Abnormal WBC Research Articles

Circulating white blood cell traits and prolonged night shifts: a cross-sectional study based on nurses in Guangxi

This study aimed to elucidate the effects of long day and night shifts on immune cells in a population of nurses. This cross-sectional study in December 2019 was based on a group of nurses. 1568 physically healthy caregivers were included, including 1540 women and 28 men. 1093 nurses had long-term shift work (working in a rotating system for > 1 year). The receiver operating characteristic curve, Ensemble Learning, and Logistic regression analyses were used to evaluate factors related to long-term shift work. The night shift group nurses had significantly higher MPV, PLCR, and WBC and significantly lower BASO%, ELR, MCHC, PLR, RDW-CV, and RDW-SD (P < 0.01). ROC curves showed that WBC, PLR, ELR, RDW_CV, and BASO% were more related to the night shift. Ensemble Learning, combined with the LASSO model, finally filtered out three indicators of night shifts related to ELR, WBC, and RDW_SD. Finally, logistic regression analysis showed that the nurses’ night shift situation greatly influenced two peripheral blood ELR and WBC indicators (ELR: log (OR) = − 3.9, 95% CI: − 5.8– − 2.0; WBC: log (OR) = 0.25, 95% CI: 0.18–0.32). Finally, we showed that, unlike WBC, the relative riskiness of ELR showed opposite results among junior nurses and middle-senior nurses (log (OR) 6.5 (95% CI: 1.2, 13) and − 7.1 (95% CI: − 10, − 3.8), respectively). Our study found that prolonged night shifts were associated with abnormal WBC and ELR, but after strict age matching, WBC remained significantly different. These findings help to confirm that COVID-19 and tumorigenesis (e.g., breast cancer) are significantly associated with circadian rhythm disruption. However, more detailed studies are needed to confirm this.

A Study on the Etiology and Clinical Manifestations of Community-Acquired Pneumonia in Adults in Western India.

Community-acquired pneumonia (CAP) is an acute lung infection affecting the alveoli in individuals who have not had recent exposure to healthcare settings. It is characterized by newly detected pulmonary infiltration on a chest X-ray or computed tomography scan, accompanied by at least two of the following symptoms: a new or worsening cough, shortness of breath, increased sputum production, fever or hypothermia, pleuritic chest pain, hypoxia, confusion, or an abnormal WBC count (either leukopenia or leukocytosis). It is a major contributor to global mortality and morbidity, especially in elderly populations. This study aims to investigate the etiology of CAP in our region and analyze the clinical characteristics of patients diagnosed with CAP. This prospective, hospital-based study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, a 2,011-bed multispecialty hospital. The study included 100 patients over 18 years old, diagnosed with CAP, and hospitalized between January 2023 and January 2024. All patients underwent a thorough clinical assessment, and sputum cultures were collected on the day of admission. Patients under 18 years old, those who had been hospitalized within the preceding two weeks, individuals with pneumonia caused by tuberculosis oraspiration pneumonia, patients with compromised immune systems, and pregnant women were excluded. The study included 100 patients with a mean age of 53.13 years (±18.31). The most common age group was 59-68 years, which included 25 (25%) cases, followed by the 69-78 yearage group with 18 (18%) cases and the 18-28 yearage group with 15 (15%) cases. The majority were male, with 61 (61%) cases. Common symptoms included fever in 78 cases (78%), chest pain in 69 cases (69%), dyspnea in 65 cases (65%), and cough in 51 cases (51%). Sputum cultures showed growth in 65 cases (65%), with Klebsiella pneumoniae being the most prevalent pathogen in 28cases (43%), followed by Streptococcus pneumoniae in 18 cases (28%). Together, these two pathogens accounted for 46 out of 65 positive samples (70%). This study highlights the clinical profile and rising etiology of K. pneumoniae in CAPin adults in Western India, particularly in the elderly. These findings underscore the need for periodic updates on CAP etiology to inform empirical treatment strategies effectively. Future research should use advanced diagnostics and diverse samples to refine CAP management, with continuous monitoring to update treatment protocols.

Prognostic value of anthropometric- and biochemistry-based nutrition status indices on blood chemistry panel levels during cancer treatment

Body weight, body mass index (BMI), Nutrition Risk Screening 2002 (NRS2002), and prognostic nutritional index (PNI) are among vital nutrition status indices employed during cancer treatment. These have also been associated with levels of blood chemistry panels (BCPs), which are touted as significant indicators of disease prognosis. However, it remains unclear which nutrition status index better predicts future trends in specific BCPs. Using the records of 407 cancer patients, we retrospectively examined the potential of nutritional status indices at baseline for predicting changes in specific BCPs over a 6-week period. Generally, both serum biochemical parameters and nutrition status indices fluctuated over the study period among study participants. PNI was often linearly associated with blood cell counts (white blood cells [WBCs] and hemoglobin) compared with anthropometric-based nutrition status indices. Increase in body weight was protective against having abnormal lymphocyte levels at 6 weeks (odds ratio [OR]: 0.960–0.974; CI: 0.935–0.997; P < 0.05), while increase in baseline PNI was associated with 0.865–0.941 and 0.675–0.915 odds of having future abnormal WBC and lymphocyte levels, respectively. Increases in PNI were also protective against having future abnormal albumin levels (OR: 0.734–0.886) and 8.5–12.5% decreases in the odds of having an abnormal C-reactive protein level in subsequent visits. Changes in NRS2002 tended to be associated with the odds of having future abnormal blood glucose levels. In conclusion, the serum biochemistry–derived nutrition status index, PNI, is a more consistent measure as an early indicator to track the trends of future changes in the BCPs of cancer patients. This implies that PNI could be targeted as an early-warning measure with relevant preventive interventions for patients at risk of malnutrition.

Neutrophil Reactivity Intensity and misclassification of immature granulocytes.

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. 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. 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%. 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.

Predictors of antimicrobial use in intensive care unit patients

Background: Identification of predictors of antibiotic use can inform targeted antimicrobial stewardship initiatives and can account for sources of bias in before-and-after interventional stewardship studies. To date, no study has identified clinical predictors of antimicrobial use within intensive care units (ICUs), where antimicrobial resistance is most prevalent and problematic. Methods: As part of an ongoing prospective, single-arm, pilot feasibility trial of an ICU diagnostic stewardship intervention, we performed a nested retrospective cohort study to explore associations between patient clinical variables and ICUs antimicrobial use and resistance rates (AURs). We included all patients hospitalized in 3 ICUs (surgical, medical, and cardiac) from 2017 to 2021 at Michigan Medicine, a large, tertiary-care, academic medical center. Data were extracted from the electronic medical record using a structured query. Admission-level data were captured, including patient demographics, medical comorbidities, International Classification of Disease, Tenth Revision (ICD-10) admission diagnoses, as well as calendar day-level data including vital signs, clinical and microbiologic laboratory data, measures of acute severity of illness, ventilator–supplemental oxygen metrics, and procedural interventions using current procedural terminology (CPT) codes. ICU AURs were defined as total antibiotic days of therapy per patient per 100 ICU days. Associations between clinical variables and ICU AURs were calculated as rate ratios (RRs). Multiple imputation using fully conditional specification was performed to create 25 imputation data sets. Negative binomial regression models were constructed for each data set using backward selection. Variables retained in &gt;50% of models were included in a final multivariate model. Results: In total, 15,177 ICU patient admissions were captured. Age, sex assigned at birth, and race did not independently associate with ICU AURs. Comorbidities, medical interventions, admission diagnoses, and laboratory data that independently associated with ICU-AURs are shown in Table 1. The clinical variables most strongly associated with increased ICU-AURs were pneumonia (RR, 1.55; 95% CI, 1.451.64), bacteremia (RR, 1.35; 95% CI, 1.25– 1.46), intraabdominal infection (RR, 1.35; 95% CI, 1.18–1.55), SOFA score (RR, 1.27; 95% CI, 1.14–1.42), abnormal WBC (RR, 1.26; 95% CI, 1.20–1.32), and immunocompromised status (RR, 1.20; 95% CI, 1.10–1.31). Clinical variables most strongly associated with decreased ICU-AURs were cardiac ICU (RR, 0.56; 95% CI, 0.52–0.60), COVID-19 (RR, 0.62; 95% CI, 0.56–0.70), and receipt of an invasive nonsurgical procedure (RR, 0.90; 95% CI, 0.82–0.98). Conclusions: In this single-center retrospective cohort study, several clinical variables were independently associated with ICU-AURs. These results may be used to identify patient subgroups for potentially high-yield ICU-based stewardship interventions and to account for sources of bias in before-and-after studies of ICU-based stewardship interventions.Disclosures: None

Clinical Features and Prognosis of Patients with Castleman's Disease

To analyze the clinical features and prognosis of patients with Castleman's disease (CD) and improve the diagnosis and treatment of CD. Clinical data of patients diagnosed with CD by pathological biopsy in Gansu Provincial Hospital from January 2009 to November 2020 were retrospectively analyzed. According to clinical classification, the patients were divided into two groups: UCD (unicentric CD) group (n=20) and MCD (multicentric CD) group (n=9). The clinical manifestations, laboratory examination, treatment regimens, pathological examination and follow-up data were statistically analyzed. There were no significant differences in average age and gender ratio between UCD group and MCD group. In UCD patients, 80.0% were hyaline vascular type, and 20.0% were plasma cell type. In MCD patients, 33.3% were hyaline vascular type, 55.6% were plasma cell type, and 11.1% were mixed type. There was significant difference in pathological classification between the two groups (P=0.039). The UCD patients usually presented asymptomatic single lymph node enlargement with mild clinical symptoms, while the MCD patients were characterized by multiple superficial and deep lymph node enlargement throughout the body. The incidences of asthenia, splenomegaly, serous effusion in MCD group were higher than those in UCD group (P<0.05). Meanwhile, the incidences of anemia, hypoproteinemia, increased ESR, elevated serum globulin and elevated β2-microglobulin were significantly higher than those in UCD group too (P<0.05). There was no significant difference in the incidences of abnormal WBC, PLT and elevated LDH between the two groups (P>0.05). Among 20 patients with UCD, 13 cases reached complete remission (CR), 1 case achieved partial remission (PR). Among 9 patients with MCD, 3 cases received CR and 4 cases received PR. Patients with CD requires pathological examination for diagnosis. Patients with UCD show mild clinical symptoms, good surgical treatment effect and good prognosis. Patients with MCD have diversified clinical manifestations and relatively poor prognosis, and these patients require comprehensive treatment.

Effect of syringic acid on steroid and gonadotropic hormones, hematological indices, sperm characteristics and morphologies, and markers of tissue damage in methyl cellosolve-administered rats

Methyl cellosolve (MTC) is an established gonadotoxic and hematotoxic compound that is commonly and universally utilized in herbicide, liquid soap, stain, dye, paint, and brake fluid manufacturing industries as a solvent. Due to its wide range usage, this study therefore investigated the effect of syringic acid (SYAC) on hematological indices, sperm characteristics and morphologies, and markers of tissue damage in MTC administered male Wistar rats. Thirty (30) rats divided into six groups were used. Rats in group 1 served as control, those in group 2 were administered MTC for 30 consecutive days, those in groups 3, 4, and 5 were treated with 25, 50, and 75 mg/kg body weight of SYAC respectively also for 30 consecutive days immediately after each day MTC administrations, while rats in group 6 received 75 mg/kg body weight of SYAC only throughout. Compared with control, administrations of MTC resulted in a significant decrease in spermatozoa count, number of normal and live spermatozoa, Hb count, MCH, MCHC, serum TC, and LH, while number of abnormal spermatozoa, RBC and WBC counts, activities of serum AST, ALT, GGT, LDH, and ADH were significantly increased. Treatments with 25 mg/kg of SYAC significantly reduced the RBC and WBC counts, serum activities of AST, ALT, GGT, and increased TC concentration. Treatments with 50 mg/kg SYAC significantly lowered the number of abnormal spermatozoa, RBC count, activities of serum ALT, AST, LDH, ADH, and increased the number of normal spermatozoa, MCV, MCH, and MCHC, while 75 mg/kg of SYAC significantly decreased the serum activities of AST, ALT, GGT, LDH, ADH, and increased serum TC concentration. Findings from this study have revealed the hepatoprotective effect of SYAC at all doses investigated but did not confer spermatoprotection and hematoprotection against MTC-induced toxicities, and looking at the 3 doses investigated, 50 mg/kg of SYAC yielded the best effect.

Biomarker of neutrophil extracellular traps is associated with deep-seated infections and predicts mortality and cardiovascular morbidity in commensal streptococcal bacteremia.

Neutrophil extracellular traps (NETs) play important roles in sepsis and deep-seated infections, but whether NET formation correlates with clinical outcomes of patients with streptococcal bloodstream infections (BSIs) is unclear. We analyzed serum levels of complexes of myeloperoxidase and DNA (MPO-DNA) in patients with streptococcal-BSIs. Invitro assay of NET induction by serum from BSI patients was performed. MPO-DNA values for the Streptococci-BSI group (n=59) were significantly higher than those for healthy controls (p<0.00001) and matched control groups (n=59, p=0.004). The rate of higher MPO-DNA levels (>1.87μg/mL) were higher in abscess-prone streptococcal groups (streptococcus milleri group) (72.2% vs. 52.5%, p=0.02). For patients with BSIs due to highly infective endocarditis (IE)-prone pathogens, the values of serum MPO-DNA were also higher in patients diagnosed of IE compared to their counterparts (p=0.009). Notably, serum from patients with leukopenia could induce higher amounts of invitro NET formation, despite having low MPO-DNA levels, suggesting that NET formation could be influenced by WBC counts. Therefore, we combined WBC counts with MPO-DNA to predict all-cause 30-day mortality in patients with commensal streptococcal-BSIs. The mortality risk was lowest among patients who had neither high MPO-DNA levels nor abnormal WBC counts (p=0.058). Furthermore, this group of patients also had a favorable composite outcome consisting of major adverse cardiovascular events (MACE) and all-cause mortality (p=0.026). Together, these study data suggested that serum MPO-DNA can be a biomarker for predicting a composite outcome consisting of MACE and all-cause mortality in patients with commensal streptococcal-BSIs.

FREQUENCY OF WBC FLAGS GENERATED BY AUTOMATED HEMATOLOGY ANALYZER IN DIAGNOSED CASES OF DENGUE INFECTION

Objective: To determine the frequency of WBC flags generated by automated hematology analyzers in cases of dengue diagnosed by serological tests. We also aim to compare the platelet count in the presence of different WBC flags. Material and Methods: It was a cross sectional study, conducted at Chughtai Institute of Pathology. Total 1007 blood samples of serologically confirmed dengue patients in EDTA vial were obtained over a period of 03 months from September,2021 to November, 2021.These samples were run through Mindray BC-6800 which displayed flags for white blood cells. WBC flags displayed were analyzed in correlation with findings of CBC and peripheral smear through careful statistical analysis of the observed parameters. Results: An abnormal WBC flag was displayed in all patients. The most common flag among these was atypical lymphocytes in 671 (66.6%) samples, followed by atypical lymphocytes + basophilia in 136 (13.5%), Atypical lymphocytes + neutropenia in 66 (6.6%), Atypical lymphocytes + lymphocytosis in 47 (4.7%), Atypical lymphocytes + lymphopenia in 31 (3.1%), Lymphopenia in 29 (2.9%), Atypical lymphocytes + monocytosis in 15 (1.5%), Lymphopenia + neutropenia in 9 (0.9%) and Neutropenia in 3 (0.3%) samples. Conclusion: WBC flags generated by automated hematology analyzer in a suspected dengue patient, especially during dengue epidemics can be used as a screening tool and can help in avoiding unnecessary serological testing. Key Words: Dengue, NS1 antigen, WBC flags, Automated hematology analyzer.

Safety of robotic surgical management of non-elective colectomies for diverticulitis compared to laparoscopic surgery.

Non-elective minimally invasive surgery (MIS) remains controversial, with minimal focus on robotics. This study aims to evaluate the short-term outcomes for non-elective robotic colectomies for diverticulitis. All colectomies for diverticulitis in ACS-NSQIP between 2012 and 2019 were identified by CPT and diagnosis codes. Open and elective cases were excluded. Patients with disseminated cancer, ascites, and ventilator-dependence were excluded. Procedures were grouped by approach (laparoscopic and robotic). Demographics, operative variables, and postoperative outcomes were compared between groups. Covariates with p < .1 were entered into multivariable logistic regression models for 30day mortality, postoperative septic shock and reoperation. 6880 colectomies were evaluated (Laparoscopic = 6583, Robotic = 297). The laparoscopic group included more preoperative sepsis (31.6% vs. 10.8%), emergency cases (32.3% vs. 6.7%), and grade 3/4 wound classifications (53.3% vs. 42.8%). There was no difference in mortality, anastomotic leak, SSI, reoperation, readmission, or length of stay. The laparoscopic group had more postoperative sepsis (p = 0.001) and the robotic group showed increased bleeding (p = 0.011). In a multivariate regression model, increased age (OR = 1.083, p < 0.001), COPD (OR = 2.667, p = 0.007), dependent functional status (OR = 2.657, p = 0.021), dialysis (OR = 4.074, p = 0.016), preoperative transfusions (OR = 3.182, p = 0.019), emergency status (OR = 2.241, p = 0.010), higher ASA classification (OR = 3.170, p = 0.035), abnormal WBC (OR = 1.883, p = 0.046) were independent predictors for mortality. When controlling for confounders, robotic approach was not statistically significantly associated with septic shock or reoperation. When controlling for confounders, robotic approach was not a predictor for mortality, reoperation or septic shock. Robotic surgery is a feasible option for the acute management of diverticulitis.

Real world utilization of Dalbavancin at a rural community emergency department

IntroductionAcute bacterial skin and skin structure infections (ABSSI) are frequently encountered in the emergency department and compromise more than 700,000 hospital admissions annually. Dalbavancin is a single dose long acting semi-synthetic lipogylcopepitde antibiotic with coverage against gram-positive organisms including methicillin resistant Staphylococcus aureus. Recent data from large tertiary care centers have shown a decrease in hospital admissions and repeat emergency department visits for ABSSI's but little data is available for those who practice in a rural community setting. The primary objective of this study was to describe the use of dalbavancin at a single rural emergency department. MethodsA retrospective cohort study of all adult patients who received dalbavancin between 2019 and 2021 while in the emergency department was completed. Abstracted data included patient demographics, infection location by body region, emergency department return visits, hospital admissions, and length of stay. Analysis was conducted using descriptive statistics, the Mann-Whitney test for continuous data, and the chi-squared analysis for nominal data. ResultsA total of 125 patients were included in the final analysis with 35.2% being female. The median age of those treated with dalbavancin was 54 years (42.0–64.0) and the most common infection site was the lower extremities. A total of 35 patients re-presented to the emergency department following treatment with dalbavancin within 30 days and 16 were admitted to the hospital. Of those who re-presented to the emergency department, the median age was 56 (40.0–66.0) and the median re-presentation was 9 days (3–17) after dalbavancin administration. A total of 16 patients (12.8%) were subsequently admitted to the hospital with a median length of stay of 5.5 days (3.0–8.0). 30-day readmission rates were 23.9% in those who had an abnormal WBC count at initial presentation, 26.1% for those with congestive heart failure, 20.3% for those with hypertension, and 26.0% in those who had diabetes mellitus. ConclusionFollowing the administration of dalbavancin for ABSSI at a rural emergency department, few patients are subsequently admitted within the following 30 days. To further decrease this number and alleviate the burden on emergency departments and hospitals, local treatment algorithms should be developed to minimize the risk of representation and hospitalization following administration.

Early Determinants of Mortality in Hospitalized COVID-19 Patients in the Eastern Province of Saudi Arabia.

PurposeThis study investigated the clinical determinants of mortality in hospitalized patients infected with COVID-19.Patients and MethodsA retrospective multicenter large cohort of COVID-19 patients hospitalized between March 2020 and February 2021. We included patients admitted with a confirmed COVID-19 infection with positive COVID-19 through real-time polymerase chain reaction (RT-PCR). SPSS version 25.0 (Armonk, NY: IBM Corp.) was used to analyze the data.ResultsAmong the study participants (n = 1444), the mean age of the population was 49.22±17.69 years, of which 63.9% were males (n = 924). Overall, the mean age for non-survivors was 55.65 ±16.41 years and the length of ICU stay was 13.95 ±12.4 years. The most common comorbidity among the study subjects was hypertension (HTN) (32.7%), followed by cardiovascular disease (CVD) (10.7%). Patients who were mechanically ventilated (MV) had higher mortality than those who did not require MV (p < 0.001).ConclusionOur study concluded that old age, the presence of underlying cardiovascular conditions, an abnormal WBC count (leukopenia or leukocytosis), and abnormal blood urea nitrogen (BUN) levels are among the independent predictors of mortality in the Saudi population. These findings may guide health care providers to manage COVID-19 patients more effectively with better outcomes.

CT-based radiomic nomogram for predicting the severity of patients with COVID-19

BackgroundThe coronavirus disease 2019 (COVID-19) is a pandemic now, and the severity of COVID-19 determines the management, treatment, and even prognosis. We aim to develop and validate a radiomics nomogram for identifying patients with severe COVID-19.MethodsThere were 156 and 104 patients with COVID-19 enrolled in primary and validation cohorts, respectively. Radiomics features were extracted from chest CT images. Least absolute shrinkage and selection operator (LASSO) method was used for feature selection and radiomics signature building. Multivariable logistic regression analysis was used to develop a predictive model, and the radiomics signature, abnormal WBC counts, and comorbidity were incorporated and presented as a radiomics nomogram. The performance of the nomogram was assessed through its calibration, discrimination, and clinical usefulness.ResultsThe radiomics signature consisting of four selected features was significantly associated with clinical condition of patients with COVID-19 in the primary and validation cohorts (P < 0.001). The radiomics nomogram including radiomics signature, comorbidity and abnormal WBC counts showed good discrimination of severe COVID-19, with an AUC of 0.972, and good calibration in the primary cohort. Application of the nomogram in the validation cohort still gave good discrimination with an AUC of 0.978 and good calibration. Decision curve analysis demonstrated that the radiomics nomogram was clinically useful to identify the severe COVID-19.ConclusionWe present an easy-to-use radiomics nomogram to identify the patients with severe COVID-19 for better guiding a prompt management and treatment.

Analysis of unplanned revisits and readmissions: results of the General Surgery clinic in a private hospital

Objectives: In recent years, the rate of readmission (RA) within the first thirty days of discharge has been an important parameter for cost and quality standards. It is therefore extremely important for each center to analyze its own results and determine the factors affecting the RA rates in order to organize the measures to be taken. Another important issue, especially for centers focusing on specific areas of expertise, is unplanned revisit (RV) after discharge. Determination of these rates and reasons is of importance for every hospital and/or clinic to decrease these rates, thus increasing patient satisfaction and reducing costs. The aim of this study was to analyze RA and RV patients operated in the general surgery clinic of our hospital for a period of two years as well as factors affecting these rates. Methods: The study included patients who were operated in the general surgery clinic of Bursa Private Medicabil Hospital between 1 January 2018 and 31 December 2019 and who revisited and were readmitted within the first thirty days of discharge. The reasons for RA/RV and time to RA/RV, and patients’ treatments were investigated by comparing RA/RV patients with those who were not readmitted (NA) for demographic results at initial admission to determine the differences between these patient groups. Univariate and multivariate analyses were carried out using the SPSS software. The level of significance was set at p &amp;lt; 0.05. Results: Of the 890 patients who were operated in our clinic throughout the study period and met the study inclusion criteria, 52 (5.8%) were included in the unplanned RA group and 107 (12%) in the unplanned RV group. The mean time to RA was 10.5 ± 7.0 days for the RV group and 8.8 ± 6.7 days for the RA group (p = 0.17). Thirty-two (61.5%) of the RA patients and 41 (38.3%) of the RV patients were readmitted within the first 7 days of discharge (p = 0.003). The multivariate analysis revealed that prolonged length of hospital stay, emergency surgery, abnormal WBC, electrolyte imbalance, and abnormal hemoglobin level were significant risk factors for RV, while the development of complications, prolonged length of hospital stay, and advanced age were significant risk factors for RA. Conclusions: This study analyzing the RA and RV patients operated in the general surgery clinic of a private hospital demonstrated that the most important reasons for RA were nonspecific and preventable. Patients who developed complications, had prolonged length of hospital stay, and were at an advanced age had a higher rate of RA, while patients who had prolonged length of hospital stay, underwent emergency surgery, and had biochemical problems at initial admission had a higher rate of RV. Focusing on these patients during and after discharge and increasing home care facilities can solve the problems of many patients without admitting them to the hospital. This will be a factor that would improve patient satisfaction while reducing costs.

11. Electronic Surveillance Criteria for Non-Ventilator HAP: Empiric testing and Chart Review at Veterans Affairs Facilities

BackgroundSurveillance of Non-Ventilator Hospital-Acquired Pneumonia (NV-HAP) is limited by the ambiguity in diagnosing pneumonia. We implemented electronic surveillance criteria for NV-HAP across the VA healthcare system and tested for reliability, validity and meaning of the electronic criteria vs manual chart review.MethodsWe defined NV-HAP surveillance criteria as oxygen deterioration concurrent with fever or abnormal WBC count, ≥3 days of antibiotics, and orders for chest imaging. We applied these criteria to EHR data from all patients hospitalized ≥3 days at all VA acute care facilities from 1/1/2015-12/31/2020 and calculated NV-HAP incidence and inpatient mortality. Clinician reviewers used a consensus review guide to independently review and adjudicate 47 cases meeting NV-HAP surveillance criteria for 1) clinical deterioration, 2) CDC-NHSN pneumonia criteria, 3) treating clinicians’ assessment, and 4) reviewer’s diagnosis. All reviewers subsequently adjudicated all cases and conducted an error analysis to identify sources of discordance.ResultsAmong 2.3M hospitalizations, 14,023 met NV-HAP surveillance criteria (0.6 per 100 admissions). Inpatient mortality was 26% (vs 2% for non-flagged hospitalizations). Among 47 hospitalizations flagged by surveillance criteria, 45 (97%) had a confirmed clinical deterioration, (the other 2 were immediate post-operative cases), 20 (43%) met CDC-NHSN pneumonia criteria, 21 (47%) had possible pneumonia per treating clinicians, and 25 (53%) had possible or probable NV-HAP per reviewers. Agreement among the 3 reviewers before adjudication was 51% (Fleiss’ κ 0.43) for CDC-NHSN and 58% (Fleiss’ κ 0.33) for NV-HAP. The most common source of discordance between reviewers was chest imaging classification (15/19 discordant cases).ConclusionNV-HAP electronic surveillance criteria demonstrated high precision for identifying clinical deterioration and moderate concordance with CDC-NHSN pneumonia criteria or reviewer diagnosis. Agreement between electronic surveillance criteria vs manual chart review was low but similar to agreement amongst manual reviewers applying NHSN criteria. Electronic surveillance may provide greater consistency than human review while facilitating wide-scale automated surveillance.Disclosures Chanu Rhee, MD, MPH, UpToDate (Other Financial or Material Support, Chapter Author) Michael Klompas, MD, MPH, UpToDate (Other Financial or Material Support, Chapter Author)

Abnormal WBC Scattergrams by Sysmex XN550, A Supplementary Diagnostic Tool for Malaria to the Conventional Methods

Background: In India, malaria has a major impact on health system. It is usually diagnosed based on symptomatology, parasite detection in the peripheral smear (PS) or rapid diagnostic tests (RDT) such as malaria antigen test (MAT). Detection of malaria by MAT is considered as the gold standard. A rapid, cost effective screening of malaria can be done with the automated analyzers. The present study was undertaken to assess the efficacy of WBC scattergram generated by Sysmex XN 550 hematology analyzer to diagnose malaria.&#x0D; Methods: A prospective study was conducted over a period of 4 months from August to November 2019, after obtaining institutional ethical clearance. All cases diagnosed as Plasmodium vivax / Plasmodium falciparum infections on malaria antigen test (MAT) were included. Their hemogram and WBC scattergrams obtained from Sysmex XN 550 were studied. Thick &amp; thin Smears were made and stained with Leishman’s stain for microscopy.&#x0D; Results: A total of 101 cases were diagnosed as malaria positive by MAT and thick smear. Ninety-seven were positive by Leishman’s stain. Abnormal scattergrams were 81 out of 101 malaria positive cases. The commonest pattern was double neutrophil zone (n=22) followed by double neutrophil with less space between neutrophil and eosinophil (n=17). An abnormal event on X axis was observed in 16 patients. Gray zone and double eosinophil areas were observed in 11 and 4 cases respectively. The sensitivity of the analyzer was found to be 80.19%.&#x0D; Conclusion: Scattergram of automated haematology analyser (Sysmex XN 550) has good sensitivity, which can be increased to a better level if combined with thrombocytopenia and symptomatology of the patients.

Retrospective Analyses Associate Hemostasis Activation Biomarkers With Poor Outcomes in Patients With COVID-19.

ObjectivesPatients with coronavirus disease 2019 (COVID-19) have thromboembolic complications. Assessment of coagulation and other markers could be useful to understand their coagulopathy.MethodsWe performed a retrospective study of inflammatory and coagulation parameters, including prothrombin fragment 1.2 (PF1.2), thrombin-antithrombin complexes (TATs), fibrin monomers, and D-dimer, in hospitalized patients with COVID-19. We compared the markers in patients with thrombosis, admission to the intensive care unit (ICU), and poor outcome.ResultsOf the 81 patients, 9 (11%) experienced an acute thrombotic event (4 with pulmonary embolism, 3 with venous thrombosis, and 2 with stroke). PF1.2 was elevated in 32 (39%) patients, TATs in 54 (67%), fibrin monomers in 49 (60%), and D-dimer in 76 (94%). Statistically significant elevation in PF1.2 and TATs was seen in patients admitted to the ICU, while D-dimer and fibrin monomers were significantly elevated in patients with poor outcomes. The presence of multiple abnormal coagulation parameters was associated with ICU admission. Other parameters with statistically significant results included abnormal WBC counts and elevated C-reactive protein, which were associated with ICU admission and poor outcomes.ConclusionsOur data demonstrate that abnormalities of biomarkers of hemostasis activation and inflammatory markers are associated with poor outcomes in patients with COVID-19.

Clinical Significance of CBC and WBC Morphology in the Diagnosis and Clinical Course of COVID-19 Infection.

ObjectivesTo investigate the clinical significance of numeric and morphologic peripheral blood (PB) changes in coronavirus disease 2019 (COVID-19)–positive patients in predicting the outcome, as well as to compare these changes between critically ill COVID-19–positive and COVID-19–negative patients.MethodsThe study included 90 COVID-19–positive (51 intensive care unit [ICU] and 39 non-ICU) patients and 30 COVID-19–negative ICU patients. We collected CBC parameters (both standard and research) and PB morphologic findings, which were independently scored by two hematopathologists.ResultsAll patients with COVID-19 demonstrated striking numeric and morphologic WBC changes, which were different between mild and severe disease states. More severe disease was associated with significant neutrophilia and lymphopenia, which was intensified in critically ill patients. Abnormal WBC morphology, most pronounced in monocytes and lymphocytes, was associated with more mild disease; the changes were lost with disease progression. Between COVID-19–positive and COVID-19–negative ICU patients, significant differences in morphology-associated research parameters were indicative of changes due to the severe acute respiratory syndrome coronavirus 2 virus, including higher RNA content in monocytes, lower RNA content in lymphocytes, and smaller hypogranular neutrophils.ConclusionsHospitalized patients with COVID-19 should undergo a comprehensive daily CBC with manual WBC differential to monitor for numerical and morphologic changes predictive of poor outcome and signs of disease progression.

Procalcitonin Correlates With but Is Not Superior to Other Diagnostic Markers of Bacterial Pneumonia.

Despite extensive research on procalcitonin (PCT)-guided therapy in lower respiratory tract infections, the association between PCT and bacterial pneumonia remains unclear. We evaluated retrospectively the performance of PCT in patients presenting with lower respiratory tract infection symptoms and grouped by seven diagnoses. All patients had microbial testing, chest imaging, and CBC counts within 1 day of PCT testing. Median PCT level in patients diagnosed with bacterial pneumonia was significantly higher than in patients diagnosed with other sources of infections or those not diagnosed with infections. Median PCT levels were not different among patients grouped by type or quantity of pathogen detected. They were significantly higher in patients with higher pathogenicity scores for isolated bacteria, those with abnormal WBC count, and those with chest imaging consistent with bacterial pneumonia. A diagnostic workup that included imaging, WBC count, and Gram stain had an area under the receiver operating characteristic curve of 0.748, and the addition of PCT increased it to 0.778. PCT was higher in patients diagnosed with bacterial pneumonia. Less clear is its diagnostic ability to detect bacterial pneumonia over and above imaging and laboratory data routinely available to clinicians.

Outcome and complications following transrectal and transabdominal large intestinal trocarization in equids with colic: 228 cases (2004-2015).

To describe outcome and complications after large intestinal trocarization in equids with colic and identify factors associated with nonsurvival and clinically relevant peritonitis (CRP). 228 (198 horses, 24 ponies, and 6 donkeys and mules) equids with colic that underwent large intestinal trocarization. Medical records from 2004 through 2015 were reviewed for equids with colic that underwent large intestinal trocarization. Factors associated with nonsurvival in all (ie, surgically and medically treated) equids and with CRP in medically only treated equids were identified. Medically only treated equids with a high peritoneal fluid cell count (ie, > 10,000 cells/μL) after large intestinal trocarization were classified as having CRP if they met ≥ 2 of the following clinical criteria: anorexia, fever, lethargy, abnormal oral mucous membrane color, abnormal WBC count, or high blood fibrinogen concentration (> 5 g/L). Transabdominal large intestinal trocarization was performed in 190 (83%) equids, transrectal trocarization in 17 (7%), and both procedures in 21 (9%). Of 228 equids, 167 (73%) survived to hospital discharge. None died or were euthanized because of complications from large intestinal trocarization. Nonsurvival was associated with an increasing number of trocarization procedures and diagnosis of a large intestinal strangulating lesion. A diagnosis of nephrosplenic ligament entrapment of the large colon decreased the odds of nonsurvival. Twelve of 60 (20%) equids that received medical treatment only had CRP following large intestinal trocarization. Large intestinal trocarization could be considered for equids with colic and large intestinal gas distension. More than one trocarization procedure was associated with an increase in nonsurvival, which should be considered for equids for which consent for surgery has been obtained.