Synergistic role of circulating CD14++CD16+ monocytes and fibrinogen in predicting the cardiovascular events after myocardial infarction

Correlation between hemoglobin, albumin, lymphocyte, and platelet score and short-term mortality in critically ill patients

BACKGROUND

Hemoglobin, albumin, lymphocyte and platelet (HALP) score is derived from the counts of hemoglobin, albumin, lymphocytes, and platelets. It serves as a valuable tool for assessing both inflammation and nutritional status in critically ill patients. However, there hasn't been a specific study exploring the role of the HALP score in critically ill patients. Additionally, whether the HALP score exhibits an incremental effect on the Sequential Organ Failure Assessment (SOFA) score remains unknown.

METHODS

In this study, we used the Medical Information Mart for Intensive Care (MIMIC-IV) version 2.2 database to evaluate the predictive value of HALP score for critically ill patients. The primary outcome investigated was intensive care unit (ICU) death, and the secondary outcomes included in-hospital mortality, ICU length of stay (LOS), hospital LOS, and 28-day mortality.

RESULTS

We analyzed 20,083 critically ill patients. In logistic regression, a low HALP score (HALP score < 3.56) showed higher risk of ICU death (adjusted odds ratio: 1.41, 95% confidence interval [CI]: 1.25 to 1.59). Additionally, the HALP score improved the predictive ability of the SOFA score (∆Area under curve: 0.009, p < 0.001). In Cox proportional hazards models, a low HALP score (HALP score < 3.2) was also associated with a higher risk of 28-day mortality (adjusted hazard ratio: 1.52, 95% CI: 1.33 to 1.74).

CONCLUSION

HALP score is associated with short-term mortality. Additionally, HALP score showed an incremental effect on SOFA score in predicting short-term mortality.

Circulating intermediate monocytes CD14++CD16+ are increased after elective percutaneous coronary intervention

AIM

Inflammation plays a central role in the pathogenesis of atherosclerosis and in the sequelae of percutaneous coronary intervention (PCI). Previous work demonstrated that intermediate monocytes (CD14++CD16+) are associated with adverse cardiovascular events, yet monocyte subset response following elective PCI has not been described. This article explores the changes in monocyte subset and humoral response after elective PCI.

METHODS

This prospective study included 30 patients without inflammatory diseases being referred for elective PCI. We included patients treated with drug coated balloons or 2nd generation drug eluting stents. Patients underwent blood tests at baseline (prior to PCI), four hours, two weeks and two months later. Analyses were performed in terms of monocyte subsets (classical CD14++CD16-, intermediate CD14++CD16+ and non-classical CD14+CD16++), gene expression of CD14+ leucocytes and humoral biomarkers.

RESULTS

Intermediate monocytes decreased significantly four hours after PCI, were recovered at two weeks, and increased significantly at two months post elective, uncomplicated PCI. They remain significantly elevated in the DES group but not in the DCB group. Gene expression analysis of CD14+ leucocytes showed IL18 had decreased expression at two weeks, CXCR4 and IL1β decreased at two months, while pentraxin 3 increased at two weeks and two months. In terms of humoral biomarkers, hsTnI remains elevated up to two weeks post PCI while IL6 and TNFα remain elevated till two months post PCI.

CONCLUSION

Intermediate monocytes increase significantly two months following elective, uncomplicated PCI. They remain significantly elevated in the DES group but not in the DCB group suggesting that the PCI strategy could be one of the ways to modulate the inflammatory response post PCI.