Inflammation marker ESR is effective in predicting outcome of diffuse large B-cell lymphoma

Predictive Value of Corrected 18 F-FDG PET/CT Baseline Parameters for Primary DLBCL Prognosis: A Single-center Study

Objective  The purpose of this study was to evaluate the prognostic significance of corrected baseline metabolic parameters in fluorodeoxyglucose positron emission tomography imaging ( 18 F-FDG PET/CT) for 3-year progression-free survival (PFS) in patients with primary diffuse large B cell lymphoma (DLBCL). Patients and Methods  Retrospective clinical and pathological data were collected for 199 patients of DLBCL diagnosed between January 2018 and January 2021. All patients underwent 18 F-FDG PET/CT scans without any form of treatment. The corrected maximum standardized uptake value (corSUVmax), corrected mean standardized uptake value (corSUVmean), corrected whole-body tumor metabolic volume sum (corMTVsum), and corrected total lesion glycolysis of whole body (corTLGtotal) were corrected using the SUVmean in a 1-cm diameter mediastinal blood pool (MBP) from the descending thoracic aorta of patients. Kaplan-Meier survival curves and Cox regression were used to examine the predictive significance of corrected baseline metabolic parameters on 3-year PFS of patients. The incremental values of corrected baseline metabolic parameters were evaluated by using Harrell's C-indices, receiver operating characteristic, and Decision Curve Analysis. Results  The multivariate analysis revealed that only the National Comprehensive Cancer Network (NCCN)-International Prognostic Index (IPI) and corMTVsum had an effect on 3-year PFS of patients ( p  < 0.05, respectively). The Kaplan-Meier survival analysis demonstrated significant differences in PFS between the risk groups classified by corSUVsum, corMTVsum, and corTLGtotal (log-rank test, p  < 0.05). The predictive model composed of corMTVsum and corTLGtotal surpasses the predictive performance of the model incorporating MTVsum and TLGtotal. The optimal performance was observed when corMTVsum was combined with NCCN-IPI, resulting in a Harrell's C index of 0.785 and area under the curve values of 0.863, 0.891, and 0.947 for the 1-, 2-, and 3-year PFS rates, respectively. Conclusion  The corMTVsum offers significant prognostic value for patients with DLBCL. Furthermore, the combination of corMTVsum with the NCCN-IPI can provide an accurate prediction of the prognosis.

The Role of Erythrocyte Sedimentation Rate (ESR) in Myeloproliferative and Lymphoproliferative Diseases: Comparison between DIESSE CUBE 30 TOUCH and Alifax Test 1

(1) Background: The erythrocyte sedimentation rate (ESR) is widely diffused in hematology laboratories to monitor inflammatory statuses, response to therapies (such as antibiotics), and oncologic diseases. However, ESR is not a specific diagnostic marker but needs to be contextualized and compared with clinical and other laboratory findings. This study aimed to investigate the performance of two automated instruments, namely the DIESSE CUBE 30 TOUCH (DIESSE, Siena, Italy) and the Alifax Test 1 (Alifax Srl, Polverara, Italy), in comparison with the gold standard, the Westergren method, in lymphoproliferative and myeloproliferative patients. (2) Methods: 97 EDTA samples were selected from the hematology department of Roma Tor Vergata Hospital and analyzed. Statistical analysis was applied. (3) A good correlation between CUBE 30 TOUCH and the gold standard was observed in the overall sample (R2 = 0.90), as well as in patients with lymphoproliferative diseases (R2 = 0.90) and myeloproliferative diseases (R2 = 0.90). The correlation between Test 1 and the gold standard was observed in the overall sample (R2 = 0.68), as well as in patients with lymphoproliferative diseases (R2 = 0.79) and myeloproliferative diseases (R2 = 0.53). (4) Conclusions: The CUBE 30 TOUCH appears to be a more trustworthy tool for evaluating ESR in these pathologies.

Effect of storage temperature and time on erythrocyte sedimentation rate

Objective

This paper explores the effect of blood sample storage temperature and time on the erythrocyte sedimentation rate (ESR) by using the Weiss method.

Methods

Whole blood samples were collected from 80 patients and diluted 1:9 with sodium citrate solution. Each sample was split into two tubes. Using the Weiss method, ESR was tested within 1 h of collection, and one sample was placed at 4 °C and the other at room temperature (23 ± 2 °C). ESR was then measured at 2, 4, 6, 8, 12, and 24 h. The data were statistically analyzed with consideration for temperature and time.

Results

ESR decreased gradually over 6 h at room temperature, but the results were not statistically significant. Similarly, there was no significant difference in the decline of ESR within 8 h at 4 °C. However, ESR results decreased significantly after the samples were stored at room temperature for more than 6 h or at 4 °C for more than 8 h. ESR reduction was lower in the samples stored at 4 °C than in those stored at room temperature over the same time period.

Conclusion

Blood sample storage temperature and duration can affect the measurement of ESR using the Weiss method. ESR testing should be completed within 4 h of sample collection in clinical work.

Erythrocyte sedimentation rate, C-reactive protein, and interleukin-6 as inflammatory biomarkers in dogs naturally infected with Ehrlichia canis

Background and Aim

Canine monocytotropic ehrlichiosis (CME), a tick-borne disease, leads to a systemic inflammatory response syndrome; it is thus important to assess the intensity of inflammation in order to treat it appropriately. The current study was designed to evaluate hematological, biochemical, and inflammatory parameters in dogs naturally infected with Ehrlichia canis compared with those in healthy dogs. We also assessed the relationship among several inflammation-related parameters and considered these parameters for use as inflammatory biomarkers of CME.

Materials and Methods

Twenty-eight dogs were divided into two groups based on the results of nested polymerase chain reaction for detecting E. canis, comprising a healthy group (n=11) and an infected group (n=17). A blood sample was collected from each dog to evaluate hematological, biochemical, and inflammatory parameters, with the obtained results being statistically compared between the groups. Moreover, the correlations of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin-6 (IL-6) were investigated in the 28 dogs.

Results

In the infected group, the mean levels of red blood cells, hemoglobin, and hematocrit were significantly lower than in the healthy group, while the mean lymphocyte and monocyte counts were higher. The mean levels of ESR and CRP were significantly higher (p<0.05) in the infected group, whereas no significant differences were found in IL-6 levels between the two groups. In the correlation analysis, ESR and CRP levels were highly correlated (p<0.01, r=0.531).

Conclusion

Elevated ESR and CRP levels were found in dogs naturally infected with E. canis, which also presented mild to moderate inflammation in this study. Moreover, CRP was significantly correlated with ESR, so ESR and CRP may serve as inflammatory biomarkers for monitoring CME.

The prognostic significance of erythrocyte sedimentation rate in COVID-19

OBJECTIVE

There are limited data about the significance of erythrocyte sedimentation rate as a single prognostic parameter for the prognosis and mortality of COVID-19. This study aimed to investigate the diagnostic utility of erythrocyte sedimentation rate as a prognostic factor for the disease severity and mortality in patients with COVID-19.

METHODS

A total of 148 consecutive patients with a confirmed diagnosis of COVID-19 and hospitalized at the intensive care unit or non-the intensive care unit were included in the study. The patients were allocated to groups as severe/critical disease versus nonsevere disease and survivors and nonsurvivors. The prognostic role and predictable values of erythrocyte sedimentation rate were analyzed.

RESULTS

Erythrocyte sedimentation rate was found to be higher among patients with severe/critical disease compared to those with nonsevere disease (p<0.001) and among nonsurvivors compared to survivors (p<0.001). The logistic regression analysis showed that erythrocyte sedimentation rate was an independent parameter for predicting disease severity and mortality. The role of erythrocyte sedimentation rate in the assessment of severity and mortality in patients with COVID-19 was analyzed using the receiver operating characteristic curve and was found to be significant in both. The analyses suggested that the optimum erythrocyte sedimentation rate cutoff point for disease severity and mortality were 52.5 mm/h with 65.5% sensitivity and 76.3% specificity and 56.5 mm/h with 66.7% sensitivity and 72.5% specificity.

CONCLUSION

Our results suggest that erythrocyte sedimentation rate was an independent prognostic factor for severity and mortality in patients with COVID-19.

The dynamics of inflammatory markers in coronavirus disease-2019 (COVID-19) patients: A systematic review and meta-analysis

BACKGROUND

Coronavirus disease-2019 (COVID-19) is a global pandemic and high mortality rate among severe or critical COVID-19 is linked with SARS-CoV-2 infection-induced hyperinflammation of the innate and adaptive immune systems and the resulting cytokine storm. This paper attempts to conduct a systematic review and meta-analysis of published articles, to evaluate the association of inflammatory parameters with the severity and mortality in COVID-19 patients.

METHODS

A comprehensive systematic literature search of medical electronic databases including Pubmed/Medline, Europe PMC, and Google Scholar was performed for relevant data published from January 1, 2020 to June 26, 2020. Observational studies reporting clear extractable data on inflammatory parameters in laboratory-confirmed COVID-19 patients were included. Screening of articles, data extraction and quality assessment were carried out by two authors independently. Standardized mean difference (SMD)/mean difference (MD/WMD) and 95% confidence intervals (CIs) were calculated using random or fixed-effects models.

RESULTS

A total of 83 studies were included in the meta-analysis. Of which, 54 studies were grouped by severity, 25 studies were grouped by mortality, and 04 studies were grouped by both severity and mortality. Random effect model results demonstrated that patients with severe COVID-19 group had significantly higher levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-2R (IL-2R), serum amyloid A (SAA) and neutrophil-to-lymphocyte ratio (NLR) compared to those in the non-severe group. Similarly, the fixed-effect model revealed significant higher ferritin level in the severe group when compared with the non-severe group. Furthermore, the random effect model results demonstrated that the non-survivor group had significantly higher levels of CRP, PCT, IL-6, ferritin, and NLR when compared with the survivor group.

CONCLUSION

In conclusion, the measurement of these inflammatory parameters could help the physicians to rapidly identify severe COVID-19 patients, hence facilitating the early initiation of effective treatment.

PROSPERO REGISTRATION NUMBER

CRD42020193169.

Classifying 2-year recurrence in patients with dlbcl using clinical variables with imbalanced data and machine learning methods

BACKGROUND

Treatments are limited for patients with relapsed/refractory Diffuse large B-cell lymphoma (DLBCL), and their survival rate is low. Prediction of the recurrence hazard for each patient could provide a reference regarding chemotherapy regimens for clinicians to extend patients' period of long-term remission. As current strategies cannot satisfy such need, we have established predictive models to classify patients with DLBCL with complete remission who had recurrences in 2 years from ones who did not.

METHODS

We assessed 518 patients with DLBCL and measured 52 variables of each patient. They were treated between January 2011 and July 2016. 17 variables were first selected by variable selection methods (including Lasso, Adaptive Lasso, and Elastic net). Then, we set classifiers and probability models for imbalanced data by combining the SMOTE sampling, cost-sensitive, and ensemble learning (consisting of AdaBoost, voting strategy, and Stacking) methods with the machine learning methods (Support Vector Machine, BackPropagation Artificial Neural Network, Random Forest), respectively. Last, assessed their performance.

RESULTS

The disease stage and other 5 variables are significant indicators for recurrence. The SVM with AdaBoost ensemble learning method modeling by SMOTE data performs the best (Sensitivity=97.3%, AUC=96%, RMSE=19.6%, G-mean=96%) in all classifiers. The SVM with AdaBoost method(AUC=98.7%, RMSE=17.7%, MXE=12.7%, Cal mean=3.2%, BS0=2.5%, BS1=4%, BSALL=3.1%) and random forest (AUC=99.5%, RMSE=19.8%, MXE=16.2%, Cal mean=9.1%, BS0=4.8%, BS1=2.9%, BSALL=3.9%) both modeling by SMOTE sampling data perform well in probability models.

CONCLUSIONS

This predictive model has high accuracy for almost all DLBCL patients and the six indicators can be recurrence signals.

Association of inflammatory markers with the severity of COVID-19: A meta-analysis

Objectives

Studies reported associations of inflammatory markers with the severity of COVID-19, but conclusions were inconsistent. We aimed to provide an overview of the association of inflammatory markers with the severity of COVID-19.

Methods

We searched PubMed, Embase, Cochrane Library, Wanfang and China National Knowledge Infrastructure (CNKI) database until March 20, 2020. Weighted mean difference (WMD) and 95% confidence intervals (CIs) were pooled using random or fixed-effects models.

Results

A total of 16 studies comprising 3962 patients with COVID-19 were included in our analysis. Random-effect results demonstrated that patients with COVID-19 in the nonsevere group had lower levels for CRP (WMD = −41.78 mg/l, 95% CI = [−52.43, −31.13], P < 0.001), PCT (WMD = −0.13 ng/ml, 95% CI = [−0.20, −0.05], P < 0.001), IL-6 (WMD = −21.32 ng/l, 95% CI = [−28.34, −14.31], P < 0.001), ESR (WMD = −8 mm/h, 95% CI = [−14, −2], P = 0.005), SAA (WMD = −43.35 μg/ml, 95% CI = [−80.85, −5.85], P = 0.020) and serum ferritin (WMD = −398.80 mg/l, 95% CI = [−625.89, −171.71], P < 0.001), compared with those in the severe group. Moreover, survivors had a lower level of IL-6 than non-survivors (WMD = −4.80 ng/ml, 95% CI = [−5.87, −3.73], P < 0.001). These results were consistent through sensitivity analysis and publication bias assessment.

Conclusions

The meta-analysis highlights the association of inflammatory markers with the severity of COVID-19. Measurement of inflammatory markers might assist clinicians to monitor and evaluate the severity and prognosis of COVID-19.