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Martinez JM, Espírito Santo A, Ramada D, Fontes F, Medeiros R. Diagnostic accuracy of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and neutrophil-lymphocyte-to-platelet ratio biomarkers in predicting bacteremia and sepsis in immunosuppressive patients with cancer: literature review. Porto Biomed J 2024; 9:254. [PMID: 38835655 PMCID: PMC11146520 DOI: 10.1097/j.pbj.0000000000000254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/23/2024] [Accepted: 05/05/2024] [Indexed: 06/06/2024] Open
Abstract
Background This literature review explores the role of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and neutrophil-lymphocyte-to-platelet ratio (NLPR) biomarkers, as potential indicators for predicting bacteremia and sepsis in patients with cancer. Objective Tracing the evolution of interest in this area since 2001, the aim of this review was to report a comprehensive overview of current knowledge and gaps, particularly in patients undergoing immunosuppression. Summary of Findings The literature research indicates the potential of NLR, PLR, and other biomarkers in diagnosing and predicting sepsis, with some studies emphasizing their value in mortality prediction. A specific focus on bacteremia shows the effectiveness of NLR and PLR as early indicators and prognostic tools, though mostly in noncancer patient populations. While NLR and PLR are promising in general cancer patient populations, the review addresses the challenges in applying these biomarkers to patients with neutropenic and lymphopenic cancer. The NLPR could be considered a significant biomarker for inflammation and mortality risk in various medical conditions, yet its diagnostic accuracy in patients with immunosuppressed cancer is not extensively validated. Conclusion This review offers a snapshot of the current research on biomarkers in patients with immunocompromised cancer in the sepsis and bacteremia area. More focused research on their application is necessary. This gap underscores an opportunity for future studies to enhance diagnostic and prognostic capabilities in this high-risk group.
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Affiliation(s)
- Jose Manuel Martinez
- Oncology Clinical Research Unit IPO Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Ana Espírito Santo
- Oncology Clinical Research Unit IPO Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Diana Ramada
- Oncology Nursing Research Unit IPO Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Filipa Fontes
- Approach to Precursor Lesions and Early Cancer Research Unit IPO Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
- Public Health Department and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Medeiros
- Molecular Oncology and Viral Pathology Group Research Unit IPO Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
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Wu H, Cao T, Ji T, Luo Y, Huang J, Ma K. Predictive value of the neutrophil-to-lymphocyte ratio in the prognosis and risk of death for adult sepsis patients: a meta-analysis. Front Immunol 2024; 15:1336456. [PMID: 38562922 PMCID: PMC10982325 DOI: 10.3389/fimmu.2024.1336456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Background The neutrophil-to-lymphocyte ratio (NLR) is a commonly used biomarker for acute inflammation that often rises during sepsis, making it a valuable diagnostic indicator for clinical practice. However, no consensus has been reached on the prognostic value of NLR for predicting the prognosis and mortality risk in adult sepsis patients. In light of this controversy, we conducted a meta-analysis to clarify the prognostic significance of NLR in adult sepsis patients. The meta-analysis was registered in the PROSPERO database (registration number CRD42023433143). Methods We performed a comprehensive literature search in PubMed, Cochrane Library, Ovid, and Springer databases, using retrieval terms "sepsis" or "septic shock" and "prognosis" or "mortality" for studies published between January 1, 2000, and May 31, 2023. Children and neonates with sepsis were excluded from our research. Two independent researchers conducted the literature search and data extraction. Consensus was reached when discrepancies occurred, and in case of persistent discrepancies, the final decision was made by the research supervisor. The hazard ratio (HR) and its corresponding 95% confidence interval (95% CI) were extracted from each study included in the analysis. A random-effects model was used to synthesize all HRs and their 95% CIs. Sensitivity analysis was performed to investigate heterogeneity. Sensitivity analysis was conducted to identify studies that had a significant impact on the overall results of the meta-analysis. Subgroup analysis and meta-regression were performed to explore sources of heterogeneity. Egger's test was also used to investigate publication bias in this meta-analysis. Results After a comprehensive literature search and screening, we included 12 studies comprising 10,811 patients for the meta-analysis. The pooled results indicated that patients with a higher NLR level were associated with a poor prognosis (Random-effects model, HR: 1.6273, 95% CI: 1.3951-1.8981). Heterogeneity testing showed significant heterogeneity (I2 = 87.2%, 95% CI: 79.5-92, p<0.0001). Sensitivity analysis was performed to investigate the sources of heterogeneity, which revealed that the omission of one highly sensitive study significantly reduced the I2 value. After removing this study, a strong association was found between a higher NLR level and poor prognosis and risk of death in adult sepsis patients (Random-effects model, HR: 1.6884, 95% CI: 1.4338-1.9882). Both subgroup analysis and meta-regression indicated that the study design and testing time of NLR were sources of heterogeneity. Egger's test showed no obvious publication bias in this meta-analysis. Conclusion NLR is a reliable and valuable biomarker for predicting prognosis and the risk of death in adult sepsis patients. Systematic Review Registration [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023433143] PROSPERO, identifier [CRD42023433143].
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Affiliation(s)
- Hongsheng Wu
- Department of Hepatobiliary Pancreatic Surgery, Huadu District People's Hospital of Guangzhou, Guangzhou, Guangdong, China
| | - Tiansheng Cao
- Department of Hepatobiliary Pancreatic Surgery, Huadu District People's Hospital of Guangzhou, Guangzhou, Guangdong, China
| | - Tengfei Ji
- Department of Hepatobiliary Pancreatic Surgery, Huadu District People's Hospital of Guangzhou, Guangzhou, Guangdong, China
| | - Yumei Luo
- Department of Hepatobiliary Pancreatic Surgery, Huadu District People's Hospital of Guangzhou, Guangzhou, Guangdong, China
| | - Jianbin Huang
- Department of Hepatobiliary Pancreatic Surgery, Huadu District People's Hospital of Guangzhou, Guangzhou, Guangdong, China
| | - Keqiang Ma
- Department of Hepatobiliary Pancreatic Surgery, Huadu District People's Hospital of Guangzhou, Guangzhou, Guangdong, China
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Yoshitomi K, Koya Y, Miyagawa K, Maruno Y, Yamaguchi K, Taniguchi R, Onitsuka K, Sakamoto Y, Oe S, Harada M. Symptomatic Liver Cyst Successfully Treated with Transgastric Drainage and Sclerotherapy Using Minocycline Hydrochloride. Case Rep Gastrointest Med 2024; 2024:6942345. [PMID: 38273972 PMCID: PMC10807977 DOI: 10.1155/2024/6942345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
A liver cyst is hepatic fluid-filled cavities often detected in clinical surveillances such as a health examination. Although the liver cyst is usually asymptomatic and observed without any therapeutic intervention, it can be symptomatic and needs treatment due to its enlargement, hemorrhage, and infection. A 74-year-old woman presented with upper abdominal pain and a huge liver cyst in the left lobe. Several examinations including image findings revealed that the symptom could be derived from the liver cyst. Although there is no definite guideline of treatment for symptomatic liver cysts, percutaneous ultrasound-guided drainage with sclerotherapy or surgery is often selected. Because of anatomical accessibility to the liver cyst and the patient's wish, we performed endoscopic transgastric drainage with insertion of both an internal stent and an external nasocystic tube. Sclerotherapy with minocycline hydrochloride was performed through the nasocystic tube, and the liver cyst shrunk completely without any complications. This is the first reported method of administering minocycline hydrochloride through a nasocystic tube, which can be a therapeutic option for patients with symptomatic liver cysts.
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Affiliation(s)
- Kengo Yoshitomi
- Department of Gastroenterology, Kyushu Rosai Hospital, Moji Medical Center, Kitakyushu, Japan
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yudai Koya
- Department of Gastroenterology, Kyushu Rosai Hospital, Moji Medical Center, Kitakyushu, Japan
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koichiro Miyagawa
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yuki Maruno
- Department of Gastroenterology, Kyushu Rosai Hospital, Moji Medical Center, Kitakyushu, Japan
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koki Yamaguchi
- Department of Gastroenterology, Kyushu Rosai Hospital, Moji Medical Center, Kitakyushu, Japan
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ryuta Taniguchi
- Department of Surgery, Kyushu Rosai Hospital, Moji Medical Center, Kitakyushu, Japan
| | - Koji Onitsuka
- Department of Surgery, Kyushu Rosai Hospital, Moji Medical Center, Kitakyushu, Japan
| | - Yoshitaka Sakamoto
- Department of Surgery, Kyushu Rosai Hospital, Moji Medical Center, Kitakyushu, Japan
| | - Shinji Oe
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masaru Harada
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Yang B, Niu K, Zhu Y, Zheng X, Li T, Wang Z, Jin X, Lu X, Qiang H, Shen C. Effects of ondansetron exposure during ICU stay on outcomes of critically ill patients with sepsis: a cohort study. Front Cell Infect Microbiol 2023; 13:1256382. [PMID: 38179420 PMCID: PMC10764599 DOI: 10.3389/fcimb.2023.1256382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/01/2023] [Indexed: 01/06/2024] Open
Abstract
Background Sepsis is a life-threatening disease with high morbidity and mortality, characterized by an inadequate systemic immune response to an initial stimulus. Whether the use of ondansetron (OND) during intensive care unit (ICU) stay is associated with the prognosis of sepsis patients remains unclear. Methods Critically ill patients with sepsis were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Multivariate logistic regression and Cox regression analyses were used to explore the association between OND use and clinical outcomes after adjusting for confounders. Kaplan-Meier survival curve was used for survival analysis. Propensity score matching (PSM) and subgroup analysis were performed to further confirm the results. Results The OND-medication group showed reduced in-hospital mortality, 28-day and 90-day mortalities. The OR for in-hospital mortality was 0.80 (0.64-0.99) and HRs for 28-day mortality and 90-day mortality were 0.77 (0.64-0.92) and 0.83 (0.70-0.98), respectively. After PSM, the clinical outcomes remained consistent. In-hospital mortality was lower in the OND-medication group (28.1% vs. 35.8%, P= 0.044), as well as 28-day mortality (23.4% vs. 32.1%, P=0.022) and 90-day mortality (27.4% vs. 35.8%, P=0.035). The protective effect of OND in sepsis patients was relatively robust, independent of age, septic shock, vasopressin and mechanical ventilation. Additionally, the OND users had longer lengths of stay in ICU (6.9(3.1-13.2) vs. 5.1(2.5-11.0), P = 0.026) while no statistical differences were found in lengths of stay in hospital (P = 0.333). Conclusion OND exposure might be associated with lower in-hospital, 28-day, and 90-day mortality rates in critically ill patients with sepsis. This study indicated that OND might help improve the prognosis of patients with sepsis.
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Affiliation(s)
- Boshen Yang
- Department of Cardiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kaifan Niu
- Department of Cardiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuankang Zhu
- Department of Gerontology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xinjie Zheng
- Department of Cardiac Surgery, Xiamen University Affiliated Cardiovascular Hospital, Xiamen, China
| | - Taixi Li
- Department of Cardiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhixiang Wang
- Department of Cardiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xian Jin
- Department of Cardiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xia Lu
- Department of Cardiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haifeng Qiang
- International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
| | - Chengxing Shen
- Department of Cardiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Vélez-Pinto JF, Garcia-Arranz M, García-Bernal D, García Gómez-Heras S, Villarejo-Campos P, García-Hernández AM, Vega-Clemente L, Jiménez-Galanes S, Guadalajara H, Moraleda JM, García-Olmo D. Therapeutic effect of adipose-derived mesenchymal stem cells in a porcine model of abdominal sepsis. Stem Cell Res Ther 2023; 14:365. [PMID: 38087374 PMCID: PMC10717819 DOI: 10.1186/s13287-023-03588-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The term sepsis refers to a complex and heterogeneous syndrome. Although great progress has been made in improving the diagnosis and treatment of this condition, it continues to have a huge impact on morbidity and mortality worldwide. Mesenchymal stem cells are a population of multipotent cells that have immunomodulatory properties, anti-apoptotic effects, and antimicrobial activity. We studied these capacities in a porcine model of peritoneal sepsis. METHODS We infused human adipose-derived mesenchymal stem cells (ADSCs) into a porcine model of peritoneal sepsis. Twenty piglets were treated with antibiotics alone (control group) or antibiotics plus peritoneal infusion of ADSCs at a concentration of 2 × 106 cells/kg or 4 × 106 cells/kg (low- and high-dose experimental groups, respectively). The animals were evaluated at different time points to determine their clinical status, biochemical and hematologic parameters, presence of inflammatory cytokines and chemokines in blood and peritoneal fluid, and finally by histologic analysis of the organs of the peritoneal cavity. RESULTS One day after sepsis induction, all animals presented peritonitis with bacterial infection as well as elevated C-reactive protein, haptoglobin, IL-1Ra, IL-6, and IL-1b. Xenogeneic ADSC infusion did not elicit an immune response, and peritoneal administration of the treatment was safe and feasible. One day after infusion, the two experimental groups showed a superior physical condition (e.g., mobility, feeding) and a significant increase of IL-10 and TGF-β in blood and a decrease of IL-1Ra, IL-1b, and IL-6. After 7 days, all animals treated with ADSCs had better results concerning blood biomarkers, and histopathological analysis revealed a lower degree of inflammatory cell infiltration of the organs of the peritoneal cavity. CONCLUSIONS Intraperitoneal administration of ADSCs as an adjuvant therapy for sepsis improves the outcome and diminishes the effects of peritonitis and associated organ damage by regulating the immune system and reducing intra-abdominal adhesions in a clinically relevant porcine model of abdominal sepsis.
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Affiliation(s)
- J F Vélez-Pinto
- Surgery Department, Fundación Jiménez Díaz University Hospital, 28033, Madrid, Spain
| | - M Garcia-Arranz
- New Therapy Laboratory, Health Research Institute of the Jimenez Diaz Foundation (Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz), Avda Reyes Católicos 2, 28040, Madrid, Spain.
- Department of Surgery, Faculty of Medicine, Universidad Autónoma de Madrid, 28029, Madrid, Spain.
| | - D García-Bernal
- Hematopoietic Transplant and Cellular Therapy Unit, Instituto Murciano de Investigación Biosanitaria (IMIB) Pascual Parrilla, Virgen de la Arrixaca University Hospital, University of Murcia, Murcia, Spain
- Biochemistry, Molecular Biology and Immunology Department, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - S García Gómez-Heras
- Department of Basic Health Science, Faculty of Health Sciences, Rey Juan Carlos University, 28922, Alcorcón, Madrid, Spain
| | - P Villarejo-Campos
- Surgery Department, Fundación Jiménez Díaz University Hospital, 28033, Madrid, Spain
| | - A M García-Hernández
- Hematopoietic Transplant and Cellular Therapy Unit, Instituto Murciano de Investigación Biosanitaria (IMIB) Pascual Parrilla, Virgen de la Arrixaca University Hospital, University of Murcia, Murcia, Spain
| | - L Vega-Clemente
- New Therapy Laboratory, Health Research Institute of the Jimenez Diaz Foundation (Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz), Avda Reyes Católicos 2, 28040, Madrid, Spain
| | - S Jiménez-Galanes
- Department of Surgery, Infanta Elena University Hospital, 28342, Valdemoro, Madrid, Spain
| | - H Guadalajara
- Surgery Department, Fundación Jiménez Díaz University Hospital, 28033, Madrid, Spain
- Department of Surgery, Faculty of Medicine, Universidad Autónoma de Madrid, 28029, Madrid, Spain
| | - J M Moraleda
- Hematopoietic Transplant and Cellular Therapy Unit, Instituto Murciano de Investigación Biosanitaria (IMIB) Pascual Parrilla, Virgen de la Arrixaca University Hospital, University of Murcia, Murcia, Spain
| | - D García-Olmo
- Surgery Department, Fundación Jiménez Díaz University Hospital, 28033, Madrid, Spain
- New Therapy Laboratory, Health Research Institute of the Jimenez Diaz Foundation (Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz), Avda Reyes Católicos 2, 28040, Madrid, Spain
- Department of Surgery, Faculty of Medicine, Universidad Autónoma de Madrid, 28029, Madrid, Spain
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Tiwari B, Sharma A, Vashishtha V. Comprehensive Assessment of Inflammatory Indices to Predict Outcomes in Acute Pancreatitis. J INVEST SURG 2023; 36:2152914. [PMID: 36514899 DOI: 10.1080/08941939.2022.2152914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Bhavana Tiwari
- Department of Surgery, Army College of Medical Sciences, Delhi, India
| | - Ankur Sharma
- Department of Surgery, Base Hospital Delhi Cantonment, Delhi, India
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Kumar R, Kattimani B, Ojha PR, Khasage UJ. Quick Sequential Organ Failure Assessment Score, Lactate, and Neutrophil-Lymphocyte Ratio Help in Diagnosis and Mortality Prediction during Golden Hour of Sepsis in Emergency Department. J Emerg Trauma Shock 2023; 16:161-166. [PMID: 38292274 PMCID: PMC10824218 DOI: 10.4103/jets.jets_37_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Sepsis is a life-threatening condition with a very narrow golden period in which confirmatory diagnosis may change the outcome dramatically. No confirmatory biomarker is available till date for early diagnosis of sepsis. This study aimed to evaluate the combined and independent role of quick sequential organ failure assessment (qSOFA) score, lactate, and neutrophil-lymphocyte ratio (NLR) in diagnosis and mortality prediction in early sepsis. Methods This was a hospital-based, single-center, prospective cohort study conducted in a tertiary care institute, Karnataka, India. Three hundred adult sepsis patients were recruited during 10-month period, and demographic data, qSOFA score, lactate, NLR, and culture samples were collected in ED within 1 h of admission. Outcome groups (survivor and nonsurvivor) were statistically analyzed with relative frequencies (%), median, mean ± standard deviation with 95% confidence interval (CI), univariate, bivariate, and multivariate logistic regression analysis, and Receiver -operating characteristic curve (ROC) curve to test the predictive ability of initial levels of three biomarkers. Results Sepsis was more prevalent among middle-aged male patients. Male gender (odds ratio [OR], 6.9; 95% CI: 1.61-30.1), qSOFA (OR, 154; 95% CI: 15-1565), and lactate (OR, 1.36; 95% CI: 22-833) show 97% (area under the curve) predictive accuracy of the model for sepsis on bivariate and multivariate logistic regression analysis. A significant rise in NLR was a poor outcome indicator on univariate analysis (P = 0.773). Conclusion All three biomarkers are good outcome predictors whereas qSOFA and lactate have diagnostic significance in early sepsis. These markers can be used for patient triaging, minimizing culture report dependence for treatment and ultimately the outcome.
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Affiliation(s)
- Rakesh Kumar
- Department of Emergency Medicine, BLDE, Vijayapura, Karnataka, India
| | - Babu Kattimani
- Department of Emergency Medicine, BLDE, Vijayapura, Karnataka, India
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Palčić Marija G, Hana M, Ivan K, Lucija V, Vedran H, Luka V, Mrsić F, Radovan Z, Ivana Ć, Petar G. Post-treatment neutrophil to lymphocyte ratio as a prognostic tool in patients treated with tocilizumab for severe COVID-19 pneumonia - a single center experience. Biochem Med (Zagreb) 2023; 33:020704. [PMID: 37324114 PMCID: PMC10231768 DOI: 10.11613/bm.2023.020704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Introduction Tocilizumab is used in patients with severe COVID-19 pneumonia and high concentration of IL-6. We studied potential prognostic role of neutrophil and lymphocyte count regarding tocilizumab treatment. Materials and methods We enrolled 31 patients with severe COVID-19 pneumonia and higher serum IL-6 concentration. The samples were taken on the day of tocilizumab administration and five days later. We used ROC analysis to investigate the association between the analysed parameters and 30-day mortality in order to determine the best pre-treatment and post-treatment prognostic factor. Kaplan-Meier curves and log-rank test were used to present and to analyse the difference in survival. Results Patients had a median age of 63 (55-67) years and were treated with a median tocilizumab dose of 800 mg. During the 30-day follow-up period, 17 patients died (30-day mortality 54%). Among pre-treatment variables, neutrophil count had the best prognostic accuracy (AUC 0.81, 95%CI: 0.65-0.96, P = 0.004), while neutrophil to lymphocyte ratio (NLR) had the highest accuracy among post-treatment variables in predicting 30-day mortality (AUC 0.94, 95%CI: 0.86-1.00, P < 0.001). Among post-treatment parameters, neutrophil count and NLR were equally good prognostic factors. Post-treatment NLR cut-off of 9.8 had the sensitivity of 81% and specificity of 93%. Patients with NLR ≥ 9.8 had the median survival of 7.0 (3-10) days vs. median survival not reached in patients with NLR < 9.8 (P < 0.001). Conclusion Pre-treatment and post-treatment neutrophil count with post-treatment NLR may represent prognostic tools for patients with higher IL-6 concentration in severe COVID-19 pneumonia treated with tocilizumab.
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Affiliation(s)
- Gomerčić Palčić Marija
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Internal Medicine, Sestre milosrdnice University Hospital Center, Division of Pulmonology, Zagreb, Croatia
| | - Matijaca Hana
- Department of Internal Medicine, Sestre milosrdnice University Hospital Center, Division of Hematology, Zagreb, Croatia
| | - Kruljac Ivan
- Solmed Group, Department: Poliklinika Solmed, Zagreb, Croatia
| | - Vusić Lucija
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Hostić Vedran
- Department of Anesthesiology, Intensive Care Medicine and Pain Management, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vrbanić Luka
- Department of Internal Medicine, Sestre milosrdnice University Hospital Center, Division of Pulmonology, Zagreb, Croatia
| | - Fanika Mrsić
- Department of Internal Medicine, Sestre milosrdnice University Hospital Center, Division of Clinical Immunology and Rheumatology, Zagreb, Croatia
| | - Zrilić Radovan
- Polyclinic for Respiratory Diseases, Dom zdravlja Zagreb - Zapad, Zagreb, Croatia
| | - Ćelap Ivana
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Croatia
| | - Gaćina Petar
- Department of Internal Medicine, Sestre milosrdnice University Hospital Center, Division of Hematology, Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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Chelariu AC, Coman AE, Lionte C, Gorciac V, Sorodoc V, Haliga RE, Petris OR, Bologa C, Puha G, Stoica A, Constantin M, Sirbu O, Ceasovschih A, Sorodoc L. The Value of Early and Follow-Up Elevated Scores Based on Peripheral Complete Blood Cell Count for Predicting Adverse Outcomes in COVID-19 Patients. J Pers Med 2022; 12:jpm12122037. [PMID: 36556258 PMCID: PMC9781715 DOI: 10.3390/jpm12122037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/20/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Background: The ongoing COVID-19 pandemic has put a constant strain on hospital resources, so there is a dire need for investigation methods that are widely available and that can predict mortality and the need for critical care. Hematological indices, which can be easily calculated from a complete blood count (CBC), are useful in determining a patient’s inflammatory response to infectious diseases. Aim: This was a prospective cohort study that aimed to assess the prognostic value of scores based on CBCs in hospitalized patients with mild or moderate COVID-19 and medical comorbidities regarding the need for intensive care unit (ICU) therapy and short-term mortality. Methods: We included 607 patients with confirmed COVID-19, followed up for the need for ICU admission (15.5%) and 30 day mortality post-discharge (21.7%). CBC-derived scores were tested upon emergency department (ED) admission and after a median of 8 days. Results: In a multivariate model, elevated followed-up neutrophil-to-lymphocyte ratio (NLR) predicted increased odds for ICU admission (OR: 1.14 [95%CI: 1.06−1.22], p < 0.001) and short-term mortality (OR: 1.30 [95%CI: 1.09−1.57], p = 0.005). Monocyte-to-lymphocyte ratio (MLR) predicted 2.5-fold increased odds for ICU admission and 2.2-fold increased odds for mortality. Conclusion: NLR and MLR followed up 8 days post-admission are predictive for adverse outcomes in mild or moderate COVID-19 patients.
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Affiliation(s)
- Andrei-Costin Chelariu
- Hematology Department, Regional Institute of Oncology, 700483 Iasi, Romania
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Adorata Elena Coman
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
- Preventive Medicine and Interdisciplinarity Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Catalina Lionte
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
- Correspondence: (C.L.); (V.S.)
| | - Victoria Gorciac
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
- Rheumatology Department, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Victorita Sorodoc
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
- Correspondence: (C.L.); (V.S.)
| | - Raluca Ecaterina Haliga
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Ovidiu Rusalim Petris
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
- Nursing Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Cristina Bologa
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Gabriela Puha
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Alexandra Stoica
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Mihai Constantin
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Oana Sirbu
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Alexandr Ceasovschih
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Laurentiu Sorodoc
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
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10
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Mangalesh S, Dudani S, Malik A. The systemic immune-inflammation index in predicting sepsis mortality. Postgrad Med 2022; 135:345-351. [PMID: 36287784 DOI: 10.1080/00325481.2022.2140535] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The systemic immune-inflammation index (SII) is a novel parameter and its role in the prognosis of sepsis has never been explored previously. METHODS We retrospectively assessed 267 patients with blood-culture confirmed sepsis. Clinical and laboratory data recorded at intensive care unit (ICU) admission were analyzed. Outcomes of interest included in-hospital mortality and length-of-stay (LOS) in the ICU. Sequential Organ Failure Assessment (SOFA) scores, SII, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were calculated. Multivariable regression analysis was used to identify independent predictors of LOS and mortality. Area under receiver operator characteristic (AUROC) curves were used to determine optimum cutoffs, and the incremental effect of SII on the SOFA score was assessed using model discrimination and calibration properties. RESULTS There were 76 (28.5%) non-survivors. SII, NLR, and PLR were independent predictors of sepsis mortality, with adjusted odds ratios of 1.51 (1.24-1.84), 1.67 (1.30-2.13) and 1.24 (1.11-1.39). SII and SOFA score were independent predictors of LOS. SII had an AUROC of 0.848, and the optimum cutoff was 564 with a sensitivity and specificity of 85.5% and 71.2%. The addition of SII to the model had a significant incremental effect on the predictive ability of SOFA score (Net Reclassification Index = 0.084, P = 0.025; Integrated Discrimination Index = 0.056, P = 0.001). CONCLUSION The SII is an inexpensive parameter that can be used in addition to clinical sepsis scores to improve the accuracy of patient assessment.
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Affiliation(s)
- Sridhar Mangalesh
- Department of Medicine, Army College of Medical Sciences, New Delhi, India
| | - Sharmila Dudani
- Department of Pathology, Army College of Medical Sciences, New Delhi, India
| | - Ajay Malik
- Department of Pathology, Army College of Medical Sciences, New Delhi, India
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11
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Chebl RB, Assaf M, Kattouf N, Haidar S, Khamis M, Abdeldaem K, Makki M, Tamim H, Dagher GA. The association between the neutrophil to lymphocyte ratio and in-hospital mortality among sepsis patients: A prospective study. Medicine (Baltimore) 2022; 101:e29343. [PMID: 35905272 PMCID: PMC9333497 DOI: 10.1097/md.0000000000029343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The Neutrophil to lymphocyte ratio (NLR) was shown to be associated with disease severity, poor prognosis and increased mortality in sepsis. However, the association between NLR and sepsis prognosis remains controversial. Our study aims to prospectively examine the prognostic ability of NLR in predicting in-hospital mortality among sepsis patients and determine the optimal cutoff of NLR that can most accurately predict in-hospital mortality in sepsis patients. This study was a prospective cohort study that included adult sepsis patients that presented to the emergency department of a tertiary care center between September 2018 and February 2021. Receiver operating characteristic curve was used to determine the optimal cutoff of the neutrophil to lymphocyte ratio that predicts in-hospital mortality. Patients were divided into 2 groups: above and below the optimal cutoff. Stepwise logistic regression was performed to assess the magnitude of the association between NLR and in-hospital mortality. A total of 865 patients were included in the study. The optimal cutoff for the neutrophil to lymphocyte ratio that predicts in-hospital mortality was found to be 14.20 with a sensitivity of 44.8% and a specificity of 65.3% (with PPV = 0.27 and NPV = 0.80). The area under the curve for the ratio was 0.552 with a 95% confidence intervals = [0.504-0.599] with a P value = .03. Patients that have a NLR above the cutoff were less likely to survive with time compared to patients below the cutoff based on the Kaplan-Meier curves. In the stepwise logistic regression, the optimal neutrophil to lymphocyte ratio cutoff was not associated with in-hospital mortality (odds ratios = 1.451, 95% confidence intervals = [0.927-2.270], P = .103). In conclusion the optimal cutoff of the NLR that predicts in-hospital mortality among sepsis patients was 14.20. There was no association between the NLR and in-hospital mortality in sepsis patients after adjusting for confounders. Further studies with a larger sample size should be done to determine the optimal NLR cutoff and its prognostic role in septic patients (in-hospital mortality and other clinically significant outcomes).
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Affiliation(s)
- Ralph Bou Chebl
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohamad Assaf
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Nadim Kattouf
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Saadeddine Haidar
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohamed Khamis
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Karim Abdeldaem
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Maha Makki
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Gilbert Abou Dagher
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
- *Correspondence: Gilbert Abou Dagher, Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box - 11-0236 Riad El Solh, Beirut 1107 2020, Lebanon (e-mail: )
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12
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Usefulness of Selected Peripheral Blood Counts in Predicting Death in Patients with Severe and Critical COVID-19. J Clin Med 2022; 11:jcm11041011. [PMID: 35207281 PMCID: PMC8878821 DOI: 10.3390/jcm11041011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/05/2022] [Accepted: 02/13/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Immune dysregulation and hypoxemia are two important pathophysiological problems in patients with COVID-19 that affect peripheral blood count parameters. We hypothesized that assessment of the neutrophil-lymphocyte ratio (NLR) and red blood cell distribution width index (RDW-SD) could predict death in patients with severe and critical COVID-19. METHODS Seventy patients admitted to the intensive care unit (ICU) for COVID-19 acute respiratory failure were included in the study. RDW-SD and NLR on the day of ICU admission and peak values during the entire hospitalization were assessed. The primary endpoint was death before ICU discharge. RESULTS Patients who died had higher NLR on admission (20.3, IQR 15.3-30.2 vs. 11.0, IQR 6.8-16.9; p = 0.003) and higher RDW-SD (48.1 fL; IQR 43.1-50.5 vs. 43.9 fL; IQR 40.9-47.3, p = 0.01) than patients discharged from the ICU. NLR and RDW-SD values on ICU admission accurately predicted death in 76% (AUC = 0.76; 95%CI 0.65-0.86; p = 0.001; cut-off > 14.38) and 72% of cases (AUC = 0.72; 95%CI 0.60-0.82; p = 0.003; cut-off > 44.7 fL), respectively. Multivariable analysis confirmed that NLR > 14.38 on the day of ICU admission was associated with a 12-fold increased risk of death (logOR 12.43; 95%CI 1.61-96.29, p = 0.02), independent of other blood counts, clinical and demographic parameters. CONCLUSIONS Neutrophil-lymphocyte ratio determined on the day of ICU admission may be a useful biomarker predicting death in patients with severe and critical COVID-19.
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Predictors of rapidly progressive- interstitial lung disease and mortality in patients with autoantibodies against melanoma differentiation-associated protein 5 dermatomyositis. Rheumatology (Oxford) 2022; 61:4437-4444. [DOI: 10.1093/rheumatology/keac094] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/03/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
Anti-melanoma differentiation-associated protein 5 (MDA5) positive dermatomyositis (DM) is associated with rapidly progressive interstitial lung disease (RP-ILD) and high mortality. This multicentre retrospective study aimed to identify predictors for mortality and RP-ILD.
Methods
Anti-MDA5 positive DM patients were identified from the Hong Kong Myositis Registry and the Clinical Data Analysis and Reporting System. Clinical characteristics were reviewed. Risk factors for mortality and RP-ILD were identified.
Results
Among the 116 recruited patients, 100 (86.2%) had ILD, 47 (40.5%) had RP-ILD and 44 (37.9%) patients died. Cox regression analysis revealed that RP-ILD (HR 9.735, 95%CI 3.905–24.272), age >52 (HR 4.750, 95%CI 1.692–13.333), ferritin level >2800pmol/l (HR 3.042, 95%CI 1.323–6.997) and lactate dehydrogenase (LDH) >400 IU/l (HR 2.290, 95% CI 1.009–5.198) were independent predictors of mortality. With regard to RP-ILD, analyses showed that potential predictors at baseline included age >50 years old (HR 2.640, 95%CI 1.277–5.455), LDH >300IU/l (HR3.189, 95%CI 1.469–6.918), fever (HR 1.903, 95% CI: 0.956–3.790) and neutrophil to lymphocyte ratio (NLR) >7.0 (HR 1.967, 95%CI 0.942–4.107). We proposed a prediction model, based on Fever, LDH, Age and White cell count (“FLAW”), to stratify risk of development of RP-ILD. The probability of RP-ILD in a patient with a score of 4 was 100%. A small internal validation cohort showed the odds of RP-ILD with FLAW scores of 0, 1, 2 and 3 were 0%, 0%, 42.9% and 75% respectively.
Conclusions
Anti-MDA5-associated RP-ILD is significantly associated with poor survival rates. The “FLAW” model maybe useful to predict the development of RP-ILD.
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Hussen J, Shawaf T, Alhojaily SM. The Impact of Anticoagulation Agent on the Composition and Phenotype of Blood Leukocytes in Dromedary Camels. Vet Sci 2022; 9:vetsci9020078. [PMID: 35202331 PMCID: PMC8878879 DOI: 10.3390/vetsci9020078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/26/2022] [Accepted: 02/11/2022] [Indexed: 01/01/2023] Open
Abstract
For the analysis of several cellular biomarkers, blood samples are anticoagulated using different agents with different modes of action. However, for the most commonly used anticoagulants, EDTA and heparin, varying effects on blood components have been reported in different species. As little is known about the impact of anticoagulants on the immunological evaluation of camel leukocytes, the present study analyzed the leukogram, the immunophenotype, and the cell vitality of camel leukocytes separated from blood samples anticoagulated with EDTA or lithium heparin. Using flow cytometry and staining with monoclonal antibodies to several cell surface markers, the composition and immunophenotype of camel leukocytes separated from blood anticoagulated with EDTA or heparin were analyzed. In comparison to EDTA-anticoagulated blood, using lithium heparin as an anticoagulant resulted in reduced numbers of total leukocytes and reduced numbers of neutrophils, which led to a reduced neutrophil to lymphocyte ratio. The analysis of cell necrosis and apoptosis after the staining of leukocytes with the DNA-sensitive dye propidium iodide and the mitochondrial membrane potential probe JC1 revealed a higher fraction of necrotic neutrophils and higher fractions of apoptotic neutrophils and monocytes in heparin blood than in EDTA blood. In addition, monocytes from heparin blood showed higher expression levels of the cell surface markers CD14, CD163, and MHCII when compared to cells from EDTA blood. Similarly, in heparin blood, CD44 and CD172a were expressed higher on neutrophils, while CD11a was expressed higher on lymphocytes in comparison to cells from EDTA blood. The results of the current study indicate the importance of considering the type of anticoagulant when investigating the composition, vitality, and immunophenotype of camel leukocytes.
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Affiliation(s)
- Jamal Hussen
- Department of Microbiology, College of Veterinary Medicine, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- Correspondence: ; Tel.: +966-135896626
| | - Turke Shawaf
- Department of Clinical Sciences, College of Veterinary Medicine, King Faisal University, Al-Ahsa 31982, Saudi Arabia;
| | - Sameer M. Alhojaily
- Department of Biomedical Sciences, College of Veterinary Medicine, King Faisal University, Al-Ahsa 31982, Saudi Arabia;
- Agricultural and Veterinary Training and Research Station, King Faisal University, Al-Ahsa 31982, Saudi Arabia
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15
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Dinler Ay C. Neutrophil to lymphocyte ratio as a prognostic biomarker in puppies with acute diarrhea. J Vet Emerg Crit Care (San Antonio) 2021; 32:83-89. [PMID: 34800354 DOI: 10.1111/vec.13159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/29/2021] [Accepted: 05/29/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To document the neutrophil to lymphocyte ratio (NLR) values in systemic inflammatory response syndrome positive (SIRS+) and negative (SIRS-) puppies presenting with acute diarrhea (AD). To determine whether the calculated canine acute diarrhea severity index (CADSI) score was associated with NLR. Also, to investigate the prognostic value of NLR in puppies with acute diarrhea. DESIGN Retrospective study. SETTING University veterinary teaching hospital. ANIMALS A total of 85 puppies (2-6 months old), 70 with AD and 15 healthy controls (CON). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Pertinent history, physical examination findings and results of complete blood count analysis of dogs with AD at the time of admission to the hospital were obtained from medical records. Forty-seven of the dogs with AD were SIRS+ and 23 were SIRS-. Of the puppies with AD, 11 died within 7 days after initiation of treatment, 59 survived. NLR values in dogs with AD were statistically higher (P < 0.001) than the CON group, but there was no difference (P = 0.791) between the two groups in terms of white blood cell (WBC) count. The median NLR of SIRS+ (3.66) dogs was significantly higher than the median NLRs of dogs in the SIRS- (1.88) and CON (1.35) groups. While a strong positive correlation (ρ = 0.740; P < 0.001) was found between the CADSI score and NLR in dogs with AD, the relationship between WBC and disease severity was not significant (ρ = -0.117; P = 0.336). The area under the receiver-operating characteristic curves for nonsurvival in dogs with AD was 0.710 (P = 0.039) for the NLR and 0.773 (P = 0.008) for the WBC. CONCLUSIONS Evaluation of NLR at hospital admission may be a useful marker of disease severity and may have prognostic value in puppies with AD. Further investigations are required to understand the implications of these findings.
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Affiliation(s)
- Ceren Dinler Ay
- Department of Internal Medicine, Veterinary Faculty, Aydin Adnan Menderes University, Aydın, Turkey
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16
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Mas-Celis F, Olea-López J, Parroquin-Maldonado JA. Sepsis in Trauma: A Deadly Complication. Arch Med Res 2021; 52:808-816. [PMID: 34706851 DOI: 10.1016/j.arcmed.2021.10.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 11/28/2022]
Abstract
Sepsis is a major cause of death following a traumatic injury. As a life-threatening medical emergency, it is defined as the body's extreme response to an infection. Without timely treatment, sepsis can rapidly lead to tissue damage, and organ failure The capacity to limit tissue damage through metabolic adaptation and repair processes is associated with an excessive immune response of the host. It is important to make an early prediction of sepsis, based on the quick Sepsis associated Organ Failure Assessment Score (qSOFA), so an accurate treatment can be initiated reducing the morbidity and mortality at the emergency and UCI services. Many factors increase the rate of complications and the development of sepsis in a trauma patient, representing a challenge to orthopedic surgeons. Several early biomarkers that help to identify and predict the inflammatory and immune responses of the host going through polytrauma and sepsis have been studied; procalcitonin (PCT), C-reactive protein (CRP), glycosylated hemoglobin (HbA1c), the Neutrophil/lymphocyte ratio (NLR), Interleukin-17 (IL-17), Caspase-1, Vanin-1, High-density lipoproteins (HDL), and the Thrombin-activable fibrinolysis inhibitor (TAFI). Once sepsis is diagnosed, treatment must be immediately initiated with an appropriate empiric antimicrobial, an all-purpose supporting treatment, and metabolic control, followed by the specific antibiotic therapy based on blood culture. Since the participation of sepsis in polytrauma has been recognized as a key event in the outcome of patients at the ICU, the ability of the specialist to early recognize a septic process has become a key feature to reduce mortality and improve clinical prognosis.
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Affiliation(s)
- Fernanda Mas-Celis
- Departamento de Ortopedia y Traumatología, Hospital Angeles del Pedregal, Ciudad de México, México.
| | - Jimena Olea-López
- Departamento de Ortopedia y Traumatología, Hospital Angeles del Pedregal, Ciudad de México, México
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Purnamantara IMD, Wiargitha IK, Mahadewa TGB. Role of Neutrophil-to-Lymphocyte Ratio as a Predictor of Systemic Inflammatory Response Syndrome in Blunt Abdominal Trauma Following Emergency Laparotomy in Sanglah General Hospital, Denpasar. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Abdominal trauma, both blunt and penetrating abdominal trauma, is the third most common trauma, which is about 10% after head trauma (30%) and chest trauma (20%). Trauma has an influence on the balance of the immune system. The excessive inflammatory response can trigger systemic inflammatory response syndrome (SIRS). The ratio of neutrophils to lymphocytes acts as a marker of the inflammatory response in both surgical and non-surgical patients.
AIM: The purpose of the study was to predict the incidence of SIRS using neutrophils-to-lymphocytes ratio (NLR) in patients with blunt abdominal trauma undergoing emergency laparotomy.
METHODS: This study is an observational analytic study with a prospective design which was carried out at the emergency room, intensive care unit, Sanglah Hospital, Denpasar, Surgery for 1 year from January 2019 to December 2019, involving 59 research subjects with the consecutive sampling method who is met the inclusion and exclusion criteria.
RESULTS: The area under the curve value obtained an NLR sensitivity of 87.1% with a cutoff point of 5.25. In the path analysis, it was found that NLR was the dominant factor and had a positive effect of 43.9% (p < 0.001) on SIRS.
CONCLUSION: NLR is expected to be used as a reference to predict the incidence of SIRS in blunt abdominal trauma following laparotomy emergency.
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Kandeel M, Almubarak AI, Hussen J, El-Deeb W, Venugopala KN. Pharmacokinetic, Clinical, and Myeloid Marker Responses to Acepromazine Sedation in Arabian Camels. Front Vet Sci 2021; 8:725841. [PMID: 34568476 PMCID: PMC8455987 DOI: 10.3389/fvets.2021.725841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022] Open
Abstract
Sedatives and tranquilizers are important in the control of excited camels during camel transport. This study was conducted to investigate the clinical sedation of camels with acepromazine and its correlation with pharmacokinetics and pharmacodynamics. The sedation score, heart rate, respiration, body temperature, and pharmacokinetics were monitored before and after acepromazine injection, and myeloid marker expression was analyzed using membrane immunofluorescence and flow cytometry. The distribution (t1/2α) and elimination (t1/2β) half-lives were 0.1 and 9.4 h, respectively. The volume of distribution at steady state (Vss) was 20.01 L/kg, and the mean residence time (MRT) was 12.25 h. Sedation started rapidly within 10 min followed by persistent low-medium sedation for 2 h with an average sedation score of 1.2 ± 0.61, which might be associated with a slow elimination phase and prolonged MRT. Compared to horses, camels showed a lower clearance rate, higher volume of distribution, and higher elimination half-life. Slight changes in body temperature and heart and respiratory rate, as well as a lower hematocrit and changes in blood cell composition, suggest the careful application of acepromazine in animals with abnormal blood parameters or poor vital conditions.
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Affiliation(s)
- Mahmoud Kandeel
- Department of Biomedical Sciences, College of Veterinary Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.,Department of Pharmacology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Adel I Almubarak
- Department of Clinical Scienses, College of Veterinary Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Jamal Hussen
- Department of Microbiology, College of Veterinary Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Wael El-Deeb
- Department of Clinical Scienses, College of Veterinary Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.,Department of Internal Medicine, Infectious Diseases and Fish Diseases, Faculty of Veterinary Medicine, Mansoura University, Manosura, Egypt
| | - Katharigatta N Venugopala
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia.,Department of Biotechnology and Food Science, Faculty of Applied Sciences, Durban University of Technology, Durban, South Africa
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Fiorella ML, Greco P, Madami LM, Giannico OV, Pontillo V, Quaranta N. New laboratory predictive tools in deep neck space infections. ACTA ACUST UNITED AC 2021; 40:332-337. [PMID: 33299222 PMCID: PMC7726647 DOI: 10.14639/0392-100x-n0790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
Abstract
Introduction Deep neck space infections (DNSIs) are a group of infective suppurative diseases involving deep neck spaces and cervical fascia. Necrotising and septic evolutions are rare, but severe complications can dramatically affect the prognosis and should be promptly managed. Clinical examination often has low sensitivity, although instrumental diagnosis may delay te treatment. We investigated two laboratory tools, LRINEC (Laboratory Risk Indicator for the Necrotizing fasciitis) and NLR (neutrophil to lymphocyte ratio), in the expectation to find a rapidly available predictive indicator that may help in distinguishing necrotising complications and/or systemic septic involvement. Methods A retrospective observational cohort study was performed on 118 patients who had underwent surgical treatment for DNSIs at our Surgical Unit. LRINEC, NLR and the product LRINEC x NLR were calculated. Results Statistical analysis showed that these scores may have utility in rapidly predicting the risk of necrotising fasciitis and systemic involvement at an early diagnostic stage. Conclusions Further studies with a larger cohort may be necessary in order to increase the sensitivity and specificity.
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Affiliation(s)
- Maria Luisa Fiorella
- Unit of Otorhinolaryngology, Department of Biomedical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | - Paolo Greco
- Unit of Otorhinolaryngology, Department of Biomedical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | - Luigi Maria Madami
- Unit of Otorhinolaryngology, Department of Biomedical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | - Orazio Valerio Giannico
- Section of Hygiene, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Vito Pontillo
- Unit of Otorhinolaryngology, Department of Biomedical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | - Nicola Quaranta
- Unit of Otorhinolaryngology, Department of Biomedical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
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Immunomodulatory Effects of the Cyclooxygenase Inhibitor Lornoxicam on Phenotype and Function of Camel Blood Leukocytes. Animals (Basel) 2021; 11:ani11072023. [PMID: 34359151 PMCID: PMC8300418 DOI: 10.3390/ani11072023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary The present study investigated the immunomodulatory effects of the unspecific cyclooxygenase inhibitor lornoxicam on the immunophenotype and some functions of dromedary camel blood leukocytes. Intravenous injection of camels with a single dose of lornoxicam induced a significant change in the camel leukogram, which is characterized by reduced cell numbers of all leukocyte subpopulations. In vitro analysis of cell vitality revealed a pro-apoptotic effect of lornoxicam on camel leukocytes, which may be responsible for the lornoxicam-induced leukocytopenia in vivo. Functional ex vivo and in vitro analysis of the key antimicrobial functions, phagocytosis and ROS production indicates inhibitory effects of lornoxicam on the antimicrobial capacity of the blood phagocytes, monocytes and neutrophils. Furthermore, lornoxicam induced an anti-inflammatory phenotype of monocytes, characterized by reduced expression of major histocompatibility complex (MHC) class II molecules and increased expression of CD163 molecules. The present study identified for the first time inhibitory effects of the COX-inhibitor lornoxicam on some phenotypic and functional properties of camel blood immune cells and recommends considering these effects when using lornoxicam in camel medicine. Abstract (1) Background: Lornoxicam is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, antiphlogistic and antipyretic effects. The improved tolerance of lornoxicam due to the relatively shorter elimination half-life in comparison to other members of the oxicams may favor its application in the management of pain and inflammation in race dromedary camels. There are no studies conducted yet on the immunomodulatory or immunotoxilogic effect of lornoxicam in camels. Therefore, the current study aimed to evaluate the immunomodulatory effects of the cyclooxygenase inhibitor lornoxicam on some phenotypic and functional properties of camel blood leukocytes; (2) Methods: Using flow cytometry, blood leukocyte composition, monocyte phenotype, and antimicrobial functions of neutrophils and monocytes were analyzed ex vivo after a single dose injection with lornoxicam. In addition, the effect of in vitro incubation of camel blood with lornoxicam on leukocyte cell vitality and antimicrobial functions were evaluated; (3) Results: The injection of camels with a single dose of lornoxicam resulted in a significant change in their leukogram with reduced numbers of total leukocytes, neutrophils, eosinophils, monocytes, and lymphocytes. Within the lymphocyte population, the numbers of CD4+ T cells, γδ T cells, and B cells decreased significantly in blood after injection of camels with lornoxicam. In addition, injection of lornoxicam resulted in decreased abundance of major histocompatibility complex (MHC) class II molecules and increased abundance of the scavenger receptor CD163 on blood monocytes, indicating an anti-inflammatory phenotype of monocytes. Functionally, administration of lornoxicam decreased the capacity of camel neutrophils and monocytes to uptake bacteria and to produce reactive oxygen species (ROS) after bacterial stimulation. Similarly, the in vitro whole blood incubation with lornoxicam resulted in reduced phagocytosis and ROS production activity of the camel blood phagocytes. Flow cytometric analysis of cell vitality, including cell necrosis and apoptosis, revealed a pro-apoptotic effect of lornoxicam on camel leukocytes; (4) Conclusions: Lornoxicam administration, at the dose and intervals utilized herein, induces significant changes in the phenotype and function of camel blood leukocytes. The reduced cell numbers of all studied leukocyte subpopulations in lornoxicam-treated camels, which seems to be a result of enhanced cell apoptosis, indicates an inhibitory effect rather than a modulatory effect of lornoxicam on the camel immune system, which need to be considered when using lornoxicam in camel medicine.
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Altas OF, Kizilkaya M. The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care. Medeni Med J 2021; 36:130-137. [PMID: 34239765 PMCID: PMC8226410 DOI: 10.5222/mmj.2021.64160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/29/2021] [Indexed: 11/22/2022] Open
Abstract
Objective In this study, we aimed to reveal the level of predicting mortality of the Neutrophil/Lymphocyte (NLR) and Platelet/Lymphocyte Ratios (TLR) calculated in patients hospitalized with the diagnosis of pneumonia in the intensive care unit when compared with other prognostic scores. Method The hospital records of 112 patients who were admitted to the intensive care unit between January 2015 and January 2018 and met the inclusion criteria were retrospectively reviewed. The patients’ demographic data, the NLR and PLR levels, and the APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment) scores were calculated from the patient files. Results Of the 112 patients examined, 70 were males. The risk analysis showed that the male gender had 2.7 times higher risk of mortality. The NLR, PLR, APACHE II, and SOFA values were found statistically significant in predicting mortality (p<0.001). An evaluation of the risk ratios demonstrated that each one point increase in the NLR increased the mortality risk by 5%, and each one point increase in the SOFA score increased the mortality risk by 13% (p<0.05). In the ROC (receiver operating characteristic) analysis, the NLR assessment proved to be the most powerful, most specific, and sensitive test. The cut-off values were 11.3 for the NLR, 227 for the PLR, 29.8 for the APACHE II scores, and 5.5 for the SOFA scores Conclusion We believe that NLR and PLR are strong and independent predictors of mortality that can be easily and cost-effectively tested.
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Affiliation(s)
- Omer Faruk Altas
- Izmir Bakircay University Cigli Training and Research Hospital, Department of Anesthesiology and Reanimation, Izmir, Turkey
| | - Mehmet Kizilkaya
- Amasya University Sabuncuoğlu Serafettin Training and Research Hospital, Department of Anesthesiology and Reanimation, Amasya, Turkey
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Al Saleh K, AlQahtani RM. Platelet count patterns and patient outcomes in sepsis at a tertiary care center: Beyond the APACHE score. Medicine (Baltimore) 2021; 100:e25013. [PMID: 33950914 PMCID: PMC8104228 DOI: 10.1097/md.0000000000025013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 02/12/2021] [Indexed: 01/04/2023] Open
Abstract
Acute physiology and chronic health evaluation II (APACHE-II) scoring system is used to classify disease severity of patients in the intensive care unit. However, several limitations render the scoring system inadequate in identifying risk factors associated with outcomes. Little is known about the association of platelet count patterns, and the timing of platelet count and other hematologic parameters in predicting mortality in patients with sepsis.This retrospective observational study included 205 septic shock patients, with an overall mortality of 47.8%, enrolled at a tertiary care hospital in Riyadh, Kingdom of Saudi Arabia between 2018 and 2020. Bivariate and multivariate regression analyses were used to identify hematologic risk factors associated with mortality. We used the bivariate Pearson Correlation test to determine correlations between the tested variables and APACHE-II score.Two platelet count patterns emerged: patients with a decline in platelet count after admission (group A pattern, 93.7%) and those with their lowest platelet count at admission (group B pattern, 6.3%). The lowest mean platelet count was significantly lower in nonsurvivors (105.62 ± 10.67 × 103/μL) than in survivors (185.52 ± 10.81 × 103/μL), P < .001. Bivariate Pearson correlation revealed that the lowest platelet count and platelet count decline were significantly correlated with APACHE-II score (r = -0.250, P < .01), (r = 0.326, P < .001), respectively. In multiple logistic regression analysis, the independent mortality risk factors were degree of platelet count decline in group A (odds ratio, 1.028 [95% confidence interval: 1.012-1.045], P = .001) and platelet pattern in group B (odds ratio, 6.901 [95% confidence interval: 1.446-32.932], P = .015). The patterns, values, subsets, and ratios of white blood cell count were not significantly associated with mortality.Nadir platelet count and timing, and degree of platelet count decline are useful markers to predict mortality in early septic shock. Therefore, platelet count patterns might enhance the performance of severity scoring systems in the intensive care unit.
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Affiliation(s)
| | - Rakan M. AlQahtani
- Department of Critical Care, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Mangalesh S, Dudani S, Malik A. Platelet Indices and Their Kinetics Predict Mortality in Patients of Sepsis. Indian J Hematol Blood Transfus 2021; 37:600-608. [PMID: 33776267 PMCID: PMC7988247 DOI: 10.1007/s12288-021-01411-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/09/2021] [Indexed: 12/13/2022] Open
Abstract
Platelet indices are inexpensive, easily accessible parameters and potentially useful prognostic indicators in sepsis. In this study we explore the differences in platelet indices and their kinetics between sepsis survivors and non-survivors. A retrospective cohort-study of 97 cases of culture-positive sepsis at a tertiary-care center in North India. Demographics, clinical and laboratory parameters at admission were assessed. Platelet count (PLT), mean-platelet-volume (MPV), platelet-distribution-width (PDW) and plateletcrit (PCT) on admission, and third, fifth and last days of hospitalization were analyzed. Fractional change in platelet indices (ΔMPV72h, ΔPDW72h, ΔPCT72h, and ΔPLT72h) by day-3 were calculated. Unpaired and paired t-tests were used to compare survivors with non-survivors, and to study the change in platelet indices with time. Logistic regression was used for multivariate analysis. ROC-curves and optimum cut-offs to predict mortality were obtained. There were 64 survivors. Non-survivors had significantly higher ΔMPV72h, ΔPDW72h, day-1 MPV and PDW, and lower ΔPLT72h. MPV and PDW increased, and PLT decreased with time among non-survivors. Trends were reversed in survivors. Only MPV and PDW showed significant change by day-3. Both were independent predictors of mortality on multivariate analysis, alongside ΔMPV72h and ΔPLT72h. On ROC analysis, MPV, PDW, ΔMPV72h, ΔPDW72h and ΔPLT72h effectively predicted mortality. Cut-off for MPV was 10.25 fL (sensitivity = 93.9%, specificity = 60.9%), and PDW, 12.6% (sensitivity = 84.8%, specificity = 51.6%). A rise in MPV and a fall in PLT was associated with mortality in this study. MPV and PDW values at admission are effective predictors of mortality and may be used in conjunction with traditional parameters.
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Affiliation(s)
| | - Sharmila Dudani
- Department of Pathology, Army College of Medical Sciences, Delhi, New Delhi India
| | - Ajay Malik
- Department of Pathology, Army College of Medical Sciences, Delhi, New Delhi India
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Abstract
Camels are domesticated animals that are highly adapted to the extreme desert ecosystem with relatively higher resistance to a wide range of pathogens compared to many other species from the same geographical region. Recently, there has been increased interest in the field of camel immunology. As the progress in the analysis of camel immunoglobulins has previously been covered in many recent reviews, this review intends to summarize published findings related to camel cellular immunology with a focus on the phenotype and functionality of camel leukocyte subpopulations. The review also describes the impact of different physiological (age and pregnancy) and pathological (e.g. infection) conditions on camel immune cells. Despite the progress achieved in the field of camel immunology, there are gaps in our complete understanding of the camel immune system. Questions remain regarding innate recognition mechanisms, the functional characterization of antigen-presenting cells, and the characterization of camel NK and cytotoxic T cells.
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Affiliation(s)
- Jamal Hussen
- Department of Microbiology, College of Veterinary Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Hans-Joachim Schuberth
- Institute of Immunology, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
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Rehman FU, Khan A, Aziz A, Iqbal M, Mahmood SBZ, Ali N. Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis. Cureus 2020; 12:e10851. [PMID: 33178505 PMCID: PMC7651770 DOI: 10.7759/cureus.10851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Neutrophil to lymphocyte ratio (NLR) can be easily calculated from the white cell differential count and is considered an auspicious marker for predicting different diseases, including sepsis. In this study, we aimed to compare the efficacy of NLR as a sepsis marker by comparing it with other markers of sepsis, such as C-reactive protein (CRP), procalcitonin, and the Sequential Organ Failure Assessment (SOFA) score. Methods A cross-sectional analytical study was conducted at the Aga Khan University Hospital from July 2019 to December 2019. A total of 168 patients who were admitted to the medicine department with a diagnosis of sepsis on arrival or during the hospital stay were enrolled. The neutrophil to lymphocyte ratio was calculated to form venous samples taken on admission and compared to the level of CRP, procalcitonin, culture reports, and the SOFA score as a predictor of sepsis. Results Out of 168 patients, 55.3% were male. The median age of the participants was 68.40 (interquartile range (IQR): 19.5) years in males and 64.0 (IQR: 18.0) in females. Procalcitonin was performed in 121 (72%) and CRP performed in 61 (36.3%) patients. The NLR showed significant associations with all the tested lab parameters of sepsis, such as CRP (p = 0.02), procalcitonin (p = 0.01), and SOFA score (p = 0.01). Values when analyzed according to culture-positive showed higher values in culture-positive samples but were not statistically significant. Conclusion Neutrophil to lymphocyte ratio is a cheap and rapidly available predictor of sepsis and has shown a significant correlation with other relatively expensive and non-rapidly existing markers of inflammation and sepsis. However, large prospective studies are needed to prove its real effectiveness as a marker of sepsis and its prognosis
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Affiliation(s)
- Fazal U Rehman
- Department of Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Asadullah Khan
- Department of Rheumatology, Fatima Memorial College of Medicine and Dentistry, Lahore, PAK
| | - Adil Aziz
- Department of Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Madiha Iqbal
- Department of Medicine, Aga Khan University Hospital, Karachi, PAK
| | | | - Naureen Ali
- Department of Nursing and Midwifery, Aga Khan University Hospital, Karachi, PAK
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Wang L, Guo W, Wang C, Yang X, Hao Z, Wu S, Zhang S, Wu B, Liu M. Dynamic Change of Neutrophil to Lymphocyte Ratios and Infection in Patients with Acute Ischemic Stroke. Curr Neurovasc Res 2020; 17:294-303. [PMID: 32268864 DOI: 10.2174/1567202617666200408091131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/06/2020] [Accepted: 03/11/2020] [Indexed: 02/08/2023]
Abstract
Background:
Neutrophil to lymphocyte ratio (NLR) on admission was reported to be a
predictor of pneumonia after stroke. The aim of this study was to investigate the association between
the temporal change of NLR and post-stroke infection and whether infection modified the
effect of NLR on the outcome.
Methods:
We enrolled patients with acute ischemic stroke within 24 h after onset. The blood was
collected on admission, day 1, 3, 7 after admission to detect white blood cells (WBC), neutrophils,
and lymphocytes. Primary outcomes included pneumonia, urinary tract infection (UTI), other infection,
and the secondary outcome was 3-month death.
Results:
Of 798 stroke patients, 299 (37.66%) developed infection with 240 (30.23%) pneumonia,
78 (9.82%) UTI, and 9 (1.13%) other infection. The median time of infection occurrence was 48 h
(interquartile range 27-74 h) after onset. NLR reached to the peak at 36 h. For all outcomes, NLR
at 36 h after stroke had the highest predictive value than WBC, neutrophil, lymphocyte. NLR was
independently associated with the presence of any infection (odds ratio [OR] 1.11, 95% confidence
interval [CI] 1.05-1.17), pneumonia (OR 1.12, 95%CI 1.05-1.19), but not UTI (OR 0.95, 95%CI
0.89-1.01). Adding infection or the interaction term did not substantially change the OR of NLR
predicting 3-month death (OR 1.09, 95%CI 1.01, 1.17).
Conclusion:
Increased NLR around 36 h after stroke was a predictor of infection in patients with
acute ischemic stroke. The increased NLR value was associated with a higher risk of 3-month
death, which was independent of poststroke infection.
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Affiliation(s)
- Lu Wang
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Wen Guo
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Changyi Wang
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Xue Yang
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Zilong Hao
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Simiao Wu
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Shihong Zhang
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Bo Wu
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Ming Liu
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
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El Sheikh AI, Almathen F, Hussen J. Investigation of total immunoglobulin G concentration, heavy chain antibody levels, and neutrophil to lymphocyte ratio in female camels and their newborn calves. Trop Anim Health Prod 2020; 52:3863-3868. [PMID: 32996038 DOI: 10.1007/s11250-020-02425-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 09/24/2020] [Indexed: 02/02/2023]
Abstract
Camels belong to a group of animals, where the structure of placenta does not allow intrauterine transfer of maternal immunoglobulins to the fetus and maternal immunity is exclusively transferred by colostrum to the newborn calf. There are few studies on the passive transfer of maternal immunity in the dromedary camel. This study determined total immunoglobulin G concentration, heavy chain antibody (HCAbs) levels, and neutrophils to lymphocytes ratio (NLR) in female camels and their newborn calves. For this, samples were collected from nine she-camels (blood and colostrum) and their calves (blood). IgG concentration and HCAb level were determined in mother serum and colostrum as well as in calf serum using ELISA. The NLR was calculated after the estimation of relative fractions of neutrophils and lymphocytes in collected blood samples using a blood cell analyzer. Both IgG and HCAbs were higher concentrated in camel colostrum than in mother serum. At parturition and before the first colostrum intake, calf serum did not contain any measurable concentration of IgG and only low levels of HCAbs. After colostrum consumption, a rise in IgG and HCAb levels was observed in calf serum. For total IgG, a minimum was reached on day 30 postnatum. While a significant increase in IgG concentration was seen on day 60 postnatum, no significant rise was measured in HCAbs at that age. Only post-colostrum IgG levels in calf serum correlated positively with IgG levels in mother colostrum. Directly after birth, newborn calves showed significantly higher NLR than their mothers. This indicates a pro-inflammatory nature of the calf immune response. The decrease of the NLR on day 60 postnatum may argue for the maturation of the calf immune response at this age.
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Affiliation(s)
- Ahmed I El Sheikh
- Department of Veterinary Public Health, College of Veterinary Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Faisal Almathen
- Department of Veterinary Public Health, College of Veterinary Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.,The Camel Research Center, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Jamal Hussen
- Department of Microbiology, College of Veterinary Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.
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Wang H, Chang Y, Cui ZZ, Liu ZJ, Ma SF. Admission C-Reactive Protein-to-Albumin Ratio Predicts the 180-Day Mortality of AIDS-Related Pneumocystis Pneumonia. AIDS Res Hum Retroviruses 2020; 36:753-761. [PMID: 32580561 DOI: 10.1089/aid.2020.0057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Assessment tools are necessary for the adequate stratification of patients with AIDS-related pneumocystis pneumonia (PCP). The aim of this study was to evaluate the ability of severity assessment scores and inflammation- and nutrition-based parameters for predicting the 180-day mortality of AIDS-related PCP. This was a retrospective cohort study of patients with AIDS-related PCP admitted at the Beijing Di-Tan Hospital. The CURB-65 score, Pneumonia Severity Index (PSI) score, Acute Physiology And Chronic Health Evaluation II (APACHE II) score, C-reactive protein-to-albumin ratio (CAR), procalcitonin, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio during the first 24 h of intensive care unit admission were analyzed. The prognostic values of the severity assessment scores and biomarkers for 180-day mortality were evaluated using receiver operating characteristic (ROC) curves and integrated discrimination improvement (IDI) indexes. A total of 123 patients with AIDS-related PCP were included. Fifty-five patients were dead, and 68 were still alive at 180 days after admission. CAR, CURB-65, PSI, and APACHE II were independent predictors of 180-day mortality. The optimal cutoff value of CAR was 2.0 mg/g [area under the ROC curve = 0.844, 95% credential interval (CI) = 0.776-0.913], and CAR >2.0 mg/g increased the prognostic value of all three severity assessment scores, with an IDI index of 5.1% for the CURB-65 score, 8.1% for the PSI score, and 4.1% for the APACHE II score (all p < .05). Combining CAR >2.0 mg/g enhanced the capability of CURB-65, APACHE II, and PSI in predicting the 180-day mortality of patients with AIDS-related PCP.
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Affiliation(s)
- Hui Wang
- Department of Emergency Medicine, Beijing Di-Tan Hospital, Capital Medical University, Beijing, China
| | - Yufei Chang
- Department of Emergency Medicine, Beijing Di-Tan Hospital, Capital Medical University, Beijing, China
| | - Zhi-Zhang Cui
- Department of Emergency Medicine, Beijing Di-Tan Hospital, Capital Medical University, Beijing, China
| | - Zhi-Juan Liu
- Department of Emergency Medicine, Beijing Di-Tan Hospital, Capital Medical University, Beijing, China
| | - Shan-Fang Ma
- Department of Emergency Medicine, Beijing Di-Tan Hospital, Capital Medical University, Beijing, China
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Królicki T, Bardowska K, Kościelska-Kasprzak K, Mazanowska O, Krajewska M, Kamińska D. Systemic Inflammatory Markers Predict Detrimental Outcome of Urosepsis in Kidney Transplant Recipients. Transplant Proc 2020; 52:2382-2387. [PMID: 32571705 DOI: 10.1016/j.transproceed.2020.01.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 01/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Urosepsis is a frequent cause of hospitalization among kidney transplant recipients (KTxR). Systemic inflammatory markers may reflect disease severity; nevertheless, their predictive value has not been evaluated in KTxRs. AIMS We sought to investigate the diagnostic and prognostic value of blood-derived systemic inflammatory markers during urosepsis in KTxR. METHODS We retrospectively enrolled 80 transplant recipients who were hospitalized between 2014 and 2017 due to urosepsis and followed for at least 1 year. Multiple parameters were calculated from medical records. The study endpoint was defined as death, graft loss, or a more than double serum creatinine level compared with baseline. RESULTS Seventeen patients reached an endpoint and presented at admission significantly lower total serum protein [g/dL] (5.0 ± 0.6 vs 6.0 ± 0.7) and higher urea [mg/dL] (161, 118-218 vs 80, 56-125), neutrophil-to-lymphocyte ratio (NLR) (20.0, 12.5-48.3 vs 12.9, 7.0-20.1), platelet-to-lymphocyte ratio (PLR) (447, 203-706 vs 231, 160-357), derived neutrophil-to-lymphocyte ratio (dNLR) (8.5, 5.6-10.4 vs 5.3, 2.9-8.5), and maximal Sequential Organ Failure Assessment (SOFA) score (6, 4-7 vs 3, 3-5). Among blood markers, NLR showed the strongest correlation with C-reactive protein, procalcitonin, creatinine, urea, and maximal SOFA score. The NLR cut-off value >15 predicted endpoint occurrence with 59% specificity and 75% sensitivity (area under the curve [AUC] 0.67, P = .038). The combined impact of NLR, urea, and total serum protein increased the prognostic precision (sensitivity 85% and specificity 84%, AUC = 0.88, P < .001). CONCLUSIONS The combined impact of NLR, urea, and total serum protein identifies KTxR who are at risk of a bad outcome after urosepsis and require more meticulous care.
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Affiliation(s)
- Tomasz Królicki
- Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland.
| | | | | | - Oktawia Mazanowska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Dorota Kamińska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
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Jiang Z, Ning Z, Yang L, Chen B, Tang J, Zhang J, Fang H, Xu R, Guo F, Chen M, Sun K. The correlation of neutrophil-to-lymphocyte ratio with the presence and short-time curative effect of myasthenia gravis in children: a retrospectively study. Int J Neurosci 2020; 131:894-901. [PMID: 32315556 DOI: 10.1080/00207454.2020.1759592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study aimed to investigate the influence of neutrophil-to-lymphocyte ratio (NLR) on the severity and short-time curative effect of myasthenia gravis (MG) in children. METHODS Data of 132 MG children were retrospectively analyzed, and data of 140 healthy controls (HC group) in the same period were collected. The data of both groups were compared and analyzed. RESULTS NLR of MG group was significantly higher than that of HC group (Z = 2.644, p = 0.008). According to NLR level, patients were divided into 3 groups: N1 (NLR < 1.03), N2 (NLR 1.03-2.17), and N3 (NLR > 2.17). Significant differences in white blood cell counts, course of disease, uric acid, albumin and the time of hospital stay among the 3 groups were observed (p < 0.05, 0.01). The results of logistic regression revealed that NLR (adjusted OR = 3.874, 95% CI 1.359-11.045, p = 0.011) was the risk factor of MG, and it was risk factor of higher QMG during admission (adjusted OR = 2.989, 95% CI 1.247-7.160, p = 0.014) as well. Using the NLR level for the MG diagnostic test, the area under the receiver operating characteristic (ROC) curve was 0.765 [95%CI (0.710-0.820), p = 0.000], with a cut-off value of 1.39, sensitivity of 0.833, and specificity of 0.479. Cox regression analysis suggested that NLR (N1: Wald = 9.262, p = 0.010, N2: HR = 12.267, 95%CI 2.432-61.863, p = 0.000, and N3: HR = 8.142, 95%CI 1.209-77.754, p = 0.032) was associated with poor efficacy at discharge. Elevated NLR was considered as an independent risk factor of poor outcomes during discharge. CONCLUSION NLR could reflect disease severity and short time curative effect in children with MG to some extent. It may also be a potential marker in indicating diagnosis and severity of MG in children.
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Affiliation(s)
- Zhi Jiang
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Zeshu Ning
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Liming Yang
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Bo Chen
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Jingwen Tang
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Jie Zhang
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Hongjun Fang
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Rong Xu
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Feng Guo
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Mei Chen
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Kaisheng Sun
- Institute of Pediatric Medicine, Hunan Children's Hospital, Changsha, China
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The usefulness of neutrophil/lymphocyte count ratio in the diagnosis and prognosis of bacterial sepsis – An old parameter with new implications. REV ROMANA MED LAB 2020. [DOI: 10.2478/rrlm-2020-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Aims: To analyze the diagnostic role of neutrophil/lymphocyte count ratio (NLCR) in sepsis and to evaluate its usefulness in appreciating the prognosis of septic patients.
Methods : A prospective analysis of patients diagnosed with sepsis between October 2015 and July 2017 was performed. A control group of patients with systemic inflammatory response syndrome (SIRS) with noninfectious causes was recruited. The sensitivity, specificity and AUC of NCLR for sepsis diagnosis were comparatively assessed with other biomarkers including fibrinogen (FIB), C-reactive protein (CRP) and procalcitonin (PCT). The baseline levels of NLCR were correlated with APACHE IV, APS and SOFA scores of severity.
Results : We enrolled 105 patients with sepsis and 37 patients with noninfectious SIRS. NLCR had significantly higher levels in the first group (p---lt---0.05). For an optimal cut-off value of 8.18, the sensitivity, specificity and AUC of NLCR for sepsis diagnosis were 70.5%, 72.2% and 0.766, respectively. A cut-off value of 12.0 led to moderate sensitivity (58.7%) and moderate-to-high specificity (89%). For patients with SOFA score over 2 points, the characteristics did not significantly improve. The correlations between baseline NCLR and the severity scores were not statistically significant.
Conclusion : NLCR levels were significantly higher in sepsis group compared to noninfectious SIRS group. NLCR had moderate sensitivity and specificity regarding sepsis diagnosis. Baseline levels of NLCR did not correlate with the severity scores, so its usefulness in sepsis prognosis was limited.
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Jiang J, Du H, Su Y, Li X, Zhang J, Chen M, Ren G, He F, Niu B. Nonviral infection-related lymphocytopenia for the prediction of adult sepsis and its persistence indicates a higher mortality. Medicine (Baltimore) 2019; 98:e16535. [PMID: 31335735 PMCID: PMC6708870 DOI: 10.1097/md.0000000000016535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Sepsis is a life-threatening disease that affects 30 million people worldwide each year. Despite the rapid advances in medical technology and organ support systems, it is still difficult to reduce the mortality rate. Early and rapid diagnosis is crucial to improve the treatment outcome. The aim of this study was to investigate the prediction efficiency of lymphopenia and other clinical markers, such as white blood cell (WBC), neutrophil count (N#), procalcitonin (PCT), and arterial lactic acid (Lac) in the diagnosis and prognosis assessment for adult patients with nonviral infection-related sepsis.A total of 77 sepsis- and 23 non-sepsis adult patients were enrolled in this study from September 2016 to September 2018. Daily lymphocyte count (Lym) of the patients was calculated until discharge or death. The diagnostic performance of the Lym and other biomarkers were compared using the area under the receiver operating characteristic curve (ROC) value.The level of Lym was decreased significantly in the sepsis group. Lym had a high diagnostic performance for sepsis, with an area under the curve (AUC) value of 0.971 (95% CI = 0.916-0.994). The diagnostic efficacy of Lym was more significant than WBC, N#, and PCT (P < .001). The results showed that the 28-day mortality rate of patients with continuous Lym <0.76 × 10/L was 39.66%, which significantly higher than patients without persistent lymphocytopenia.Lym is a promising, low cost, fast, and easily available biomarker for the diagnosis of sepsis. When nonviral infection is suspected and lymphocytopenia level is lower than the optimal cut-off (0.76 × 10/L) value, high vigilance is required for sepsis. The persistence with the lymphocytopenia cut-off value (<0.76 × 10/L) >3 days indicates a higher 28-day mortality rate.
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Affiliation(s)
- Jie Jiang
- Department of Intensive Care Medicine
| | | | - Yanxin Su
- Department of Intensive Care Medicine
| | - Xin Li
- Department of Urology Surgery
| | | | | | - Guosheng Ren
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Faming He
- Department of Intensive Care Medicine
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Gozdas HT, Gel KT, Yasayacak A, Kesgin MT, Akdeniz H. The role of hematological parameters in estimating nosocomial sepsis. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2019. [DOI: 10.29333/ejgm/108678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Sezigen S, Eyison RK, Kilic E, Kenar L. Evidence of sulfur mustard exposure in victims of chemical terrorism by detection of urinary β-lyase metabolites. Clin Toxicol (Phila) 2019; 58:36-44. [DOI: 10.1080/15563650.2019.1614190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Sermet Sezigen
- Department of Medical CBRN Defense, University of Health Sciences, Ankara, Turkey
| | - Rusen Koray Eyison
- Department of Medical CBRN Defense, University of Health Sciences, Ankara, Turkey
| | - Ertugrul Kilic
- Department of Anesthesia and Reanimation, SehitKamil State Hospital, Gaziantep, Turkey
| | - Levent Kenar
- Department of Medical CBRN Defense, University of Health Sciences, Ankara, Turkey
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