Correspondence to

High natural killer cell number might identify stroke patients at risk of developing infections Objective: To investigate early changes in leukocyte subsets and autonomic function as predic-tors 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 norepi-nephrine 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; p5 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 fol-lowed 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. Neurol Neuroimmunol Neuroinflamm 2015;2:e71; doi: 10.1212