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Peng Z, Jia Y, Li J, Wang G. Diagnostic Value of Neutrophil-Lymphocyte Ratio in Predicting Post-Operative Infection after Orthopedic Surgery: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2024; 25:527-537. [PMID: 39052531 DOI: 10.1089/sur.2024.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Objective: This study aims to evaluate the predictive value of neutrophil-lymphocyte ratio (NLR) in determining infection after orthopedic surgery. Methods: A comprehensive search was conducted in PubMed, EBASE, CNKI, and Wanfang databases to identify relevant studies. The quality of the included studies was assessed using QUADAS-2. Data extraction was performed to calculate sensitivity, specificity, and other indicators. Bivariate mixed-effects meta-analysis was conducted using Stata software. The sources of heterogeneity were evaluated, and a summary receiver operating characteristic curve was generated. Results: A total of 16 literatures comprising 18 studies involving 3737 patients were included in this analysis. NLR demonstrated moderate sensitivity (0.77) and specificity (0.69) in diagnosing orthopedic post-operative infection, with an area under the curve of 0.80 and diagnostic odds ratio of 7.76. Significant heterogeneity was observed among the studies, primarily due to variations in surgical type, infection type, blood test timing, and NLR cutoff value. Fagan nomogram indicated that NLR could increase the positive posterior probability to 72% and decrease the negative posterior probability to 25%. The pooled effect of the likelihood ratio dot plot for diagnosis fell in the lower right quadrant. Deek funnel plot suggested no publication bias in this study. Conclusion: NLR holds certain value in diagnosing infection after orthopedic surgery and can provide additional information to assess the risk of infection. However, its predictive performance is influenced by various factors, and it cannot be used as a sole criterion for confirming the diagnosis. Prospective studies should be conducted in the future to optimize the diagnostic threshold and explore its combination with other indicators.
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Affiliation(s)
- Zhan Peng
- Department of Spinal Surgery, Shenzhen Baoan District People's Hospital, the Second Affiliated Hospital of Shenzhen University, Shenzhen, P.R. China
| | - Yukun Jia
- Department of Spinal Surgery, Shenzhen Baoan District People's Hospital, the Second Affiliated Hospital of Shenzhen University, Shenzhen, P.R. China
| | - Jin Li
- Department of Spinal Surgery, Shenzhen Baoan District People's Hospital, the Second Affiliated Hospital of Shenzhen University, Shenzhen, P.R. China
| | - Guangye Wang
- Department of Spinal Surgery, Shenzhen Baoan District People's Hospital, the Second Affiliated Hospital of Shenzhen University, Shenzhen, P.R. China
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Ancuța DL, Lovati AB, Coman C. The clinical significance of inflammatory biomarkers, IL6 cytokine, and systemic immune inflammatory index in rabbit model of acute and chronic Methicillin-resistant Staphylococcus epidermidis-induced osteomyelitis. PLoS One 2024; 19:e0309145. [PMID: 39208074 PMCID: PMC11361425 DOI: 10.1371/journal.pone.0309145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
Infections are a major complication of open fractures and fracture fixation. In this study, an innovative bioactive medical device was used to experimentally treat MRSE-induced osteomyelitis in rabbit tibia. This paper investigates the clinical significance of inflammatory biomarkers (NLR, PLR, MLR and PMR), SII and IL-6 and assesses their role in the development of osteomyelitis. The main objective is to identify the utility of hematological reports derived from neutrophils, leukocytes, monocytes and platelets in the evolution of implant-related osteomyelitis and the estimation of treatment efficiency. In particular, this study compares the response of these inflammatory markers to different treatments in the presence or absence of bioactive materials and/or topical antibiotics over time. The analysis of the threads showed that NLR, PLR and SII had high values in the acute phase of the disease, so that after chronicization, they decrease. The animals treated with vancomycin nano-functionalized peptide-enriched silk fibroin-coated implants showed lower levels of inflammatory biomarkers compared to the other groups (empty implants and peptide-enriched silk fibroin-coated implants). NLR, PLR and SII, complemented by IL-6 can be used as fairly accurate biomarkers for the diagnosis of osteomyelitis.
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Affiliation(s)
- Diana-Larisa Ancuța
- Cantacuzino National Medical Military Institute for Research and Development, Bucharest, Romania
| | | | - Cristin Coman
- Cantacuzino National Medical Military Institute for Research and Development, Bucharest, Romania
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Che Y, Huang S, Zhou W, Shi S, Ye F, Ji Y, Huang J. Association between neutrophil-to-lymphocyte ratio and outcomes in hospitalized patients with left ventricular thrombus. Coron Artery Dis 2024; 35:397-404. [PMID: 38563191 PMCID: PMC11198952 DOI: 10.1097/mca.0000000000001363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Left ventricular thrombus (LVT) is a severe cardiovascular complication occurring in approximately 10% of patients with acute anterior ST-segment elevation myocardial infarction. This study aimed to evaluate the association between neutrophil-to-lymphocyte ratio (NLR) and in-hospital major adverse cardiovascular and cerebrovascular events (MACCE) in patients with LVT. MATERIAL AND METHODS This multicenter retrospective study was conducted between January 2000 and June 2022 in hospitalized patients with LVT. The outcome included in-hospital MACCE. The association between NLR and in-hospital MACCE was measured by odds ratios (ORs). The restricted cubic spline model was used for dose-response analysis. RESULTS A total of 197 LVT patients from four centers were included for analysis in this study. MACCE occurred in 13.7% (27/197) of the patients. After adjusting for estimated glomerular filtration rate (eGFR), D-dimer, and age, the OR for MACCE comparing first to the third tertile of NLR was 13.93 [95% confidence interval: 2.37-81.77, P = 0.004, P -trend = 0.008]. When further adjusting for etiology and heart failure with reduced ejection fraction (HFrEF), the association remained statistically significant. Spline regression models showed an increasing trend in the incidence of MACCEs with NLR both in crude and adjusted models. Subgroup analyses showed that a high NLR may be correlated with poorer outcomes for LVT patients older than 65 years, or with hypertension, dyslipidemia, low ejection fraction, liver, and renal dysfunctions. CONCLUSION In conclusion, these findings suggested that higher NLR may be associated with an increased risk of in-hospital MACCE in patients with LVT.
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Affiliation(s)
| | - Shenglan Huang
- Department of Cardiology, the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou
| | - Wei Zhou
- Department of Cardiology, Yixing People’s Hospital, Yixing
| | - Shunyi Shi
- Department of Cardiology, the Third Affiliated Hospital of Soochow University, Changzhou
| | - Fei Ye
- Department of Cardiology, Nanjing First Hospital, Nanjing
| | - Yuan Ji
- Department of Cardiology, the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou
| | - Jun Huang
- Department of Echocardiology, the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
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Tarabichi S, Goh GS, Fraval A, Lizcano JD, Abe EA, Courtney PM, Namdari S, Parvizi J. Serum and Synovial Markers in the Diagnosis of Periprosthetic Joint Infection of the Hip, Knee, and Shoulder: An Algorithmic Approach. J Bone Joint Surg Am 2024; 106:1221-1230. [PMID: 38776388 DOI: 10.2106/jbjs.23.00669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
➤ No single test has demonstrated absolute accuracy for the diagnosis of periprosthetic joint infection (PJI).➤ Physicians rely on a combination of serological tests, synovial markers, and clinical findings plus clinical judgment to help to guide preoperative decision-making.➤ Several organizations have proposed criteria for the diagnosis of hip or knee PJI on which we now rely.➤ Given that shoulder arthroplasty has only recently become popular, it is possible that a shoulder-specific definition of PJI will be introduced in the coming years.➤ Although a number of serum and synovial markers have demonstrated high accuracy for the diagnosis of PJI of the hip and knee, further research is needed in order to identify markers that may be more suitable for the diagnosis of shoulder PJI and for the potential development and identification of specific serological tests as screening tools for PJI.
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Affiliation(s)
- Saad Tarabichi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrew Fraval
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Juan D Lizcano
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elizabeth A Abe
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Surena Namdari
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Javad Parvizi
- International Joint Center, Acibadem University Hospital, Istanbul, Turkey
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Nhamoyebonde S, Chambers M, Ndlovu L, Karim F, Mazibuko M, Mhlane Z, Madziwa L, Moosa Y, Moodley S, Hoque M, Leslie A. Detailed phenotyping reveals diverse and highly skewed neutrophil subsets in both the blood and airways during active tuberculosis infection. Front Immunol 2024; 15:1422836. [PMID: 38947330 PMCID: PMC11212598 DOI: 10.3389/fimmu.2024.1422836] [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: 04/24/2024] [Accepted: 05/21/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction Neutrophils play a complex and important role in the immunopathology of TB. Data suggest they are protective during early infection but become a main driver of immunopathology if infection progresses to active disease. Neutrophils are now recognized to exist in functionally diverse states, but little work has been done on how neutrophil states or subsets are skewed in TB disease. Methods To address this, we carried out comprehensive phenotyping by flow cytometry of neutrophils in the blood and airways of individuals with active pulmonary TB with and without HIV co-infection recruited in Durban, South Africa. Results Active TB was associated with a profound skewing of neutrophils in the blood toward phenotypes associated with activation and apoptosis, reduced phagocytosis, reverse transmigration, and immune regulation. This skewing was also apparently in airway neutrophils, particularly the regulatory subsets expressing PDL-1 and LOX-1. HIV co-infection did not impact neutrophil subsets in the blood but was associated with a phenotypic change in the airways and a reduction in key neutrophil functional proteins cathelicidin and arginase 1. Discussion Active TB is associated with profound skewing of blood and airway neutrophils and suggests multiple mechanisms by which neutrophils may exacerbate the immunopathology of TB. These data indicate potential avenues for reducing neutrophil-mediated lung pathology at the point of diagnosis.
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Affiliation(s)
| | - Mark Chambers
- Africa Health Research Institute, Durban, South Africa
| | - Lerato Ndlovu
- Africa Health Research Institute, Durban, South Africa
| | - Farina Karim
- Africa Health Research Institute, Durban, South Africa
| | | | - Zoey Mhlane
- Africa Health Research Institute, Durban, South Africa
| | | | - Yunus Moosa
- Department of Infectious Diseases, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Monjurul Hoque
- Department of Infectious Diseases, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Alasdair Leslie
- Africa Health Research Institute, Durban, South Africa
- Department of Infectious Diseases, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Infection and Immunity, University College London, London, United Kingdom
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Deng L, Wang J, Yang GY, Hou YZ, Li KW, Sun B, Wang SH. Different biomarker ratios in peripheral blood have limited value in diagnosing periprosthetic joint infection after total joint arthroplasty: a single-center, retrospective study. BMC Musculoskelet Disord 2024; 25:377. [PMID: 38741113 DOI: 10.1186/s12891-024-07499-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a severe complication that can occur after total joint arthroplasty (TJA). The timely and accurate diagnosis of PJI is the key to treatment. This study investigated the diagnostic value of platelet to lymphocyte ratio (PLR), platelet count to mean platelet volume ratio (PVR), neutrophil to lymphocyte ratio (NLR) and monocyte to lymphocyte ratio (MLR) in PJI after total knee arthroplasty (TKA) and total hip arthroplasty (THA). METHODS We performed a retrospective analysis of the patients who underwent revision hip or knee arthroplasty at our Institute between June 2015 and June 2020. Of the 187 patients reviewed, 168 were included in the study. According to the diagnostic criteria of the Musculoskeletal Infection Society (MSIS), 58 patients were in the PJI group, and 110 patients were in the aseptic loosening (AL) group. We recorded and compared the preoperative peripheral blood white blood cell (WBC) count, platelet count (PLT), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), PLR, PVR, NLR, and MLR in both groups. The diagnostic performance of the WBC, PLT, PLR, PVR, NLR, and MLR individually and in combination with the ESR and CRP for PJI diagnosis was evaluated by receiver operating characteristic (ROC) curves, and the sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS Compared to those in the AL group, the mean WBC, PLT, ESR, CRP, PLR, PVR, NLR, and MLR in the peripheral blood of the PJI group were significantly greater (P < 0.05). The analysis of the ROC curve revealed that the ESR, CRP, PLR, PVR, NLR, and MLR in peripheral blood had moderate effectiveness in diagnosing PJI, with area under the curve (AUC) values of 0.760 (95% CI: 0.688-0.823), 0.758 (95% CI: 0.687-0.821), 0.714 (95% CI: 0.639-0.781), 0.709 (95% CI: 0.634-0.777), 0.723 (95% CI: 0.649-0.789), and 0.728 (95% CI: 0.654-0.793), respectively. Conversely, the WBC and PLT counts demonstrated poor diagnostic value for PJI, with AUC values of 0.578 (95% CI: 0.499-0.653) and 0.694 (95% CI: 0.619-0.763), respectively. The results of the prediction model calculations revealed that the combined AUC of the WBC, PLT, ESR, CRP, PLR, PVR, NLR, and MLR was the highest at 0.853 (95% CI, 0.790-0.909), indicating good value in the diagnosis of PJI, with a sensitivity of 82.8% and a specificity of 72.7%. Moreover, the novel composite of parameters improved the accuracy and reliability in diagnosing PJI compared to the traditional biomarkers ESR and CRP (P = 0.015). CONCLUSION Our study suggested that the diagnostic value of the peripheral blood biomarkers PLR, PVR, NLR, and MLR for diagnosing PJI is limited and not superior to that of the ESR or CRP. However, when the WBC, PLT, ESR, CRP, PLR, PVR, NLR, and MLR are combined, the diagnostic performance of PJI in TJA patients can be improved.
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Affiliation(s)
- Lei Deng
- The First School of Clinical Medicine, Henan University of Chinese Medicine, Zhengzhou, 450052, People's Republic of China
- Department of Joint Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, 450052, People's Republic of China
| | - Jie Wang
- Department of Orthopaedic, Beijing ChaoYang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Guang-Ya Yang
- The First School of Clinical Medicine, Henan University of Chinese Medicine, Zhengzhou, 450052, People's Republic of China
- Department of Joint Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, 450052, People's Republic of China
| | - Ying-Zhou Hou
- Department of Joint Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, 450052, People's Republic of China
| | - Ke-Wei Li
- Department of Joint Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, 450052, People's Republic of China
| | - Bo Sun
- Department of Joint Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, 450052, People's Republic of China
| | - Shao-Hua Wang
- Department of Joint Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, 450052, People's Republic of China.
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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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Nowaczewska-Kuchta A, Ksiazek-Winiarek D, Szpakowski P, Glabinski A. The Role of Neutrophils in Multiple Sclerosis and Ischemic Stroke. Brain Sci 2024; 14:423. [PMID: 38790402 PMCID: PMC11118671 DOI: 10.3390/brainsci14050423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
Inflammation plays an important role in numerous central nervous system (CNS) disorders. Its role is ambiguous-it can induce detrimental effects, as well as repair and recovery. In response to injury or infection, resident CNS cells secrete numerous factors that alter blood-brain barrier (BBB) function and recruit immune cells into the brain, like neutrophils. Their role in the pathophysiology of CNS diseases, like multiple sclerosis (MS) and stroke, is highly recognized. Neutrophils alter BBB permeability and attract other immune cells into the CNS. Previously, neutrophils were considered a homogenous population. Nowadays, it is known that various subtypes of these cells exist, which reveal proinflammatory or immunosuppressive functions. The primary goal of this review was to discuss the current knowledge regarding the important role of neutrophils in MS and stroke development and progression. As the pathogenesis of these two disorders is completely different, it gives the opportunity to get insight into diverse mechanisms of neutrophil involvement in brain pathology. Our understanding of the role of neutrophils in CNS diseases is still evolving as new aspects of their activity are being unraveled. Neutrophil plasticity adds another level to their functional complexity and their importance for CNS pathophysiology.
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Affiliation(s)
| | | | | | - Andrzej Glabinski
- Department of Neurology and Stroke, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland; (A.N.-K.); (D.K.-W.); (P.S.)
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Khanzadeh M, Foroughi Nematollahi S, Shavakhi M, Ghaedi A, Mallahi A, Bazrgar A, Khanzadeh S. Prognostic Role of Neutrophil to Lymphocyte Ratio in Allergic Rhinitis: A Systematic Review and Meta-analysis. Indian J Otolaryngol Head Neck Surg 2024; 76:1389-1397. [PMID: 38440632 PMCID: PMC10909046 DOI: 10.1007/s12070-023-04148-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/17/2023] [Indexed: 03/06/2024] Open
Abstract
One of the crucial triggers of allergic diseases is an inflammatory reaction and neutrophil to lymphocyte ratio (NLR) is one of the systemic inflammation biomarkers. Our review aimed to evaluate role of NLR in predicting severity and comorbidities of allergic rhinitis (AR). We systematically searched Scopus, Web of Science, and PubMed to find relevant studies. Standardized mean difference (SMD) with a 95% confidence interval (CI) was reported. Due to the high levels of heterogeneity, the random-effects model was used to generate pooled effects. Eleven articles were included in the systematic review, among which ten were included in meta-analysis including 1122 healthy controls and 1423 patients with AR. We found that patients with AR had a significantly higher level of NLR than healthy controls (SMD = 0.19, 95%CI = 0.03-0.36, P = 0.03). In addition, patients with moderate to severe AR had significantly higher levels of NLR compared to those with mild AR (SMD = 0.41, 95%CI = 0.20-0.63, P < 0.001). Interestingly, it was found that NLR could associate with some comorbidities of AR, like asthma. Our results confirmed that NLR could assist clinicians in predicting the severity and comorbidities of AR. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04148-8.
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Affiliation(s)
- Monireh Khanzadeh
- Geriatric and Gerontology Department, Medical School, Tehran University of Medical and Health Sciences, Tehran, Iran
| | | | - Mitra Shavakhi
- Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arshin Ghaedi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Mallahi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Bazrgar
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Sui J, Lin Z, Azizpour S, Chen F, Gaur S, Keene K, Soleimani F, Bhowmick T, Rafique Z, Javanmard M. Clinical evaluation of a fully electronic microfluidic white blood cell analyzer. PLoS One 2024; 19:e0296344. [PMID: 38236796 PMCID: PMC10796056 DOI: 10.1371/journal.pone.0296344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/11/2023] [Indexed: 01/22/2024] Open
Abstract
The White Blood Cell (WBC) count is one of the key parameters signaling the health of the immune system. Abnormal WBC counts often signal a systemic insult to the body such as an underlying infection or an adverse side effect to medication. Typically, the blood collected is sent to a central lab for testing, and results come back within hours, which is often inconvenient and may delay time-sensitive diagnosis or treatment. Here, we present the CytoTracker, a fully electronic, microfluidic based instant WBC analyzer with the potential to be used at point-of-care. The CytoTracker is a lightweight, portable, affordable platform capable of quantifying WBCs within minutes using only 50 μl of blood (approximately one drop of blood). In this study, we clinically evaluated the accuracy and performance of CytoTracker in measuring WBC and granulocyte counts. A total of 210 adult patients were recruited in the study. We validated the CytoTracker against a standard benchtop analyzer (Horiba Point of Care Hematology Analyzer, ABX Micros 60). Linear dynamic ranges of 2.5 k/μl- 35 k/μl and 0.6 k/μl- 26 k/μl were achieved for total WBC count and granulocyte count with correlation coefficients of 0.97 and 0.98. In addition, we verified CytoTracker's capability of identifying abnormal blood counts with above 90% sensitivity and specificity. The promising results of this clinical validation study demonstrate the potential for the use of the CytoTracker as a reliable and accurate point-of-care WBC analyzer.
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Affiliation(s)
- Jianye Sui
- RizLab Health, Inc., Princeton, New Jersey, United States of America
| | - Zhongtian Lin
- RizLab Health, Inc., Princeton, New Jersey, United States of America
| | - Shahriar Azizpour
- RizLab Health, Inc., Princeton, New Jersey, United States of America
| | - Fei Chen
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Sunanda Gaur
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Kelly Keene
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Farzad Soleimani
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Tanaya Bhowmick
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Zubaid Rafique
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Mehdi Javanmard
- RizLab Health, Inc., Princeton, New Jersey, United States of America
- Department of Electrical and Computer Engineering, Rutgers University, Piscataway, New Jersey, United States of America
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Guest JD, Luo Z, Liu Y, Gao H, Wang D, Xu XM, Zhu H. Acute penetrating injury of the spinal cord by a wooden spike with delayed surgery: a case report. Neural Regen Res 2023; 18:2781-2784. [PMID: 37449645 DOI: 10.4103/1673-5374.373668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Rarely, penetrating injuries to the spinal cord result from wooden objects, creating unique challenges to mitigate neurological injury and high rates of infection and foreign body reactions. We report a man who sustained a penetrating cervical spinal cord injury from a sharpened stick. While initially tetraparetic, he rapidly recovered function. The risks of neurological deterioration during surgical removal made the patient reluctant to consent to surgery despite the impalement of the spinal cord. A repeat MRI on day 3 showed an extension of edema indicating progressive inflammation. On the 7th day after injury, fever and paresthesias occurred with a large increase in serum inflammatory indicators, and the patient agreed to undergo surgical removal of the wooden object. We discuss the management nuances related to wood, the longitudinal evolution of MRI findings, infection risk, surgical risk mitigation and technique, an inflammatory marker profile, long-term recovery, and the surprisingly minimal neurological deficits associated with low-velocity midline spinal cord injuries. The patient had an excellent clinical outcome. The main lessons are that a wooden penetrating central nervous system injury has a high risk for infection, and that surgical removal from the spinal cord should be performed soon after injury and under direct visualization.
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Affiliation(s)
- James D Guest
- Neurological Surgery, and the Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Zhuojing Luo
- Department of Orthopedic Spinal Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Yansheng Liu
- Department of Neurosurgery, Kunming Tongren Hospital, Kunming, Yunnan Province, China
| | - Hongkun Gao
- Kunming International Spine, and Spinal Cord Injury Treatment Center, Kunming Tongren Hospital, Kunming, Yunnan Province, China
| | - Dianchun Wang
- Kunming International Spine, and Spinal Cord Injury Treatment Center, Kunming Tongren Hospital, Kunming, Yunnan Province, China
| | - Xiao-Ming Xu
- Indiana University School of Medicine, Stark Neurosciences Research Institute, Indianapolis, IN, USA
| | - Hui Zhu
- Kunming International Spine, and Spinal Cord Injury Treatment Center, Kunming Tongren Hospital, Kunming, Yunnan Province, China
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12
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Kocoglu Barlas U, Akcay N, Talip M, Menentoglu ME, Sevketoglu E. Is the prognosis of traumatic critically ill pediatric patients predictable? : A multicenter retrospective analysis. Wien Klin Wochenschr 2023; 135:639-645. [PMID: 37684531 DOI: 10.1007/s00508-023-02269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/05/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND In this retrospective study the effects of the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), mean platelet volume to platelet count ratio (MPV/PC) values as well as C‑reactive protein (CRP) and procalcitonin (PCT) levels on the severity and mortality in critically ill child trauma cases were evaluated. METHODS A total of 80 trauma cases aged 31 days to 16 years that were followed-up in the pediatric intensive care unit (PICU) were included in the study. The data of the patients on the first day of hospitalization (T1), the median day of intensive care admission (T2), and before discharge or exitus (T3) were analyzed. The cases were divided into three groups according to the injury severity score (ISS) as minor, moderate, and severe. RESULTS Of the 80 cases 59 (73.75%) were male and 21 (26.25%) were female. The mean age of all the cases was 54.5 ± 47.8 months, and the mean PICU stay was 7.35 ± 6.64 days. Of the cases 19 (23.75%) due to motor vehicle accidents and 61 (76.25%) due to falling from heights were followed-up. The mortality rate was found to be 13.75% (11 cases). The T1, T2 and T3 NLR, MLR, MPV/PC and PCT values did not differ between the groups. The T1 and T2 CRP levels were higher in the moderate trauma group than in the severe trauma group. Also, ISS and pediatric risk of mortality 3 (PRISM-3) scores were higher while the revised injury severity classification version II (RISC II), RISC II survival and Glasgow coma scale (GCS) scores were lower in the nonsurvivors. While the T3 MLR value was lower in nonsurvival cases, the T3 MPV/PC value was found to be higher. CONCLUSION The NLR, MLR, and MPV/PC values do not predict the severity of the trauma in children. In children with severe trauma, low MLR and high MPV/PC values can be used to predict mortality.
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Affiliation(s)
- Ulkem Kocoglu Barlas
- Istanbul Medeniyet University, Faculty of Medicine, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey.
| | - Nihal Akcay
- University of Health Sciences Turkey, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Mey Talip
- University of Health Sciences Turkey, Prof Dr Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Mehmet Emin Menentoglu
- University of Health Sciences Turkey, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Esra Sevketoglu
- University of Health Sciences Turkey, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Kassem E, Shapira M, Sussan M, Mahamid L, Amsalem N, Abu Fanne R. The Diagnostic Value of Human Neutrophilic Peptides 1-3 in Acute Pediatric Febrile Illness. J Clin Med 2023; 12:6514. [PMID: 37892652 PMCID: PMC10607217 DOI: 10.3390/jcm12206514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Background: It is prudent to develop biomarkers that enhance the differentiation between viral and bacterial infection in order to support expeditious and judicious antimicrobial implementation in emergency department admissions. Human neutrophilic peptides 1-3 (HNP1-3) are the major neutrophilic peptides with potent antimicrobial activity. Methods: We tested the performance of the plasma HNP1-3 test in a prospective observational cohort of children admitted to the emergency department for fever. We validated this test with traditionally used biomarkers and final diagnoses. An expert panel reviewed the patient's data and gave a final diagnosis. The final diagnosis was classified as definite, probable, or possible. Results: A total of 111 children (98 with fever and 13 control) were recruited: 55% male, mean age 6.3 years. Plasma HNP1-3 levels were higher with bacterial infections: 10,428 (5789-14,866) vs. 7352 (3762-10,672) pg/mL, p = 0.007. HNP1-3 were negatively correlated with age: r = -0.207, p = 0.029. Of the different categorical variables tested, only c-reactive protein (CRP) (≥42.3 mg/dL), neutrophil count (≥10.2), and age (odds ratio = 1.185, p = 0.013 and 95%CI = 1.037-1.354) had significant diagnostic capability for bacterial disease prediction. Conclusions: Due to its low diagnostic value in febrile patients, the HNP1-3 value is not currently recommended to support pathogen differentiation in children in an emergency setting. Further studies are needed to support its clinical use.
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Affiliation(s)
- Eiass Kassem
- Department of Pediatrics, Hillel Yaffe Medical Center, Affiliated with the Rappaport Faculty of Medicine, Technion Institute of Technology, Hadera 3810101, Israel; (E.K.); (M.S.); (L.M.)
| | - Maanit Shapira
- Laboratory Division, Hillel Yaffe Medical Center, Affiliated with the Rappaport Faculty of Medicine, Technion Institute of Technology, Hadera 3810101, Israel;
| | - Miral Sussan
- Department of Pediatrics, Hillel Yaffe Medical Center, Affiliated with the Rappaport Faculty of Medicine, Technion Institute of Technology, Hadera 3810101, Israel; (E.K.); (M.S.); (L.M.)
| | - Loay Mahamid
- Department of Pediatrics, Hillel Yaffe Medical Center, Affiliated with the Rappaport Faculty of Medicine, Technion Institute of Technology, Hadera 3810101, Israel; (E.K.); (M.S.); (L.M.)
| | - Naama Amsalem
- Department of Cardiology, Hillel Yaffe Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel;
| | - Rami Abu Fanne
- Department of Cardiology, Hillel Yaffe Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel;
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Gu M, Mo X, Fang Z, Zhang H, Lu W, Shen X, Yang L, Wang W. Characteristics of aseptic meningitis-like attack-an underestimated phenotype of myelin oligodendrocyte glycoprotein antibody-associated disease. Mult Scler Relat Disord 2023; 78:104939. [PMID: 37611382 DOI: 10.1016/j.msard.2023.104939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Aseptic meningitis was recently reported and recognized as a novel phenotype of Myelin oligodendrocyte glycoprotein antibody-associated disease (MOG-AD). However, the frequency and clinical features of this specific subtype remain unclear. METHODS We reported sixteen MOG-AD cases with aseptic meningitis from June 2018 to June 2022. Moreover, systematic literature of 17 reported cases was conducted. RESULTS Upon reviewing the records of 91 patients diagnosed with MOG-AD in our center, we identified 16 patients (17.6%; 9 men and 7 women) with aseptic meningitis-like MOG-AD. The median age at onset was 23.5 ± 15.7 years. The common clinical presentations were fever (87.5%), headache (75.0%) and seizure (18.8%). Most patients had leukocytosis (62.5%) and a significantly elevated neutrophil-lymphocyte ratio (NLR, ≥3.0). Cerebrospinal fluid showed elevated intracranial hypertension (43.8%), elevated leukocytes (100%) and protein (56.3%). Negative brain magnetic resonance images were observed in 6 patients and only meningeal enhancement was observed in 8 patients at first. Almost all patients had a prolonged fever (over 2 weeks) and ineffectual antibiotic treatment. All patients experienced an effective response to immunotherapy. The majority had a benign course (low Expanded Disability Status Scale score and relapsing rate). Five patients (31.3%) progressed and four patients (25.0%) experienced recurrence. Aseptic meningitis-like MOG-AD of 17 cases reported in previous studies showed similar clinical features to our cases. CONCLUSION Aseptic meningitis could be an initial or isolated manifestation of MOG-AD. It is an underestimated phenotype of MOG-AD.
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Affiliation(s)
- Meifeng Gu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha 410000, China; Department of Special Needs Ward, The Zhuzhou Central Hospital, Central South University, Zhuzhou 412000, China
| | - Xiaoqin Mo
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha 410000, China
| | - Ziyu Fang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha 410000, China
| | - Hainan Zhang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha 410000, China
| | - Wei Lu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha 410000, China
| | - Xiangmin Shen
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha 410000, China; Department of Neurology, Guilin Hospital of The Second Xiangya Hospital, Central South University, Gui Lin 541000, China
| | - Liang Yang
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha 410000, China
| | - Wei Wang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha 410000, China.
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Denyer S, Eikani C, Sheth M, Schmitt D, Brown N. Utility of Blood Cell Ratio Combinations for Diagnosis of Periprosthetic Joint Infection. Arthroplast Today 2023; 23:101195. [PMID: 37745972 PMCID: PMC10517275 DOI: 10.1016/j.artd.2023.101195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/19/2023] [Indexed: 09/26/2023] Open
Abstract
Background Periprosthetic joint infection (PJI) is a serious complication following joint replacement surgery, and its diagnosis can be challenging due to the similarity of symptoms to other conditions and the lack of confirmatory imaging tests. Platelet/mean platelet volume ratio (PVR), platelet/lymphocyte ratio, monocyte/lymphocyte ratio, and neutrophil/lymphocyte ratio have been proposed as potential markers to aid in the diagnosis of PJI. This study aimed to further assess the utility of these blood cell ratio combinations for the diagnosis of PJI. Methods A retrospective chart review was conducted on patients who presented to a university hospital for evaluation for PJI or underwent aseptic revision surgery. All patients were reviewed for inclusion in the study. Data were collected on several markers, including complete blood counts, synovial fluid white blood cell count, and polymorphonuclear percentage. Receiver operator characteristic curve analysis was used to evaluate the diagnostic capabilities of the markers and marker combinations. Results The combination of erythrocyte sedimentation rate, C-reactive protein, synovial white blood cell count, and synovial polymorphonuclear percentage, with PVR, had the highest area under the curve of 0.97, with a sensitivity of 94.3% and a specificity of 88.9%, and a positive predictive value of 97.1% and a negative predictive value of 80.0%. Conclusions This study further supports the use of PVR calculated from complete blood count commonly ordered laboratory values obtained during routine complete blood counts when combined with established serum and synovial markers to increase the diagnostic accuracy for diagnosing PJI.
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Affiliation(s)
- Steven Denyer
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Carlo Eikani
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Monica Sheth
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Daniel Schmitt
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Nicholas Brown
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
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16
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Wallace KME, Hart DW, Venter F, van Vuuren AKJ, Bennett NC. The best of both worlds: no apparent trade-off between immunity and reproduction in two group-living African mole-rat species. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220310. [PMID: 37381852 PMCID: PMC10291439 DOI: 10.1098/rstb.2022.0310] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/22/2023] [Indexed: 06/30/2023] Open
Abstract
Co-operatively breeding mammals often exhibit a female reproductive skew and suppression of the subordinate non-breeding group members. According to evolutionary theory and the immunity-fertility axis, an inverse relationship between reproductive investment and survival (through immunocompetence) is expected. As such, this study investigated if a trade-off between immunocompetence and reproduction arises in two co-operatively breeding African mole-rat species, namely the Damaraland mole-rat (Fukomys damarensis) and common mole-rat (Cryptomys hottentotus hottentotus), which possess female reproductive division of labour. This study also attempted to investigate the relationship between the immune and endocrine systems in Damaraland mole-rats. There was no trade-off between reproduction and immunocompetence in co-operatively breeding African mole-rat species, and in the case of the Damaraland mole-rats, breeding females (BFs) possessed increased immunocompetence compared with non-breeding females (NBFs). Furthermore, the increased levels of progesterone possessed by Damaraland mole-rat BFs compared with NBFs appear to be correlated to increased immunocompetence. In comparison, BF and NBF common mole-rats possess similar immunocompetence. The species-specific differences in the immunity-fertility axis may be due to variations in the strengths of reproductive suppression in each species. This article is part of the theme issue 'Evolutionary ecology of inequality'.
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Affiliation(s)
- K. M. E. Wallace
- Department of Zoology and Entomology, University of Pretoria, Private Bag X20, Hatfield 0028, South Africa
| | - Daniel W. Hart
- Department of Zoology and Entomology, University of Pretoria, Private Bag X20, Hatfield 0028, South Africa
| | - F. Venter
- Department of Biochemistry, Genetics and Microbiology and Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Private Bag X20, Hatfield 0028, South Africa
| | - A. K. Janse van Vuuren
- Department of Zoology and Entomology, University of Pretoria, Private Bag X20, Hatfield 0028, South Africa
| | - N. C. Bennett
- Department of Zoology and Entomology, University of Pretoria, Private Bag X20, Hatfield 0028, South Africa
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Tripathi S, Tarabichi S, Parvizi J, Rajgopal A. Current relevance of biomarkers in diagnosis of periprosthetic joint infection: an update. ARTHROPLASTY 2023; 5:41. [PMID: 37525262 PMCID: PMC10391917 DOI: 10.1186/s42836-023-00192-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/03/2023] [Indexed: 08/02/2023] Open
Abstract
With a significant rise in the number of arthroplasty procedures performed worldwide, the increasing revision burden posed by periprosthetic joint infection (PJI) is a matter of growing concern. In spite of various attempts to diagnose PJI, there are no defined tests that can be called a gold standard. Given the importance of early diagnosis in PJI, newer tests and biomarkers have been introduced to improve cumulative diagnostic accuracy. Novel biomarkers like calprotectin, lipocalcin, monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and platelet-to-mean platelet volume ratio have demonstrated a potential as diagnostic biomarkers for PJI. This article discusses the relevance of available and newly described diagnostic biomarkers to provide a perspective on the practical applicability in current medical practice, as well as highlights some recent advances in biomarkers for the diagnosis of PJI.
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Affiliation(s)
- Saksham Tripathi
- Institute of Musculoskeletal Disorders and Orthopaedics, Medanta-The Medicity, Gurugram, HR, 122001, India.
| | - Saad Tarabichi
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Ashok Rajgopal
- Institute of Musculoskeletal Disorders and Orthopaedics, Medanta-The Medicity, Gurugram, HR, 122001, India
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18
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Wang N, He S, Zheng Y, Wang L. The value of NLR versus MLR in the short-term prognostic assessment of HBV-related acute-on-chronic liver failure. Int Immunopharmacol 2023; 121:110489. [PMID: 37327515 DOI: 10.1016/j.intimp.2023.110489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Systemic inflammation is associated with the development and progression of hepatitis B-associated acute-on-chronic liver failure (HBV-ACLF). The neutrophil-to-lymphocyte ratio (NLR) has been reported to be a prognostic biomarker in patients with HBV-ACLF. However, the role of the monocyte-to-lymphocyte ratio (MLR) as a prognostic inflammatory biomarker in multiple diseases is rarely mentioned in HBV-ACLF. METHODS We included a total of 347 patients with HBV-ACLF who met the definition of the Chinese Guidelines for the Diagnosis and Treatment of Liver Failure (2018 edition). Among them, 275 cases were included retrospectively, and 72 cases were collected prospectively. Clinical characteristics and laboratory examination data were collected from medical records within 24 h after diagnosis to calculate MLR and NLR levels, and lymphocyte subpopulation counts were collected in prospectively included patients. RESULTS Of the 347 patients with HBV-ACLF, 128 patients in the non-surviving group had a mean age of 48.87 ± 12.89 years; 219 patients in the survival group had a mean age of 44.80 ± 11.80 years and a combined 90-day mortality rate of 36.9%. The median MLR was higher in the non-survivors than in the survivors (0.690 vs 0.497, P < 0.001). MLR values were significantly associated with 90-day mortality in HBV-ACLF (OR 6.738; 95% CI 3.188-14.240, P < 0.001). The AUC for the predictive power of the combined MLR and NLR analysis for HBV-ACLF was 0.694, and the calculated MLR threshold was 4.495. In addition, in the analysis of peripheral blood lymphocyte subsets in HBV-ACLF, a significant decrease in the number of circulating lymphocytes was found in HBV-ACLF patients in the non-surviving group (P < 0.001), with a predominant decrease in the number of CD8 + T cells and no significant difference in the number of CD4 + T cells, B cells or NK cells. CONCLUSION Increased MLR values are associated with 90-day mortality in patients with HBV-ACLF, and the MLR may serve as a potential prognostic indicator for patients with HBV-ACLF. Decreased CD8 + T-cell counts may be associated with poor survival in patients with HBV-ACLF.
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Affiliation(s)
- Neng Wang
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Sike He
- West China School of Medicine, Sichuan University, Chengdu, PR China
| | - Yu Zheng
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Lichun Wang
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
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Sejópoles MD, Souza-Silva JP, Silva-Santos C, Paula-Duarte MM, Fontes CJ, Gomes LT. Prognostic value of neutrophil and lymphocyte counts and neutrophil/lymphocyte ratio for predicting death in patients hospitalized for COVID-19. Heliyon 2023; 9:e16964. [PMID: 37292322 PMCID: PMC10238120 DOI: 10.1016/j.heliyon.2023.e16964] [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: 10/26/2022] [Revised: 04/25/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023] Open
Abstract
COVID-19 primarily affects the respiratory system and can cause changes in other systems. Early identification of patients with a higher potential for complications is critical to provide the best possible treatment to reduce the disease's lethality. This study aimed to analyze the behavior of hematologic biomarkers in predicting mortality in patients hospitalized with COVID-19. This retrospective cohort study used data from the medical records of patients hospitalized with COVID-19 between March and August 2020 in two referral hospitals for treatment of the disease in the city of Cuiabá (in the state of Mato Grosso, Brazil). Clinical and laboratory characteristics related to cardiovascular involvement and death during hospitalization were evaluated. Neutrophils, lymphocytes, and monocytes, as well as the neutrophil-to-lymphocyte ratio (NLR) and the monocyte-to-lymphocyte ratio (MRL), were used as potential biomarkers of death. A total of 199 patients were included (male: 113; mean age: 51.4 years). Leukocyte, neutrophil, and lymphocyte counts showed a statistically significant association with death, as did NLR and MRL. Satisfactory accuracy in predicting death was observed for leukocyte, neutrophil, lymphocyte, NLR, and MLR counts. The hematologic biomarkers studied may be useful for prognosticating hospitalized patients for the possibility of death from COVID-19.
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Affiliation(s)
- Marcia D Sejópoles
- Julio Müller School Hospital, Federal University of Mato Grosso. Rua Dr Luis P Pereira Leite Sn, Cuiabá (MT), Brazil
| | - João P Souza-Silva
- Julio Müller School Hospital, Federal University of Mato Grosso. Rua Dr Luis P Pereira Leite Sn, Cuiabá (MT), Brazil
- Faculty of Medicine. Post-Graduation in Health Sciences, Federal University of Mato Grosso, Av Fernando Correa da Costa, 2367, Cuiabá (MT), Brazil
| | - Cristiane Silva-Santos
- Julio Müller School Hospital, Federal University of Mato Grosso. Rua Dr Luis P Pereira Leite Sn, Cuiabá (MT), Brazil
- Faculty of Medicine. Post-Graduation in Health Sciences, Federal University of Mato Grosso, Av Fernando Correa da Costa, 2367, Cuiabá (MT), Brazil
| | - Matheus M Paula-Duarte
- Julio Müller School Hospital, Federal University of Mato Grosso. Rua Dr Luis P Pereira Leite Sn, Cuiabá (MT), Brazil
- Faculty of Medicine. Post-Graduation in Health Sciences, Federal University of Mato Grosso, Av Fernando Correa da Costa, 2367, Cuiabá (MT), Brazil
| | - Cor Jf Fontes
- Julio Müller School Hospital, Federal University of Mato Grosso. Rua Dr Luis P Pereira Leite Sn, Cuiabá (MT), Brazil
- Faculty of Medicine. Post-Graduation in Health Sciences, Federal University of Mato Grosso, Av Fernando Correa da Costa, 2367, Cuiabá (MT), Brazil
| | - Luciano T Gomes
- Julio Müller School Hospital, Federal University of Mato Grosso. Rua Dr Luis P Pereira Leite Sn, Cuiabá (MT), Brazil
- Faculty of Medicine. Post-Graduation in Health Sciences, Federal University of Mato Grosso, Av Fernando Correa da Costa, 2367, Cuiabá (MT), Brazil
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Howe CL, Johnson RK, Overlee BL, Sagen JA, Mehta N, Farias‐Moeller R. Drug-resistant seizures associated with hyperinflammatory monocytes in FIRES. Ann Clin Transl Neurol 2023; 10:719-731. [PMID: 36924141 PMCID: PMC10187718 DOI: 10.1002/acn3.51755] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE Therapeutic strategies for patients with febrile infection-related epilepsy syndrome (FIRES) are limited, ad hoc, and frequently ineffective. Based on evidence that inflammation drives pathogenesis in FIRES, we used ex vivo stimulation of peripheral blood mononuclear cells (PBMCs) to characterize the monocytic response profile before and after therapy in a child successfully treated with dexamethasone delivered intrathecally six times between hospital Day 23 and 40 at 0.25 mg/kg/dose. METHODS PBMCs were isolated from serial blood draws acquired during refractory status epilepticus (RSE) and following resolution associated with intrathecal dexamethasone therapy in a previously healthy 9-year-old male that presented with seizures following Streptococcal pharyngitis. Cells were stimulated with bacterial or viral ligands and cytokine release was measured and compared to responses in age-matched healthy control PBMCs. Levels of inflammatory factors in the blood and CSF were also measured and compared to pediatric healthy control ranges. RESULTS During RSE, serum levels of IL6, CXCL8, HMGB1, S100A8/A9, and CRP were significantly elevated. IL6 was elevated in CSF. Ex vivo stimulation of PBMCs collected during RSE revealed hyperinflammatory release of IL6 and CXCL8 in response to bacterial stimulation. Following intrathecal dexamethasone, RSE resolved, inflammatory levels normalized in serum and CSF, and the PBMC hyperinflammatory response renormalized. SIGNIFICANCE FIRES may be associated with a hyperinflammatory monocytic response to normally banal bacterial pathogens. This hyperinflammatory response may induce a profound neutrophil burden and the consequent release of factors that further exacerbate inflammation and drive neuroinflammation. Intrathecal dexamethasone may resolve RSE by resetting this inflammatory feedback loop.
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Affiliation(s)
- Charles L. Howe
- Translational Neuroimmunology LabMayo ClinicRochesterMinnesotaUSA
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for MS and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
- Division of Experimental NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Renee K. Johnson
- Translational Neuroimmunology LabMayo ClinicRochesterMinnesotaUSA
| | | | - Jessica A. Sagen
- Translational Neuroimmunology LabMayo ClinicRochesterMinnesotaUSA
- Center for MS and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Niyati Mehta
- Department of NeurologyMedical College of WisconsinMilwaukeeWisconsinUSA
- Division of Child NeurologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Raquel Farias‐Moeller
- Department of NeurologyMedical College of WisconsinMilwaukeeWisconsinUSA
- Division of Child NeurologyMedical College of WisconsinMilwaukeeWisconsinUSA
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Kushiro S, Fukui S, Inui A, Kobayashi D, Saita M, Naito T. Clinical prediction rule for bacterial arthritis: Chi-squared
automatic interaction detector decision tree analysis model. SAGE Open Med 2023; 11:20503121231160962. [PMID: 36969723 PMCID: PMC10034275 DOI: 10.1177/20503121231160962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/14/2023] [Indexed: 03/24/2023] Open
Abstract
Objectives: Differences in demographic factors, symptoms, and laboratory data between
bacterial and non-bacterial arthritis have not been defined. We aimed to
identify predictors of bacterial arthritis, excluding synovial testing. Methods: This retrospective cross-sectional survey was performed at a university
hospital. All patients included received arthrocentesis from January 1,
2010, to December 31, 2020. Clinical information was gathered from medical
charts from the time of synovial fluid sample collection. Factors
potentially predictive of bacterial arthritis were analyzed using the
Student’s t-test or chi-squared test, and the chi-squared
automatic interaction detector decision tree analysis. The resulting
subgroups were divided into three groups according to the risk of bacterial
arthritis: low-risk, intermediate-risk, or high-risk groups. Results: A total of 460 patients (male/female = 229/231; mean ± standard deviation
age, 70.26 ± 17.66 years) were included, of whom 68 patients (14.8%) had
bacterial arthritis. The chi-squared automatic interaction detector decision
tree analysis revealed that patients with C-reactive
protein > 21.09 mg/dL (incidence of septic arthritis: 48.7%) and
C-reactive protein ⩽ 21.09 mg/dL plus 27.70 < platelet
count ⩽ 30.70 × 104/μL (incidence: 36.1%) were high-risk
groups. Conclusions: Our results emphasize that patients categorized as high risk of bacterial
arthritis, and appropriate treatment could be initiated as soon as
possible.
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Affiliation(s)
- Seiko Kushiro
- Department of General Medicine,
Juntendo University Faculty of Medicine, Tokyo, Japan
- Seiko Kushiro, Department of General
Medicine, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo
113-8421, Japan.
| | - Sayato Fukui
- Department of General Medicine,
Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Akihiro Inui
- Department of General Medicine,
Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Daiki Kobayashi
- Department of Internal Medicine, St.
Luke’s International Hospital, Tokyo, Japan
| | - Mizue Saita
- Department of General Medicine,
Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine,
Juntendo University Faculty of Medicine, Tokyo, Japan
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Kissling M, Fritschi N, Baumann P, Buettcher M, Bonhoeffer J, Naranbhai V, Ritz N. Monocyte, Lymphocyte and Neutrophil Ratios - Easy-to-Use Biomarkers for the Diagnosis of Pediatric Tuberculosis. Pediatr Infect Dis J 2023; 42:520-527. [PMID: 36977187 DOI: 10.1097/inf.0000000000003901] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND The neutrophil-to-lymphocyte-ratio (NLR), neutrophil-to-monocyte-plus-lymphocyte-ratio (NMLR) and monocyte-to-lymphocyte-ratio (MLR) may have diagnostic potential for tuberculosis (TB). METHODS Data of two prospective multicenter studies in Switzerland were used, which included children <18 years with TB exposure, infection or disease or with febrile non-TB lower-respiratory-tract infection (nTB-LRTI). RESULTS Of the 389 children included 25 (6.4%) had TB disease, 12 (3.1%) TB infection, 28 (7.2%) were healthy TB exposed and 324 (83.3%) nTB-LRTI. Median (IQR) NLR was highest with 2.0 (1.2, 2.2) in children with TB disease compared to TB exposed [0.8 (0.6, 1.3); P = 0.002] and nTB-LRTI [0.3 (0.1, 1.0); P < 0.001]. Median (IQR) NMLR was highest with 1.4 (1.2, 1.7) in children with TB disease compared to healthy exposed [0.7 (0.6, 1.1); P = 0.003] and children with nTB-LRTI [0.2 (0.1, 0.6); P < 0.001). Receiver operating characteristic curves to detect TB disease compared to nTB-LRTI for NLR and NMLR had an area under the curve of 0.82 and 0.86, the sensitivity of 88% and 88%, and specificity of 71% and 76%, respectively. CONCLUSION NLR and NMLR are promising, easy-to-obtain diagnostic biomarkers to differentiate children with TB disease from other lower respiratory tract infections. These results require validation in a larger study and in settings with high and low TB endemicity.
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Affiliation(s)
- Mirjam Kissling
- From the Department of Clinical Research, Mycobacterial and Migrant Health Research Group, University of Basel, Switzerland
| | - Nora Fritschi
- From the Department of Clinical Research, Mycobacterial and Migrant Health Research Group, University of Basel, Switzerland
- University Children's Hospital Basel, Switzerland
| | - Philipp Baumann
- Department of Intensive Care Medicine and Neonatology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Infectious Disease and Vaccinology Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases Unit, Children's Hospital, Lucerne Cantonal Hospital, Lucerne Switzerland
- Paediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Vivek Naranbhai
- Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Boston
- Dana-Farber Cancer Institute, Boston, Massachusetts
- Center for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Nicole Ritz
- From the Department of Clinical Research, Mycobacterial and Migrant Health Research Group, University of Basel, Switzerland
- University Children's Hospital Basel, Switzerland
- Paediatric Infectious Diseases Unit, Children's Hospital, Lucerne Cantonal Hospital, Lucerne Switzerland
- Department of Pediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Australia
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Jahan I, Ahmed R, Ahmed J, Khurshid S, Biswas PP, Upama IJ, Hamid Y, Papri N, Islam Z. Neutrophil-lymphocyte ratio in Guillain-Barré syndrome: A prognostic biomarker of severe disease and mechanical ventilation in Bangladesh. J Peripher Nerv Syst 2023; 28:47-57. [PMID: 36700342 PMCID: PMC10155239 DOI: 10.1111/jns.12531] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023]
Abstract
In addition to cellular and humoral immunity, inflammatory markers play an important role in the pathogenesis of Guillain-Barré syndrome (GBS) and are used to predict prognosis in many autoimmune diseases. The aim of this study was to identify whether the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, and monocyte-lymphocyte ratio in the early stages of GBS have prognostic value for severe disease, mechanical ventilation (MV) and poor long-term outcome. A prospective cohort study of 140 adult patients with GBS and 140 healthy controls (HC) was performed in Bangladesh during 2019-2022. Clinicodemographic characteristics of the patients were recorded, and hematological parameters were measured using an automated hematology analyzer. Median patient age was 35 (44-23) years; 71% were male; 88% were severely affected (GBS Disability Score> 3); 32% required MV. Patients had higher NLR than HC (P< .0001). Among patients, elevated NLR was associated with severe GBS and MV (P= .001 and <.0001, respectively) and moderately positively correlated with poor outcomes at 4 weeks (r = 0.423). Multiple logistic regression revealed NLR was an independent risk factor for severe GBS (OR = 5.2, 95% CI = 1.6-17.4) and MV (OR = 1.5 1.1-2.1). No significant association was observed between elevated NLR and the long-term outcome of GBS. Receiver operating characteristic curves revealed NLR cut-off values of ≥ 2.432 and ≥ 4.4423 predicted severe disease (sensitivity = 71%, specificity = 75%, AUC = 0.750, 95% CI = 0.651-0.849, P = .001) and MV (sensitivity = 65.9%, specificity = 81.7%, AUC = 0.804, 95% CI=0.724-0.884; P< .001). The NLR in the early stage of GBS may represent an independent prognostic factor of severe GBS and the requirement for MV.
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Affiliation(s)
- Israt Jahan
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rasel Ahmed
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
| | - Jigishu Ahmed
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
| | - Sarah Khurshid
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
| | - Pritha Promita Biswas
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
| | - Ismat Jahan Upama
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
| | - Yameen Hamid
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
| | - Nowshin Papri
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Zhahirul Islam
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
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Johnson SR, Benvenuti T, Nian H, Thomson IP, Baldwin K, Obremskey WT, Schoenecker JG, Moore-Lotridge SN. Measures of Admission Immunocoagulopathy as an Indicator for In-Hospital Mortality in Patients with Necrotizing Fasciitis: A Retrospective Study. JB JS Open Access 2023; 8:JBJSOA-D-22-00106. [PMID: 36864907 PMCID: PMC9974085 DOI: 10.2106/jbjs.oa.22.00106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Necrotizing fasciitis is a rapidly progressive infection with a high mortality rate. Pathogens evade the host containment and bactericidal mechanisms by hijacking the coagulation and inflammation signaling pathways, leading to their rapid dissemination, thrombosis, organ dysfunction, and death. This study examines the hypothesis that measures of immunocoagulopathy upon admission could aid in the identification of patients with necrotizing fasciitis at high risk for in-hospital mortality. Methods Demographic data, infection characteristics, and laboratory values from 389 confirmed necrotizing fasciitis cases from a single institution were analyzed. A multivariable logistic regression model was built on admission immunocoagulopathy measures (absolute neutrophil, absolute lymphocyte, and platelet counts) and patient age to predict in-hospital mortality. Results The overall in-hospital mortality rate was 19.8% for the 389 cases and 14.6% for the 261 cases with complete measures of immunocoagulopathy on admission. A multivariable logistic regression model indicated that platelet count was the most important predictor of mortality, followed by age and absolute neutrophil count. Greater age, higher neutrophil count, and lower platelet count led to significantly higher risk of mortality. The model discriminated well between survivors and non-survivors, with an overfitting-corrected C-index of 0.806. Conclusions This study determined that measures of immunocoagulopathy and patient age at admission effectively prognosticated the in-hospital mortality risk of patients with necrotizing fasciitis. Given the accessibility of neutrophil-to-lymphocyte ratio and platelet count measurements determined from a simple complete blood-cell count with differential, future prospective studies examining the utility of these measures are warranted. Level of Evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Teresa Benvenuti
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hui Nian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Isaac P. Thomson
- Division of Infectious Disease, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Keith Baldwin
- Department of Orthopaedics, The Children’s Hospital of Pennsylvania, Philadelphia, Pennsylvania
| | - William T. Obremskey
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan G. Schoenecker
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee,Division of Pediatric Orthopaedics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee,Center for Bone Biology, Vanderbilt University Medical Center, Nashville, Tennessee,Email for corresponding author:
| | - Stephanie N. Moore-Lotridge
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee,Division of Pediatric Orthopaedics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee,Center for Bone Biology, Vanderbilt University Medical Center, Nashville, Tennessee
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Liu R, Li M, Zhang L, Wang Y, Zhang Y, Li W, Liu S. Utility of the neutrophil-to-lymphocyte ratio in the prediction of anti-neutrophil cytoplasmic antibody-associated vasculitis with infection. Clin Rheumatol 2023; 42:471-477. [PMID: 36564556 DOI: 10.1007/s10067-022-06483-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/27/2022] [Accepted: 12/09/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study aimed to evaluate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) for infection in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). METHODS Newly onset patients with AAV in China were included, and their laboratory tests and disease activity were analyzed. Based on infection, patients were divided into the infection group (A-I) and the non-infection group (A-NI). Univariable and multivariable logistic regression analyses were used to investigate variables that are independently associated with infection. RESULTS In total, 418 patients were enrolled. Significantly higher white blood cell count (WBC, p < 0.001), neutrophils (p < 0.001), NLR (p < 0.001), platelet-to-lymphocyte ratio (p < 0.001), monocyte-to-lymphocyte ratio (MLR, p < 0.001), erythrocyte sedimentation rate (ESR, p = 0.032), C-reactive protein (CRP, p < 0.001), procalcitonin (PCT, p < 0.001), and Birmingham vasculitis activity score (BVAS, p = 0.005) were observed in the A-I group than in the A-NI group. It was detected that NLR (ρ = 0.273, p < 0.001), MLR (ρ = 0.153, p = 0.011), ESR (ρ = 0.143, p = 0.020), and PCT (ρ = 0.391, p < 0.001) were positively correlated with BVAS. Furthermore, NLR was not only an independent predictor of infection (adjusted OR: 1.144, 95% CI: 1.059-1.236, p = 0.001), but with the largest area under ROC curve, of which value was 0.750. Notably, the optimal cut-off value of NLR for infection was 6.01, with sensitivity of 70.07% and specificity of 71.68%. CONCLUSION Our study demonstrated that in addition to WBC, CRP, ESR, and PCT, NLR should also be used as a beneficial inflammatory indicator to differentiate infection in newly diagnosed AAV. Key Points • NLR was a helpful inflammatory marker in differentiating infection in newly diagnosed AAV.
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Affiliation(s)
- Rui Liu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengdi Li
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei Zhang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuqi Zhang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Li
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Shengyun Liu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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26
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van Rensburg J, Davids S, Smuts C, Davison GM. Use of full blood count parameters and haematology cell ratios in screening for sepsis in South Africa. Afr J Lab Med 2023; 12:2104. [PMID: 37151816 PMCID: PMC10157447 DOI: 10.4102/ajlm.v12i1.2104] [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: 10/21/2022] [Accepted: 01/31/2023] [Indexed: 05/09/2023] Open
Abstract
Background Sepsis is characterised by multi-organ failure due to an uncontrolled immune response to infection. Sepsis prevalence is increased in developing countries and requires prompt diagnosis and treatment. Reports, although controversial, suggest that full blood count parameters and cell ratios could assist in the early screening for sepsis. Objective The study evaluated the use of haematological cell ratios in screening for sepsis in a South African population. Methods The study retrospectively analysed the complete blood counts, blood cultures (BC) and biochemical test results of 125 adult patients who presented between January 2021 and July 2021 at a hospital in Cape Town. An ISO15189-accredited laboratory performed all of the tests. We compared and correlated the automated differential counts, neutrophil, monocyte and platelet-to-lymphocyte ratios with procalcitonin levels. A p-value of < 0.05 was considered significant. Results Sixty-two sepsis patients (procalcitonin > 2 ng/L and positive BC) were identified and compared to 63 non-sepsis controls. All cell ratios were significantly elevated in sepsis patients (p < 0.001). However, the two groups had no significant difference in absolute monocyte counts (p = 0.377). In addition, no correlation was detected between any cell ratios and procalcitonin. Conclusion In combination with complete blood count parameters, haematology cell ratios can be used for early sepsis detection. The full blood count is widely available, inexpensive, and routinely requested by emergency care clinicians. Although procalcitonin and BC remain the gold standard, the calculation of cell ratios could provide a simple screening tool for the early detection of sepsis. What this study adds This study adds evidence to the proposal that calculating haematological cell ratios assists in the early screening of sepsis in a South African setting.
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Affiliation(s)
- Jason van Rensburg
- Department of Biomedical Sciences, Faculty of Health and Wellness, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Saarah Davids
- South African Medical Research Council/Cape Peninsula University of Technology Cardiometabolic Health Research Unit and Biomedical Sciences, Faculty of Health and Wellness, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Carine Smuts
- Department of Biomedical Sciences, Faculty of Health and Wellness, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Glenda M Davison
- South African Medical Research Council/Cape Peninsula University of Technology Cardiometabolic Health Research Unit and Biomedical Sciences, Faculty of Health and Wellness, Cape Peninsula University of Technology, Cape Town, South Africa
- Division of Haematology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Zhang P, Zhang W, Shi W, Weng J, Zhang Z, Lin C, Wang N, Shen Z, Chen ZL. Swallowing function after acute ischemic stroke: Development and validation of a novel clinical prognostic model. Front Nutr 2022; 9:970253. [PMID: 36276823 PMCID: PMC9581060 DOI: 10.3389/fnut.2022.970253] [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: 06/15/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Predicting the duration of dysphagia after acute ischemic stroke (AIS) is important for clinical treatment decisions. Objective The purpose of this study is to assess the swallowing function of AIS patients and to develop and validate a prognostic model for the need for nasogastric tube (NGT) in these patients. Materials and methods We included 554 AIS patients during 2018–2019 as the development group and had 186 AIS patients as the external validation group. The primary end point of the study was the retention of NGT in patients 1 week after admission (Functional Oral Intake Scale ≤ 4). Swallowing function and stroke-associated pneumonia (SAP) at 1 month post-onset were also the objectives of this study. The volume-viscosity swallow test (V-VST) was used to assess the patient’s impaired swallowing function. The Predictive model was built by logistic regression. Results Overall, a total of 104 patients required indwelling NGT at 1 week of AIS onset in development group. The final prognostic model includes 5 variables: age (OR: 1.085, 95%CI: 1.049–1.123), neutrophil-to-lymphocyte ratio (NLR) (OR: 1.332, 95%CI: 1.090–1.626), NIHSS (OR: 1.092, 95%CI: 1.025–1.164), history of drinking (OR: 2.532, 95%CI: 1.452–4.417) and stroke location (Subtentorial vs. Supratentorial, OR: 1.954, 95%CI: 1.088–3.509). The prediction model had an AUC of 0.810, while the external validation group was 0.794. Conclusion In stroke patients, it is very important to decide early whether to indwell a NGT. The nomogram will support decision making for NGT insertion and help these patients recover from their condition.
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Affiliation(s)
- Peiliang Zhang
- Department of Neurosurgery, The Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Wenbo Zhang
- Department of Neurosurgery, The Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Wujie Shi
- Department of Neurosurgery, The Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jianbin Weng
- Department of Neurosurgery, The Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhongyuan Zhang
- Department of Neurosurgery, The Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chao Lin
- Department of Neurosurgery, The Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ning Wang
- Department of Neurosurgery, The Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhipeng Shen
- Department of Neurosurgery, The Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China,*Correspondence: Zhipeng Shen,
| | - Zhi-Lin Chen
- Department of Neurology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai, China,Zhi-Lin Chen,
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TUĞRUL ERSAK D, ERSAK B, ZORLU U, KOKANALI MK, MORALOĞLU TEKİN Ö, DOĞANAY M. Düşük riskli kadınlarda enfekte epizyotomi riskini öngören bir model. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1123893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: Infected episiotomy (IE) is a rare complication of vaginal delivery. However, the practical use of the risk factors involved in the development of IE is unclear. The aim of this study is to create a risk scoring model to be applied in clinical practice with the risk factors we will determine so as to predict the development of IE.
Materials and Methods: All women who were delivered vaginally with mediolateral episiotomy within a 1-year period were included in this retrospective study. While 42 women (cases) with the diagnosis of IE were eligible for inclusion in the study and formed the case group, randomly selected 168 women in whom IE was not detected formed the control group. Possible risk factors for the development of IE were evaluated by multivariate regression analysis.
Results: The analysis revealed 5 significant independent factors related to IE. Among these factors, 5 points were given to current smoking presence, 4 points to weight gain during pregnancy ≥11.5 kg, 3 points to postpartum neutrophil to lymphocyte ratio ≥10.4, 2 points to presence of diabetes mellitus, and 1 point to presence of hospitalization before active phase of labor. And a cut-off value of 5.5 was found to be moderately effective in predicting IE.
Conclusion: Consequently, this five-variable model can predict the presence of IE with significant efficiency. In the presence of these variables, the clinician can identificate the patients at risk of IE. In this way, individualized patient risk assessment and situation-specific counseling can be made.
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Affiliation(s)
- Duygu TUĞRUL ERSAK
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Burak ERSAK
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Uğurcan ZORLU
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Mahmut Kuntay KOKANALI
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Özlem MORALOĞLU TEKİN
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Melike DOĞANAY
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
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Halaseh SA, Kostalas M, Kopec CA, Nimer A. Single-Center Retrospective Analysis of Neutrophil, Monocyte, and Platelet to Lymphocyte Ratios as Predictors of Complicated Appendicitis. Cureus 2022; 14:e29177. [PMID: 36259022 PMCID: PMC9568680 DOI: 10.7759/cureus.29177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/09/2022] Open
Abstract
Aim We look at the ability of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) to differentiate between uncomplicated and complicated appendicitis. Methods and materials This was a retrospective, single-center study of 234 individuals diagnosed with acute appendicitis between January 1, 2020, and December 31, 2020. Patients were grouped into uncomplicated and complicated appendicitis subgroups. Patients with histologically or radiologically proven gangrenous or perforated appendicitis, as well as those with peritonitis or peri-appendiceal abscess development, comprise the complicated subgroup. Independent Mann-Whitney samples The U test was used to predict lab values of complicated appendicitis. Furthermore, the receiver operating characteristic (ROC) curve and area under the curve (AUC) were utilized to predict the sensitivity and specificity of laboratory results reported to have a significant connection with complex appendicitis Results The criteria were met by 186 patients, with a male-to-female proportion of 1.06:1, an average age of 36.4 years, and an average stay of 2.73 days. There were 95 individuals with complicated appendicitis. With 66.3%, perforated appendicitis was the most prevalent condition. The ratios of neutrophils to lymphocytes, monocytes to lymphocytes, and platelets to lymphocytes were linked with complicated appendicitis with a p-value of < 0.0001, and p-values = 0.015, and 0.015, respectively. Conclusion NLR, MLR, and PLR are valid, less onerous surrogate biomarkers for measuring the severity of acute complicated appendicitis and differentiating it from uncomplicated appendicitis.
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Jheng JC, Tseng YT, Wang TH, Chen LF, Chung JY. Using neutrophil to lymphocyte ratio to predict discharge among geriatric patients with influenza infection in emergency department. Medicine (Baltimore) 2022; 101:e30261. [PMID: 36042631 PMCID: PMC9410611 DOI: 10.1097/md.0000000000030261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) is used to predict the prognosis of various diseases, such as coronavirus disease 2019, community-acquired pneumonia, bacteremia, and endocarditis. However, NLR has never been reported to predict patient discharge in geriatric patients with influenza infection. This retrospective case-control study enrolled geriatric patients (≥65 years) with influenza virus infection who visited the emergency department of a medical center between January 01, 2010 and December 31, 2015. Demographic data, vital signs, past histories, influenza subtypes, outcomes, and disposition were analyzed. The optimal NLR cut-off value to predict patient discharge was determined using the Youden index. We also evaluated the accuracy of NLR in predicting patient discharge using logistic regression and receiver operating characteristic analysis. The study included 409 geriatric patients in the emergency department with a mean age of 79.5 years and an approximately equal sex ratio. NLR was significantly lower in the discharged group than in the nondischarged group (5.8 ± 3.7 vs 9.7 ± 8.4). Logistic regression revealed that patients with NLR ≤ 6.5 predicted discharge with an odds ratio of 3.62. The Hosmer-Lemeshow goodness-of-fit test was calculated as 0.36, and the adjusted area under the receiver operating characteristic was 0.75. The negative predictive value of NLR ≤ 6.5, to predict patient discharge, was 91.8%. NLR ≤ 6.5 is a simple and easy-to-obtain laboratory tool to guide the physicians to discharge geriatric patients with influenza infection in the crowded emergency department.
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Affiliation(s)
- Jing-Cheng Jheng
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan
| | - Yen-Ting Tseng
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan
| | - Te-Hao Wang
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan
| | - Li-Fu Chen
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jui-Yuan Chung
- Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
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Festa E, Ascione T, Bernasconi A, Di Gennaro D, Basso MA, Guarino A, Balato G. Diagnostic Performance of Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio, Platelet to Lymphocyte Ratio, and Platelet to Mean Platelet Volume Ratio in Periprosthetic Hip and Knee Infections: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12092033. [PMID: 36140435 PMCID: PMC9497749 DOI: 10.3390/diagnostics12092033] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 12/20/2022] Open
Abstract
The current literature on the diagnosis of periprosthetic joint infection provides controversial evidence on the diagnostic accuracy of MLR, NLR, PVR, and PLR. Therefore, this critical literature search and meta-analysis was aimed to summarize the diagnostic accuracy of these biomarkers for the diagnosis of hip and knee prosthetic infection. According to the PRISMA flowchart, we searched MEDLINE, Scopus, and Web of Science, for studies on these ratios for diagnosing PJI. Sensitivity, specificity, positive and negative likelihood ratio, diagnostic odds ratio, and AUC were analyzed. We included 11 articles in our meta-analysis, including 7537 patients who underwent total hip and knee arthroplasties; among these, 1974 (26%) patients reported a joint infection. The pooled sensitivity and specificity were 0.72 and 0.74, respectively, for NLR, 0.72 and 0.77 for PVR, and 0.77 and 0.75 for PLR. The sensitivity of MLR ranges from 0.54 to 0.81, while the specificity ranges from 0.78 to 0.81. Regarding the evaluation of AUCs, the best diagnostic performance was achieved by MLR (AUC = 0.77) followed by PLR (AUC = 0.75), NLR (AUC = 0.73), and PVR (AUC = 0.70). This meta-analysis demonstrates a fair diagnostic accuracy of these ratios, thus not being useful as a screening tool.
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Affiliation(s)
- Enrico Festa
- Orthopedic Unit, Department of Public Health, Federico II University Naples, 80131 Naples, Italy
- Correspondence:
| | - Tiziana Ascione
- Service of Infectious Disease, Department of Medicine, Cardarelli Hospital Naples, 80131 Naples, Italy
| | - Alessio Bernasconi
- Orthopedic Unit, Department of Public Health, Federico II University Naples, 80131 Naples, Italy
| | - Donato Di Gennaro
- Orthopedic Unit, Department of Public Health, Federico II University Naples, 80131 Naples, Italy
| | - Morena Anna Basso
- Orthopedic Unit, Department of Public Health, Federico II University Naples, 80131 Naples, Italy
| | - Amedeo Guarino
- Orthopedic Unit, Department of Public Health, Federico II University Naples, 80131 Naples, Italy
| | - Giovanni Balato
- Orthopedic Unit, Department of Public Health, Federico II University Naples, 80131 Naples, Italy
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Neutrophil-to-Lymphocyte Ratio and Early Neurological Deterioration in Stroke Patients: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8656864. [PMID: 36033552 PMCID: PMC9402292 DOI: 10.1155/2022/8656864] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/13/2022] [Accepted: 07/25/2022] [Indexed: 12/26/2022]
Abstract
In light of the growing emphasis on classifying stroke patients for different levels of monitoring intensity and emergency treatments, we conducted a systematic review of a wide range of clinical studies, according to the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines, with no restrictions on the language or publication date, to analyze the potential of the neutrophil-to-lymphocyte ratio (NLR) as an early neurological deterioration (END) risk predictor. A comprehensive search was carried out in PubMed, Scopus, and Web of Science databases from the inception to March 13, 2022. Nine articles were included in our study. Stroke patients with END had significantly higher NLR levels than the those without END (SMD = 0.73; CI 95% = 0.42-1.05, P value < 0.001). In the subgroup analysis, according to ethnicity, East Asian patients with END had elevated levels of NLR compared to those without END (SMD = 0.79; CI 95% = 0.52-1.06, P value < 0.001). However, the difference in the Caucasian group was not significant (SMD = 0.60; CI 95% = -0.50-1.70, P value = 0.28). In the subgroup analysis according to the type of stroke, the NLR levels in patients with hemorrhagic stroke who developed END were similar to those without END (SMD = 0.84, CI 95% = -0.10-1.77, P value = 0.07). Vice versa, in the ischemic stroke group, patients with END had elevated levels of NLR compared to those without END (SMD = 0.67, CI 95% = 0.38-0.96, P value < 0.001). NLR is a unique inflammatory biomarker whose increase in END suggests an immune system dysfunction in the pathogenesis of the disease.
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Asaduzzaman MD, Romel Bhuia M, Nazmul Alam ZHM, Zabed Jillul Bari M, Ferdousi T. Significance of hemogram-derived ratios for predicting in-hospital mortality in COVID-19: A multicenter study. Health Sci Rep 2022; 5:e663. [PMID: 35686199 PMCID: PMC9172589 DOI: 10.1002/hsr2.663] [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: 01/06/2022] [Revised: 03/27/2022] [Accepted: 05/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background To address the problem of resource limitation, biomarkers having a potential for mortality prediction are urgently required. This study was designed to evaluate whether hemogram-derived ratios could predict in-hospital deaths in COVID-19 patients. Materials and Methods This multicenter retrospective study included hospitalized COVID-19 patients from four COVID-19 dedicated hospitals in Sylhet, Bangladesh. Data on clinical characteristics, laboratory parameters, and survival outcomes were analyzed. Logistic regression models were fitted to identify the predictors of in-hospital death. Results Out of 442 patients, 55 (12.44%) suffered in-hospital death. The proportion of male was higher in nonsurvivor group (61.8%). The mean age was higher in nonsurvivors (69 ± 13 vs. 59 ± 14 years, p < 0.001). Compared to survivors, nonsurvivors exhibited higher frequency of comorbidities, such as chronic kidney disease (34.5% vs. 15.2%, p ≤ 0.001), chronic obstructive pulmonary disease (23.6% vs. 10.6%, p = 0.011), ischemic heart disease (41.8% vs. 19.4%, p < 0.001), and diabetes mellitus (76.4% vs. 61.8%, p = 0.05). Leukocytosis and lymphocytopenia were more prevalent in nonsurvivors (p < 0.05). Neutrophil-to-lymphocyte ratio (NLR), derived NLR (d-NLR), and neutrophil-to-platelet ratio (NPR) were significantly higher in nonsurvivors (p < 0.05). After adjusting for potential covariates, NLR (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.009-1.08), d-NLR (OR 1.08; 95% CI 1.006-1.14), and NPR (OR 1.20; 95% CI 1.09-1.32) have been found to be significant predictors of mortality in hospitalized COVID-19 patients. The optimal cut-off points for NLR, d-NLR, and NPR for prediction of in-hospital mortality for COVID-19 patients were 7.57, 5.52 and 3.87, respectively. Conclusion Initial assessment of NLR, d-NLR, and NPR values at hospital admission is of good prognostic value for predicting mortality of patients with COVID-19.
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Affiliation(s)
- MD Asaduzzaman
- Department of MedicineSylhet MAG Osmani Medical College HospitalSylhetBangladesh
| | - Mohammad Romel Bhuia
- Department of StatisticsShahjalal University of Science and TechnologySylhetBangladesh
| | - ZHM Nazmul Alam
- Department of MedicineSylhet MAG Osmani Medical College HospitalSylhetBangladesh
| | | | - Tasnim Ferdousi
- Department of OphthalmologyBangabandhu Sheikh Mujib Medical UniversityDhakaBangladesh
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Hua C, Li J, Yang Y, Liu Z. Hematological features and risk factors of hospitalized COVID-19 patients: A retrospective analysis. EUR J INFLAMM 2022. [DOI: 10.1177/1721727x221092909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) became pandemic in 2020 and recently, mutated coronaviruses have emerged in many countries. The aim of this study was to identify the clinical characteristics and risk factors for critical illness in hospitalized COVID-19 patients in Zhengzhou for clinical prevention and management. Materials and methods: A total of 70 patients hospitalized with COVID-19 were enrolled between 21 January and 29 February 2020, in Zhengzhou, China. Clinical characteristics, hematological findings, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and inflammatory index on admission were obtained from medical records, COVID-19 patients with different outcomes were compared. Results: The median age was 55 years. Forty-three (61.0%) patients were classified as having severe or critical cases. Eighteen (25.7%) patients died in hospital and the remaining 52 were discharged. Patients who died tend to be old with expectoration and chronic obstructive pulmonary disease. Compared to survivor, non-survivor had significantly higher numbers of leucocytes and neutrophils, NLR, aspartate aminotransferase (AST), γ-glutamyl transpeptidase, total bilirubin, direct bilirubin, lactate dehydrogenase (LDH), prothrombin time, D-dimer, C-reactive protein, and decreased platelets, lymphocytes, uric acid, and albumin (ALB). Logistic regression analysis identified leucocytes, platelets, PLR, NLR, AST, and ALB as independent predictive factors for poor outcomes. The area under curve of the combination of leucocytes, PLR, NLR, and AST was 0.87, with a sensitivity of 0.83 and specificity of 0.81. Conclusion: Our results identified risk factors among COVID-19 patients for in-hospital mortality. Leucocytes, PLR, NLR, and AST could have important reference value for predicting prognosis, especially in low-resource countries.
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Affiliation(s)
- Chaoyang Hua
- Department of Urology, Henan Children’s Hospital, Children’s Hospital Affiliated to Zhengzhou University, Zhengzhou, P. R. China
| | - Jia Li
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, P. R. China
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P. R. China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, P. R. China
| | - Yanfang Yang
- Department of Urology, Henan Children’s Hospital, Children’s Hospital Affiliated to Zhengzhou University, Zhengzhou, P. R. China
| | - Zhangsuo Liu
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, P. R. China
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P. R. China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, P. R. China
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Diagnostic Value of the Blood Neutrophil-to-Lymphocyte Ratio and Monocyte-to-Lymphocyte Ratio in Tibia Fracture-Related Infection. DISEASE MARKERS 2022; 2022:6119583. [PMID: 35692886 PMCID: PMC9184170 DOI: 10.1155/2022/6119583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/16/2022] [Indexed: 12/25/2022]
Abstract
Objective. The diagnostic value of neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) in predicting fracture-related infection (FRI) in tibia fracture patients remains to be explored. Methods. A retrospective controlled study was carried out with 170 tibia FRI patients and 162 control subjects. The following information was evaluated at admission: age, gender, clinical features, number of white blood cells (WBCs), neutrophils, lymphocytes, monocytes, red blood cells (RBCs), platelets, level of hemoglobin, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), as well as NLR, MLR, and PLR. Results. The number of lymphocytes, RBCs, and platelets in the FRI group was higher than those in the control group, while the number of neutrophils and ESR level was lower (
). The level of NLR and MLR was significantly lower in patients with tibia FRI than in control subjects (
). Both indicators were positively correlated with WBCs, CRP level, and ESR level (
). The results of logistic regression analysis showed that five variables including NLR, MLR, platelets, fracture pattern (closed or open fracture), and site pattern (single or multiple site) were used to construct the FRI risk predictor. The ROC curve analysis result showed that FRI risk predictor yielded the highest AUC, with a sensitivity of 91.2% and a specificity of 90.1%, and made the distinction efficiently between tibia FRI patients and non-FRI patients. Conclusion. NLR and MLR were decreased in tibia FRI patients compared to non-FRI patients. Both indicators had a positive correlation with WBCs, CRP level, and ESR level. FRI risk predictor constructed based on five variables including NLR and MLR had a high diagnostic value for tibia FRI.
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Kubat M, Şengül S. Value of neutrophil-to-platelet ratio, immature granulocyte-to-lymphocyte ratio, red blood cell distribution width-to-lymphocyte ratio in differentiating complicated acute appendicitis. ULUS TRAVMA ACIL CER 2022; 28:607-614. [PMID: 35485466 PMCID: PMC10442979 DOI: 10.14744/tjtes.2022.30434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/31/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The discovery that medical treatment could be successful in cases with uncomplicated acute appendicitis (UCAA) has revealed the need for successfully differentiating cases with complicated acute appendicitis (CAA). The present study exam-ined the usability of neutrophil-to-platelet ratio (NPR), immature granulocyte-to-lymphocyte ratio, and red blood cell distribution width-to-lymphocyte ratio (RDWLR) in the CAA/UCAA differentiation. METHODS A retrospective evaluation was made of patients undergoing appendectomy between January 2019 and December 2020. According to pathological and clinical findings, the patients were divided into negative appendectomy, CAA and UCAA groups. Labo-ratory parameters and associated ratios were evaluated by comparing the groups. RESULTS The study included 348 patients. Of the patients, 11.2% had CAA, 81.6% had UCAA, and 7.2% had negative appendec-tomy. The neutrophil-to-lymphocyte ratio (AUC=0.742), platelet-to-lymphocyte ratio (AUC=0.707), immature granulocyte-to-lym-phocyte ratio (AUC=0.782), monocyte-to-lymphocyte ratio (AUC=0.720), and RDWLR (AUC=0.711) were found significant in the differentiation between complicated and uncomplicated AA. The NPR (AUC=0.789) was found to be significant in the differentiation between positive and negative appendectomy. CONCLUSION It was concluded that the immature granulocyte-to-lymphocyte ratio, NPR, monocyte-to-lymphocyte, and RD-WLR, which have not been previously studied in patients with acute appendicitis (AA), could be used to differentiate between com-plicated and uncomplicated AA groups.
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Affiliation(s)
- Mehmet Kubat
- Department of General Surgery, Alanya Training and Research Hospital, Antalya-Turkey
| | - Serkan Şengül
- Department of General Surgery, Alanya Alaaddin Keykubat University Faculty of Medicine, Antalya-Turkey
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Üstündağ Y, G Kazanci E, Koloğlu RF, Çağlak HA, Yildirim F, Y Arikan E, Huysal K. A retrospective study of age-defined hematologic inflammatory markers related to pediatric COVID-19 diagnosis. Int J Lab Hematol 2022; 44:722-728. [PMID: 35437914 PMCID: PMC9111715 DOI: 10.1111/ijlh.13838] [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: 11/29/2021] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
Background The aim of this study was to examine age‐related differences in hemogram parameters and hematologic inflammatory markers in pediatric patients with COVID‐19. Methods This retrospective study included children aged 2 months to 18 years (n = 208) who have a confirmed diagnosis of COVID‐19 and a control group comprising 117 healthy children between February 2021 and July 2021. The analysis of subgroup hematological values were performed according to the children's age cutoffs. Results The most significant difference between pediatric patients with COVID‐19 and controls were peripheral blood eosinophil counts and eosinophil‐to‐monocyte ratio (EMR) levels on admission. The levels of monocyte‐to‐lymphocyte ratio, aggeregate index of systemic inflammation (neutrophil × platelet × monocyte/lymphocyte), neutrophil‐to‐ lymphocyte × platelet ratio, and systemic inflammation response index (neutrophil × monocyte/ lymphocyte) were higher in patients than in controls. EMR had the highest area under the curve (AUC) value of 0.777, with a cutoff value of 0.26. The sensitivity for EMR was 75% under 2 years of age, and between 78.6–87.5% in the other age groups. Conclusion In children younger than 6 months, the discriminative power of hematological indices is low, while the discriminative power of EMR is high at all ages when age appropriate cutoffs are used. Hematological inflammatory parameters may be particularly practical in pediatric clinics to help identify COVID‐19 infection.
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Affiliation(s)
- Yasemin Üstündağ
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Elif G Kazanci
- Department of Pediatric Hemato-Oncology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Rahime F Koloğlu
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Hatice A Çağlak
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Fatih Yildirim
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Elif Y Arikan
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Kağan Huysal
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
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Kamiya N, Ishikawa Y, Kotani K, Hatakeyama S, Matsumura M. Monocyte-to-Lymphocyte Ratio in the Diagnosis of Lymphoma in Adult Patients. Int J Gen Med 2022; 15:4221-4226. [PMID: 35480988 PMCID: PMC9035440 DOI: 10.2147/ijgm.s357468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 12/22/2022] Open
Abstract
Background Lymphomas, including Hodgkin lymphoma and non-Hodgkin lymphoma, are one of the differentials for peripheral lymphadenopathy and are difficult to diagnose clinically. Biopsy is essential for diagnosing lymphoma, although it is invasive. Non-invasive methods are required to identify patients with suspected lymphoma who should undergo a biopsy. The relevance of the monocyte-to-lymphocyte ratio has recently been reported to be a useful diagnostic marker in children with lymphoma and a prognostic marker of various other diseases. This study aimed to determine the relevance of the monocyte-to-lymphocyte ratio in the diagnosis of lymphoma in adults. Methods The study included 246 adult outpatients (median age of 49.0 years) presenting with peripheral lymphadenopathy. The final diagnosis was determined by reviewing the medical records. We categorized all patients into either the lymphoma group or the non-lymphoma group. The lymphoma group included patients who underwent biopsy and were diagnosed with lymphoma by histopathology, while the non-lymphoma group included those diagnosed with disease excluding lymphoma. The monocyte-to-lymphocyte ratios were compared between the two groups. Results Of the participants, 33 (13.4%) were assigned to the lymphoma group. The median age of the lymphoma and non-lymphoma groups were 67.0 years (interquartile range [IQR] 55.5–75.5 years) and 46.0 years (IQR 36.0–61.0 years), respectively. The lymphocyte and monocyte levels showed no significant differences between the two groups individually. Nonetheless, the monocyte-to-lymphocyte ratio was significantly higher in the lymphoma group (median, 0.36; IQR, 0.24–0.73) than in the non-lymphoma group (median, 0.29; IQR, 0.21–0.43; P = 0.022), independent of lymph node diameter ≥ 1 cm and C-reactive protein levels. Conclusion This study suggests that the monocyte-to-lymphocyte ratio can be a helpful diagnostic marker for lymphoma in adults with peripheral lymphadenopathy when the etiology is unclear even after a medical interview and physical examination.
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Affiliation(s)
- Naoko Kamiya
- Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke-shi, Tochigi, Japan
- Correspondence: Naoko Kamiya, Division of General Internal Medicine, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan, Tel +81-285-58-7498, Fax +81-285-40-5160, Email
| | - Yukiko Ishikawa
- Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke-shi, Tochigi, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan
| | - Shuji Hatakeyama
- Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke-shi, Tochigi, Japan
- Division of Infectious Diseases, Jichi Medical University Hospital, Shimotsuke-shi, Tochigi, Japan
| | - Masami Matsumura
- Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke-shi, Tochigi, Japan
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Al Zahmi F, Habuza T, Awawdeh R, Elshekhali H, Lee M, Salamin N, Sajid R, Kiran D, Nihalani S, Smetanina D, Talako T, Neidl-Van Gorkom K, Zaki N, Loney T, Statsenko Y. Ethnicity-Specific Features of COVID-19 Among Arabs, Africans, South Asians, East Asians, and Caucasians in the United Arab Emirates. Front Cell Infect Microbiol 2022; 11:773141. [PMID: 35368452 PMCID: PMC8967254 DOI: 10.3389/fcimb.2021.773141] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/22/2021] [Indexed: 01/08/2023] Open
Abstract
BackgroundDubai (United Arab Emirates; UAE) has a multi-national population which makes it exceptionally interesting study sample because of its unique demographic factors.ObjectiveTo stratify the risk factors for the multinational society of the UAE.MethodsA retrospective chart review of 560 patients sequentially admitted to inpatient care with laboratory confirmed COVID-19 was conducted. We studied patients’ demographics, clinical features, laboratory results, disease severity, and outcomes. The parameters were compared across different ethnic groups using tree-based estimators to rank the ethnicity-specific disease features. We trained ML classification algorithms to build a model of ethnic specificity of COVID-19 based on clinical presentation and laboratory findings on admission.ResultsOut of 560 patients, 43.6% were South Asians, 26.4% Middle Easterns, 16.8% East Asians, 10.7% Caucasians, and 2.5% are under others. UAE nationals represented half of the Middle Eastern patients, and 13% of the entire cohort. Hypertension was the most common comorbidity in COVID-19 patients. Subjective complaint of fever and cough were the chief presenting symptoms. Two-thirds of the patients had either a mild disease or were asymptomatic. Only 20% of the entire cohort needed oxygen therapy, and 12% needed ICU admission. Forty patients (~7%) needed invasive ventilation and fifteen patients died (2.7%). We observed differences in disease severity among different ethnic groups. Caucasian or East-Asian COVID-19 patients tended to have a more severe disease despite a lower risk profile. In contrast to this, Middle Eastern COVID-19 patients had a higher risk factor profile, but they did not differ markedly in disease severity from the other ethnic groups. There was no noticeable difference between the Middle Eastern subethnicities—Arabs and Africans—in disease severity (p = 0.81). However, there were disparities in the SOFA score, D-dimer (p = 0.015), fibrinogen (p = 0.007), and background diseases (hypertension, p = 0.003; diabetes and smoking, p = 0.045) between the subethnicities.ConclusionWe observed variations in disease severity among different ethnic groups. The high accuracy (average AUC = 0.9586) of the ethnicity classification model based on the laboratory and clinical findings suggests the presence of ethnic-specific disease features. Larger studies are needed to explore the role of ethnicity in COVID-19 disease features.
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Affiliation(s)
- Fatmah Al Zahmi
- Mediclinic Parkview Hospital, Dubai, United Arab Emirates
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- *Correspondence: Fatmah Al Zahmi, ; Yauhen Statsenko, ;
| | - Tetiana Habuza
- College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates
- Big Data Analytics Center, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Rasha Awawdeh
- Mediclinic Parkview Hospital, Dubai, United Arab Emirates
| | | | - Martin Lee
- Mediclinic Parkview Hospital, Dubai, United Arab Emirates
| | - Nassim Salamin
- Mediclinic Parkview Hospital, Dubai, United Arab Emirates
| | - Ruhina Sajid
- Mediclinic Parkview Hospital, Dubai, United Arab Emirates
| | - Dhanya Kiran
- Mediclinic Parkview Hospital, Dubai, United Arab Emirates
| | | | - Darya Smetanina
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Tatsiana Talako
- Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
- Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Belarus
| | - Klaus Neidl-Van Gorkom
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Nazar Zaki
- College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates
- Big Data Analytics Center, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Yauhen Statsenko
- Big Data Analytics Center, United Arab Emirates University, Al Ain, United Arab Emirates
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- *Correspondence: Fatmah Al Zahmi, ; Yauhen Statsenko, ;
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The lymphocyte-to-monocyte ratio may distinguish complicated from non-complicated pediatric appendicitis: A retrospective study and literature review. Pediatr Neonatol 2022; 63:146-153. [PMID: 34799285 DOI: 10.1016/j.pedneo.2021.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/02/2021] [Accepted: 08/18/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND To date, no parameter with satisfactory accuracy exists for the diagnosis of appendicitis. This retrospective study describes the discriminatory value of preoperative hematologic factors associated with complicated and non-complicated pediatric appendicitis. METHODS Clinical and laboratory data were obtained from 294 children diagnosed with appendicitis on admission and treated at our tertiary-level pediatric hospital from 2015 to 2017; they were divided into three groups: control group (n = 118), histologically proven complicated (n = 120), and non-complicated (n = 56) appendicitis. RESULTS Complicated appendicitis was associated with male preponderance and elevated neutrophil and monocyte levels (all p < 0.001). Non-complicated appendicitis was associated with elevated eosinophil levels (p = 0.023), and unaltered lymphocyte levels (p = 0.30). Compared to non-complicated disease, the lymphocyte-to-monocyte ratio (LMR) was decreased in complicated appendicitis (p = 0.003) but unaltered in the control group (p = 0.38). In the discrimination analysis, LMR had high accuracy (AUC 0.73 ± 0.05; p < 0.001; odds ratio (OR) (95% confidence interval (CI)) 6.0 (2.4-15.3)) and was the only parameter independently associated with complicated appendicitis on regression analysis (OR (95% CI), 0.544 (0.359-0.825); p = 0.004). CONCLUSION We identified LMR as a novel potential marker for the differentiation of complicated from non-complicated pediatric appendicitis. This has implications on the treatment approach, either surgical in complicated disease or conservative in non-complicated disease.
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Kurt A, Tosun MS, Altuntaş N. Diagnostic accuracy of complete blood cell count and neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and platelet-to-lymphocyte ratios for neonatal infection. ASIAN BIOMED 2022; 16:43-52. [PMID: 37551395 PMCID: PMC10321158 DOI: 10.2478/abm-2022-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Complete blood cell (CBC) counts and neutrophil-to-lymphocyte (NLR), lymphocyte-to-monocyte (LMR), and platelet-to-lymphocyte ratios (PLR) are simple measurements that are conducted as part of routine diagnostic procedures. Objective To determine the diagnostic importance, specificity, and sensitivity of these measurements for the diagnosis of neonatal infections and in discriminating between neonatal sepsis and various other infections. Methods We conducted a retrospective study of data from a consecutive series of 232 neonatal patients admitted to Yildirim Beyazit University Yenimahalle Training and Research Hospital in Ankara for 2 years from 2016 to 2018. We included patients with a diagnosis of or clinically suspected infection, and healthy neonates were included as controls. Data included CBC counts, and bacterial culture results, considered the criterion standard for the diagnosis of neonatal sepsis. NLR, LMR, and PLR were calculated. We compared data using independent Student t and Mann-Whitney U tests and determined the sensitivity, specificity, and likelihood ratio (LHOR) of the characteristics for neonatal sepsis using receiver operating characteristic curve analyses. Results We included data from 155 neonatal patients with a diagnosis or suspicion of infection and 77 healthy neonates. NLR was significantly higher in neonates with sepsis or fever due to dehydration (P < 0.001) than in neonates with other infections or healthy neonates. LMR was significantly higher in neonates with sepsis or viral infection than in those with other infections or healthy controls (P = 0.003). In neonates with early-onset sepsis (EOS), we found cut-off values of ≥4.79 [area under curve (AUC) 0.845, 95% confidence interval (CI) 0.76-0.93, LHOR 11.6, specificity 98.7%, sensitivity 15%] for NLR, ≥1.24 (AUC 0.295; CI 0.18-0.41, LHOR 1.02, specificity 2.6%, sensitivity 100%) for LMR, and ≥37.72 (AUC 0.268; CI 0.15-0.39, LHOR 0.86, specificity 7.8%, sensitivity 80%) for PLR. We found cut-off values of ≥4.94 (AUC 0.667; CI 0.56-0.77, LHOR 4.16, specificity 98.7%, sensitivity 5.4%) for NLR and ≥10.92 (AUC 0.384; CI 0.26-0.51, LHOR 6.24, specificity 98.7%, sensitivity 8.1%) for LMR in those with late-onset sepsis (LOS). Conclusions CBCs, NLR, LMR, and PLR may be useful for the differential diagnosis of EOS and LOS, and neonates with sepsis from those with other infection. NLR may be a useful diagnostic test to identify neonatal patients with septicemia more quickly than other commonly used diagnostic tests such as blood cultures. NLR has high specificity and LHOR, but low sensitivity.
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Affiliation(s)
- Abdullah Kurt
- Department of Pediatrics, Ankara Yildirim Beyazit University Yenimahalle Training and Research Hospital, Ankara06370, Turkey
| | - Merve Sezen Tosun
- Department of Pediatrics, Ankara Yildirim Beyazit University Yenimahalle Training and Research Hospital, Ankara06370, Turkey
| | - Nilgün Altuntaş
- Department of Pediatrics, Ankara Yildirim Beyazit University Yenimahalle Training and Research Hospital, Ankara06370, Turkey
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Kurt A, Zenciroğlu A, Akduman H. The impact of therapeutic hypothermia on peripheral blood cell in newborns with hypoxic ischemic encephalopathy. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e181053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Zhao W, He L, Xie XZ, Liao X, Tong DJ, Wu SJ, Liu J. Clustering cases of Chlamydia psittaci pneumonia mimicking COVID-19 pneumonia. World J Clin Cases 2021; 9:11237-11247. [PMID: 35071554 PMCID: PMC8717496 DOI: 10.12998/wjcc.v9.i36.11237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/11/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The onset symptoms of people infected by Chlamydia psittaci can mimic the coronavirus disease 2019 (COVID-19). However, the differences in laboratory tests and imaging features between psittacosis and COVID-19 remain unknown.
AIM To better understand the two diseases and then make an early diagnosis and treatment.
METHODS Six patients from two institutions confirmed as psittacosis by high-throughput genetic testing and 31 patients confirmed as COVID-19 were retrospectively included. The epidemiology, clinical characteristics, laboratory tests and computed tomography (CT) imaging features were collected and compared between the two groups. The follow-up CT imaging findings of patients with psittacosis were also investigated.
RESULTS The white blood cell count (WBC), neutrophil count and calcium were more likely to be decreased in patients with COVID-19 but were increased in patients with psittacosis (all P = 0.000). Lymphocyte count and platelet count were higher in patients with psittacosis than in those with COVID-19 (P = 0.044, P = 0.035, respectively). Lesions in patients with psittacosis were more likely to be unilateral (P = 0.001), involve fewer lung lobes (P = 0.006) and have pleural effusions (P = 0.002). Vascular enlargement was more common in patients with COVID-19 (P = 0.003). Consolidation in lung CT images was absorbed in all 6 patients.
CONCLUSION Psittacosis has the potential for human-to-human transmission. Patients with psittacosis present increased WBC count and neutrophil count and have specific CT imaging findings, including unilateral distribution, less involvement of lung lobes and pleural effusions, which might help us to differentiate it from COVID-19.
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Affiliation(s)
- Wei Zhao
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha 410011, Hunan Province, China
| | - Lei He
- Department of Radiology, The First People’s Hospital of Yueyang, Yueyang 410005, Hunan Province, China
| | - Xing-Zhi Xie
- Department of Radiology, Hunan Chest Hospital, Changsha 410013, Hunan Province, China
| | - Xuan Liao
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - De-Jun Tong
- Hospital Infection Control Center, The Second Xiangya Hospital, Changsha 410011, Hunan Province, China
| | - Shang-Jie Wu
- Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Changsha 410011, Hunan Province, China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha 410011, Hunan Province, China
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Maimaiti Z, Xu C, Fu J, Chai W, Zhou Y, Chen J. The Potential Value of Monocyte to Lymphocyte Ratio, Platelet to Mean Platelet Volume Ratio in the Diagnosis of Periprosthetic Joint Infections. Orthop Surg 2021; 14:306-314. [PMID: 34939337 PMCID: PMC8867408 DOI: 10.1111/os.12992] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/16/2021] [Accepted: 02/21/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To explore the possibility of obtaining more accurate information from routine blood tests for the diagnosis of periprosthetic joint infection (PJI). Methods This is a retrospective study. Between 2017 and 2018, a total of 246 patients who underwent total hip or knee revision surgery were included in this study. There were 146 females and 100 males, and the mean age of the patients was 62.1 ± 12.75 years. Laboratory parameters erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP), D‐dimer, plasma fibrinogen, serum white blood cell (WBC), and calculable ratio markers were collected. Based on leukocytes (monocyte count, neutrophil count, lymphocyte count), platelet count, and mean platelet volume Inflammation‐related ratio markers were calculated, which including monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and platelet to mean platelet volume ratio (PMR). Follow‐up of all studied cases for at least 1 year. The diagnostic value of the markers based on the receiver operating characteristic (ROC) analysis. The most optimal combinations of blood markers were selected by the prediction models. Statistical analyses and prediction models were performed using R software. Results Of the 246 patients, 125 were diagnosed with PJI and 121 with aseptic loosening. A higher rate of patients underwent revision surgery due to hip prosthesis loosening in the aseptic loosening group (74.4%) compared to the PJI group (45.6%, P < 0.001). ROC curves showed that the area under the curve (AUC) for classical markers, fibrinogen was 0.853 (95% confidence interval [CI], 0.805–0.901), ESR was 0.836 (95% CI, 0.785–0.887) and CRP was 0.825 (95% CI, 0.773–0.878). Followed by the PMR, PLR, NLR and MLR, which showed promising diagnostic performance with AUCs of 0.791, 0.785, 0.736, and 0.733. The AUCs of the ratio markers were higher than those of D‐dimer (0.691;95% CI, 0.6243–0.7584) and serum WBC (0.622; 95% CI, 0.552–0.691). After the predictive model calculation, AUC was up to 0.923 (95% CI, 0.891–0.951) when plasma fibrinogen combined with MLR and PMR and interpreted excellent discriminatory capacity with a sensitivity of 86.40% and a specificity of 84.17%. The new combination significantly increases the accuracy and reliability of the diagnosis of PJI (P < 0.001). The AUC increased to 0.899 (95% CI, 0.861–0.931; P = 0.007) and 0.916 (95% CI, 0.880–0.946; P < 0.001), followed by CRP and ESR, respectively. All plasma fibrinogen, ESR, and CRP combined with both PMR and MLR achieved the highest specificity (89.17%) and PPV (85.34%). Conclusion The diagnostic performance greatly improved when plasma fibrinogen, ESR, and CRP combined with ratio markers.
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Affiliation(s)
- Zulipikaer Maimaiti
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Chi Xu
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jun Fu
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Wei Chai
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yonggang Zhou
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jiying Chen
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
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Chen Y, Wang W, Zeng L, Mi K, Li N, Shi J, Yang S. Association Between Neutrophil-Lymphocyte Ratio and All-Cause Mortality and Cause-Specific Mortality in US Adults, 1999-2014. Int J Gen Med 2021; 14:10203-10211. [PMID: 34992439 PMCID: PMC8710673 DOI: 10.2147/ijgm.s339378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/02/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Neutrophil-lymphocyte ratio (NLR) is a novel marker of inflammation. Emerging studies have evaluated the relationship of NLR with cardiovascular diseases and malignant conditions. However, rare studies regarded the association between NLR and long-term health status. This study aimed to evaluate the association of NLR with all-cause mortality and cause-specific mortality among adults in the United States. METHODS We obtained eight cycles data of National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2014, and enrolled 32328 participants after certain screening. By weighted chi-square test and linear regression analysis, we analyzed the correlation between NLR and baseline characteristics of the participants. Kaplan-Meier curves and Cox regression models were used to assess the survival relevance of NLR. We conducted stratified analysis, interaction analysis, and sensitivity analysis to robustness of our results. RESULTS Participants with high NLR levels had a higher risk of death. After adjustment for baseline characteristics, the hazard ratio comparing the higher vs lower NLR levels was 1.43 (95% CI, 1.18-1.73) for all-cause mortality, 1.27 (95% CI, 0.84-1.92) for cancer mortality, and 1.44 (95% CI, 0.96-2.16) for cardiovascular disease mortality. Stratified analysis found that the observed associations between NLR levels and mortality did not differ significantly. CONCLUSION In this nationally representative cohort of US adults, higher NLR was significantly associated with an increased risk of all-cause mortality.
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Affiliation(s)
- Yang Chen
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Wei Wang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Lizhong Zeng
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Ke Mi
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Na Li
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Jie Shi
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Shuanying Yang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
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Monocyte/Lymphocyte Ratio and MCHC as Predictors of Collateral Carotid Artery Disease-Preliminary Report. J Pers Med 2021; 11:jpm11121266. [PMID: 34945738 PMCID: PMC8707882 DOI: 10.3390/jpm11121266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Carotid artery disease accounts for 30% of ischemic strokes in the general population. Numerous biomarkers have been investigated for predicting either the progression or the severity of the disease. The aim of this retrospective study was to compare hematologic indices among patients referred for surgical interventions due to severe carotid disease. Methods: In total, 135 patients (87 (64.4%) men and 48 (35.6%) women) with a mean age of 70 ± 8 years who underwent surgical carotid intervention were enrolled into the study. Results: A Mann–Whitney test for independent samples revealed significant differences in monocyte to lymphocyte ratio (MLR) and mean corpuscular hemoglobin concentration (MCHC) between patients with one and two (collateral) carotid diseases. The cut-off value for MLR was 0.3 (AUC = 0.654, p = 0.048, 70.0% sensitivity and 74.6% specificity) and for MHCH was 21.6. (AUC = 0.730, p < 0.001, 70.0% sensitivity and 77.2% specificity). A multivariable model of logistic regression revealed two significant parameters for collateral carotid stenosis disease including MLR > 0.3 (OR 6.19 with 95% CI 2.02–19.01, p = 0.001) and MCHC > 21.6 (OR 7.76, 95% CI 2.54–23.72, p < 0.001). Conclusions: MLR above 0.3 and MCHC above 21.6 have predictive values for colleterial carotid stenosis and may be used as easily accessible indicators for atherosclerosis severity.
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Bebeshko VG, Bruslova KM, Lyashenko LO, Pushkariova TI, Tsvetkova NM, Galkina SG, Vasylenko VV, Yaroshenko ZS, Zaitseva AL, Gonchar LO, Yatsemirskyi SM. ASSESSMENT OF QUALITATIVE CHANGES IN PERIPHERAL BLOOD CELLS IN CHILDREN - RESIDENTS OF RADIOLOGICALLY CONTAMINATED TERRITORIES IN THE LATE PERIOD AFTER THE ChNPP ACCIDENT. PROBLEMY RADIATSIINOI MEDYTSYNY TA RADIOBIOLOHII 2021; 26:297-308. [PMID: 34965556 DOI: 10.33145/2304-8336-2021-26-297-308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE to establish the relationship between quantitative and qualitative parameters of peripheral blood cells(lymphocytes, neutrophilic granulocytes, monocytes, platelets) depending on the type of somatic diseases andannual internal radiation doses from 137Cs in children - residents of radiologically contaminated territories in thelate period after the Chornobyl Nuclear Power Plant (ChNPP) accident. MATERIALS AND METHODS There were 175 children included in the study comprising residents of radiologically con-taminated territories (n = 79) aged from 4 to 18 years. Annual internal radiation doses in children from 137Cs rangedfrom 0.004 to 0.067 mSv. Certain blood parameters were assessed in a comparative mode in children having got theradiation doses up to 0.01 mSv and higher. The comparison group (n = 96) included children living in settlementsnot attributed to the radiologically contaminated ones. Incidence and type of somatic diseases and its impact onquantitative and qualitative changes in blood parameters (i.e. lymphocyte, neutrophilic granulocyte, monocyte, andplatelet count) were studied. The cell size, state of nucleus, membranes and cytoplasm, signs of proliferative anddegenerative processes were taken into account. RESULTS Incidence and type of somatic diseases in children did not depend on the annual internal radiation dose.Number of cases of monocytosis was significantly higher among the children exposed to ionizing radiation than inthe comparison group (16.6 % vs. 7.3 %). There were, however, no correlation between these changes and radiationdoses. Number of activated blood monocytes with cytoplasmic basophilia and residues of nucleoli in nuclei washigher in individuals with internal radiation doses > 0.01 mSv. A direct correlation between the qualitative param-eters of monocytes and internal radiation doses was established (rs = 0.60; р < 0.001), as well as a direct correlationof different strength between qualitative parameters of blood cells, indicating their unidirectional pattern depend-ing on the somatic morbid conditions. Regardless of annual internal radiation dose, there was an increase in thenumber of degenerative and aberrant cells vs. the comparison group (р < 0.05), which could be due to the role ofnon-radiation factors. CONCLUSIONS Results of the assessment of quantitative and qualitative parameters of peripheral blood cells reflect-ed the state of morbid conditions in children and are of a diagnostic value. The identified dose-dependent changesin monocyte lineage of hematopoiesis may be the markers of impact of long-term radionuclide incorporation withfood in children living in environmentally unfavorable conditions after the ChNPP accident.
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Affiliation(s)
- V G Bebeshko
- State Institution «National Research Center for Radiation Medicine of the National Academy of MedicalSciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - K M Bruslova
- State Institution «National Research Center for Radiation Medicine of the National Academy of MedicalSciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - L O Lyashenko
- State Institution «National Research Center for Radiation Medicine of the National Academy of MedicalSciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - T I Pushkariova
- State Institution «National Research Center for Radiation Medicine of the National Academy of MedicalSciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - N M Tsvetkova
- State Institution «National Research Center for Radiation Medicine of the National Academy of MedicalSciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - S G Galkina
- State Institution «National Research Center for Radiation Medicine of the National Academy of MedicalSciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - V V Vasylenko
- State Institution «National Research Center for Radiation Medicine of the National Academy of MedicalSciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - Zh S Yaroshenko
- State Institution «National Research Center for Radiation Medicine of the National Academy of MedicalSciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - A L Zaitseva
- State Institution «National Research Center for Radiation Medicine of the National Academy of MedicalSciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - L O Gonchar
- State Institution «National Research Center for Radiation Medicine of the National Academy of MedicalSciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - S M Yatsemirskyi
- State Institution «National Research Center for Radiation Medicine of the National Academy of MedicalSciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
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Muto R, Kato S, Lindholm B, Qureshi AR, Ishimoto T, Kosugi T, Maruyama S. Increased Monocyte/Lymphocyte Ratio as Risk Marker for Cardiovascular Events and Infectious Disease Hospitalization in Dialysis Patients. Blood Purif 2021; 51:747-755. [PMID: 34814140 PMCID: PMC9533453 DOI: 10.1159/000519289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/22/2021] [Indexed: 11/23/2022]
Abstract
Introduction In dialysis patients, cardiovascular disease (CVD) and infectious disease contribute to poor clinical outcomes. We investigated if a higher monocyte/lymphocyte ratio (MLR) is associated with an increased risk of CVD events and infectious disease hospitalizations in incident dialysis patients. Methods In an ongoing observational prospective cohort study, 132 Japanese dialysis patients (age 58.7 ± 11.7 years; 70% men) starting dialysis therapy were enrolled and followed up for a median of 48.7 months. Laboratory biomarkers, including white blood cell count and its differential count, were determined at baseline. Event-free time and relative risks (RRs) were calculated using the Kaplan-Meier curves and Cox models, respectively. Results When divided into 2 groups according to median MLR (0.35 [range, 0.27–0.46]), the periods without CVD events were significantly shorter in the high MLR group than in the low MLR group (log-rank test = 5.60, p = 0.018). The RR of CVD events, after adjusting for age, sex, and diabetes, was 2.43 (1.22–4.84) in the high MLR group compared to the low MLR group. The periods without infections requiring hospitalization were also shorter (log-rank test = 4.16, p = 0.041). The RR of infections requiring hospitalization was 1.98 (1.02–3.83) after the same adjustments. The number of CVD events was higher in the high MLR group (18.6 events per 100 person-years at risk [pyr]) than the low MLR group (11.1 events per 100 pyr). The duration of infectious disease hospitalization was longer in the high MLR group (6.3 days per pyr) than in the low MLR group (2.8 days per pyr). Conclusion A higher MLR is associated with increased risks of both CVD events and infectious disease hospitalization in dialysis patients.
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Affiliation(s)
- Reiko Muto
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sawako Kato
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Bengt Lindholm
- Baxter Novum & Renal Medicine Karolinska Institutet, Stockholm, Sweden
| | | | - Takuji Ishimoto
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoki Kosugi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Fan Y, Fan C, Mao P, Rui C, Wang X, Hou W, Luan T, Dong Z, Li P, Feng S, Zeng X. Study on perinatal-related factors of maternity and newborn in parturients with intrapartum fever in part of Eastern China: A cross-sectional study. J Clin Lab Anal 2021; 36:e24050. [PMID: 34786765 PMCID: PMC8761421 DOI: 10.1002/jcla.24050] [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: 08/28/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 12/31/2022] Open
Abstract
Background Maternal intrapartum fever has a serious impact on mother and child. However, the corresponding study seems to be in short. Methods The role of inflammatory cells in patients who were diagnosed with intrapartum fever lived in part of Eastern China was evaluated. The obstetrics outcomes, complete blood cell count (CBC) and thereby converted neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio, monocyte to lymphocyte ratio (MLR), and vaginal secretion were compared in different groups. Results Prepartum values of white blood cell (WBC), red blood cell (RBC), and hemoglobin (Hb) were all a little higher in the febrile group than in the afebrile group, and postpartum WBC in the afebrile group was still higher while postpartum RBC and Hb were inferior to non‐fever maternity. Postpartum NLR and MLR were all higher in the fever group but not preferred overtly difference before delivery. Additionally, the comparison of WBC, RBC, Hb, platelets, neutrophils, and monocytes in prepartum and postpartum all showed significant differences. Conclusion The parturition could bring about the value change of CBC and intrapartum fever might aggravate or alleviate this change. Besides, the intrapartum fever might not be caused mainly by infection and the difference between bacteria and fungus could reflect in the CBC.
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Affiliation(s)
- Yuru Fan
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Chong Fan
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Pengyuan Mao
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Can Rui
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Xinyan Wang
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Wenwen Hou
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Ting Luan
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Zhiyong Dong
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Ping Li
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Shanwu Feng
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Xin Zeng
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
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Tsouloufi TK, Frezoulis PS, Soubasis N, Kritsepi-Konstantinou M, Oikonomidis IL. Diagnostic and prognostic value of peripheral blood leucocyte ratios in sick cats. Acta Vet Hung 2021; 69:308-314. [PMID: 34747357 DOI: 10.1556/004.2021.00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022]
Abstract
The objective of this study was to assess the diagnostic and prognostic utility of feline neutrophil-to-lymphocyte (NLR) and lymphocyte-to-monocyte ratios (LMR) in a variety of underlying diseases. Five-year medical records from cats presenting to the internal medicine unit of a veterinary teaching hospital were retrospectively reviewed. Cats were considered for inclusion based on complete medical records. ADVIA 120 was used for the complete blood counts; the NLR and LMR were calculated by dividing the absolute numbers of the respective leucocytes. Two hundred and nineteen sick and 20 healthy cats were included in the study. The median NLR and LMR were significantly (P < 0.05) elevated and decreased, respectively, in cats with infectious, neoplastic and chronic kidney diseases compared to controls. Additionally, cats with neoplasia had significantly higher median NLR compared to cats with urinary tract and gastrointestinal diseases. Non-survivors had significantly higher NLR and lower LMR compared to survivors. Both ratios had suboptimal prognostic performance for the outcome of sick cats (NLR sensitivity: 37.9%, specificity: 86.4%; LMR sensitivity: 69.0%, specificity: 61.0%). Many different disease categories were associated with increased NLR and decreased LMR compared to controls, but the overall prognostic performance of the two leucocyte ratios was suboptimal.
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Affiliation(s)
- Theodora K Tsouloufi
- 1 School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petros S Frezoulis
- 1 School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- 2 Southfields Veterinary Specialists, Laindon, Essex, UK
| | - Nectarios Soubasis
- 1 School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Kritsepi-Konstantinou
- 1 School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis L Oikonomidis
- 1 School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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