Immature granulocytes as novel blood-based biomarkers forbrain tumours: Aprospective case-control study.

Background:This study aimed to investigate the utility of immature granulocyte count and percentage on the prediction of suspected acute appendicitis according to the Alvarado scoring system and its effect on the need for computed tomography scanning.Methods:Adult patients who had an Alvarado scoring system between 4 and 7 with the first imaging technique computed tomography were included and retrospectively analyzed. The immature granulocyte count and granulocyte percentage were obtained from the blood samples taken at the time of the patient’s first admission to the hospital.Results:A total of 652 patients were evaluated and 186 patients were included in the study. Acute appendicitis was not detected in computed tomography imaging of 121 (65%) patients (group N) and detected in 65 (35%) patients (group P). The mean immature granulocyte percentage in group N and group P were 0.314 ± 0.188 (0.00-1.40) and 0.364 ± 0.205 (0.05-1.00), respectively. The mean immature granulocyte percentage was similar between groups (P = .095). The mean immature granulocyte count was 33 ± 46/µL (0-50) in group N and 60 ± 85/µL (10-690) in group P. Immature granulocyte count was significantly higher in group P (P = .005). Univariate analysis results revealed that age and immature granulocyte percentage were not predictive factors for the presence of acute appendicitis in suspected cases (P > .05). On the other hand white blood cell, neutrophil–lymphocyte ratio, C-reactive protein, and immature granulocyte count were determined as predictive factors in univariate analysis and multivariate analysis. Receiver operating characteristic curve analysis of preoperative immature granulocyte percentage and immature granulocyte count values in the diagnosis of acute appendicitis: the cut-off value of immature granulocyte percentage was ≥0.35 and its sensitivity, specificity, positive predictive value, and negative predictive value were 44.1%, 72.1%, 71.1%, and 41.5%, respectively (area under the curve: 0.588; CI: 0.484-0.682). The cut-off value of immature granulocyte count was ≥35/µL and its sensitivity, specificity, positive predictive value, and negative predictive value were 66.1%, 73.6%, 71.9%, and 67.7%, respectively (area under the curve: 0.743; CI: 0.659-0.827)Conclusion:Immature granulocyte count is a predictive factor for acute appendicitis in patients with the middle-risk group according to the Alvarado score and may be useful for the selective use of tomography.

SummaryBackgroundMean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have all been investigated as novel inflammatory markers of cardiac and oncological diseases, while there is only a limited number of studies investigating these markers in chronic obstructive pulmonary disease (COPD). In the present study we examine NLR, PLR; and other markers, such as eosinophil, MPV, plateletcrit (PCT), platelet distribution width (PDW), red cell distribution width (RDW), and C-reactive protein (CRP) in patients with stable and acute exacerbation of COPD.MethodsStable COPD (Group 1, n=140), COPD with acute exacerbation (Group 2, n=110), and healthy controls (Group 3, n=50) were included in the study. Leukocyte, CRP, hemoglobin (HB), RDW, platelet, MPV, PCT, PDW, neutrophil, lymphocyte, eosinophil, NLR, and PLR were analyzed in all groups.ResultsHB, leukocyte, platelet, neutrophil, eosinophil, MPV, PCT, CRP, NLR, and PLR were significantly higher, while the lymphocyte was lower in Group 1 than in Group 3. Leukocyte, neutrophil, RDW, CRP, NLR, and PLR were significantly higher, while lymphocyte was lower in Group 2 than in Group 3. Leukocyte, neutrophil, RDW, CRP, NLR, and PLR were significantly higher, while HB, platelet, MPV, PCT, and lymphocyte were significantly lower in Group 2 than in Group 1. NLR and PLR increased significantly in patients with bronchiectasis when compared to those without in Group 1.ConclusionsOur study results suggest that NLR, PLR and RDW can be used as simple and cost-effective markers for the evaluation of severity of exacerbation and for predicting hospitalization and further exacerbations in patients with COPD.

BackgroundBrucellosis is still endemic in many developing countries and frequently leads to misdiagnosis and treatment delays. Indirect inflammatory markers such as mean platelet volume (MPV), platelet distribution width (PDW), red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been identified as markers of inflammation. The present study aimed to evaluate and compare the levels of these markers for prognostic purposes, and to assess the correlation of C-reactive protein (CRP) with brucellosis in adults and children.MethodsThe study included 137 adults and 141 age- and gender-matched healthy controls, as well 71 children and 81 age- and gender-matched healthy controls. Hematological parameters and CRP were retrospectively recorded and compared between the adult and pediatric patients.ResultsThe mean age of the adult patients (54% female) was 43.1 ± 15.4 years, whereas the mean age of the pediatric patients (50.7% male) was 9.5 ± 3.6 years. Significantly higher lymphocyte count, and lower neutrophil count, platelet count, RDW, MPV, NLR and PLR values were found in adult brucellosis patients compared with their healthy subjects, whereas higher lymphocyte count, PDW and lower neutrophil count, platelet count, MPV, NLR and PLR values were observed in pediatric brucellosis patients compared with the control subjects. Significantly higher neutrophil count (p=0.019) and NLR (p<0.001) were found in adult patients compared with the pediatric patients. Positive correlation was found between CRP and NLR (R2 = 0.052, P = 0.011), PLR (R2 = 0.061, P = 0.006) in adult patients.ConclusionBased on our findings, we consider that the use of complementary indirect markers such as MPV, NLR, PLR and RDW together with the CRP test – which is used concomitantly with serological diagnostic tests in situations where brucellosis is suspected – might be helpful in the diagnosis and follow-up of brucellosis, as well as in the evaluation of complications and response to therapy, in both adult and pediatric brucellosis patients.DisclosuresAll authors: No reported disclosures.

Objective: A complex inflammatory response forms against the local effects of malignancy. In the differentiation of colorectal cancer from benign colorectal polypoid lesions, inflammatory biomarkers such as platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), and Red Cell Distribution Width (RDW) have previously provided promising results. This study aimed to investigate the results of immature granulocytes (IG) and as yet unstudied biomarkers such as nucleated red blood cells (NRBC), platelet distribution width (PDW), and Mean Platelet Volume (MPV) with new inflammatory indexes such as the RDW-lymphocyte ratio (RDWLR) and the PDW-lymphocyte ratio (PDWLR). Material and Method: The hematological biomarkers were compared between 269 patients with colorectal benign polyps and 57 patients with colorectal adenocarcinoma. To determine the sensitivity and specificity of the biomarkers related to the neoplastic characteristics of the colorectal polyps, the Receiver Operating Characteristics (ROC) curve analysis was performed. Results: The mean NRBC count, IG count, and rates were similar in both groups. In the colorectal carcinoma group, PDW was lower (p=0.004) and RDW was higher (p=0.018). The NLR, PLR, RDWLR, and PDWLR values were significantly higher in the colorectal carcinoma group (p

Behçet's Disease (BD) is a polygenic and chronic autoinflammatory multisystemic vasculitis disease characterised by mucocutaneous, musculoskeletal, neurological, gastrointestinal and ophthalmologic lesions. There has been no specific test or serum marker to measure and determine the diagnosis and severity of BD. The study aimed to investigate the diagnostic performance of haematological parameters as MLR (monocyte to lymphocyte ratio), NLR (neutrophil to lymphocyte ratio), PLR (platelet to lymphocyte ratio), MPV (mean platelet volume), MPVPR (mean platelet volume to platelet ratio), LMR (lymphocyte to monocyte ratio), LPM (lymphocyte and platelet multiplication), WLP (lymphocyte and leukocyte multiplication), RDW (red blood cell distribution width) and PCT (plateletcrit) in BD and compare these with disease activity and clinical findings. A total of 266 participants (49 healthy control and 217 BD patients) were recruited from the rheumatology department in a single-centre as a case-control study. The laboratory data were obtained from the electronic registration database. BD Activity scores (BDCAF/Behcet's Disease Current Activity Form) were calculated. Laboratory findings of BD patients and healthy controls were compared and evaluated. RDW, Platelet, PCT, NLR and PLR values were significantly higher in patient group than in the healthy controls. However, haemoglobin, MPVPR and LMR were significantly lower in the patient group which compared with the healthy controls. LPM in BD with genital ulcers, WLP in BD with genital ulcers and arthritis, MPR in BD with uveitis, RDW in BD with thrombosis and neuro-Behçet's disease (NBD), PLR in NBD were observed to be higher. However, LMR in NBD and MPV in BD with thrombosis were lower than those without. There was a positive correlation between BDCAF score and RDW, and NLR. Haemoglobin, RDW, Platelet, PCT, NLR, LMR, PLR and MPVPR were statistically significant predictors for BD. RDW, PCT and NLR are the most valuable predictors for BD.

Hematologic parameters and disease activity in patients with primary Sjögren's syndrome

PURPOSE:Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), platelet distribution width (PDW), red cell distribution width (RDW), mean platelet volume (MPV), and plateletcrit (PCT) are known as systemic inflammatory response markers. In this study, we aimed to evaluate changes in NLR, PLR, PDW, RDW, MPV, and PCT in preeclampsia (PE) and their use in predicting its severity.MATERIALS AND METHODS:This is a retrospective case–control study. The study comprised 64 control group (healthy pregnant females), 51 females with mild PE, and 13 with severe PE. These three groups were compared with demographic data and inflammation markers.RESULTS:There were no statistically significant differences between healthy pregnant females and preeclaptic females in terms of median age, hemoglobin, lymphocyte, neutrophil, platelet, NLR, PLR, PDV, RDW, MPV, PCT (P > 0.05). The control group has a higher number of gravity and parity than the PE group (P < 0.001). MPV value is a lower PE group than the control group (P < 0.001). Both gravity and parity were significantly higher in the patients with mild PE than in the control group (P < 0.001). MPV value was statistically higher in the control group compared both mild and severe PE (P < 0.001), however, no statistical difference between mild and severe PE (P = 0.305).CONCLUSIONS:MPV may be clinically useful markers in the prediction of PE. Further, prospective multicenter studies are needed to reveal the association between these markers and PE.

Objective: In our study, we aimed at determining the levels of Gamma Glutamyl Transferase (GGT), Mean PlateletVolume (MPV), Red Cell Distribution Width (RDW), Neutrophile/Lymphocyte Ratio (NLR), as well as severity ofischemic stroke and prognosis comparison, including the instructive parameters in ischemic stroke treatment, for thepatients with ischemic stroke diagnosis.Methods: This retrospective study was carried put with 473 patients diagnosed with ischemic stroke.40 healthyindividuals that meet the requirements with respect to gender and age criteria were included in the study as thecontrol group. The NLR, RDW, MPV, GGT values checked when the cases applied were analyzed with regards to theirrelation with mortality.Results: The mean GGT, MPV, RDW, NLR values within the patient group were identified to be significantly high withregards to statistical aspect, compared to the control group. GGT, MPV, RDW, NLR values in all the groups were foundto be higher than the control group in line with TOAST and OCSP classifications. Along with the increasing NIHSS anddecreasing GKS values, an increase was detected in GGT, MPV, RDW, NLR values. GGT, MPV, RDW and NLR valueswere significantly higher in the patients who lost their lives compared to the surviving patients, with regards tostatistical aspect.Conclusion: We are of opinion that the prognosis and mortality prediction can be performed in patients with ischemicstroke, thanks to GGT, MPV, RDW, NLR values that are easy to Access and inexpensive blood parameters.

To the Editor: We have read the article entitled, Association between Red Blood Cell Distribution Width (RDW) and Coronary Artery Calcification in Patients Undergoing 64-Multidetector Computed Tomography by Gurel et al.1) They aimed to determine whether the RDW measures are associated with the coronary artery calcification score (CACS) in patients who did not present with obvious coronary artery disease (CAD). They concluded that the RDW is an independent predictor of the CACS, suggesting that it might be a useful marker for predicting CAD. This study provides important information on this clinically relevant condition. Inflammation is a significant feature of the arteriosclerotic process, and some novel inflammatory indicators have been shown in any stage of the arteriosclerotic process.2) Complete blood count has several routinely available markers that can indicate inflammatory status. At present, many studies concluded that parameters like neutrophil-lymphocyte ratio, RDW, mean platelet volume levels were higher in patients with inflammatory diseases compared with controls.2),3),4) RDW indicates the variability in the size of circulating erythrocytes and is expressed as the coefficient of variation of the erythrocyte volume. Recently, a number of studies have reported that RDW levels, which may be related to subclinical inflammation, are increased in many inflammatory diseases.5) Furthermore, some studies reported that RDW levels were independently associated with mortality in both the general population and in patients with certain diseases. However, some conditions should be considered when RDW levels are evaluated. RDW can reflect ethnicity, neurohumoral activation, renal dysfunction, thyroid disease, nutritional deficiencies (i.e. iron, vitamin B12, and folic acid), bone marrow dysfunction, inflammatory diseases, chronic or acute systemic inflammation6) and use of some drugs.7) The correlation with bilirubin could also be due to hepatic dysfunction and excessive alcohol intake, resulting in macrocytosis and increased RDW. Also, it would be better if the authors might define how much time they specified on measuring RDW levels, because delaying blood sampling can lead to abnormal results in RDW assessments.8) In conclusion, we strongly believe that the findings obtained from the current study will lead to further studies assessing the relationship between RDW and CAD. Finally, not only RDW but also mean platelet volume, neutrophil lymphocyte ratio, platelet distribution width, RDW- lymphocyte ratio are easy methods for predicting cardiovascular disease in patients.9) These markers might be useful in clinical practice.10)

The prevalence of thyroid carcinoma is increasing, and papillary thyroid carcinoma (PTC) is the most frequent subtype. More and more attention is being concentrated on the association between inflammation indicators and malignant tumors. The aim of the present study was to analyze whether the preoperative red blood cell distribution width (RDW) and platelet parameters, including mean platelet volume (MPV) and platelet distribution width (PDW), can be applied to distinguish between patients with PTC or papillary thyroid microcarcinoma (PTMC) and healthy controls, and to explore the associations with clinicopathological characteristics. The study retrospectively compared the RDW, MPV and PDW values of 780 patients with PTC or PTMC against a healthy control group. Receiver operating characteristic (ROC) curves were conducted to determine diagnostic accuracy. Furthermore, the clinicopathological features of the patients with PTC or PTMC were compared between higher and lower platelet parameter groups based on the RDW, MPV and PDW values. Significantly higher preoperative RDW, MPV and PDW values were found in patients with PTC or PTMC compared with those of the healthy group. ROC curve analysis showed that the area under the curve (AUC) plus 95% confidence interval (95% CI) values of RDW, MPV and PDW were 0.808 (0.780-0.835), 0.771 (0.743-0.799) and 0.711 (0.681-0.742), respectively. When RDW and MPV were combined together, the AUC (95% CI) value was enhanced to 0.858 (0.835-0.881) for the patients with PTC. For the patients with PTMC, RDW, MPV and PDW had AUC (95% CI) values of 0.812 (0.783-0.840), 0.779 (0.749-0.808) and 0.718 (0.685-0.751), respectively. When RDW and MPV were combined together, the AUC (95% CI) value was enhanced to 0.858 (0.835-0.881). A higher RDW was significantly associated with being female, deeper tumor infiltration, and normal FT3 and FT4 levels. A higher PDW was significantly associated with elevated thyrotropin receptor antibody levels. In conclusion, as convenient and available inflammation indicators, RDW, PDW and MPV have diagnostic ability and can distinguish between patients with PTC or PTMC and healthy controls. In addition, the combined application of RDW and MPV can improve the diagnostic power. The values of RDW and MPV were associated with clinicopathological characteristics. To the best of our knowledge, this is the first study to prove the usefulness of preoperative RDW combined with MPV in diagnosing patients with PTC or PTMC.

INTRODUCTION:Subclinical inflammation markers play a significant role in hyperemesis gravidarum (HEG). Simple hematological markers such as mean platelet volume (MPV), platelet distribution width (PDW), neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), plateletcrit (PCT), and platelet-to-lymphocyte ratio (PLR) have been shown to reflect inflammatory burden and disease activity in several disorders. Ketonuria is a parameter used in the diagnosis of severe HEG, but its correlation with disease severity remains controversial. The relationship of subclinical inflammation markers with degree of ketonuria has not been examined previously. In this study, we aimed to determine the diagnostic value of these subclinical inflammation markers and the relationship between these markers and grade of ketonuria in patients with HEG.MATERIALS AND METHODS:A total of 94 pregnant women with a diagnosis of HEG and 100 gestational age-matched healthy pregnant women were enrolled in this retrospective study. MPV, PDW, NLR, PLR, PCT, and ketonuria were calculated and analyzed from complete blood cell counts and total urine analyses.RESULTS:Lymphocyte count was significantly higher in the control group (P < 0,001); NLR and PLR values were significantly higher in the HEG group (P < 0,001). Among inflammation markers, RDW increased significantly (P = 0,008) with an increase in ketonuria in patients with HEG. A statistically significant correlation was found between white blood cell (WBC) and NLR, PLR, PCT. A moderate uphill relationship was observed between NLR and WBC and a weak uphill linear relationship was observed between WBC and PLR and between WBC and PCTCONCLUSIONS:PLR and NLR can be considered effective markers to aid in the diagnosis of HEG. No marker was found to correlate with ketonuria grade except RDW, although the relationship of the severity of ketonuria with severity of disease is controversial. RDW increases as the degree of ketonuria increases.

Aim: The aim of this study was to evaluate hematological inflammatory parameters before and after bariatric surgery and investigate the effect of surgery on these parameters.Material and Methods: A total of 71 patients who underwent a Roux-en-Y gastric bypass (RYGBP) or a sleeve gastrectomy (SG) procedure were included in the study. The preoperative levels of the inflammatory parameters of C-reactive protein (CRP) and the white blood cell count (WBC), as well as the hematological inflammatory parameters of red blood cell distribution width (RDW), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and the neutrophil-to-lymphocyte ratio (NLR) were compared with the postoperative 6th and 12th month values.Results: Both the RYGBP and SG surgical techniques were used in this study. Significant reductions were seen in the postoperative 6th and 12th month values of CRP and WBC, which were used as an indicator of the severity of inflammation. Along with the decrease in BMI and the standard indicators of inflammation, there were also corresponding statistically significant changes in the levels of the more recently used hematological inflammatory markers of RDW, MPV, PDW, PCT, and NLR (p0.05).The statistical evaluation revealed a significant positive correlation between the serum WBC and CRP values and NLR measured at postoperative 6 th months. The postoperative 12 th month results indicated a significant positive correlation between the serum WBC and PCT values and also between the CRP and MPV values.Conclusion: Significant improvements were observed in previously elevated hematological inflammatory parameters in obese patients after bariatric surgery.

ABSTRACTBACKGROUND:Although appendectomy is still a curative therapy for acute appendicitis, medical treatment has come to the fore in uncomplicated cases. This study aimed to determine the importance of immature granulocyte (IG) count and percentage for the role of medical treatment success in uncomplicated acute appendicitis.METHODS:Acute appendicitis cases were prospectively registered between July 2019 and April 2020. Using ball drawing, patients were divided into two groups as medical treatment (Group M) and undergo appendectomy (Group A). Group M was divided into two subgroups as those who responded to medical treatment medically responded (MR) and failed medical treatment (MF) within 24 h of follow-up. Changes in IG count and percentage, C-reactive protein levels, neutrophil-lymphocyte ratio, and white blood cell count between initial administration and 24th h of follow-up were examined.RESULTS:Sixty-four patients who met the inclusion criteria were followed as 31 patients in Group A and 33 in Group M. At Subgroup MF 11 patients and Subgroup MR 22 patients were followed up. At the 24th h of the follow-up, the IG count and percentage were higher in the Group MF (for IG count: Between Group A and MF, p=0.002; between Group A and Group MR, p=0.111; and between Group MR and MF, p<0.001) (for IG percentage: Between Group A and MF, p=0.001; between Group A and MR, p=0.809; and between Group MF and MR, p=0.001). This decrease in the IG count and percentage suggests that the response to medical treatment was effective [for IG count: F (148.862) = 61, p≤0.001, η2=0.707] [for IG percentage: F (10.157) = 0.252, p≤0.001, η2=0.504].CONCLUSION:IG count and percentage are effective for evaluating the success of medical treatment of uncomplicated acute appendicitis and they guide in the decision to continue medical treatment of uncomplicated acute appendicitis.

Background Obesity is a growing public health problem of rapidly increasing prevalence in developing countries. Chronic low-grade inflammation plays a key role in the pathophysiology of obesity. Blood count values and ratios have been used as markers of inflammatory diseases. These parameters may be useful to determine the severity of chronic inflammation in obese children.&#x0D; Objective To determine if red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), platelet distribution width (PDW), and platelet-to-lymphocyte ratio (PLR) can be useful for determining the severity of chronic inflammation in obese children.&#x0D; Methods This observational, analytic study was conducted in obese adolescents aged 14-18 years at senior high schools in Manado, North Sulawesi, from July to September 2018. Students with congenital anomalies, autoimmune diseases, history of asthma, or malignancy were excluded. Pearson’s correlation was used to analyze for potential relationships between obesity and red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), platelet distribution width (PDW), and platelet-to-lymphocyte ratio (PLR).&#x0D; Results There was a negative relationship between obesity and MPV, but it was not statistically significant (r=-0.006; P=0.485). There were positive, but not significant relationships between obesity and RDW (r=0.139; P=0.192), NLR (r=0.155; P=0.166), PDW (r=0.02; P=0.45), and PLR (r=0.146; P=0.181).&#x0D; Conclusion The RDW, NLR, MPV, PDW, and PLR values are not significantly associated with severity of obesity in adolescents.&#x0D;

To investigate the monocyte-to-HDL-cholesterol ratio (MHR), neutrophil to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), eosinophil-to-lymphocytes ratio (ELR), platelet distribution width (PDW), red blood cell distribution width (RDW), mean platelet volume (MPV), MPV to platelet count ratio (MPV/PC), and RDW to platelet ratio (RPR) that are accepted as inflammatory markers in patients with keratoconus. In this study, 43 patients with keratoconus and 43 healthy individuals as the control group were retrospectively evaluated. High density lipoprotein cholesterol (HDL-c), lymphocyte, neutrophil, eosinophil, monocyte, platelet, MPV, PDW, and RDW values were obtained with complete blood count performed on the peripheral blood samples. Absolute monocyte (593 ± 182 vs 492 ± 177; p < 0.05) and neutrophil (4860 ± 1553 vs 3954 ± 1297; p < 0.01) counts were statistically significantly higher in the keratoconus groups compared to the control group. MHR (13.18 ± 5.02 vs 9.88 ± 4.45; p < 0.01) and NLR (2.30 ± 0.87 vs 1.77 ± 0.61; p < 0.01) were statistically significantly higher and LMR (4.07 ± 1.67 vs 5.18 ± 2.06; p < 0.01) was significantly lower in the keratoconus group. As a result of univariate logistic regression analysis, it was observed that MHR and NLR were statistically significant relationship with keratoconus (p = 0.02 and p = 0.021) (Odds ratio = 5.41 (95% CI: 1.169-6.669) and Odds ratio:5.28 (95% CI: 1.024-6.321); respectively). No statistically significant difference was found between the groups in terms of PLR, ELR, RDW, MPV, PDW, MPV/PC, and RPR. Adjusting for age and gender, multivariate regression analysis revealed that MHR was the most significant parameter to demonstrate relationship with keratoconus (p = 0.025) (Odds ratio = 4.99 (95% CI: 1.019-6.332)). MHR and NLR values considered as inflammatory markers were statistically significantly higher and LMR value was significantly lower in the keratoconus group. Among these values, MHR was the most reliable parameter.