Immature granulocytes predict severe acute pancreatitis independently of systemic inflammatory response syndrome

The role of immature granulocyte in the early prediction of gastrointestinal tract perforations

Background/Aim: Gastrointestinal system (GIS) perforations cause acute abdomen an indication for emergency intervention. Early detection is very important in gastrointestinal perforations to prevent mortality and morbidity. This study aimed to examine whether immature granulocyte (IG) and IG percentages (IG%) can be used as a simple and easy marker for identifying gastrointestinal system perforations early on. Methods: Between January 1, 2020, and January 1, 2022, 120 patients who presented to Hitit University Erol Olçok Training and Research Hospital's emergency service and underwent surgery on by the General Surgery Clinic with the diagnosis of the acute abdomen were investigated. The patients were divided into two groups. Patients in group 1 included those with peptic ulcers and bowel perforations. Group 2 was considered the control group. Of the 36 patients in group 2, 22 had acute appendicitis, 12 had ileus-related bridectomy or bowel resection, and two had acute cholecystitis. The common patient feature in this group was full-thickness or serosal iatrogenic bowel injury and repair. Pre-operative IG and IG% values were obtained from routine complete blood count values. IG and IG% values were compared between groups 1 and 2, and the predictive value of these biomarkers in the early diagnosis of GIS perforations was investigated. Results: The mean age of the patients was 55.49 (19.58). The study consisted of 45 (37.5%) female patients and 75 (62.5%) male patients. Group 1 had 84 patients, whereas Group 2 had 36. When the two groups were evaluated, the IG value was higher in Group 1 (P < 0.001). In terms of the percentage value of immature granulocytes, a statistically significant difference was found between Groups 1 and 2 (P = 0.001). As a result, Group 1's IG and IG% values were much greater than those in Group 2. Conclusion: IG and IG% values are inflammatory parameters that can be easily studied in routine hematology tests. According to this study, IG and IG% values were found to be higher in gastrointestinal tract perforations based on result blood tests taken at the time of admission to the emergency department.

The role of immature granulocyte in the early prediction of acute perforated and nonperforated appendicitis in children

BACKGROUND

Acute appendicitis (AA) is the most common reason for pediatric abdominal surgery in the world. Despite ad-vances in science and technology, diagnosing AA is still difficult today, and complications are common as a result. The early prediction of complicated appendicitis is of great importance for the surgical planning, further treatments, and predicting the course of disease. The immature granulocyte (IG) is a new and more effective marker in predicting the severity of inflammation than traditional markers. Our aim is to determine the effectiveness of IG% in the diagnosis and severity of AA.

METHODS

Eighty-eight patients diagnosed with AA and a control group of fifty-eight healthy children were included in this prospec-tive study. Patients with pathologically confirmed AA were divided into two subgroups: acute simple appendicitis (ASA) and acute perforated appendicitis (APA). The demographic characteristics, white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), IG%, and C-reactive protein (CRP) values were analyzed. Receiver operating characteristics (ROC) anal-ysis was used to compare the diagnostic accuracies and predictive performances.

RESULTS

Patients with AA had higher IG%, WBC count, NLR, and MPV value than control group (p=0.28, p=0.22, p<0.001, p=0.001, respectively). Only IG% showed statistically significant difference from other inflammatory markers evaluated in ASA and APA patients (p<0.001). ROC analysis showed that IG% is a good predictor for the presence of APA at an optimal cut-off for IG being 0.2% (sensitivity 81.8%, specificity 85.2%, area under the ROC curve 0.83).

CONCLUSION

In the present study, we demonstrated that AA patients with higher IG levels might be more likely to develop perforation. The IG values combined with a physical examination, imaging studies, and other laboratory tests may help clinicians to identify high-risk AA patients in the pediatric emergency department.

Leukocyte cell population data from the blood cell analyzer as a predictive marker for severity of acute pancreatitis

BACKGROUND

The prediction for severe acute pancreatitis (SAP) is the key to give timely targeted treatment. Leukocyte cell population data (CPD) have been widely applied in early prediction and diagnosis of many diseases, but their predictive ability for SAP remains unexplored. We aim to testify whether CPD could be an indicator of AP severity in the early stage of the disease.

METHODS

The prospective observational study was conducted in the emergency department ward of a territory hospital in Shanghai. The enrolled AP patients should meet 2012 Atlanta guideline.

RESULTS

Totally, 103 AP patients and 62 healthy controls were enrolled and patients were classified into mild AP (n = 30), moderate SAP (n = 42), and SAP (n = 31). Forty-two CPD parameters were examined in first 3 days of admission. Four CPD parameters were highest in SAP on admission and were constantly different among 3 groups during first 3 days of hospital stay. Eighteen CPD parameters were found correlated with the occurrence of SAP. Stepwise multivariate logistic regression analysis identified a scoring system of 4 parameters (SD_LALS_NE, MN_LALS_LY, SD_LMALS_MO, and SD_AL2_MO) with a sensitivity of 96.8%, specificity of 65.3%, and AUC of 0.87 for diagnostic accuracy on early identification of SAP. AUC of this scoring system was comparable with MCTSI, SOFA, APACHE II, MMS, BISAP, or biomarkers as CRP, PCT, and WBC in prediction of SAP and ICU transfer or death.

CONCLUSIONS

Several leukocyte CPD parameters have been identified different among MAP, MSAP, and SAP. They might be ultimately incorporated into a predictive system marker for severity of AP.

Hematological Indices Predicting the Severity of Acute Pancreatitis Presenting to the Emergency Department: A Retrospective Analysis

Introduction Acute pancreatitis is defined as inflammation of the pancreas. The body responds to inflammation by producing excessive neutrophils and causing programmed cell death of lymphocytes. This leads to immunological instability, which increases the severity of the disease and mortality rate. Recent data suggest that markers of systemic inflammation are able to predict the prognosis of various diseases. Our study aims to assess the severity of acute pancreatitis in conjunction with these hematological markers of systemic inflammation. Materials and methods Our study was carried out in the emergency medicine department of a tertiary care hospital among patients diagnosed with acute pancreatitis. It was a retrospective study done by reviewing the hospital's medical records. Hematological indices such as hemoglobin levels, packed cell volume (PCV), red blood cell (RBC) count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), total leukocyte count (TLC), neutrophil count, lymphocyte count, monocyte count, platelet count, neutrophil to lymphocyte count ratio (NLR), lymphocyte to monocyte ratio (LMR), and platelet to lymphocyte ratio (PLR) were observed to be associated with severity of pancreatitis. Those with computed tomography (CT) severity score >=7 were termed as severe pancreatitis, while those below 7 were considered mild to moderate. Results A total of 154 patients were included in the final analysis. The mean age of those patients was 48.47 ± 16.71 years. There were 94 male and 60 female patients. There was no difference found among the study groups with respect to mean hemoglobin levels, RBC count, PCV, MCV, MCH, MCHC, lymphocytes, and platelet counts. TLC (p<0.001), neutrophils (p<0.001), monocytes (p=0.008), NLR (p<0.001), and PLR (p=0.006) were found higher in severe pancreatitis, while LMR was found lower in severe pancreatitis (p=0.003). A linear relationship between the hematological indices and CT severity score has shown that TLC (p=0.015), neutrophils (p=0.005), NLR (p=0.001), and PLR (p<0.001) were positively correlated with severity while lymphocyte count (p=0.004) and LMR (p=0.005) were negatively correlated with severe pancreatitis. TLC and LMR were independent predictors of severe pancreatitis with an adjusted odds ratio of 12.80 and 5.47, respectively, on multivariable regression analysis. Conclusion Many markers correlated with the CT severity score, but few of them were able to demonstrate statistical significance on receiver operating characteristic (ROC) analysis.

High levels of reactive oxygen species in pancreatic necrotic fluid of patients with walled-off pancreatic necrosis

Introduction

Walled-off pancreatic necrosis (WOPN) is a life-threatening, late complication of acute pancreatitis, in which a fluid collection containing necrotic material is formed. Infection of the fluid collection significantly increases the mortality of patients with WOPN.

Aim

To examine the levels of oxidative stress markers in the pancreatic necrotic fluid (PNF) and serum of patients with sterile and infected WOPN.

Material and methods

Thirty-three adult patients with sterile WOPN and 14 with infected WOPN, as well as 31 patients with mild AP, were included in this study. Concentrations of oxidative stress markers (8-isoprostane, protein carbonyl groups, and 8-hydroxyguanine) were measured in the PNF and serum of patients with sterile and infected WOPN.

Results

High concentrations of all measured oxidative stress markers in PNF, but not in serum, were detected in patients with WOPN. Additionally, oxidative stress markers in PNF were significantly increased in patients with infected as compared to sterile WOPN. The serum high sensitive C-reactive protein (hsCRP) concentrations showed the highest correlation with PNF oxidative stress marker levels. Receiver operating characteristics (ROC) curve analysis confirmed that serum hsCRP could be a good predictor of WOPN infection.

Conclusions

Oxidative stress is associated with WOPN development; infection of PNF worsens the course of WOPN, possibly via increased production of reactive oxygen species; and serum hsCRP concentrations seem to be a good, noninvasive indicator of PNF infection.

New markers in predicting the severity of acute pancreatitis in the emergency department: Immature granulocyte count and percentage

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.

Is Immature Granulocyte Count a Potential Prognostic Marker for Upper Gastrointestinal Tract Bleeding? A New Road to Explore

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.

Dexamethasone inhibits NF‑кBp65 and HMGB1 expression in the pancreas of rats with severe acute pancreatitis

Severe acute pancreatitis (SAP) starts as a local inflammation of pancreatic tissue that induces the development of multiple extra-pancreatic organ dysfunction; however, the underlying mechanisms remain unclear. The present study was designed to evaluate the effect of dexamethasone (DXM) on pancreatic damage and to investigate the role of high-mobility group box-1 (HMGB1) and nuclear factor-κB (NF-κBp65) in the development of SAP in animal and cell models. For the in vivo experiment, 35 Sprague-Dawley rats were randomly assigned to three groups: The sham-operation control group, the SAP group and the DXM treatment group. Histological analysis revealed that, when DXM was infused into SAP rats, edema formation and structural alterations with necrosis were reduced, and the number of apoptotic cells was markedly reduced. In addition, compared with the SAP group, the expression level of HMGB1 was significantly decreased in the nucleus and the expression level of NF-κBp65 was significantly decreased in the cytoplasm from rats treated with DXM. In vitro, DXM was able to suppress the apoptosis and cell death induced by caerulein (CAE), and DXM could suppress the expression of NF-κBp65 and HMGB1 induced by CAE, as demonstrated by western blotting and immunofluorescence analysis. Therefore, these results provide an experimental basis for investigating the underlying therapeutic mechanisms of DXM treatment for SAP.

Update on the effect of age on acute pancreatitis morbidity: a retrospective, single-center study

Introduction

Acute pancreatitis (AP) is one of the urgent diseases of gastroenterology. Due to the growth of the elderly population, the frequency of the disease in the elderly population is also increasing.

Aim

To evaluate the contributing factors of mortality in geriatric patients (age ≥ 65 years) and non-geriatric (age < 65 years) patients.

Material and methods

We retrospectively analyzed data of consecutive patients with AP, in the Adana Numune Education and Research Hospital between March 2013 and September 2015.

Results

Of the 602 patients studied, 405 were female and 197 were male and their mean age was 55.2 ±19.5 years. The most common etiological factors were biliary stone, hyperlipidemia and alcohol, respectively. Two hundred and four patients were in the geriatric group and 394 patients were in the non-geriatric group. 84.4% of patients had mild AP, and 15.6% of patients had moderate to severe AP according to the revised Atlanta classification. 91.7% of non-geriatric patients had mild AP while 70.7% of geriatric patients had mild AP (p < 0.001). 29.4% of geriatric patients had moderate-to-severe AP while 8.4% of non-geriatric patients had moderate-severe AP. Duration of hospital stay was 6.2 ±3 days and 5.3 ±2.3 days in geriatric and non-geriatric groups respectively (p < 0.001). Mortality was higher in the geriatric group than the non-geriatric group (9.6% vs. 0.5%, respectively) (p < 0.001).

Conclusions

Acute pancreatitis in the geriatric population shows a more severe course than the non-geriatric population. Geriatric patients have longer duration of hospital stay and higher mortality than non-geriatric patients.

Endoscopic intervention combined with somatostatin for treatment of patients with severe acute pancreatitis: Impact on clinical symptoms and relative biochemical indexes

AIM

To evaluate the effect of endoscopic intervention combined with somatostatin on clinical symptoms and biochemical indexes in patients with severe acute pancreatitis (SAP).

METHODS

One hundred and forty-eight patients with SAP treated from January 2015 to June 2016 at the Jiaxing First Hospital were divided into either an observation group or a control group. Both groups were given conventional therapy. The control group was given somatostatin infusion therapy, and the observation group was given endoscopic intervention combined with somatostatin artery perfusion therapy. Clinical symptoms, serum inflammatory factors, gastrointestinal hormones, and complications were compared between the two groups.

RESULTS

Times to remission of abdominal pain, high fever, and signs of peritoneal irritation were significantly shorter in the observation group than in the control group (t = 10.720, 8.226, 11.840, and 9.143, respectively; P < 0.05 or 0.01). Serum levels of interleukin-8, hypersensitive C-reactive protein, and tumor necrosis factor α were significantly lower in the observation group than in the control group (t = 17.509, 20.189, and 14.847, respectively; P < 0.01). Serum levels of vasoactive intestinal peptide and gastrin were significantly lower and that of motilin was significantly higher in the observation group than in the control group (t = 14.586, 11.374, and 7.126, respectively; P < 0.05 or 0.01). The incidence of pancreatic or surrounding tissue necrosis, pancreatic fistula, pancreatic abscess, and pancreatic pseudocyst was significantly lower in the observation group than in the control group (χ² = 7.306, 7.955, 8.976, and 5.049, respectively; P < 0.05 or 0.01).

CONCLUSION

Endoscopic intervention combined with somatostatin can help relieve the inflammatory response, modulate gastrointestinal function, improve the clinical symptoms, and reduce complications in patients with SAP.