early changes in leukocyte subsets and autonomic function as predictors of the development of poststroke infections.

METHODS: We assessed the time course of leukocyte subsets in the blood of 59 patients with acute ischemic stroke. We divided the patients into 2 groups: those who developed infections during the first 7 days after stroke onset and those who did not. We measured urinary norepinephrine and epinephrine concentrations and pulse rate variability indices within 24 hours of admission.

RESULTS: We found that the number of circulating natural killer (NK) cells within the first hours after stroke was higher in stroke patients who developed infections (mean 435 cells/mL; 95% confidence interval [CI] 321-588) than in stroke patients who did not develop infections (mean 236 cells/mL; 95% CI 186-300; p = 0.001). This was followed by a decrease in all lymphocyte subsets from admission to day 1, varying between 22% and 40%, which was not seen in patients without poststroke infection (mean increase varied between 2% and 23%; all p < 0.005). In the group that developed infections, pulse rate variability revealed a decreased high frequency component. These findings all remained significant after adjustment for age and stroke volume.

CONCLUSIONS: High circulating NK cell count within the first hours after ischemic stroke onset followed by a drop in all lymphocyte subsets identified patients who developed infections and may be caused by a sympathovagal imbalance with sympathetic overweight. These findings need to be validated in larger studies.

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