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Vučić M, Milenkovic J, Djindjic B, Stojiljkovic V, Stojanovic D, Djordjevic B, Milojkovic M, Velickovic S. Indicators of stress hematopoiesis in the blood predict COVID-19 progression in patients over 65 years old. Hematology 2024; 29:2311006. [PMID: 38305411 DOI: 10.1080/16078454.2024.2311006] [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: 07/23/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES Advanced age is a well-established risk factor for severe coronavirus disease 2019 (COVID-19). Exacerbated inflammation affects multiple organs, among which hematopoiesis responds by increased output of various cells. We aimed to determine the association between COVID-19 progression and large immature cell (LIC) counts, changes in erythrocyte and platelet distribution widths (RDW, PDW) with reference to patients' age. METHODS A total of 755 patients with complete blood cell (CBC) analysis in the first 24 h of hospitalization were enrolled. Patients were divided into two groups: under and above 65 years of age. RESULTS The LIC counts were different in both groups (p < 0.003). However, only the senior patients had markedly different values of RDW and PDW (p < 0.001). The receiver operating characteristic (ROC) curve analysis provided increased LIC (AUC = 0.600), RDW (AUC = 0.609), PDW (AUC = 0.556), and platelet to LIC ratio (AUC = 0.634) as significant in discriminating outcome in the older group. Importantly, these results were not repeated in the younger patients. In the elderly, the progression was predicted with LIC cut-off at ≥ 0.305 × 109/L (OR = 3.166) and RDW over 12.15% (OR = 2.081). DISCUSSION Aging is characterized by a decline in immunological competence with a compromised control of inflammation leading to a proinflammatory state. This background together with the actions of pathogens may lead to emergency myelopoiesis. CONCLUSION Our results point to the important differences between age groups regarding CBC-related parameters of stress hematopoiesis during severe infection. Higher LIC, RDW and PDW levels were reliable in the early identification of COVID-19 progression only in the elderly.
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Affiliation(s)
- Miodrag Vučić
- Department of Internal medicine and patient care, Faculty of Medicine, University of Nis, Niš, Serbia
- Clinic of hematology, allergology and clinical immunology, University Clinical Center in Nis, Niš, Serbia
| | - Jelena Milenkovic
- Department of Pathophysiology, Faculty of Medicine, University of Nis, Niš, Serbia
| | - Boris Djindjic
- Department of Pathophysiology, Faculty of Medicine, University of Nis, Niš, Serbia
- Clinic of Cardiology, University Clinical Center of Nis, Niš, Serbia
| | - Vladana Stojiljkovic
- Department of Biochemistry, Faculty of Medicine, University of Nis, Niš, Serbia
- Medical Biochemistry Center, University Clinical Center of Nis, Niš, Serbia
| | - Dijana Stojanovic
- Department of Pathophysiology, Faculty of Medicine, University of Nis, Niš, Serbia
| | - Branka Djordjevic
- Department of Biochemistry, Faculty of Medicine, University of Nis, Niš, Serbia
| | - Maja Milojkovic
- Department of Pathophysiology, Faculty of Medicine, University of Nis, Niš, Serbia
| | - Sanja Velickovic
- Clinic of hematology, allergology and clinical immunology, University Clinical Center in Nis, Niš, Serbia
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Park S, Perumalsamy H, Gerelkhuu Z, Sunderraj S, Lee Y, Yoon TH. Phenotypic Landscape of Immune Cells in Sepsis: Insights from High-Dimensional Mass Cytometry. ACS Infect Dis 2024; 10:2390-2402. [PMID: 38850242 DOI: 10.1021/acsinfecdis.4c00066] [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: 06/10/2024]
Abstract
Understanding the sepsis-induced immunological response can be facilitated by identifying phenotypic changes in immune cells at the single-cell level. Mass cytometry, a novel multiparametric single-cell analysis technique, offers considerable benefits in characterizing sepsis-induced phenotypic changes in peripheral blood mononuclear cells. Here, we analyzed peripheral blood mononuclear cells from 20 sepsis patients and 10 healthy donors using mass cytometry and employing 23 markers. Both manual gating and automated clustering approaches (PhenoGraph) were used for cell identification, complemented by uniform manifold approximation and projection (UMAP) for dimensionality reduction and visualization. Our study revealed that patients with sepsis exhibited a unique immune cell profile, marked by an increased presence of monocytes, B cells, and dendritic cells, alongside a reduction in natural killer (NK) cells and CD4/CD8 T cells. Notably, significant changes in the distributions of monocytes and B and CD4 T cells were observed. Clustering with PhenoGraph unveiled the subsets of each cell type and identified elevated CCR6 expression in sepsis patients' monocyte subset (PG#5), while further PhenoGraph clustering on manually gated T and B cells discovered sepsis-specific CD4 T cell subsets (CCR4low CD20low CD38low) and B cell subsets (HLA-DRlow CCR7low CCR6high), which could potentially serve as novel diagnostic markers for sepsis.
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Affiliation(s)
- Sehee Park
- Department of Chemistry, College of Natural Sciences, Hanyang University, Seoul 04763, Republic of Korea
| | - Haribalan Perumalsamy
- Institute of Next Generation Material Design, Hanyang University, Seoul 04763, Republic of Korea
| | - Zayakhuu Gerelkhuu
- Institute of Next Generation Material Design, Hanyang University, Seoul 04763, Republic of Korea
| | - Sneha Sunderraj
- Department of Medical and Digital Engineering, College of Engineering, Hanyang University, Seoul 04763, Republic of Korea
| | - Yangsoon Lee
- Department of Laboratory Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Tae Hyun Yoon
- Department of Chemistry, College of Natural Sciences, Hanyang University, Seoul 04763, Republic of Korea
- Institute of Next Generation Material Design, Hanyang University, Seoul 04763, Republic of Korea
- Department of Medical and Digital Engineering, College of Engineering, Hanyang University, Seoul 04763, Republic of Korea
- Yoon Idea Lab Co., Ltd., Seoul 04763, Republic of Korea
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Seringec Akkececi N, Ciftcioglu M, Okyar B, Yildirim Cetin G. Relationship of immature granulocytes with disease activity in rheumatoid arthritis. Int J Rheum Dis 2024; 27:e15216. [PMID: 38873756 DOI: 10.1111/1756-185x.15216] [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: 03/28/2024] [Revised: 05/03/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024]
Abstract
AIM To determine whether the IG count (#) and IG percentage (%) are associated with disease activity in rheumatoid arthritis (RA). METHODS This retrospective study included 65 RA patients and 65 healthy controls. Clinical and demographic characteristics of controls and RA patients (at active period and when the patients achieved remission) were obtained from medical records. Disease activity was defined by disease activity score 28 (DAS28). Furthermore, the clinical disease activity index (CDAI), and simple disease activity index (SDAI) were calculated. For the differential diagnosis of RA patients from healthy controls, the cut-off value was estimated by making receiver-operator curves (ROC). RESULTS In active RA patients, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), IG#, and IG% levels were significantly higher compared to the healthy controls (p < .001, for all). When the patients achieved remission, DAS28, CDAI, SDAI, ESR, CRP, IG#, and IG% values were significantly decreased (p < .001, for all). IG# and IG% were significantly positively correlated with DAS28, CDAI, SDAI, ESR, and CRP (p = .024, p = .008, p = .003, p < .001, p < .001, respectively). According to ROC curve analysis, IG% and IG# were the biomarkers to have a significant diagnostic value for RA with the area under the curve of 0.853 and 0.865 (p < .001, for all). CONCLUSION The present study demonstrated that two novel inflammatory markers, IG# and IG%, can be useful for monitoring RA patients' disease activity. Furthermore, IG# and IG% can also be used as fast, inexpensive, and easily available complementary diagnostic markers to diagnose RA patients.
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Affiliation(s)
- Nurten Seringec Akkececi
- Department of Physiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Muhammed Ciftcioglu
- Department of Internal Medicine, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Burak Okyar
- Department of Rheumatology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Gozde Yildirim Cetin
- Department of Rheumatology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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Yan D, Yao R, Xie X, Fu X, Pei S, Wang Y, Xu D, Li N. THE THERAPEUTIC EFFICACY OF PLASMAPHERESIS FOR SEPSIS WITH MULTIPLE ORGAN FAILURE: A PROPENSITY SCORE-MATCHED ANALYSIS BASED ON THE MIMIC-IV DATABASE. Shock 2024; 61:685-694. [PMID: 37988068 DOI: 10.1097/shk.0000000000002254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
ABSTRACT Background: Despite advancements in sepsis treatment, mortality remains high. Plasmapheresis (PE) targeting multiple pathways simultaneously seems to be a potential treatment option, but evidence is insufficient. We aimed to investigate the efficacy of PE for sepsis with multiple organ failure (MOF). Method: Septic patients with MOF were identified from the Medical Information Mart for Intensive Care IV database. Patients who received PE were matched with those receiving conventional therapy via propensity score matching. Regression analyses evaluated the association between PE and outcomes. The Kaplan-Meier (KM) method was used to analyze the survival probability. The generalized additive mixed model investigated early indexes changes' association with treatment modalities and 28-day mortality. Results: Nine hundred six septic patients with MOF were enrolled. After propensity score matching, PE and conventional groups consisted of 60 cases each. Plasmapheresis was associated with a reduced risk of 28-day mortality (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.27-0.94), 1-year mortality (HR, 0.44; 95% CI, 0.26-0.74), and in-hospital mortality (HR, 0.38; 95% CI, 0.20-0.71). The KM curves demonstrated significant differences in survival probability between groups. Compared with the conventional group, the sequential organ failure assessment, norepinephrine dosage, prothrombin time, actate dehydrogenase, total bilirubin, white blood cells, and immature granulocytes in the PE group significantly decreased over time, while platelets, red blood cells, and hemoglobin significantly increased over time. Conclusions: Plasmapheresis demonstrated an association with reduced risks of 28-day, in-hospital and 1-year mortality in septic patients with MOF. Moreover, plasmapheresis might exhibit the potential to improve outcomes by improving organ function, hemodynamics, and restoring several indicators, such as coagulation, anemia, and inflammation.
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Affiliation(s)
- Danyang Yan
- Department of Blood Transfusion, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan Province, China
| | - Run Yao
- Department of Blood Transfusion, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan Province, China
| | - Xi Xie
- Department of Blood Transfusion, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan Province, China
| | - Xiangjie Fu
- Department of Blood Transfusion, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan Province, China
| | - Siya Pei
- Department of Blood Transfusion, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan Province, China
| | - Yanjie Wang
- Department of Blood Transfusion, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan Province, China
| | - Daomiao Xu
- General ICU/Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Ning Li
- Department of Blood Transfusion, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan Province, China
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Wiwe EF, Kofoed IK, Dufréchou MJF, Philipsen JP, Lemvig B, Rasmussen KL, Smith J, Hillig T. Neutrophil Reactivity Intensity and misclassification of immature granulocytes. Int J Lab Hematol 2024; 46:312-321. [PMID: 37985128 DOI: 10.1111/ijlh.14204] [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: 07/14/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Immature granulocyte percentage (IG%) is an important biomarker for infection control. We observed spurious cases where the IG% was dramatically underestimated on the automated Sysmex XN-series hehmatology analyzer compared with manual differential. These cases were associated with high values of "Neutrophil Reactivity Intensity" (NEUT-RI), which should reflect the metabolic activity of the neutrophils. METHODS We conducted a three-stage study to evaluate whether NEUT-RI could be utilized to screen for misclassified IG% results defined as the manual differential estimating a 10 percentage points higher IG% compared with the automated Sysmex differential. First, 124 patient samples were selected for 800-cell manual smear analysis based on their NEUT-RI values and compared with the automatic Sysmex IG% results. Next, 11 098 routine 110-cell manual smear analyses were compared with the corresponding Sysmex IG% results. Finally, during a 19-day period 160 additional patient samples underwent smear based on NEUT-RI values ≥56 fluorescence intensity (FI) to screen for misclassified results beyond our current smear practice. RESULTS NEUT-RI ≥56 predicted IG% misclassification with 91% sensitivity and 88% specificity, but primarily when the internal Sysmex flag "Abnormal WBC Scattergram" was present. 90.1% of misclassified results were identified by this flag. Beyond our existing smear rules including this flag, NEUT-RI ≥56 FI had a positive predictive value below 1%. CONCLUSION Both NEUT-RI and the internal Sysmex flag "Abnormal WBC Scattergram" work well to identify cases of IG% misclassification. However, in our setting NEUT-RI ≥56 FI had no meaningful additional predictive capacity to identify misclassifications beyond our current smear rules.
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Affiliation(s)
- Elias Frost Wiwe
- Department of Clinical Biochemistry, Nordsjaellands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Isabella Katarina Kofoed
- Department of Clinical Biochemistry, Nordsjaellands Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Technology, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
| | - Muriel Julie Falk Dufréchou
- Department of Clinical Biochemistry, Nordsjaellands Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Technology, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
| | - Jens Peter Philipsen
- Department of Clinical Biochemistry, Nordsjaellands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Birthe Lemvig
- Department of Clinical Biochemistry, Nordsjaellands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Laura Rasmussen
- Department of Clinical Biochemistry, Nordsjaellands Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Smith
- Department of Technology, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
| | - Thore Hillig
- Department of Clinical Biochemistry, Nordsjaellands Hospital, University of Copenhagen, Copenhagen, Denmark
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Khan R, Salman S, Harford L, Sheriff L, Hazeldine J, Rajoriya N, Newsome PN, Lalor PF. Circulating myeloid populations have prognostic utility in alcohol-related liver disease. Front Immunol 2024; 15:1330536. [PMID: 38545104 PMCID: PMC10965684 DOI: 10.3389/fimmu.2024.1330536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/23/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Alcohol-related liver disease (ARLD) accounts for over one third of all deaths from liver conditions, and mortality from alcohol-related liver disease has increased nearly five-fold over the last 30 years. Severe alcohol-related hepatitis almost always occurs in patients with a background of chronic liver disease with extensive fibrosis or cirrhosis, can precipitate 'acute on chronic' liver failure and has a high short-term mortality. Patients with alcohol-related liver disease have impaired immune responses, and increased susceptibility to infections, thus prompt diagnosis of infection and careful patient management is required. The identification of early and non-invasive diagnostic and prognostic biomarkers in ARLD remains an unresolved challenge. Easily calculated predictors of infection and mortality are required for use in patients who often exhibit variable symptoms and disease severity and may not always present in a specialized gastroenterology unit. Methods We have used a simple haematological analyser to rapidly measure circulating myeloid cell parameters across the ARLD spectrum. Results and Discussion We demonstrate for the first time that immature granulocyte (IG) counts correlate with markers of disease severity, and our data suggests that elevated counts are associated with increased short-term mortality and risk of infection. Other myeloid populations such as eosinophils and basophils also show promise. Thus IG count has the potential to serve alongside established markers such as neutrophil: lymphocyte ratio as a simply calculated predictor of mortality and risk of infectious complications in patients with alcohol-related hepatitis. This would allow identification of patients who may require more intensive management.
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Affiliation(s)
- Reenam Khan
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, Birmingham, United Kingdom
| | - Shees Salman
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Laura Harford
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, Birmingham, United Kingdom
| | - Lozan Sheriff
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, Birmingham, United Kingdom
| | - Jon Hazeldine
- Institute of Inflammation and Ageing, University of Birmingham, and Birmingham National Institute for Health Research (NIHR), Biomedical Research Centre, Birmingham, United Kingdom
| | - Neil Rajoriya
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Philip N. Newsome
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, and Birmingham National Institute for Health Research (NIHR), Biomedical Research Centre, Birmingham, United Kingdom
| | - Patricia F. Lalor
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, Birmingham, United Kingdom
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Çaparlar MA, Durhan A, Süleymanov M, Binarbaşı C, Koşmaz K. Immature Granulocyte Percentage as an Early Predictor of Necrosis in Volvulus. Niger J Clin Pract 2024; 27:268-271. [PMID: 38409157 DOI: 10.4103/njcp.njcp_452_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 01/02/2024] [Indexed: 02/28/2024]
Abstract
AIM Volvulus is a disease characterized by the abnormal twisting of a gaseous distension of the loop of the intestine around itself. Colonic volvulus is the third common cause of colonic obstruction. The study aimed to determine whether the percentage of immature granulocytes is a marker of early necrosis in the volvulus. METHODS Demographic characteristics of the cases were collected in the study. In addition, age, gender, white blood cell count, immature granulocyte count, immature granulocyte percentage, platelet lymphocyte ratio, and neutrophil-lymphocyte ratio were compared between groups with and without necrosis in terms of treatment. RESULTS The effectiveness of immature granulocyte percentage (IG%) and IG markers were statistically significant in predicting necrosis. The AUC was the highest for IG (0.820, 95% CI: 0.586-1), followed by IG% (0.820, 95% CI: 0.617-1). The optimal cut-off value for the IG was 0.65, with a sensitivity of 76.2% and specificity of 85.7% (P = 0.013). The optimal cut-off value for the IG% was 0.065, with a sensitivity of 85.7% and specificity of 71.4% (0.018). CONCLUSION IG% and IG count were found to be useful for predicting necrosis in patients with volvulus.
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Affiliation(s)
- M A Çaparlar
- Department of General Surgery, Ankara Education and Research Hospital, Ankara, Turkey
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V L, K K, E Y, M S. The Clinical Utility of Automated Immature Granulocyte Measurement in the Early Diagnosis of Bacteremia. Cureus 2024; 16:e53660. [PMID: 38455811 PMCID: PMC10917650 DOI: 10.7759/cureus.53660] [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: 01/15/2024] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
Background Early diagnosis and prompt management are crucial for bacteremia and sepsis, as they have the potential to lead to septic shock and fatal outcomes. Bacteremia induces the recruitment of immature granulocytes (IGs) into the circulation, which indicates active bone marrow response. The goal of our present study is to determine the effectiveness of automated IG measurement as an alternate indicator for infection and also its clinical utility in predicting positive blood culture (BC) results. Methods We conducted a retrospective study including 100 BC-positive patients for whom complete blood count (CBC) and BC were done at the same time. Multiple hematological parameters including total white blood cell count (TWC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), IG count (IGC), and IG percentage (IG%) were obtained from the automated hematology analyzer, and IGC/TWC (IG ratio), IGC/ANC (immature-to-total neutrophil ratio), and ANC/ALC (neutrophil-to-lymphocyte ratio) were calculated using the primary data and compared with 100 uninfected normal individuals. Results The mean value of IG% and IGC between culture-positive and culture-negative groups were statistically significant (p-value < 0.05), suggesting that they are potential markers for bacteremia, and also the IG% was significantly higher in patients with positive BCs. Conclusion IG measurement is an easily accessible, cost-effective potential marker for screening bacteremia. Therefore, IGC and IG% could be incorporated as a part of the CBC report.
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Affiliation(s)
- Lakshmipriya V
- Department of Pathology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Kavitha K
- Department of Pathology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Yogalakshmi E
- Department of Pathology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Sridevi M
- Department of Pathology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Karakurt G, Guven O, Aynaci E, Kerget B, Senkardesler G, Duger M. Evaluation of Hemogram Parameters in the Diagnosis of Pulmonary Embolism: Immature Granulocytes and Other New Tips. Clin Appl Thromb Hemost 2024; 30:10760296241227212. [PMID: 38348584 PMCID: PMC10865945 DOI: 10.1177/10760296241227212] [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: 10/09/2023] [Revised: 12/03/2023] [Accepted: 01/04/2024] [Indexed: 02/15/2024] Open
Abstract
Pulmonary embolism (PE) is an important cause of sudden death and is difficult to diagnose. Therefore unnecessary radiological investigations are often resorted to. Although some inflammatory parameters in the hemogram have been found to play a role in the diagnosis of PE, many parameters have not been adequately investigated. We aimed to evaluate potential inflammatory parameters in hemogram in the diagnosis of PE and to determine the parameters with the highest diagnostic value. This single-center, retrospective study was performed by evaluating 114 cases with suspected PE admitted to the emergency department between January 2017 and June 2022. Among 114 cases, 62 cases with a definitive diagnosis of PE by pulmonary computed tomography angiography served as the PE group and 52 cases without PE served as the control group. Admission hemogram parameters of both groups were recorded. Potential chronic diseases and acute conditions affecting hemogram were excluded from the study. In the multivariate model; immature granulocyte (IG), neutrophil/lymphocyte ratio (NLR), monocyte % and platelet large cell ratio (P-LCR) were found to be significantly and independently effective in differentiating cases with and without PE (P˂.05). Our findings suggest that high IG, high NLR, high monocyte %, and low P-LCR values have diagnostic value in cases with suspected PE. However the usability of IGs in the diagnosis of PE is a new finding. Hemogram is cheap, easily accessible, and potential inflammatory biomarkers in hemograms may increase physicians' awareness in the diagnosis of PE.
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Affiliation(s)
- Gokhan Karakurt
- Chest Diseases Department, Kirklareli Training and Research Hospital, Kirklareli, Turkey
| | - Oya Guven
- Emergency Medicine Department, Kirklareli University, Kirklareli, Turkey
| | - Engin Aynaci
- Chest Diseases Department, Beykent University, Istanbul, Turkey
| | - Bugra Kerget
- Chest Diseases Department, Ataturk University, Erzurum, Turkey
| | - Gizem Senkardesler
- Chest Diseases Department, Kirklareli Training and Research Hospital, Kirklareli, Turkey
| | - Mustafa Duger
- Chest Diseases Department, Medipol University, Istanbul, Turkey
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Leal PDS, Veeren IBL, Fonseca S, Machado CH, Lopes CWG. The importance of morphological changes in neutrophils in the diagnosis of bacterial infections in dogs with confirmed urinary tract infections in a Veterinary Care Service, Rio de Janeiro, Brazil. BRAZILIAN JOURNAL OF VETERINARY MEDICINE 2023; 45:e004022. [PMID: 37521363 PMCID: PMC10374294 DOI: 10.29374/2527-2179.bjvm0004022] [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: 11/06/2022] [Accepted: 06/06/2023] [Indexed: 08/01/2023] Open
Abstract
Neutrophils (PMNs) are cellular markers used for diagnosing inflammation and/or infections. In this study, the objective was to highlight the importance of recording the toxic morphological alterations of the PMNs as markers of infection in 10 cases, positive bacterial isolation by culture due to dysuria, hematuria and/or fetid urine, as manifestations of urinary tract disease. Smear observations were performed by immersion for counting and morphological evaluations of 3,000 leukocytes in smears and in leukocyte concentrate. One (10.0%) of the dogs had leukocytosis, and two (20.0%) dogs had leukopenia. All animals showed toxic PMNs with positive bacterial culture. None of the cases in the study showed any quantitative alterations in PMNs such as: neutropenia or neutrophilia, where 100% had nuclear displacement of the regenerative type of PMNs to the left. 100% cases had toxic morphological changes: 90.0% had PMNs with toxic granulations, 80.0% had giant rod neutrophils, 70.0% had target PMNs, in 50.0% of those with vacuolation in the cytoplasm, in 40.0% of the animals, the presence of giant PMNs, 10.0% with Döhle bodies, and another animal 10.0% with karyorrhexis. All case studies had at least one association of two types of toxic changes. Toxic morphological alterations observed in PMNs through cystoscopy proved to be more reliable and sensitive in evidencing the diagnosis of infections than the quantitative alterations of absolute values of total leukocytes; therefore, they were essential in the laboratory diagnosis by blood count in the course of infections in dogs.
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Affiliation(s)
- Paulo Daniel Sant’Anna Leal
- Veterinarian, DSc., Programa de Pós-Graduação em Ciências Veterinárias (PPGCV), Departamento de Parasitologia Animal (DPA), Instituto de Veterinária (IV), Universidade Federal Rural do Rio de Janeiro (UFRRJ). Seropédica, RJ, Brazil.
| | - Ianna Barbosa Lima Veeren
- Veterinarian, autonomous. Rua Januário José Pinto de Oliveira, 735, Recreio dos Bandeirantes, RJ, Brazil.
| | - Solange Fonseca
- Microbiologist, Hospital Getúlio Vargas, Penha Circular, Rio de Janeiro, RJ, Brazil.
| | - Carlos Henrique Machado
- Veterinarian, DSc., Departamento de Clínica e Cirurgia Veterinária, IV, UFRRJ. Seropédica, RJ, Brazil.
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The Value of Peripheral Blood Leukocyte Parameters in the Early Diagnosis and Clinical Prognosis of Sepsis. Int J Anal Chem 2023; 2023:6052085. [PMID: 36691469 PMCID: PMC9867575 DOI: 10.1155/2023/6052085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/06/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
Background Early diagnosis of sepsis is the key to timely, targeted treatment. Cell population data (CPD) has been widely used in many diseases, but its predictive value for early diagnosis and the clinical outcome of sepsis remains unclear. Therefore, this paper discusses whether peripheral blood leukocyte parameters can be used as predictive indicators for early diagnosis and the clinical outcome of sepsis. Methods A retrospective study of 45 patients with sepsis, 53 patients with nonseptic infections, and 86 healthy check-ups admitted to Gansu Provincial Hospital from January 2021 to June 2022 was done using a hematology analyzer. Results The results of LYMPH#, HFLC#, IG#, NE-WX, LY-WX, LY-WY, and MO-WX showed better diagnostic efficiency in the sepsis group and nonseptic infection group. When the seven differential leukocyte parameters were used to establish diagnostic models, the sensitivity and specificity were 82.20% and 77.40%, respectively. Correlation analysis showed that LYMPH# and HFLC# were positively correlated with PCT (P < 0.05). The clinical outcome of sepsis showed that the leukocyte parameters of discharged WBC and LY-X had better predictive efficacy. When the two differential leukocyte parameters were used to establish diagnostic models, the sensitivity and specificity were 90.90% and 100.00%. Cox regression analysis showed that leukocyte parameters of discharged WBC and LY-X were independent predictors of clinical outcomes (P < 0.05). Conclusion Leucocyte parameters HFLC#, IG#, NE-WX, LY-WX, LY-WY, and MO-WX had a certain auxiliary effect on the early diagnosis of sepsis leukocyte parameters of discharged WBC and LY-X were independent predictors of clinical outcomes in patients with sepsis. Therefore, peripheral blood leukocyte parameters may have predictive value for early diagnosis and the clinical outcome of sepsis, but large-scale retrospective studies are still needed to prove our preliminary results.
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12
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Yaradilmiş RM, Güneylioğlu MM, Öztürk B, Göktuğ A, Aydın O, Güngör A, Bodur İ, Kaya Ö, Örün UA, Karacan CD, Tuygun N. A Novel Marker for Predicting Fulminant Myocarditis: Systemic Immune-Inflammation Index. Pediatr Cardiol 2023; 44:647-655. [PMID: 35984471 PMCID: PMC9389492 DOI: 10.1007/s00246-022-02988-9] [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: 05/16/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022]
Abstract
In myocarditis, the search for effective and appropriate prognostic biomarkers can help clinicians identify high-risk patients in a timely manner and make better medical decisions in clinical practice. The prognostic value of systemic immune-inflammatory index (SII), an innovate biomarker of inflammation, in fulminant myocarditis in children has not been assessed. This study aims to (1) determine the effect of SII and other inflammatory markers on the prognosis of patients with myocarditis, and (2) characterize other factors affecting adverse outcomes in myocarditis. All patients aged between 1 months and 18 years who admitted to Pediatric Emergency Department between January 1, 2015 and October 1, 2021 and were diagnosed with myocarditis were retrospectively analyzed. 106 Eligible subjects were enrolled (67% male, 12.5 years (IQR 6-16). Fulminant myocarditis developed in 16 (15%) of the patients. The median SII was 1927 (1147.75-3610.25) in the fulminant myocarditis group and 351 (251.75-531.25) in the non-fulminant group (p < 0.001). In estimation of fulminant myocarditis, AUC was 0.87 for WBC [95% confidence interval (CI) 0.72-1.00, p = 0.002], 0.94 for ANC (95% CI 0.85-1.00), p = 0.000), 0.92 for SII (95% CI 0.82-1.00, p = 0.000). Spearman's correlation analysis showed a significant negative correlation between SII and LVEF (r = 0.576, p < 0.001). The highest AUC values were associated with ANC, SII, and WBC levels to predict fulminant myocarditis. SII, a readily available biomarker from routine blood parameters, allows early recognition of negative outcomes and can independently predict the prognosis of myocarditis in children.
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Affiliation(s)
- Raziye Merve Yaradilmiş
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Plevne M Babur C No 41, Gunesevler, 06080, Ankara, Turkey.
| | - Muhammed Mustafa Güneylioğlu
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Plevne M Babur C No 41, Gunesevler, 06080 Ankara, Turkey
| | - Betül Öztürk
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Plevne M Babur C No 41, Gunesevler, 06080 Ankara, Turkey
| | - Aytaç Göktuğ
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Plevne M Babur C No 41, Gunesevler, 06080 Ankara, Turkey
| | - Orkun Aydın
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Plevne M Babur C No 41, Gunesevler, 06080 Ankara, Turkey
| | - Ali Güngör
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Plevne M Babur C No 41, Gunesevler, 06080 Ankara, Turkey
| | - İlknur Bodur
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Plevne M Babur C No 41, Gunesevler, 06080 Ankara, Turkey
| | - Özkan Kaya
- Department of Pediatric Cardiology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Plevne M Babur C No 41, Gunesevler, 06080 Ankara, Turkey
| | - Utku Arman Örün
- Department of Pediatric Cardiology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Plevne M Babur C No 41, Gunesevler, 06080 Ankara, Turkey
| | - Can Demir Karacan
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Plevne M Babur C No 41, Gunesevler, 06080 Ankara, Turkey
| | - Nilden Tuygun
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Plevne M Babur C No 41, Gunesevler, 06080 Ankara, Turkey
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Niemantsverdriet MSA, de Hond TAP, Hoefer IE, van Solinge WW, Bellomo D, Oosterheert JJ, Kaasjager KAH, Haitjema S. A machine learning approach using endpoint adjudication committee labels for the identification of sepsis predictors at the emergency department. BMC Emerg Med 2022; 22:208. [PMID: 36550392 PMCID: PMC9784058 DOI: 10.1186/s12873-022-00764-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Accurate sepsis diagnosis is paramount for treatment decisions, especially at the emergency department (ED). To improve diagnosis, clinical decision support (CDS) tools are being developed with machine learning (ML) algorithms, using a wide range of variable groups. ML models can find patterns in Electronic Health Record (EHR) data that are unseen by the human eye. A prerequisite for a good model is the use of high-quality labels. Sepsis gold-standard labels are hard to define due to a lack of reliable diagnostic tools for sepsis at the ED. Therefore, standard clinical tools, such as clinical prediction scores (e.g. modified early warning score and quick sequential organ failure assessment), and claims-based methods (e.g. ICD-10) are used to generate suboptimal labels. As a consequence, models trained with these "silver" labels result in ill-trained models. In this study, we trained ML models for sepsis diagnosis at the ED with labels of 375 ED visits assigned by an endpoint adjudication committee (EAC) that consisted of 18 independent experts. Our objective was to evaluate which routinely measured variables show diagnostic value for sepsis. We performed univariate testing and trained multiple ML models with 95 routinely measured variables of three variable groups; demographic and vital, laboratory and advanced haematological variables. Apart from known diagnostic variables, we identified added diagnostic value for less conventional variables such as eosinophil count and platelet distribution width. In this explorative study, we show that the use of an EAC together with ML can identify new targets for future sepsis diagnosis research.
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Affiliation(s)
- Michael S. A. Niemantsverdriet
- grid.7692.a0000000090126352Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Room Number G03.551, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands ,SkylineDx, Rotterdam, The Netherlands
| | - Titus A. P. de Hond
- grid.7692.a0000000090126352Department of Internal Medicine and Acute Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Imo E. Hoefer
- grid.7692.a0000000090126352Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Room Number G03.551, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Wouter W. van Solinge
- grid.7692.a0000000090126352Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Room Number G03.551, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | | | - Jan Jelrik Oosterheert
- grid.7692.a0000000090126352Department of Internal Medicine, Infectious Diseases, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karin A. H. Kaasjager
- grid.7692.a0000000090126352Department of Internal Medicine and Acute Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Saskia Haitjema
- grid.7692.a0000000090126352Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Room Number G03.551, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Could an Increased Percentage of Immature Granulocytes Accompanying Dyspepsia Predict COVID-19? Medicina (B Aires) 2022; 58:medicina58101460. [PMID: 36295620 PMCID: PMC9609211 DOI: 10.3390/medicina58101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
Background and Aim: Although vaccination practices continue at a fast pace around the world, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) still threatens people’s lives. In this study, we aimed to determine the presence of SARS-CoV-2 in patients who do not have the typical symptoms of the novel coronavirus disease 2019 (COVID-19), but only present with dyspepsia, and to investigate the role of immature granulocytes in the early diagnosis of these patients. Material and Methods: Adult and pediatric patients suffering from dyspepsia were included in the study. The patients were divided into two groups, ‘‘positive’’ and ‘‘negative’’, based on their SARS-CoV-2 polymerase chain reaction test results. Immature granulocyte count (IG), immature granulocyte percentage (IG%), C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) values were recorded. Results: A total of 238 patients, including 25 (10.5%) pediatric and 213 (89.5%) adult patients, were included in the study. A total of 2 (8%) pediatric patients and 17 (7.9%) adult patients tested positive for SARS-CoV-2. The IG, IG%, and CRP parameters were significantly higher in the SARS-CoV-2-positive patients compared to the SARS-CoV-2-negative patients. The optimal cut-off value predictive of COVID-19 infection was determined to be ≥0.650 (sensitivity: 52.6% and specificity: 95.5%, p = 0.001) for IG%. Conclusions: It should be noted that dyspepsia may also be a COVID-19 symptom. IG% values, which can be determined with a hemogram test, a cheap and easily accessible test, may be a warning in the early detection of patients who do not have the typical symptoms of COVID-19.
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Moreira ID, Lessa CLM, Rocha GLG, Schmitz LD, Jahnke VS, Fogliatto LM, Werlang MC, Rotta LN. Advanced Clinical Parameters: a complementary hydroxyurea adherence evaluation in sickle cell anemia treatment. Eur J Haematol 2022; 109:736-748. [PMID: 36048130 DOI: 10.1111/ejh.13860] [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: 05/20/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Given the complex pathology of sickle cell anemia (SCA) and low adherence to Hydroxyurea (HU) treatment, there is a need to seek parameters that identify recent changes in patient status. The Advanced Clinical Parameters (ACPs) allow an early analysis of hematopoiesis. We aimed to draw the demographic profile of non-adherent SCA patients and to verify the use of ACPs as a measure of HU treatment adherence. METHOD In a cross-sectional study, we divided 83 SCA subjects treated with HU into Children (<12 years old) and Adolescents/Adults (≥12 years old). Their haemogram with the ACPs, electronic medical charts and pharmacy claim data were analyzed. RESULTS Non-adherent ≥12 years old patients had significantly increased WBC, absolute neutrophil, lymphocyte, monocyte, and basophil counts, RBC, RET, RDW, and PLT, and significantly decreased MCV and MCH. Subjects in the Adolescent/Adult group with IG† ≥0.035 cells/mm3 had the RR for non-adherence increased by 4.6 times (p=0.014), and the systemic immune inflammation index (SII) of non-adherent patients was also significantly higher (p=0.042). CONCLUSION IG† presents clinical utility in early identification of non-adherence to HU, especially when combined with other parameters, suggesting the evaluation of ACPs in laboratory routine, as they can be easily implemented. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Isabela Delfino Moreira
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Carem Luana Machado Lessa
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Gueverson Leonardo Gonçalves Rocha
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil.,Clinicas Hospital of Porto Alegre/RS, Brazil
| | - Laura Dewes Schmitz
- Undergraduate Program in Pharmacy, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Laura Maria Fogliatto
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil.,Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Maria Cristina Werlang
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Liane Nanci Rotta
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
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16
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Georgakopoulou VE, Makrodimitri S, Triantafyllou M, Samara S, Voutsinas PM, Anastasopoulou A, Papageorgiou CV, Spandidos DA, Gkoufa A, Papalexis P, Xenou E, Chelidonis G, Sklapani P, Trakas N, Sipsas NV. Immature granulocytes: Innovative biomarker for SARS‑CoV‑2 infection. Mol Med Rep 2022; 26:217. [PMID: 35551416 PMCID: PMC9175277 DOI: 10.3892/mmr.2022.12733] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/29/2022] [Indexed: 12/15/2022] Open
Abstract
Immature granulocytes (IGs) include metamyelocytes, myelocytes and promyelocytes, and are the precursors of neutrophils. Increased IG counts found in peripheral blood indicate an enhanced bone marrow activity. In addition, IGs have been evaluated in numerous clinical conditions, such as severe acute pancreatitis, systemic inflammatory response syndrome and infectious complications following open‑heart surgery under cardiopulmonary bypass. Neutrophils are considered to play a crucial role in the host defense during bacterial and fungal infections, and are involved in the antiviral immune response. Numerous studies have reported the role of neutrophils in coronavirus disease 2019 (COVID‑19) infection, concluding that the percentage of neutrophils may be a predictor of the severity of COVID‑19 infection. There has been limited research regarding the role of neutrophil precursors in viral infections, including severe acute respiratory syndrome coronavirus 2 infection. The present thus aimed to evaluate the role of the IG count in patients hospitalized due to COVID‑19 infection. The patients were predominantly infected with the alpha variant and were all unvaccinated. The IG count was measured and was found to be associated with disease severity, with patient outcomes, with the duration of hospitalization and with the development of complications. The IG count was a significantly associated with the severity of COVID‑19 infection, with greater IG count values being detected in severe and critical cases. In addition, greater IG count values were associated with a longer duration of hospitalization. Furthermore, the IG count was found to be an independent prognostic biomarker of intubation and mortality in patients with COVID‑19, according to multivariate logistic regression analysis, including age, the male sex and the presence of comorbidities as confounders.
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Affiliation(s)
| | - Sotiria Makrodimitri
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, 11527 Athens, Greece
| | - Maria Triantafyllou
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, 11527 Athens, Greece
| | - Stamatia Samara
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, 11527 Athens, Greece
| | - Pantazis M. Voutsinas
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, 11527 Athens, Greece
| | - Amalia Anastasopoulou
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Aikaterini Gkoufa
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Petros Papalexis
- Unit of Endocrinology, First Department of Propedeutic and Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
| | - Euthalia Xenou
- Laboratory of Hematology, Laiko General Hospital, 11527 Athens, Greece
| | | | - Pagona Sklapani
- Department of Cytology, Mitera Hospital, 15123 Athens, Greece
| | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Nikolaos V. Sipsas
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, 11527 Athens, Greece
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Lemkus L, Lawrie D, Vaughan J. The utility of extended differential parameters as a biomarker of bacteremia at a tertiary academic hospital in persons with and without HIV infection in South Africa. PLoS One 2022; 17:e0262938. [PMID: 35176042 PMCID: PMC8853519 DOI: 10.1371/journal.pone.0262938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/07/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Extended differential parameters (EDPs) are generated with the automated differential count by Sysmex XN-series automated hematology analysers, and include the immature granulocyte count (IG%), the neutrophil fluorescent light intensity (NE-SFL) and the neutrophil fluorescent light distribution width (NE-WY). These have been proposed as early biomarkers of bacteremia. This study aimed to evaluate the NE-SFL, NE-WY and IG% in comparison to neutrophil CD64 (nCD64) expression (as a high quality sepsis biomarker) among patients with suspected bacterial sepsis at the Chris Hani Baragwanath Academic Hospital in Johannesburg, South Africa. METHODS A daily search of the laboratory information system identified samples submitted for a blood culture (BC) and a concurrent full blood count (FBC). Automated differential counts using a Sysmex XN-9000 haematology analyser and neutrophil CD64 expression by flow cytometry were assessed on the residual FBC samples. RESULTS A total of 151 samples were collected, of which 83 were excluded due to equivocal results with regards to the presence of bacterial infection. The remaining 68 samples included 23 with bacteremia, 28 with evidence of non-bacteremic bacterial infection, 13 with no evidence of bacterial infection and 4 with Tuberculosis. HIV status was documented in 90 of the patients, with a seropositivity rate of 57.8%. The EDPs were all significantly higher among patients with bacteremia as compared to those without bacterial infection, but on ROC curve analyses, only the NE-SFL showed good performance (AUC>0.8) for discriminating cases with bacteremia from those without bacterial infection at a cut-off value of 49.75. In comparison to the nCD64, the NE-SFL showed moderate agreement (kappa = 0.5). On stratification of the ROC analysis by HIV status, the NE-SFL showed superior performance among persons with HIV infection (AUC = 1), while the automated IG% showed better performance among the patients without HIV infection (AUC = 0.9). CONCLUSION In this study, EDPs showed differential performance as biomarkers for bacteremia according to HIV-status in the South African setting, with the most promising results seen with the NE-SFL and IG% parameters among people with and without HIV infection, respectively. Further assessment of these parameters without pre-selection of patients likely to have infection is required to further determine their clinical utility, particularly among patients with underlying inflammatory conditions or malignancy.
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Affiliation(s)
- Lauren Lemkus
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Services, Johannesburg, South Africa
| | - Denise Lawrie
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Services, Johannesburg, South Africa
| | - Jenifer Vaughan
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Services, Johannesburg, South Africa
- * E-mail:
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18
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An Assessment on the Effectiveness of the Immature Granulocyte Percentage in Predicting Internal Organ Involvement Among Children With Henoch-Schönlein Purpura. J Pediatr Hematol Oncol 2022; 44:e413-e417. [PMID: 34486546 DOI: 10.1097/mph.0000000000002288] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022]
Abstract
Henoch-Schönlein purpura (HSP) is the most common childhood systemic vasculitis. The present study aims to investigate the effectiveness of the immature granulocyte (IG) percentage as a new marker for predicting internal organ involvement in HSP. This study included 75 patients below 18 years old who were diagnosed with HSP. The mean age was 7.48±2.77 years. The male/female ratio was 1.14. The findings showed that 35 (46.7%) of the patients had an internal organ involvement. The mean IG percentage was 0.88±0.68 among the patient group with HSP internal organ involvement, while it was 0.31±0.15 in the group without internal organ involvement, and a significant difference was determined between the 2 groups (P=0.000). The findings showed that the patients with renal involvement had the highest mean IG percentage (IG; 1.00±0.21). When the cutoff value for the IG percentage was specified as 0.45 to predict internal organ involvement, the sensitivity was 77.1%, and the specificity was 85%. In this study, the findings showed that IG percentage increased among patients with internal organ involvement in HSP and that its sensitivity, specificity, and predictive values were higher in predicting internal organ involvement compared with other markers.
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Korkut M, bedel C, selvi F, Eyvaz K, Zortuk Ö. Is immature granulocyte a new predictor in the diagnosis of peptic ulcer perforation? POLISH JOURNAL OF SURGERY 2022. [DOI: 10.5604/01.3001.0015.7360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Introduction:</b> Peptic ulcer perforation (PUP) requires immediate treatment. Immature granulocyte (IG) takes part in the inflammation process and is a biomarker which can be easily tested in peripheral venous blood. </br></br> <b>Aim:</b> This study demonstrates that IG is a convenient biomarker in the diagnosis of PUP. </br></br> <b> Material and methods: </b> Medical records of patients treated in the years 2018–2020 were analysed retrospectively. The study recognized three groups of patients: 42 PUD patients (Group 1), 42 PUP patients (Group 2) and 45 individuals acting as a healthy control (HC, Group 3). Surgical repair was performed in all patients from the PUP group. Differences between the groups were analysed statistically. The receiver operating characteristic curve (ROC) was calculated in order to predict the likelihood of PUP diagnosis based on the immature granulocyte count (IGC) and immature granulocyte percentage (IG%). </br></br> <b> Results:</b> The average IGC was high in group 1 and group 2, while the IG levels remained low in the HC group A statistically significant difference between the groups was confirmed (mean values, respectively; 0.05 [0.12], 0.04 [0.06], 0.03 [0.03], and P = 0.001). The average value of IG% was high in group 1 and group 2 but remained low in the HC group A statistically significant difference between the groups was confirmed (mean values, respectively; 1.62 ± 0.41, 0.68 ± 0.22, 0.37 ± 0.55, and P = 0.003). The following parameters were calculated for IGC and IG%: AUC: 0.637; sensitivity: 61.9%; specificity: 57.1%; P = 0.031, AUC: 0.693; sensitivity: 61.9%; specificity: 64.3%; P = 0.02), respectively. </br></br> <b>Results:</b> IG is convenient as a diagnostic biomarker in PUP patients admitted to the emergency department.
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Affiliation(s)
- Mustafa Korkut
- Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital
| | - cihan bedel
- Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital
| | - fatih selvi
- Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital
| | - Kemal Eyvaz
- Department of General Surgery, Health Science University Antalya Training and Research Hospital
| | - Ökkeş Zortuk
- Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital
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Bhansaly P, Mehta S, Sharma N, Gupta E, Mehta S, Gupta S. Evaluation of Immature Granulocyte Count as the Earliest Biomarker for Sepsis. Indian J Crit Care Med 2022; 26:216-223. [PMID: 35712744 PMCID: PMC8857719 DOI: 10.5005/jp-journals-10071-23920] [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] [Indexed: 11/23/2022] Open
Abstract
Background Diagnosing sepsis early is important for its successful management. Various biomarkers are being used currently, but mostly they are either expensive or not readily available. This study aims to evaluate usefulness of automated immature granulocyte count (IG#) and immature granulocyte percentage (IG%) as early diagnostic markers of sepsis and compares it to other established predictive markers. Patients and methods In this prospective observational study, 137 eligible, critically ill, nonseptic intensive care unit patients were analyzed for automated IG#, IG%, serum procalcitonin (PCT), and blood lactate (Lac), daily for 7 days after recruitment. Patients were followed for the development of sepsis, defined by the new Sepsis-3 criteria. The study was divided into four time periods of 24 hours each with respect to the day of developing organ dysfunction. Using area under receiver operator characteristic and diagnostic odds ratio (DOR) methods, the best biomarker for the prediction of sepsis in each time period was calculated. Results IG# and IG% were the earliest biomarkers to have a significant discriminating value with area under the curve of 0.81 and 0.82, respectively, as early as 24 hours before clinical sepsis is diagnosed by Sepsis-3 criteria. Both IG# and IG% have a high DOR of 34.91 and 18.11, respectively, when compared to others like PCT and Lac having a DOR of 27.06 and 4.78, respectively. Conclusion IG# and IG% are easily available, rapid, and inexpensive tools to differentiate between septic and nonseptic patients with high specificity and sensitivity. It is the earliest biomarker to show a significant rise in patients developing sepsis. How to cite this article Bhansaly P, Mehta S, Sharma N, Gupta E, Mehta S, Gupta S. Evaluation of Immature Granulocyte Count as the Earliest Biomarker for Sepsis. Indian J Crit Care Med 2022;26(2):216–223.
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Affiliation(s)
- Prabhav Bhansaly
- Department of Medicine, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
- Prabhav Bhansaly, Department of Medicine, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India, Phone: +91 9836057540, e-mail:
| | - Sudhir Mehta
- Department of Medicine, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Nidhi Sharma
- Department of Pathology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Esha Gupta
- Department of Pediatrics, Our Kids’ MD, New York, United States
| | - Shaurya Mehta
- Department of Nephrology, Jaslok Hospital, Mumbai, Maharashtra, India
| | - Sweta Gupta
- Department of Pathology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
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21
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Jeon K, Lee N, Jeong S, Park MJ, Song W. Immature granulocyte percentage for prediction of sepsis in severe burn patients: a machine leaning-based approach. BMC Infect Dis 2021; 21:1258. [PMID: 34915849 PMCID: PMC8680375 DOI: 10.1186/s12879-021-06971-2] [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: 08/11/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Of the existing sepsis markers, immature granulocytes (IG) most frequently reflect the presence of an infection. The importance of IG as an early predictor of sepsis and bacteremia is evaluated differently for each study. This study aimed to evaluate the effectiveness of the Sysmex XN series' IG% as an independent prognostic indicator of sepsis using machine learning. METHODS A total of 2465 IG% results from 117 severe burn patients in the intensive care unit of one institution were retrospectively analyzed. We evaluated the IG% for sepsis using the receiver operating characteristic, logistic regression, and partial dependence plot analyses. Clinical characteristics and other laboratory markers associated with sepsis, including WBC, procalcitonin, and C-reactive protein, were compared with the IG% values. RESULTS Twenty-six of the 117 patients were diagnosed with sepsis. The median IG% value was 2.6% (95% CI: 1.4-3.1). The area under the receiver operating characteristic curve was 0.77 (95% CI: 0.78-0.84) and the optimal cut-off value was 3%, with a sensitivity of 76.9% and specificity of 68.1%. The partial dependence plot of IG% on predicting sepsis showed that an IG% < 4% had low predictability, but increased thereafter. The interaction plot of IG% and C-reactive protein showed an increase in sepsis probability at an IG% of 6% and C-reactive protein of 160 mg/L. CONCLUSIONS IG% is moderately useful for predicting sepsis. However, since it can be determined from routine laboratory test results and requires no additional intervention or cost, it could be particularly useful as an auxiliary marker.
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Affiliation(s)
- Kibum Jeon
- Department of Laboratory Medicine, Hallym University Hangang Sacred Heart Hospital, 12 Beodeunaru-ro 7-gil, Yeongdeungpo-gu, Seoul, 150719, South Korea
| | - Nuri Lee
- Department of Laboratory Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 22, Singil-ro 1, Yeongdeungpo-gu, Seoul, 07440, South Korea.
| | - Seri Jeong
- Department of Laboratory Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 22, Singil-ro 1, Yeongdeungpo-gu, Seoul, 07440, South Korea
| | - Min-Jeong Park
- Department of Laboratory Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 22, Singil-ro 1, Yeongdeungpo-gu, Seoul, 07440, South Korea
| | - Wonkeun Song
- Department of Laboratory Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 22, Singil-ro 1, Yeongdeungpo-gu, Seoul, 07440, South Korea
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22
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The Value of a Complete Blood Count (CBC) for Sepsis Diagnosis and Prognosis. Diagnostics (Basel) 2021; 11:diagnostics11101881. [PMID: 34679578 PMCID: PMC8534992 DOI: 10.3390/diagnostics11101881] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 12/28/2022] Open
Abstract
Sepsis represents an important global health burden due to its high mortality and morbidity. The rapid detection of sepsis is crucial in order to prevent adverse outcomes and reduce mortality. However, the diagnosis of sepsis is still challenging and many efforts have been made to identify reliable biomarkers. Unfortunately, many investigated biomarkers have several limitations that do not support their introduction in clinical practice, such as moderate diagnostic and prognostic accuracy, long turn-around time, and high-costs. Complete blood count represents instead a precious test that provides a wealth of information on individual health status. It can guide clinicians to early-identify patients at high risk of developing sepsis and to predict adverse outcomes. It has several advantages, being cheap, easy-to-perform, and available in all wards, from the emergency department to the intensive care unit. Noteworthy, it represents a first-level test and an alteration of its parameters must always be considered within the clinical context, and the eventual suspect of sepsis must be confirmed by more specific investigations. In this review, we describe the usefulness of basic and new complete blood count parameters as diagnostic and prognostic biomarkers of sepsis.
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23
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Myari A, Papapetrou E, Tsaousi C. Diagnostic value of white blood cell parameters for COVID-19: Is there a role for HFLC and IG? Int J Lab Hematol 2021; 44:104-111. [PMID: 34623763 PMCID: PMC8653118 DOI: 10.1111/ijlh.13728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/02/2021] [Accepted: 09/20/2021] [Indexed: 12/13/2022]
Abstract
Introduction As the Coronavirus disease 2019 (COVID‐19) pandemic is still ongoing with patients overwhelming healthcare facilities, we aimed to investigate the ability of white blood cell count (WBC) and their subsets, high fluorescence lymphocyte cells (HFLC), immature granulocyte count (IG), and C‐reactive protein (CRP) to aid diagnosis of COVID‐19 during the triage process and as indicators of disease progression to serious and critical condition. Methods We collected clinical and laboratory data of patients, suspected COVID‐19 cases, admitted at the emergency department of University General Hospital of Ioannina (Ioannina, Greece). We selected 197 negative and 368 positive cases, confirmed by polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2. COVID‐19 cases were classified into mild, serious, and critical disease. Receiver operating characteristic curve and binary logistic regression analysis were utilized for assessing the diagnosing ability of biomarkers. Results WBC, neutrophil count (NEUT), and HFLC can discriminate efficiently negative cases from mild and serious COVID‐19, whereas eosinopenia and basopenia are early indicators of the disease. The combined WBC‐HFLC marker is the best diagnostic marker for both mild (sensitivity: 90.6% and specificity: 64.1%) and serious (sensitivity: 90.3% and specificity: 73.4%) disease. CRP and Lymphocyte count are early indicators of progression to serious disease whereas WBC, NEUT, IG, and neutrophil‐to‐lymphocyte ratio are the best indicators of critical disease. Conclusion Lymphopenia is not useful in screening patients with COVID‐19. HFLC is a good diagnostic marker for mild and serious disease either as a single marker or combined with WBC whereas IG is a good indicator of progression to critical disease.
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Affiliation(s)
- Alexandra Myari
- Hematology Lab, University General Hospital of Ioannina, Ioannina, Greece
| | | | - Christina Tsaousi
- Hematology Lab, University General Hospital of Ioannina, Ioannina, Greece
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24
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d'Onofrio G. Full-field hemocytometry. Forty years of progress seen through Clinical and Laboratory Hematology and the International Journal of Laboratory Hematology. Int J Lab Hematol 2021; 43 Suppl 1:7-14. [PMID: 34288438 DOI: 10.1111/ijlh.13546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/19/2021] [Accepted: 03/29/2021] [Indexed: 12/19/2022]
Abstract
The extraordinary advances in clinical hematology, biology, and oncology in the last decades would not have been possible without discovering how to identify and count the cells circulating in the blood. For centuries, scientists have used slides, counting chambers (hemocytometers), and diluting and staining solutions for this task. Then, automated hemocytometry began. This science, now linked to the daily routine of laboratory hematology, has completed an overwhelming path over a few decades. Our laboratories today operate with versatile multiparameter systems, ranging from complex single-channel instruments to bulky continuous flow machines. In terms of clinical information obtained from a simple routine blood test, the full exploitation of their potential depends on the operators' imagination and courage. A comprehensive review of the scientific publications that have accompanied the development of hemocytometry from the 1950s to today would require entire volumes. More than seven hundred contributions that authors worldwide have published in Clinical and Laboratory Haematology until 2007 and then the International Journal of Laboratory Hematology are summarized. Such journals have represented and hopefully will continue to represent the privileged place of welcome for future scientific research in hemocytometry. Improved technologies, attention to quality, new reagents and electronics, information technology, and scientist talent ensure a more profound and deeper knowledge of cell properties: current laboratory devices measure and count even minor immature or pathological cell subpopulations. Full-field hemocytometry includes the analysis of nonhematic fluids, digital adds to the microscope, and the development of effective point-of-care devices.
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Affiliation(s)
- Giuseppe d'Onofrio
- Clinical Pathology and Sports Hematology, Catholic University of Sacred Heart, Rome, Italy
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25
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Senlikci A, Kosmaz K, Durhan A, Suner MO, Bezirci R, Mercan U, Suleyman M. A New Marker Evaluating the Risk of Ischemic Bowel in Incarcerated Hernia: Immature Granulocytes. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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26
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Mature and Immature/Activated Cells Fractionation: Time for a Paradigm Shift in Differential Leucocyte Count Reporting? Diagnostics (Basel) 2021; 11:diagnostics11060922. [PMID: 34063858 PMCID: PMC8223966 DOI: 10.3390/diagnostics11060922] [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: 04/08/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 11/30/2022] Open
Abstract
Leucocytes, especially neutrophils featuring pro- and anti-cancerous characteristics, are involved in nearly every stage of tumorigenesis. Phenotypic and functional differences among mature and immature neutrophil fractions are well reported, and their correlation with tumor progression and therapy has emerging implications in modern oncology practices. Technological advancements enabled modern hematology analyzers to generate extended information (research parameters) during complete blood cell count (CBC) analysis. We hypothesized that neutrophil and lymphocyte fractions-related extended differential leucocytes count (DLC) parameters hold superior diagnostic utility over routine modalities. The present study was carried out over a four-and-a-half-year period wherein extended neutrophil (immature granulocyte [IG] and mature neutrophil [NEUT#&]), and lymphocyte (activated/high fluorescence lymphocyte count [HFLC] and resting lymphocyte [LYMP#&]) parameters were challenged over routine neutrophil [NEUT#] and lymphocyte [LYMP#] items in a study population of 1067 hematological neoplasm patients. Extending the classical statistical approaches, machine-learning-backed data visualization was used to explore trends in the study parameters. As a whole, extended neutrophil and lymphocyte count outperformed and was diagnostically more relevant than routine neutrophil and lymphocyte parameters by showing the least difference from their respective (gold-standard) manual DLC counts. The mature neutrophil count was compared to IG, and resting lymphocyte count was compared to HFLC by calling the function ‘correlation’ as a ‘clustering function’ for heatmap based visualization. The aforementioned study parameters displayed close clustering (rearrangement) for their respective study items by presenting distinct trends of equally valuable weights (deviated values), advocating fractions-based extended DLC reporting. Importantly, using a Bland and Altman analysis analogously to a manual neutrophil count, the mature neutrophil count [NEUT#&] remained unbiased since a routine neutrophil count [NEUT#] was found to be a negatively biased. The extended DLC-parameter-driven fractions-based reporting has superior diagnostic utility over classical routine approaches; this finding can largely minimize labor-intensive manual DLC practices, especially in hematology–oncology departments.
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27
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Bedel C, Korkut M, Selvi F. New markers in predicting the severity of acute pancreatitis in the emergency department: Immature granulocyte count and percentage. J Postgrad Med 2021; 67:7-11. [PMID: 33533745 PMCID: PMC8098866 DOI: 10.4103/jpgm.jpgm_784_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Acute pancreatitis (AP) may vary in severity, from mild, self-limiting pancreatic inflammation to rapidly progressive life-threatening clinical course. If the severity of AP can be predicted early and treated quickly, it may lead to a decrease in morbidity and mortality rates. There?fore, we aimed to investigate the clinical utility of immature granulocyte count (IGC) and IGC percentage (IG%) in showing the severity of AP in this study. Methods: Two hundred and twenty-seven patients who were admitted to our emergency department and diagnosed with AP between March 1 and September 30, 2019, were included in the study. The patients were divided into two groups as mild and severe AP (MAP and SAP) according to the severity of the disease. Demographic characteristics of the patients, disease etiology, disease severity, and inflammation markers [white blood cell count (WBC), IGC, IG%, neutrophil–lymphocyte ratio (NLR), and C-reactive protein (CRP)] were recorded. Differences between the groups were statistically analyzed. Results: Of the patients included in the study, 183 (80.7%) were in the MAP group and 44 (19.3%) were in the SAP group. The mean WBC, NLR, CRP, IGC, and IG% levels were significantly higher in the SAP group compared to the MAP group. The power of IGC and IG% in predicting SAP was higher than other inflammation markers (WBC, NLR, and CRP) [(AUC for IGC: 0.902; sensitivity: 78.2%; specificity: 92.8%); (AUC for IG%: 0.843; sensitivity: 72.7%; specificity: 84.6%)]. Conclusion: IGC and IG% show the severity of AP more effectively than WBC, NLR, and CRP, which are traditional inflammation markers.
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Affiliation(s)
- C Bedel
- Health Science University Antalya Training and Research Hospital, Department of Emergency Medicine, Antalya, Turkey
| | - M Korkut
- Health Science University Antalya Training and Research Hospital, Department of Emergency Medicine, Antalya, Turkey
| | - F Selvi
- Health Science University Antalya Training and Research Hospital, Department of Emergency Medicine, Antalya, Turkey
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28
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Güngör A, Göktuğ A, Tekeli A, Bodur İ, Öztürk B, Güneylioğlu MM, Yaradılmış RM, Akca Çağlar A, Tuygun N, Karacan CD. Evaluation of the accuracy of immature granulocyte percentage in predicting pediatric serious bacterial infection. Int J Lab Hematol 2021; 43:632-637. [PMID: 33527769 DOI: 10.1111/ijlh.13474] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/30/2020] [Accepted: 01/08/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Serious bacterial infections (SBI) are major causes of mortality and morbidity in children. The aim of this study was to determine the accuracy of the immature granulocyte (IG) percentage in predicting SBI. METHODS Patients admitted to the pediatric emergency department with fever were divided into two groups: with SBI and with non-SBI. White blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP), and the percentage of IG value were recorded, and their accuracy in predicting SBI was evaluated. RESULTS Sixty-one (14.3%) patients fell into the SBI group and 367 (85.7%) were with non-SBI. Mean IG percentage among SBI patients was 0.84 ± 1.21 and 0.27 ± 0.20 for with non-SBI patients (P = .001). Based on disease, the highest IG percentage was found in patients diagnosed with sepsis (IG 3.7 ± 3.5%) and with bacterial meningitis (IG 1.6 ± 1.3%). The area under the curve (AUC) of IG percentage to predict SBI was 0.83 with 95% confidence interval (CI) [0.78-0.88]; WBC was 0.76 (95% CI 0.70-0.83); ANC was 0.73 (95% CI 0.67-0.80), and CRP was 0.79 (95% CI 0.73-0.85). When infection markers were compared to the most appropriate cut-off values in predicting SBI, IG percentage showed the highest sensitivity and specificity. When the cut-off value was determined as >0.35 for IG percentage, sensitivity was 75.4% and specificity was 76.6% in predicting SBI. CONCLUSION Patients with SBI had a higher IG percentage. Compared to other biomarkers, IG percentage had higher sensitivity and specificity in predicting SBI.
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Affiliation(s)
- Ali Güngör
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Aytaç Göktuğ
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Aysun Tekeli
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - İlknur Bodur
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Betül Öztürk
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Muhammed Mustafa Güneylioğlu
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Raziye Merve Yaradılmış
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ayla Akca Çağlar
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Nilden Tuygun
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Can Demir Karacan
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
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29
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Narcı H, Berkeşoğlu M, Üçbilek E, Ayrık C. The usefulness of the percentage of immature granulocytes in predicting in-hospital mortality in patients with upper gastrointestinal bleeding. Am J Emerg Med 2020; 46:646-650. [PMID: 33358899 DOI: 10.1016/j.ajem.2020.12.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/13/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) is an important health problem with a potentially life threatening course. Measurement of immature granulocytes percentage (IG %), reflecting the fraction of circulating immature granulocyte (IG), is associated with increased mortality in patients with systemic inflammation, or distress. The aim of this study was to evaluate whether the IG% is an effective predictive marker for estimating the in-hospital mortality for patients with UGIB admitting to the emergency department (ED). METHOD This retrospective study included patients with UGIB who admitted to the ED, between 01.01.2019 and 31.12.2019. The patients were divided into two groups as discharged and dead. The IG% and other parameters were recorded. The primary end point of the study was in-hospital mortality. Logistic regression model was used to determine the factors affecting mortality. RESULTS This study included 149 patients, 94 of whom were men. The mean age of the patients was 64.5 ± 14.2. Twenty patients died during hospitalization and 129 were discharged. IG% was significantly higher in patients who died compared with patients who discharged. In the receiver operating characteristic (ROC) curves analysis to determine the in-hospital mortality, the cut-off value (>1%) for IG% level was found specificity (93.8%), sensitivity (100%), positive predictive value (PPV = 71.43%), negative predictive value (NPV = 100.00%) and area under curve (AUC = 0.98). Univariate logistic regression analysis showed that IG% was predicting in-hospital mortality (odds ratio, OR = 65.6, confidence interval, CI = 2.00-2152.6). CONCLUSıONS: High IG% levels may be used as a predictor of in-hospital mortality in patients with UGIB.
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Affiliation(s)
- Hüseyin Narcı
- Mersin University, Faculty of Medicine, Department of Emergency Medicine, Mersin, Turkey.
| | - Mustafa Berkeşoğlu
- Mersin University, Faculty of Medicine, Department of General Surgery, Mersin, Turkey
| | - Enver Üçbilek
- Associate professor, Mersin University, Faculty of Medicine, Department of Gastroenterology, Mersin, Turkey
| | - Cüneyt Ayrık
- Mersin University, Faculty of Medicine, Department of Emergency Medicine, Mersin, Turkey
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30
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Linssen J, Ermens A, Berrevoets M, Seghezzi M, Previtali G, van der Sar-van der Brugge S, Russcher H, Verbon A, Gillis J, Riedl J, de Jongh E, Saker J, Münster M, Munnix IC, Dofferhof A, Scharnhorst V, Ammerlaan H, Deiteren K, Bakker SJ, Van Pelt LJ, Kluiters-de Hingh Y, Leers MP, van der Ven AJ. A novel haemocytometric COVID-19 prognostic score developed and validated in an observational multicentre European hospital-based study. eLife 2020; 9:63195. [PMID: 33241996 PMCID: PMC7732342 DOI: 10.7554/elife.63195] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/25/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 induces haemocytometric changes. Complete blood count changes, including new cell activation parameters, from 982 confirmed COVID-19 adult patients from 11 European hospitals were retrospectively analysed for distinctive patterns based on age, gender, clinical severity, symptom duration, and hospital days. The observed haemocytometric patterns formed the basis to develop a multi-haemocytometric-parameter prognostic score to predict, during the first three days after presentation, which patients will recover without ventilation or deteriorate within a two-week timeframe, needing intensive care or with fatal outcome. The prognostic score, with ROC curve AUC at baseline of 0.753 (95% CI 0.723-0.781) increasing to 0.875 (95% CI 0.806-0.926) on day 3, was superior to any individual parameter at distinguishing between clinical severity. Findings were confirmed in a validation cohort. Aim is that the score and haemocytometry results are simultaneously provided by analyser software, enabling wide applicability of the score as haemocytometry is commonly requested in COVID-19 patients.
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Affiliation(s)
| | | | | | | | | | | | - Henk Russcher
- Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Annelies Verbon
- Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Judith Gillis
- Leiden University Medical Center, Leiden, Netherlands
| | - Jürgen Riedl
- Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Eva de Jongh
- Albert Schweitzer Hospital, Dordrecht, Netherlands
| | | | | | | | | | | | | | | | - Stephan Jl Bakker
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lucas Joost Van Pelt
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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31
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Bedel C, Korkut M, Avcı A, Uzun A. Immature Granulocyte Count and Percentage as New Predictors of Mortality in Patients with Upper Gastrointestinal Bleeding. Indian J Crit Care Med 2020; 24:794-798. [PMID: 33132562 PMCID: PMC7584826 DOI: 10.5005/jp-journals-10071-23563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Aims Early identification of patients at risk of adverse outcomes may increase the survival rates in patients with upper gastrointestinal bleeding (UGIB), but this can be difficult to predict in emergencies. The aim of the study is to evaluate immature granulocyte (IG), which can be obtained from simple hemogram tests in patients with UGIB, in terms of clinical use and as a mortality marker. Materials and methods The patients diagnosed with UGIB between March 1, 2019, and September 30, 2019, were evaluated retrospectively. Demographic characteristics, causes of hemorrhage, clinical presentations, hemogram, and biochemistry values at ED admission and 30-day mortality status of the patients were examined. We divided the patients into groups according to their mortality status, and the groups were compared among themselves in terms of parameters. Results A total of 213 patients who met the inclusion criteria were included in the study. Of these patients, 139 (65.3%) were male and the mean age was 65.05 ± 16.7 years. Fifteen (7%) of them were in the nonsurvival group, while 198 (93%) were in the survival group. The efficacy of both the IG count (IGC) and IG% in predicting mortality was statistically significant (p = 0.002, p = 0.008, respectively). The sensitivity and specificity for the IGC were found as 60% and 84.4; for the IG%, they were found as 66.7% and 75.7%, respectively. Conclusion IGC and IG% are independent risk factors for the 30-day mortality status. These measurements are obtained from simple hemogram tests and may be useful for the evaluation of mortality in patients with UGIB. How to cite this article Bedel C, Korkut M, Avcı A, Uzun A. Immature Granulocyte Count and Percentage as New Predictors of Mortality in Patients with Upper Gastrointestinal Bleeding. Indian J Crit Care Med 2020;24(9):794-798.
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Affiliation(s)
- Cihan Bedel
- Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - Mustafa Korkut
- Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - Ali Avcı
- Department of Emergency Medicine, Karaman State Hospital, Karaman, Turkey
| | - Ahmet Uzun
- Department of Emergency Medicine, Karabük University Training and Research Hospital, Karabük, Turkey
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Zeng L, Wang S, Lin M, Chen Y, Deng Q, Zhong H, Guan X, Yao S, Liu H. Evaluation of time to positivity for blood culture combined with immature granulocytes, neutrophil-to-lymphocyte ratio, and CRP in identifying bloodstream coagulase-negative Staphylococci infection in pediatric patients. J Clin Lab Anal 2020; 34:e23473. [PMID: 33463771 PMCID: PMC7676180 DOI: 10.1002/jcla.23473] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/13/2020] [Accepted: 06/13/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate the application value of time to positivity (TTP) for blood culture combined with inflammatory parameters that included immature granulocyte percentage (IG%), immature granulocyte count (IG#), C-reactive protein (CRP), white blood cells (WBC) neutrophil percentage (NE%), and neutrophil-to-lymphocyte ratio (NLR), and to identify bloodstream infections from contamination with coagulase-negative staphylococci (CoNS) in pediatric patients. METHODS Data of 12 897 inpatients with blood culture CoNS were retrospectively collected and analyzed from January-December 2019 at our hospital. According to pre-defined criteria, they were divided into a CoNS infection group (132 cases) and a CoNS contamination group (124 cases). Infection with Staphylococcus aureus (SA, 27 cases) at the same period was considered a positive control group. ROC curve analysis assisted in determining the value of applying TTP combined with the above-mentioned inflammatory parameters to distinguish CoNS infection from contamination. RESULTS Among the 256 strains of CoNS, Staphylococcus hominis (55.1%), Staphylococcus epidermidis (32.0%), and Staphylococcus capitis (7.0%) were common. There was no significant difference in the subspecies distribution between the infection and contamination groups. The TTP of the CoNS infection group was significantly lower than the contamination group (P < .05). IG%, IG#, CRP, NE%, and NLR were all higher in the infected group as compared to the contaminated group (P < .05), while WBC was similar among groups. There was also no statistical difference in those parameters when comparing the CoNS infection and SA groups. ROC analysis showed that TTP value in identifying CoNS infection from contamination was the highest with area under the curve (AUC) of 0.913, and the sensitivity and specificity were 0.827 and 0.852, respectively, at the optimal cutoff value of 23.9 hours. This was followed by IG% (AUC = 0.712), with an optimal critical value of 0.55%, and a sensitivity of 0.519 and specificity of 0.797. All the AUC values of IG#, CRP, NE%, and NLR were <0.7. A combination of TTP with IG%, CRP, and NLR improved the AUC, sensitivity, specificity, accuracy, PPV, and NPV values to 0.977, 0.922, 0.957, 91.8%, 92.2%, and 91.3%, respectively. CONCLUSIONS TTP within 24 hours indicates likelihood of CoNS as the pathogenic agent in pediatric patient blood culture. The combination of TTP with IG% CRP and NLR might improve the diagnostic accuracy.
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Affiliation(s)
- Lanlan Zeng
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Shuhui Wang
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Minchun Lin
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Yaxing Chen
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Qiulian Deng
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Huamin Zhong
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Xiaoshan Guan
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Shuwen Yao
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Haiying Liu
- Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
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Bozan MB, Yazar FM, Kale İT, Yüzbaşıoğlu MF, Boran ÖF, Azak Bozan A. Delta Neutrophil Index and Neutrophil-to-Lymphocyte Ratio in the Differentiation of Thyroid Malignancy and Nodular Goiter. World J Surg 2020; 45:507-514. [PMID: 33067685 DOI: 10.1007/s00268-020-05822-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND It was aimed to evaluate the relationship between delta neutrophil index (DNI) and neutrophil-to-lymphocyte ratio (NLR) in the preoperative differentiation of nodular goiter and thyroid malignancy. METHODS Patients over the age of 18 who underwent thyroid surgery between November 2014 and November 2019 were evaluated in this retrospective cohort study. Patients were divided into two groups according to their pathology results: malignant (Group M) and benign (Group B) thyroid disorders. White blood cell (WBC) count, neutrophil count, lymphocyte count, IG count and DNI were measured using an automated hematological analyzer from blood samples obtained at the preoperative period and postoperative 6th month of the follow-up. Neutrophil-to-lymphocyte ratio (NLR) values were manually calculated. Numerical data are expressed as means ± standard deviations (minimum-maximum values) or medians (minimum-maximum values) according to the normal distribution. Categorical values are expressed as percentages (%). RESULTS A total of 243 patients (190 patients in Group B and 53 patients in Group M) who met the inclusion criteria were evaluated. The male/female ratio was 49/194. A statistically significant difference between Group M and Group B in terms of preoperative NLR, DNI and IG count was observed (p = 0.001, < 0.001 and < 0.001, respectively). No statistically significant difference was observed between the groups in terms of the control values performed in the postoperative period in terms of the NLR, DNI and IG count (p = 0.711, 0.333 and 0.714, respectively). A significant decrease was observed in the preoperative and postoperative DNIs, IG counts and NLRs in Group M (p = 0.009, < 0.001 and < 0.001, respectively). For the diagnosis of malignant thyroid diseases, the cut-off value of DNIs was ≥0.35%, and DNI sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 79.2%, 78.9%, 79.2% and 77.9%, respectively (area under the curve [AUC]: 0.847; confidence interval [CI]: 0.784-0.911). The cut-off value of the IG count was ≥25/mm3, and its sensitivity, specificity, PPV and NPV were 83%, 72.1%, 83%, and 72.1%, respectively (AUC: 0.847; CI: 0.784-0.911). CONCLUSION DNI and IG counts are cheap and easily accessible tests that can be automatically calculated from automated systems without additional cost in differentiation of thyroid malignancies from benign disorders in the preoperative period.
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Affiliation(s)
- Mehmet Buğra Bozan
- Faculty of Medicine, Department of Surgery, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey.
| | - Fatih Mehmet Yazar
- Faculty of Medicine, Department of Surgery, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - İlhami Taner Kale
- Faculty of Medicine, Department of Surgery, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Mehmet Fatih Yüzbaşıoğlu
- Faculty of Medicine, Department of Surgery, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Ömer Faruk Boran
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Ayşe Azak Bozan
- Department of Anesthesiology and Reanimation, Necip Fazıl State Hospital, Kahramanmaraş, Turkey
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Prabu NR, Patil VP. Is Immature Granulocyte Count a Potential Prognostic Marker for Upper Gastrointestinal Tract Bleeding? A New Road to Explore. Indian J Crit Care Med 2020; 24:750-752. [PMID: 33132553 PMCID: PMC7584830 DOI: 10.5005/jp-journals-10071-23606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
How to cite this article: Prabu NR, Patil VP. Is Immature Granulocyte Count a Potential Prognostic Marker for Upper Gastrointestinal Tract Bleeding? A New Road to Explore. Indian J Crit Care Med 2020;24(9):750-752.
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Affiliation(s)
- Natesh R Prabu
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Vijaya P Patil
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Macichová M, Grochová M, Rácz O, Firment J, Mitníková M, Rosenberger J, Šimonová J, Hudák V. Improvement of mortality prediction accuracy in critically ill patients through combination of SOFA and APACHE II score with markers of stress haematopoiesis. Int J Lab Hematol 2020; 42:796-800. [PMID: 32803866 DOI: 10.1111/ijlh.13308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/16/2020] [Accepted: 07/15/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In critically ill patients nucleated red blood cells (NRBC) and immature granulocytes (IG) appear in the peripheral blood as the consequence of stress haematopoesis. The aim of this retrospective study was to evaluate the diagnostic value of NRBC and IG and to propose a model of improved mortality prediction including these parameters in the assessment of critically ill patients. METHODS The study included 338 critically ill adult patients hospitalized at Department of Anaesthesiology and Intensive Medicine, Louis Pasteur University Hospital in Kosice. As NRBC positive patients were considered patients with peripheral NRBC > 0.01 × 109 /L and IG positivity as >0.03 × 109 /L. Apache II index was calculated 24 hours after admission and Systemic Organ Failure Assessment (SOFA) on the day with the worst clinical condition. RESULTS NRBC positivity was found in 27.6% of patients. The mortality of NRBC positive patients was 48.38%, significantly higher than 23.7% of NRBC negative patients. IG positivity was 79.0% and their mortality was also higher as compared with that of IG negative patients (69.3% vs 33.8%). Three regression models predicting mortality including stress haematopoiesis markers, APACHE II, SOFA scores and age had sufficient level of sensitivity and specificity. CONCLUSION The presence of NRBC in the peripheral blood and the IG increase are available early risk predictors of mortality in critically ill patients. Regression models designed by combination of SOFA, APACHE II, and the new haematological parameters increase the accuracy and effectivity of diagnostic process in predicting prognosis and risk of mortality with high sensitivity and specificity.
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Affiliation(s)
- Michaela Macichová
- Clinical Hematology Unit, Department of Laboratory Medicine, Louis Pasteur University Hospital, Košice, Slovakia
| | - Monika Grochová
- 1st Department of Anesthesiology and Intensive Medicine, Medical School, Louis Pasteur University Hospital, Šafárik University, Košice, Slovakia
| | - Oliver Rácz
- Medical School, Institute of Pathological Physiology, Šafárik University, Košice, Slovakia
| | - Jozef Firment
- 1st Department of Anesthesiology and Intensive Medicine, Medical School, Louis Pasteur University Hospital, Šafárik University, Košice, Slovakia
| | - Miriam Mitníková
- Clinical Hematology Unit, Department of Laboratory Medicine, Louis Pasteur University Hospital, Košice, Slovakia
| | | | - Jana Šimonová
- 1st Department of Anesthesiology and Intensive Medicine, Medical School, Louis Pasteur University Hospital, Šafárik University, Košice, Slovakia
| | - Vladimir Hudák
- 1st Department of Anesthesiology and Intensive Medicine, Medical School, Louis Pasteur University Hospital, Šafárik University, Košice, Slovakia
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Karakulak S, Narcı H, Ayrık C, Erdoğan S, Üçbilek E. The prognostic value of immature granulocyte in patients with acute pancreatitis. Am J Emerg Med 2020; 44:203-207. [PMID: 32220526 DOI: 10.1016/j.ajem.2020.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/16/2020] [Accepted: 03/16/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Acute pancreatitis is the inflammation of the pancreas. It can range from mild forms to life-threatening severe cases. There is not yet a marker that can detect severe cases in the early period. Early diagnosis and treatment of this disease has critical importance for prognosis. In this study, we aimed to investigate the percentage of immature granulocyte (IG %) in patients with acute pancreatitis in order to predict the severity of the disease and in-hospital mortality. METHOD This study was carried out retrospectively in academic emergency department (ED), faculty of medicine between 01.01.2017 and 30.06.2019. The patients were divided into three groups as mild, moderate and severe. In addition, the patients were divided into two groups: those discharged from the hospital and those who died in the hospital. IG % and other laboratory parameters of the patients were recorded in the study form. The primary outcome for this study is the value of IG% in predicting severity in AP patients. A receiver operating characteristic (ROC) curve analysis was performed. RESULTS A total of 218 patients (107 male) were included in the study. The mean age of the patients was 56.9 ± 18.3 years. It was found that IG% levels were higher in patients with severe pancreatitis (p = .018). In the ROC analysis that was done to determine the severity of the disease, the cut-off value of IG% was found as >1.1. As such case, specificity was %38.89, sensitivity was 95.00%, positive predictive value (PPV) was 41.18% and negative predictive value (NPV) was found as 94.53% (Area Under Curve (AUC) = 0.698). In ROC analysis that was performed to determine in-hospital mortality, the cut-off value of IG level was found as >1.8, sensitivity was 50.00%, specificity was 97.12%, PPV was 45.45% and NPV was found as 97.58% (AUC = 0.708). CONCLUSıONS: This study shows that higher IG% levels may correlate with higher disease severity and in-hospital mortality in patients with acute pancreatitis.
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Affiliation(s)
- Serkan Karakulak
- Mersin University, Faculty of Medicine, Department of Emergency Medicine, Mersin, Turkey
| | - Hüseyin Narcı
- Mersin University, Faculty of Medicine, Department of Emergency Medicine, Mersin, Turkey.
| | - Cüneyt Ayrık
- Mersin University, Faculty of Medicine, Department of Emergency Medicine, Mersin, Turkey
| | - Semra Erdoğan
- Mersin University, Faculty of Medicine, Department of Biostatistics, Mersin, Turkey
| | - Enver Üçbilek
- Mersin University, Faculty of Medicine, Department of Gastroenterology, Mersin, Turkey
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Abstract
The complete blood count has a longstanding role in the diagnosis of septic shock. Despite its limitations, this is a pragmatic tool because patients will generally have a blood count measured upon presentation to the hospital. Therefore, it is sensible to extract as much information from these values as possible. Although the white blood cell count continues to attract the most attention, it is the least useful. Emerging evidence suggests that emphasis should be shifted to the neutrophil to lymphocyte ratio (NLR) and perhaps the fraction of immune granulocytes.
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Affiliation(s)
- Joshua David Farkas
- Division of Pulmonary and Critical Care Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
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Rubio I, Osuchowski MF, Shankar-Hari M, Skirecki T, Winkler MS, Lachmann G, La Rosée P, Monneret G, Venet F, Bauer M, Brunkhorst FM, Kox M, Cavaillon JM, Uhle F, Weigand MA, Flohé SB, Wiersinga WJ, Martin-Fernandez M, Almansa R, Martin-Loeches I, Torres A, Giamarellos-Bourboulis EJ, Girardis M, Cossarizza A, Netea MG, van der Poll T, Scherag A, Meisel C, Schefold JC, Bermejo-Martín JF. Current gaps in sepsis immunology: new opportunities for translational research. THE LANCET. INFECTIOUS DISEASES 2019; 19:e422-e436. [DOI: 10.1016/s1473-3099(19)30567-5] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/30/2019] [Accepted: 08/06/2019] [Indexed: 12/18/2022]
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Shao SL, Cong HY, Wang MY, Liu P. The diagnostic roles of neutrophil in bloodstream infections. Immunobiology 2019; 225:151858. [PMID: 31836303 DOI: 10.1016/j.imbio.2019.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/15/2019] [Accepted: 10/15/2019] [Indexed: 12/21/2022]
Abstract
Bloodstream infections remain a leading cause of death worldwide, despite advances in critical care and understanding of the pathophysiology and treatment strategies. No specific biomarkers or therapy are available for these conditions. Neutrophils play a critical role in controlling infection and it is suggested that their migration and antimicrobial activity are impaired during sepsis which contribute to the dysregulation of immune responses. Recent studies further demonstrated that interruption or reversal of the impaired migration and antimicrobial function of neutrophils improves the outcome of sepsis in animal models. In this review, we provide an overview of the associated diagnostic biomarkers involved neutrophils in sepsis, and discuss the potential of neutrophils as a target to specifically predict the outcome of sepsis.
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Affiliation(s)
- Shu-Li Shao
- Department of Central Lab, Weihai Municipal Hospital Affiliated to Dalian Medical University, Weihai, Shandong, 264200, PR China
| | - Hai-Yan Cong
- Department of Central Lab, Weihai Municipal Hospital Affiliated to Dalian Medical University, Weihai, Shandong, 264200, PR China
| | - Ming-Yi Wang
- Department of Central Lab, Weihai Municipal Hospital Affiliated to Dalian Medical University, Weihai, Shandong, 264200, PR China.
| | - Peng Liu
- Department of Central Lab, Weihai Municipal Hospital Affiliated to Dalian Medical University, Weihai, Shandong, 264200, PR China.
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