Impact of single-dose systemic glucocorticoids on blood leukocytes in hospitalized adults

BACKGROUND: Glucocorticoids (GCs) may cause leukocytosis through several mechanisms. The objective of this study was to examine the impact of a single-GCs dose on total white blood cell (WBC) count, absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) in hospitalized adults without bacterial infections. METHODS: This retrospective cohort study included hospitalized patients ≥18 years of age who received a single dose of a systemic GC (oral or intravenous methylprednisolone and hydrocortisone and oral prednisone). Total WBC count, ANC, and ALC changes over the 72 h after GC administration were evaluated. RESULTS: A total of 99 patients were included. After the administration of a single-GC dose, ALC began to drop significantly as early as the interval of 0-<6 h (median interquartile range, 0.90 [0.60-1.10], P = 0.011). ANC increased significantly as early as the interval of 6-<12 h (6.22 [4.45-7.33], P = 0.049) and continued to be significantly increased from baseline up to 42 h from GC administration. Total WBC counts significantly decreased in the 6-<12 h interval (6.90 [5.15-8.85], P = 0.03) and then increased significantly in the 12-<18 h interval (8.80 [6.50-11.95], P = 0.002). This effect on total WBC count continued to be significant until the 36-<42 h interval (10.55 [7.23-13.03], P < 0.001). CONCLUSIONS: ANC followed by WBC count increased significantly after a single-GC dose in hospitalized patients within 12 h of a single-GC dose, while a decrease in WBC and ALC was seen within the first few hours of GC dose.