Prognostic Value of the Baseline and Early Changes in Monocyte-to-Lymphocyte Ratio for Short-Term Mortality among Critically Ill Patients with Acute Kidney Injury

Risk factors and age-specific monthly patterns of primary spontaneous pneumothorax: a multicenter study

Background

Primary spontaneous pneumothorax (PSP) is characterized by sudden lung collapse without external injury or underlying lung disease. However, detailed research on its causes and recurrence patterns is lacking, prompting investigating monthly epidemiology and factors influencing recurrence. Therefore, we aimed to assess the monthly trends in PSP occurrence and identify factors contributing to its recurrence, with a focus on teenagers due to the high incidence rates in this population, while also examining risk factors across other age groups.

Methods

We conducted a multicenter retrospective study involving 4,231 cases of PSP from five hospitals in Korea. Patients aged 10-39 years were included, wherein monthly incidence patterns were assessed. Statistical analyses using physical parameters and laboratory data were performed to determine factors influencing recurrence.

Results

Our analysis revealed that July was the most common diagnosis month in teenagers, followed by October and March. This month-based pattern differed from that observed in the other age groups. Multivariate analysis revealed body mass index (BMI) at initial diagnosis to be a significant risk factor for first recurrence in male patients aged 16-19 years [hazard ratio (HR), 0.98; 95% confidence interval (CI): 0.97-0.99; P=0.001] and in male patients older than 20 years (HR, 0.99; 95% CI: 0.98-0.99; P<0.001). In male patients aged ≥20 years, the monocyte-lymphocyte ratio (MLR) at initial diagnosis was also a significant factor for first recurrence (HR, 1.20; 95% CI: 1.10-1.32; P<0.001). In female patients aged ≥20 years, MLR at the time of the first pneumothorax was significantly associated with recurrence (HR, 1.41; 95% CI: 1.07-1.87; P=0.01).

Conclusions

Our study provided valuable insights into the month-based epidemiology of PSP in Korea, highlighting differences in incidence patterns among teenagers compared with those in the other age groups. Moreover, the reported link between BMI, inflammation, and pneumothorax recurrence might be a basis for future prospective studies aimed to prevent and treat pneumothorax.

Descending necrotizing mediastinitis complicating deep neck abscesses: clinical features and prognostic assessment in 45 ICU patients

PURPOSE

To describe the clinical features and identify mortality risk factors in descending necrotizing mediastinitis (DNM) complicating deep neck abscesses (DNA) among patients admitted to the ICU.

METHODS

A retrospective analysis was conducted on consecutive patients admitted to the ICU of a tertiary care public hospital. Data were collected from July 2017 to July 2024. A bivariate analysis of variables, along with a multiple logistic regression model, were performed to identify mortality risk factors.

RESULTS

Forty-five patients with DNA complicated by DNM were admitted to the ICU, of whom 29 (58%) were men. The mean age was 49.8 ± 14 years. All underwent emergency neck and mediastinum debridement. Forty-one (91%) were admitted directly from the operating room. All DNAs were of odontogenic origin. In 36 patients (80%), the mediastinal infection extended below the tracheal carina. Thirty-nine patients (86.6%) required mechanical ventilation, and 25 (55.5%) presented with septic shock. The in-hospital mortality rate was 33.3%. Risk factors for mortality in the bivariate analysis included the total SOFA (Sequential Organ Failure Assessment) score, individual SOFA components (respiratory, hematologic, and cardiovascular), SAPS-3 (Simplified Acute Physiology Score-3), platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio. In the multivariate analysis, the number of neck surgical debridements performed during ICU stay and the SOFA respiratory component were independent predictors of mortality.

CONCLUSIONS

DNM complicating a DNA is a severe condition frequently associated with septic shock and multi-organ failure. Impaired oxygenation at admission and the number of neck wound debridements significantly influenced patient outcomes.

Immature platelet fraction as a systemic inflammation marker in patients with chronic obstructive pulmonary disease

INTRODUCTION

Recently, there has been an increasing interest to find a simple, low cost, widely available biomarker for outcome predictors in chronic obstructive pulmonary disease (COPD).

METHODS

Absolute immature platelet count (AIPC), the percentage of AIPC to the total platelet count (immature platelet fraction [IPF%]), symptoms, spirometry results, age-dyspne-airflow obstruction index, and C-reactive protein tests of COPD patients and control group were recorded. Neutrophil/lymphocyte, monocyte/lymphocyte, and platelet/lymphocyte ratios and Charlson comorbidity index scores were calculated.

RESULTS

One hundred and thirty-four COPD patients and 30 healthy control subjects were included in the study. Eighty-nine patients were in exacerbation (AECOPD) and 45 of them were in stable COPD period. There was a difference between IPF% values and AIPC of COPD group and control group (3.45 ± 2.41 vs. 2.04 ± 1.12, p = 0.01; 5.87 ± 2.45 vs. 5.20 ± 3.02, p = 0.01). A positive correlation was observed between IPF% with white blood cell count and neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio in all patients (r = 0.352, p < 0.001; r = 0.399, p < 0.001; r = 0.186, p = 0.032; r = 0.200, p = 0.021) and AECOPD (r = 0.356, p < 0.001; r = 0.414, p < 0.001; r = 0.239, p = 0.025; r = 0.273, p = 0.010). At a cut-off of 3.4, IPF% showed the highest accuracy in identifying COPD (sensitivity: 80.3%, specificity: 82.5%) using receiver-operating characteristic analysis.

CONCLUSION

This is the first study to examine the relationship between AIPC, IPF%, and COPD. The higher IPF% values in COPD and the positive correlation between IPF% and other inflammatory markers are suggested that IPF may be an indicator of systemic inflammation in COPD.

Association between monocyte to lymphocyte ratio and diabetic foot ulcer in the population of the US with diabetes based on the 1999-2004 National Health and Nutrition Examination Survey data: a retrospective cross-sectional study

Background

Diabetic foot ulcer (DFU) is a severe complication that occurs in patients with diabetes and is a primary factor that necessitates amputation. Therefore, the occurrence and progression of DFU must be predicted at an early stage to improve patient prognosis and outcomes. In this regard, emerging evidence suggests that inflammation-related markers play a significant role in DFU. One such potential marker, the monocyte-lymphocyte ratio (MLR), has not been extensively studied in relation to DFU. This study aimed to define a connection between MLR and DFU.

Methods

A cross-sectional study was conducted using National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2004. DFU was defined based on survey questionnaires assessing the presence of nonhealing ulcers in the lower extremities for more than 4 weeks in diabetes patients. The MLR was calculated as the ratio of the monocyte count to the lymphocyte count, which was directly obtained from laboratory data files. Logistic regression analysis was performed to assess the relationship between the MLR and DFU. Stratified analysis according to age, sex, body mass index, blood glucose, hemoglobin, and glycated hemoglobin categories was conducted, and multiple imputations were applied to missing data.

Results

In total, 1246 participants were included; the prevalence of DFU was 9.4% (117/1246). A multivariable regression model revealed a significant association between DFU and a 0.1 unit increase in MLR after adjusting for all covariates (adjusted odds ratio=1.16, 95% confidence interval: 1.02-1.33). Subgroup analyses revealed consistent findings regarding the impact of MLR on the presence of DFU (p > 0.05).

Conclusion

MLR is significantly associated with DFU in diabetes patients, and can be used as one of the indicators for predicting the occurrence of DFU. MLR assessment may be a valuable component in the follow-up of patients with diabetes.