Leukocytosis in acute stroke: A prospective study from an emergency department setting

Abstract

Objective: To determine the total leukocyte count (TLC) in patients with acute stroke and assess its association with stroke type and age in a tertiary care hospital in Pakistan.

Methodology: This prospective observational study was conducted in the Department of Emergency Medicine, Lady Reading Hospital, Peshawar, from May to November 2025. A non-probability consecutive sampling technique was used to enroll adult patients presenting with acute ischemic or hemorrhagic stroke. TLC was measured at presentation, and demographic data, including age and stroke subtype, were recorded. Patients with active infections, inflammatory diseases, hematological disorders, or those on immunosuppressive therapy were excluded. Data were analyzed using SPSS version 23. A one-sample t-test was applied to compare mean TLC with the international reference value of 7×10⁹/L. Chi-square was used to assess the association between TLC category and stroke type. One-way ANOVA evaluated TLC differences across three age groups (30-49, 50-69, ≥70 years). Pearson correlation tested the relationship between age and TLC. A p-value <0.05 was considered significant.

Results: Ninety patients were included. The mean TLC was significantly higher than the reference value (11.95±4.62×10⁹/L; p<0.001). No significant association was found between TLC category and stroke type (p=0.399). ANOVA showed no significant difference in TLC across age groups (p=0.119), and no correlation was observed between age and TLC (r=-0.108; p=0.313).

Conclusion: TLC was elevated in patients with acute stroke but showed no significant relationship with stroke subtype or age. Although leukocytosis is common in acute stroke, it may have limited diagnostic value in differentiating stroke categories. Further large-scale studies are recommended to explore the prognostic significance of TLC in local populations.