The usefulness of the percentage of immature granulocytes in predicting in-hospital mortality in patients with upper gastrointestinal bleeding

The impact of immature granulocytes on the outcome of patients with decompensated cirrhosis

BACKGROUND

Higher immature granulocyte levels have a predictive role in several clinical conditions, although data concerning cirrhosis are scarce. Reduced muscle mass is a known factor affecting the outcome of these patients. The aim of the study was to evaluate the association of immature granulocytes with muscle mass and their role in predicting the outcome (survival, death or liver transplantation) in patients with stable decompensated cirrhosis.

METHODS

We prospectively studied 210 patients with decompensated cirrhosis awaiting liver transplantation. Their clinical and laboratory characteristics were recorded, including complete blood count with immature granulocyte count and immature granulocyte percentage. The severity of liver disease was evaluated by estimating the Child-Turcotte-Pugh and MELD-sodium scores. Dual energy X-ray absorptiometry was used to quantify the total and regional lean mass, while mid-arm muscle circumference was used for the evaluation of upper limb muscle mass.

RESULTS

Immature granulocyte percentage was proved to be the only factor independently associated with transplant-free survival (Hazard Ratio: 1.98, 95% confidence interval [1.03-3.81], p = .04). Stratification of our cohort based on the best discriminative cut-off values of immature granulocyte count and percentage revealed significant differences in the outcome based on Kaplan-Meier curves, while immature granulocyte count and percentage were significantly associated with parameters of body composition.

CONCLUSIONS

Higher immature granulocyte count and percentage have a significant prognostic role and are associated with worse outcome in patients with stable decompensated cirrhosis.

Immature Granulocyte: A Novel Inflammatory Biomarker in Familial Mediterranean Fever

AIM

Our study aimed to evaluate the significance and clinical utility of immature granulocyte (IG) count (IGC) and IG percentage (IG%) in predicting attacks in patients with familial Mediterranean fever (FMF).

METHODS

This retrospective study included 100 FMF patients and 50 healthy controls. Data from 24 patients during the attack period and 76 patients during the attack-free period in the FMF group were obtained from medical records. Complete blood count analyses were carried out with the Mindray BC-6200 automated hematology analyzer following standard laboratory protocols. Receiver operating characteristic (ROC) curve analysis was conducted to differentiate FMF patients in the attack period from those in the attack-free period.

RESULTS

In FMF patients, levels of WBC (p = 0.032), neutrophils (p = 0.001), C-reactive protein (CRP) (p = 0.002), IG count (p < 0.001), and IG percentage (p < 0.001) were significantly higher compared to healthy controls. During the attack period, IG count and IG percentage levels were significantly elevated compared to the attack-free period (p < 0.001 for both). Based on ROC analysis, IG count and IG percentage showed significant diagnostic potential in FMF patients, with AUC values of 0.841 and 0.766, respectively.

CONCLUSION

IGC and IG% serve as indicators of inflammation in FMF patients and may facilitate the differential diagnosis of FMF attacks, with respective cut-off values of 0.04 × 109/L and 0.4%. Given their accessibility and lack of additional cost, these parameters have the potential to enhance clinical practice by augmenting the diagnostic utility of conventional inflammatory biomarkers.

Can immature granulocytes and neutrophil-lymphocyte ratio be biomarkers to evaluate diabetic nephropathy?: A cross-sectional study

AIMS

We aimed to examine the role of circulating immature granulocytes (IGs) in assessing Diabetic Nephropathy (DN) mainly and also associations of other leukocyte parameters with DN.

METHODS

In this retrospective cross-sectional study, a total of 164 Diabetes Mellitus patients were grouped as normoalbuminuric and microalbuminuric according to urinary albumin excretion in the course of admission. Neutrophil-lymphocyte ratio (NLR), IG count (IG#) and IG percentage (IG%) levels were compared between the groups. The value of IG# and IG% levels in detecting microalbuminuria was analyzed with the Receiver operating characteristic (ROC) curve.

RESULTS

NLR was remarkably higher in the microalbuminuric group (p = 0.036). Correlation results in the microalbuminuric group were as follows: A feeble positive correlation between neutrophil count (NEU#) and serum creatinine and albumin-to- creatinine ratio (ACR) (p = 0.036, r = 0.261; p = 0.005, r = 0.347, respectively), a feeble positive correlation between lymphocyte count (LYM#) and estimated glomerular filtration rate (p = 0.021, r = 0.285). Correlation results in the normooalbuminuric group were as follows: A feeble positive correlation between NEU# and ACR (p = 0.043, r = 0.204), a feeble negative correlation between LYM# and serum creatinine (p = 0.042, r = -0.205), a poor positive correlation between IG# and ACR and HBA1C% (p = 0.048, r = 0.199; p = 0.004, r = 0.290, respectively), a positive poor correlation between IG% and HBA1C% (p = 0.019, r = 0.235). Area under the ROC curve values for IG# and IG% were not statistically noteworthy in detecting microalbuminuria (p = 0.430; p = 0.510, respectively).

CONCLUSIONS

IG# and IG% values are insufficient to predict immediate microalbuminuria, but could be considered a weak biomarker for renal damage in normoalbuminuric (<30 mg/g) diabetic patients. Further researches are needed for the use of leukocyte parameters in evaluating DN.

Diagnosis Value of the Blood Urea Nitrogen-to-Creatinine Ratio in Determining the Need for Intervention of Acute Upper Gastrointestinal Bleeding

INTRODUCTION

The blood urea nitrogen (BUN)-to-creatinine (Cr) ratio (BUN/Cr ratio) may be used to evaluate the need for intervention of acute upper gastrointestinal bleeding (AUGIB). This study aimed to explore the predictive value of the BUN/Cr ratio in the need for intervention of AUGIB.

METHODS

This retrospective observational study included patients with AUGIB in the hospital's emergency department between August 2019 and May 2023. The patients were grouped according to whether they underwent an intervention for AUGIB. Patients treated between August 2019 and May 2022 were selected as the training set and the others as the validation set.

RESULTS

A total of 466 patients (328 males, 138 females) with AUGIB were enrolled in the intervention group (n = 167) and the no-intervention group (n = 299). In the training set, multivariable logistic regression showed that the BUN/Cr ratio (odds ratio [OR]: 1.013, 95% confidence interval [CI]: 1.003-1.023, p = 0.009), hemoglobin (OR: 0.989, 95% CI: 0.981-0.997, p = 0.010), and a previous history of esophageal variceal bleeding (OR: 6.898, 95% CI: 3.989-11.929, p < 0.001) were independently associated with intervention for AUGIB. The area under receiver operating characteristic curve of BUN/Cr ratio and the prediction model based on logistic regression to predict the need for intervention of AUGIB were 0.604 (95% CI: 0.544-0.664) and 0.759 (95% CI: 0.706-0.812) in the training set and 0.634 (95% CI: 0.529, 0.740) and 0.708 (95% CI: 0.609, 0.806) in the validation set, respectively.

CONCLUSION

The BUN/Cr ratio was associated with the need for AUGIB intervention. Combining it with other parameters might improve its diagnostic value to predict the need for intervention of AUGIB.

Is immature granulocyte a new predictor in the diagnosis of peptic ulcer perforation?

<b>Introduction:</b> Peptic ulcer perforation (PUP) requires immediate treatment. Immature granulocyte (IG) takes part in the inflammation process and is a biomarker which can be easily tested in peripheral venous blood. </br></br> <b>Aim:</b> This study demonstrates that IG is a convenient biomarker in the diagnosis of PUP. </br></br> <b> Material and methods: </b> Medical records of patients treated in the years 2018–2020 were analysed retrospectively. The study recognized three groups of patients: 42 PUD patients (Group 1), 42 PUP patients (Group 2) and 45 individuals acting as a healthy control (HC, Group 3). Surgical repair was performed in all patients from the PUP group. Differences between the groups were analysed statistically. The receiver operating characteristic curve (ROC) was calculated in order to predict the likelihood of PUP diagnosis based on the immature granulocyte count (IGC) and immature granulocyte percentage (IG%). </br></br> <b> Results:</b> The average IGC was high in group 1 and group 2, while the IG levels remained low in the HC group A statistically significant difference between the groups was confirmed (mean values, respectively; 0.05 [0.12], 0.04 [0.06], 0.03 [0.03], and P = 0.001). The average value of IG% was high in group 1 and group 2 but remained low in the HC group A statistically significant difference between the groups was confirmed (mean values, respectively; 1.62 ± 0.41, 0.68 ± 0.22, 0.37 ± 0.55, and P = 0.003). The following parameters were calculated for IGC and IG%: AUC: 0.637; sensitivity: 61.9%; specificity: 57.1%; P = 0.031, AUC: 0.693; sensitivity: 61.9%; specificity: 64.3%; P = 0.02), respectively. </br></br> <b>Results:</b> IG is convenient as a diagnostic biomarker in PUP patients admitted to the emergency department.