Elevated pro-inflammatory CD4+CD28- lymphocytes and stroke recurrence and death

Z. G. Nadareishvili, H. Li, V. Wright, D. Maric, S. Warach, J. M. Hallenbeck, J. Dambrosia, J. L. Barker, A. E. Baird

Research output: Contribution to journalArticlepeer-review

62 Scopus citations


Objective: To determine if the CD4+CD28- T-cell subset is expanded in patients with recurrent stroke or death after acute ischemic stroke. This subset of the peripheral blood T-cell lymphocyte population has a strong proinflammatory and tissue-damaging potential. Methods: Consecutive patients within the first 48 hours of ischemic stroke were prospectively studied. Peripheral blood CD4+CD28- cells were quantified by flow cytometry. The study endpoint was recurrent stroke or death from any cause during 1 year of follow-up. Results: One hundred six patients (mean age 75.0 ± 13.5 years; 50 women) were studied. The median CD4+CD28- cell count was 4.5% (range 0.2 to 72.2%). Twenty-seven endpoints (10 recurrent strokes and 17 deaths) occurred during follow-up. Stroke recurrence/death rates were significantly associated with increasing CD4+CD28- counts, rising from 14.2% in patients with CD4+CD28- levels of <1.0 to 48.1% for those with CD4+CD28- counts of >8.0% (p = 0.003, Cochran linear test of trend). Higher CD4+CD28- counts were also present in patients with a history of prior stroke (p = 0.03). After adjustment for age, admission NIH Stroke Scale score, prior stroke, and atrial fibrillation, CD4+CD28- counts of >8.0% were associated with a cumulative hazard ratio of 5.81 (95% CI: 1.58 to 21.32) for stroke recurrence or death. Conclusions: Rising counts of circulating CD4+CD28 - cells are associated with an increasing risk of stroke recurrence and death, in addition to an observed association with prior stroke. Expansion of this T-cell subset presumably represents a biomarker and possibly a contributory pathogenic mechanism of recurrent stroke and death after ischemic stroke.

Original languageEnglish (US)
Pages (from-to)1446-1451
Number of pages6
Issue number8
StatePublished - Oct 26 2004
Externally publishedYes

ASJC Scopus subject areas

  • Clinical Neurology


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