Absolute Monocyte Research Articles

Impact of salt intake on inflammation markers in cardiovascular disease: a retrospective observational case-control study

Background. Salt intake currently poses a serious threat due to the cardiovascular challenge incurred by excessive sodium consumption.Objectives. The identification of markers associated with high salt intake in hypertensive patients.Methods. A retrospective observational case-control study surveyed 251 persons, including 194 hypertensive patients with stable salt intake. The intake was assessed in the “Charlton: SaltScreener” questionnaire. General, biochemical blood panels and interleukin levels (IL-1, IL-2, IL-4, IL-6, IL-8, IL-10, IL-18) were evaluated in the outcome of medical examination. Statistical data processing was performed with R using the RStudio software.Results. The mean patient age in survey was 72.47 ± 9.8 years, women prevailed in the selected cohort (n = 151, 60.1%). All patients were assigned in cohorts by the daily salt intake rate, ≤5 g (n = 12), 6–10 g (n = 144), >10 g salt per day (n = 38). The largest cohort (74.2%) united patients consuming 6–10 g salt per day, whereas only 6.2% patients consumed salt <5 g/day. Final analysis included patients consuming ≥6 g/day and having a C-reactive protein (CRP) level <20 mg/L. The analysis elicited an association between the monocyte count, CRP and salt intake towards the statement that higher salt intake leads to higher monocyte counts at CRP <20 mg/L in blood. Modelling revealed a close monocyte count–salt intake relationship, with a low-to-high intake transition sharply increasing the probability of elevated absolute monocyte count in blood provided the CRP level is <20 mg/L.Conclusion. The study infers a direct relationship between salt intake >10 g/day and blood monocyte count. However, its significance ceases at CRP rising to ≥20 mg/L.

High platelet-lymphocyte ratio is a risk factor for 30-day mortality in in-hospital cardiac arrest patients: a case-control study

ABSTRACT Objectives This study explored the association of early dynamic changes in inflammatory markers with 30-day mortality in in-hospital cardiac arrest (IHCA) patients. Methods This study retrospectively enrolled 85 IHCA patients. The outcome was 30-day mortality. A linear mixed model was used to analyze the dynamic changes in laboratory indicators within 72 h after recovery of spontaneous circulation(ROSC). Results Within 72 h after ROSC, the absolute monocyte count (AMC) showed no significant change trend, and the absolute lymphocyte count (ALC) showed an overall upward trend, while the absolute neutral count (ANC), white blood cell (WBC) count, platelet (PLT) count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) showed overall downward trends. Cox multivariate analysis showed that the Charlson comorbidity index (CCI) (HR = 2.37, 95%CI (1.08, 5.17)), Acute Physiology and Chronic Health Evaluation II (APACHE II) score (HR = 2.55, 95% CI (1.00, 6.50)), abnormal creatinine level before IHCA (HR = 3.42, 95% CI (1.44, 8.10)) and PLR within 72 h after ROSC (HR = 2.99, 95% CI (1.44, 6.21)) were independent risk factors for 30-day mortality. Conclusions The PLR can be used as a predictor of 30-day mortality in IHCA patients.

Identifying distinct risks of treatment failure in nasopharyngeal carcinoma: Study based on the dynamic changes in peripheral blood lymphocytes, monocytes, N classification, and plasma Epstein-Barr virus DNA.

To evaluate the prognostic value of the dynamic change in absolute lymphocyte counts (ALCs) and absolute monocyte counts (AMCs) and identify patients with N stage and plasma Epstein-Barr virus (EBV) DNA levels in nasopharyngeal carcinoma (NPC) who are at risk of treatment failure. A total of 1124 eligible patients with Stage II-IVb NPC treated with concurrent chemoradiotherapy (CCRT) were enrolled. Percentage changes in the ALC (ΔALC%) and AMC (ΔAMC%) were calculated. Patients with high ΔALC% were correlated with poorer 5-year overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) rates than those with low ΔALC%. Likewise, high ΔAMC% was significantly associated with worse outcome than low ΔAMC% (OS, p=0.001; PFS, p=0.001; DMFS, p=0.034). Multivariate analyses revealed that ΔALC% (p=0.046), ΔAMC% (p=0.019), and EBV DNA level (p < 0.001) were independent prognostic factors for OS. With respect to PFS, ΔALC% (p=0.036), ΔAMC% (p=0.011), N classification (p=0.016), and EBV DNA level (p < 0.001) were also independent prognosticators. Based on the aforementioned independent risk factors (ΔALC% ≥ 83.33%, ΔAMC% ≥ 40.00%, Stage N2-3, EBV DNA ≥ 4000 copies/ml), patients were divided into three different risk groups (low-risk group [with <1 risk factor], intermediate risk group [with 1-3 risk factors], and high-risk group [with 4 risk factors]) that correlated with disparate risks of death (p < 0.001), disease progression (p < 0.001), and distant metastasis (p < 0.001). High ΔALC% and ΔAMC% were correlated with poor prognosis in patients with NPC. Risk stratification based on ΔALC%, ΔAMC%, N classification, and plasma EBV DNA levels could provide potential utility for risk-adapted therapeutic strategies for NPC.

Similarities and Differences in the Acute-Phase Response to SARS-CoV-2 in Rhesus Macaques and African Green Monkeys.

Understanding SARS-CoV-2 immune pathology is critical for the development of effective vaccines and treatments. Here, we employed unbiased serial whole-blood transcriptome profiling by weighted gene network correlation analysis (WGCNA) at pre-specified timepoints of infection to understand SARS-CoV-2-related immune alterations in a cohort of rhesus macaques (RMs) and African green monkeys (AGMs) presenting with varying degrees of pulmonary pathology. We found that the bulk of transcriptional changes occurred at day 3 post-infection and normalized to pre-infection levels by 3 weeks. There was evidence of coordination of transcriptional networks in blood (defined by WGCNA) and the nasopharyngeal SARS-CoV-2 burden as well as the absolute monocyte count. Pathway analysis of gene modules revealed prominent regulation of type I and type II interferon stimulated genes (ISGs) in both RMs and AGMs, with the latter species exhibiting a greater breadth of ISG upregulation. Notably, pathways relating to neutrophil degranulation were enriched in blood of SARS-CoV-2 infected AGMs, but not RMs. Our results elude to hallmark similarities as well as differences in the RM and AGM acute response to SARS-CoV-2 infection, and may help guide the selection of particular NHP species in modeling aspects of COVID-19 disease outcome.

A Survival Prediction Nomogram for Esophageal Squamous Cell Carcinoma Treated with Neoadjuvant Chemoradiotherapy Followed by Surgery.

BackgroundNeoadjuvant chemoradiotherapy (NCRT) followed by surgery is a component of the standard treatment for resectable locally advanced esophageal squamous cell carcinoma (ESCC), and the parameters for survival prediction are not clear yet. Our study aimed to construct a survival prediction nomogram for ESCC with NCRT followed by surgery.MethodsWe analyzed hematological parameters and related-derivative indexes from 122 ESCC patients treated with NCRT followed by surgery. Univariate and multivariate Cox survival analyses were performed to identify independent prognostic factors to establish a nomogram and predict overall survival (OS). The predictive value of the nomogram for OS was evaluated by the concordance index (C-index), decision curve analysis (DCA), the clinical impact curve (CIC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).ResultsThe pretreatment nutritional candidate, prognostic nutrition index, inflammation-related absolute monocyte count and TNM staging were entered into the nomogram for ESCC with NCRT followed by surgery. The C-index of the nomogram for OS was 0.790 (95% CI = 0.688–0.893), which was higher than that of TNM staging (0.681; 95% CI = 0.565–0.798, P = 0.026). The DCA, CIC, NRI, and IDI of the nomogram showed moderate improvement in predicting survival. Based on the cut point calculated according to the constructed nomogram, the high-risk group had poorer OS than that of the low-risk group (P < 0.05).ConclusionA novel nomogram based on nutrition- and inflammation-related indicators might help predict the survival of ESCC treated with NCRT followed by surgery.

DESPITE THEIR UTILITY IN IDIOPATHIC PULMONARY FIBROSIS, SERUM IGA AND MONOCYTE COUNT ARE NOT PREDICTIVE OF BASELINE PULMONARY FUNCTION, MORTALITY, OR INTERSTITIAL LUNG DISEASE PATTERN IN RHEUMATOID ARTHRITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE

TOPIC: Diffuse Lung Disease TYPE: Original Investigations PURPOSE: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease that confers a poor prognosis. Previously, immunoglobulin A (IgA) level has been used as a surrogate marker of transforming growth factor (TGF)-beta, an important mediator of pulmonary fibrosis, and increased IgA level was associated with worse outcomes in IPF [1]. Recent studies have also described associations between serum monocyte count and clinical outcomes in IPF [2]. Rheumatoid arthritis related interstitial lung disease (RA-ILD) has many similarities with IPF, including similar genetic risk, survival, and ILD pattern. We hypothesized that elevated IgA and monocyte count would correlate with clinical outcomes and ILD patterns in RA-ILD. METHODS: We performed a single-center, retrospective chart review of patients diagnosed with RA-ILD between 2010 and 2021 using an ICD9 and ICD10 based search. Of 256 patients who met our search criteria, 77 were included in the final analysis. Patients were included if they had serum IgA and monocyte count in the chart, a confirmed diagnosis of RA based on ACR/EULAR criteria, and ILD based on chart diagnosis and confirmatory imaging. Patients were excluded if they received rituximab prior to their blood draw. High resolution computed tomography images closest to the date of the blood draw were analyzed by consensus reads by two blinded thoracic radiologists using the 2018 ATS/ERS/JRS/ALAT guidelines. IgA level and monocyte count were compared to pulmonary function at time of blood draw, time to death or lung transplant, UIP pattern as well as sex, ethnicity and age. RESULTS: The mean and median IgA levels were 342.8 mg/dl and 329.0 mg/dl, respectively. There was no statistically significant association between IgA level and the UIP pattern (p = 0.689). IgA level was not associated with baseline FVC% predicted or baseline DLCO% predicted (p = 0.218 and p = 0.639). The effect of IgA level on overall survival is not significant in the simple Cox regression model [hazard ratio (HR) = 1.002, 95% confidence interval (CI) 0.999-1.004, p = 0.203].The mean and median absolute monocyte counts were 6.5×108 cells/liter and 6.0×108 cells/liter, respectively. There was no association between monocyte count and the UIP pattern (p = 0.762). Monocyte count was not associated baseline with FVC% predicted (p = 0.963) or baseline DLCO% predicted (p = 0.882). The effect of monocyte count on overall survival is not significant in the simple Cox regression model (HR = 1.099, 95% CI 0.449-2.690, p = 0.836). CONCLUSIONS: Serum IgA and monocyte concentration were not associated with important clinical outcomes in this RA-ILD cohort. This was a retrospective analysis, it may be that prospective, longitudinal analysis of IgA and monocyte count in RA-ILD could yield different results. CLINICAL IMPLICATIONS: N/A DISCLOSURES: No relevant relationships by Joe Johnstone, source=Web Response Consultant relationship with Boehringer Ingelheim Please note: $1001 - $5000 by Joyce Lee, source=Web Response, value=Consulting fee Consultant relationship with Genentech Please note: $1001 - $5000 by Joyce Lee, source=Web Response, value=Consulting fee Consultant relationship with Celgene Please note: $1001 - $5000 by Joyce Lee, source=Web Response, value=Consulting fee Consultant relationship with Galapagos Please note: $1001 - $5000 by Joyce Lee, source=Web Response, value=Consulting fee Consultant relationship with Eleven P15 Please note: $1001 - $5000 by Joyce Lee, source=Web Response, value=Consulting fee No relevant relationships by Scott Matson, source=Web Response No relevant relationships by Sahil Pandya, source=Web Response No relevant relationships by Kristen Pope, source=Web Response No relevant relationships by Xiaosong Shi, source=Web Response No relevant relationships by Christopher Walker, source=Web Response

P-070: Peripheral blood monocyte count is a dynamic prognostic biomarker for risk stratification in Multiple Myeloma

<h3>Background</h3> Tumor-associated macrophages, derived from peripheral blood monocytes, support malignant plasma cell proliferation in the bone marrow (BM). Since peripheral blood absolute monocyte count (AMC) could reflect the BM microenvironment, we sought to evaluate the prognostic significance of AMC in multiple myeloma (MM). <h3>Methods</h3> We used nationwide Veterans Affairs electronic health records to include treatment-naive MM patients diagnosed between 2000 and 2019 without concomitant aplastic anemia, myelodysplastic syndrome, myeloproliferative neoplasm, and acute or chronic leukemia. We obtained AMC (×10^-3) closest to and within 90 days prior to each timepoint: at diagnosis and every 3 months from diagnosis up to 2.5 years. Patients were stratified by AMC: low (1.25). Our selection criteria excluded any treatment-related change in AMC. Overall survival (OS) was evaluated using Kaplan-Meier estimator and logrank tests. Cox models were used for multivariable analysis. <h3>Results</h3> We identified and analyzed 10,822 patients (median age 70 years; interquartile range [IQR] 63-77) with a median follow up of 2.9 years (IQR 1.3-5.3). At diagnosis, 25.3% of patients presented with abnormal AMC. Patients with low, severely elevated, elevated, and normal AMC at diagnosis had median OS of 2.3, 2.7, 3.1, and 3.6 years (p<0.001), respectively. Abnormal AMC 1 year or more after diagnosis was associated with inferior OS (median OS at 2.5 years; 2.0, 2.6, 3.4, and 3.9 years [p<0.001] in patients with low, severely elevated, elevated, and normal AMC, respectively). If patients with normal AMC at diagnosis developed an abnormal AMC 1 year or more after diagnosis, median OS was decreased relative to patients who maintained normal AMC. Notably, median OS improved across all AMC groups for patients with MM diagnosed after 2012 when modern therapies became standard of care. After adjusting for known prognostic factors (age, ISS Stage, LDH, creatinine), multivariable analysis showed similar results, with a significant association of OS with AMC at diagnosis and AMC measured up to 2.5 years after diagnosis. Hazard ratios (HRs) at diagnosis were 1.28 (95% confidence interval [CI] 1.06–1.41; p<0.001), 1.10 (95%CI 1.04–1.17; p=0.002), and 1.19 (95%CI 1.06–1.34; p=0.004), and HRs 2.5 years after diagnosis were 1.53 (95%CI 1.22–1.93; p<0.001), 1.11 (95%CI 1.00–1.23; p=0.043, 1.58 (95%CI 1.22–2.04; p<0.001) for low, elevated and severely elevated AMC, respectively. <h3>Conclusion</h3> Abnormal AMC in MM at diagnosis or follow up is significantly associated with inferior OS, independent of known prognostic factors. Survival was also inferior for patients who had normal AMC at diagnosis and developed abnormal AMC during follow up, possibly suggesting changes in the BM microenvironment. Overall, AMC is a readily available metric that could be included in the risk stratification of MM at diagnosis and beyond.

Relationship between the absolute lymphocyte count/absolute monocyte count ratio, soluble interleukin 2 receptor level, serum programmed cell death 1 level, and the prognosis of patients with diffuse large B-cell lymphoma.

To analyze the relationship between the peripheral blood absolute lymphocyte count (ALC)/absolute monocyte count (AMC) ratio, soluble interleukin 2 receptor (sIL-2R) level, serum programmed cell death 1 (PD-1) level, and the prognosis of patients with diffuse large B-cell lymphoma (DLBCL). A total of 78 patients with DLBCL admitted to hospital and 30 healthy controls were enrolled as the case group and control group between August 2019 and June 2020, respectively. The ALC/AMC ratio and the levels of sIL-2R and serum PD-1 between the 2 groups and among patients with different prognoses were compared. The evaluation efficiency of these 3 factors for the prognosis of DLBCL patients was analyzed by receiver operating characteristic (ROC) curves. The risk factors affecting the 1-year survival rate were analyzed by the Cox hazard model. The levels of sIL-2R, AMC, and PD-1 in the case group were significantly higher than those in the control group, while the ALC/AMC ratio was lower than that in the control group (P<0.05). The levels of sIL-2R and PD-1 in the poor prognosis group were significantly higher than those in the good prognosis group, while the ALC/AMC ratio was lower than that in the good prognosis group (P<0.05). The areas under the ROC curve (AUCs) of sIL-2R level, serum PD-1 level, and the ALC/AMC ratio in evaluating the prognosis of DLBCL patients were 0.805 (95% CI: 0.700-0.886), 0.825 (95% CI: 0.722-0.902), 0.792 (95% CI: 0.685-0.876), respectively. The critical values were 474.80 µg/L, 206.85 pg/mL and 3.01, respectively. The differences in the 1-year survival rate among DLBCL patients with different tumor sizes, B symptoms, sIL-2R levels, and ALC/AMC ratios were statistically significant (P<0.05). B symptoms (RR =1.721) and ALC/AMC ratio lower than 3.01 (RR =1.484) were independent influencing factors of the 1-year survival rate in DLBCL patients (P<0.05). The ALC/AMC ratio, sIL-2R level, and serum PD-1 level can effectively assess the prognosis of DLBCL patients. B symptoms and ALC/AMC ratio lower than 3.01 are risk factors affecting the 1-year survival rate of patients.

Inflammation-nutritional markers of peripheral blood could predict survival in advanced non-small-cell lung cancer patients treated with PD-1 inhibitors.

BackgroundInflammation‐nutritional markers of peripheral blood are easily assessed and can predict survival. The aim of this study was to investigate the association between inflammation‐nutritional parameters and survival of anti‐programmed death‐1 (PD‐1) therapy in non‐small‐cell lung cancer (NSCLC) patients.MethodsWe performed a retrospective study from March 2017 to April 2020 in advanced NSCLC patients treated with PD‐1 inhibitors. Univariable and multivariable analyses were conducted to evaluate the relationship between peripheral blood parameters (absolute lymphocyte count [ALC], absolute neutrophil count [ANC], absolute monocyte count [AMC], absolute eosinocyte count [AEC], lactic dehydrogenase [LDH], plasma‐albumin [ALB], neutrophil/lymphocyte ratio [NLR], and platelet/lymphocyte ratio [PLR]) measured before therapy initiation and prognosis.ResultsAmong 184 evaluable patients, 134 (72.8%) were male and the median age was 58 years (range 33–87) with 31 (16.8%) ≥70 years. An elevated ANC (≥7500/ul), NLR (≥5), and PLR (≥200) was significantly associated with worse objective response rate (ORR), progression‐free survival (PFS), and overall survival (OS), while increased ALC (≥1000/ul) and ALB (≥3.5 g/dl) could significantly improve survival in terms of ORR, PFS, and OS. In multivariate analyses, higher AEC (≥150/ul) and AMC (≥650/ul) could significantly decrease the risk of death (hazard ratio [HR] 0.363, 95% confidence interval [CI] 0.141–0.931, p = 0.035; HR 0.370, 95% CI 0.203–0.675, p = 0.001). A higher NLR and PLR, and lower ALB were independent predictors of poor prognosis for OS (HR 1.964, 95% CI 1.027–3.755, p = 0.041; HR 4.255, 95% CI 2.364–7.658, p = 0.000; HR 1.962, 95% CI 1.213–3.174, p = 0.006, respectively).ConclusionOur research illustrated that pretreatment AEC, AMC, ALB, NLR, and PLR are independent predictors for survival in advanced NSCLC patients treated with PD‐1 inhibitors.

The relationship between pre-operative lymphocyte to monocyte ratio and serum cancer antigen-125 among women with epithelial ovarian cancer in Lagos, Nigeria.

Ovarian cancer (OC) is the second most common genital cancer worldwide, and the most lethal of all genital cancers. The role of inflammation and markers of systemic inflammation such as neutrophils, lymphocytes and monocytes in cancer biology have been investigated and reported in many studies. Cancer antigen 125 (CA-125) is currently in use as an adjunct to diagnosis, prognostication and monitoring of epithelial OC (EOC). This test is not readily available in many centres in sub-Saharan Africa, creating a need to identify alternative markers that are available and affordable. This study aimed to determine the relationship between pre-operative serum lymphocyte to monocyte ratio (LMR) and CA-125 in EOC. This was a retrospective cross-sectional study among 70 women, diagnosed with EOC in Lagos University Teaching Hospital from January 2013 to December 2019. Data were extracted from the case notes of the patients. LMR was calculated as the absolute lymphocyte count divided by the absolute monocyte count and analysed using Statistical Package for Social Sciences (SPSS) version 25.0. The correlation between LMR and CA-125 was determined using Pearson’s correlation coefficient. The mean age of the patients was 48.57 ± 13.97 years. Serous adenocarcinoma was the most common subtype of EOC making up 94.3% of the cases. The median serum CA-125 was 393.5 (215.00–765.67) U/mL. The median LMR was 6.77 (1.28–43.0). There was a statistically significant negative correlation between CA-125 and LMR, r = −0.28, p = 0.02. LMR was negatively associated with CA-125 in women with EOC. LMR may be considered as a simple, affordable alternative marker to CA-125 in the management of EOC.

Evidence of Subclinical Inflammation Relates to PAH Exposure in Overwintering Common Loons (Gavia immer)

Common Loons (Gavia immer) are migratory, piscivorous waterbirds that exhibit high wintering site fidelity. Forty-three immature loons were captured in 2013, 2015–2017, in southwest coastal Louisiana, an area moderately to heavily exposed to oil from the Deepwater Horizon oil spill of 2010. We analyzed blood from loons to examine associations between exposure to polycyclic aromatic hydrocarbons (PAH) and 25 blood analytes. Overall, 60% (26/43) of the loons had detectable concentrations of PAHs, with an average concentration of 55.3 ± 10.3 ng/g. After controlling for body weight, loons with detectable blood PAHs had higher concentrations of absolute eosinophils, lymphocytes, or monocytes compared to loons without PAH exposure. This study provides evidence of subclinical inflammation in Common Loons wintering in coastal Louisiana and identifies exposure to PAHs as a stressor, raising concern for potential impaired fitness in this population resulting from low-level exposure to PAHs.

Evaluating the Prognostic Role of Monocytopenia in Chemotherapy-Induced Febrile Neutropenia Patients Treated with Granulocyte Colony-Stimulating Factor.

ObjectiveChemotherapy-induced febrile neutropenia is a common and serious oncological emergency which carries a substantial mortality and morbidity. The main objective of this study is to evaluate the usage of absolute monocyte count (AMC) at presentation as a prognostic factor for patients with chemotherapy-induced febrile neutropenia who were subsequently treated with granulocyte colony-stimulating factor (G-CSF).Study DesignThe electronic medical records of our center were used retrospectively to identify patients diagnosed with unprecedented chemotherapy-induced febrile neutropenia treated with G-CSF between January 2010 to December 2020 and diagnosed with solid and hematological malignancies. Patient’s demographics, disease characteristics and laboratory investigations were extracted. Disease progression measures were statistically compared between the study groups in the short-term period of follow-up (six days) including absolute neutrophil count (ANC), ANC difference compared to the baseline readings, hospitalization period, and mortality.ResultsA total of 80 patients were identified and categorized into two groups namely monocytopenia (n = 34) and non-monocytopenia (n = 46) with an AMC cutoff point of 0.1×109 cells/L. The monocytopenia group exhibited a worse prognosis with lower ANC values and slower improvement illustrated by the low ANC difference values at all follow up points (P-value ≤ 0.05) apart from day 5. A statistically significant lower hospitalization period was also observed in the non-monocytopenia group (P-value = 0.006). Linear regression analysis evaluated the association between AMC values at admission and ANC values at admission along with subsequent days of follow up which were found to be statistically significant (P-value ≤ 0.05). Receiver operating characteristic curves suggest a satisfactory predictability of ANC changes by AMC values at admission, days1, 2, 3, 4 and 6.ConclusionMonocytopenia holds a worse prognosis in chemotherapy-induced febrile neutropenia patients treated with G-CSF. In addition, AMC values at presentation represents a potential risk factor that can predict short-term changes regarding ANC measures.

Comparison of Neutrophil to Lymphocyte Ratio (NLR) and Lymphocyte to Monocyte Ratio (LMR) values in controlled and uncontrolled Type 2 Diabetes Mellitus (T2DM) patient

Background: Inflammation is related to insulin resistance. Neutrophil to Lymphocyte Ratio (NLR) and Lymphocyte to Monocyte Ratio (LMR) are used as inflammation markers and predictors of complications associated with diabetes. This study aims to determine the differences of NLR and LMR values in controlled and uncontrolled type 2 diabetes mellitus (DM) patients.Methods: A cross-sectional was conducted in this study at Sanglah General Hospital. Research data were taken from the Laboratory Information System (LIS) and medical records. NLR is obtained from the absolute neutrophils divided by absolute lymphocytes, LMR is obtained from absolute lymphocytes divided by absolute monocytes. Data were analyzed using SPSS version 25 for Windows.Results: Type 2 diabetes mellitus mainly was male (58.3%) with the highest proportion at the age of 46-55 years (50.0%). The mean leukocyte count was significantly higher in the uncontrolled group (8.45±1.58 cells/µL) (p&lt;0.05). NLR showed a significant difference in the two groups (p&lt;0.05). However, there was no significant difference in LMR between groups (p&gt;0.05)Conclusion: NLR in uncontrolled type 2 DM was significantly higher than in controlled type 2 DM. Meanwhile, the LMR did not show a significant difference between the two groups.

Systemic Inflammatory Response Index and Futile Recanalization in Patients with Ischemic Stroke Undergoing Endovascular Treatment

Futile recanalization remains a significant challenge for endovascular treatment (EVT) of acute ischemic stroke (AIS). The inflammatory response that occurs after cerebral infarct plays a central role in stroke pathobiology that can influence the outcome of a recanalization procedure. The aim of this study was to evaluate the relationship between the systemic inflammatory response index (SIRI) and futile recanalization in patients with AIS. We retrospectively identified consecutive patients with ischemic stroke due to proximal arterial occlusion in the anterior circulation, who were treated with EVT and achieved near-complete or complete recanalization. Absolute neutrophil count (ANC), absolute monocyte count (AMC), and absolute lymphocyte count (ALC) were collected from admission blood work to calculate SIRI as ANC × AMC/ALC. The study outcome was futile recanalization, defined as poor functional status [modified Rankin scale (mRS) score ≥ 3] at 3 months despite complete or near-complete recanalization. A total of 184 patients were included. Futile recanalization was observed in 110 (59.8%) patients. Older patients (odds ratio (OR) = 1.07, 95% confidence interval (CI): 1.04–1.10, p < 0.001), higher admission National Institutes of Health stroke scale score (OR = 1.10, 95% CI: 1.02–1.19, p = 0.013), and higher admission SIRI (OR = 1.08, 95% CI: 1.01–1.17, p = 0.028) increased the risk of the poor outcome at 3 months despite complete or near-complete recanalization.

The correlation of neutrophil-to-lymphocyte ratio (NLR) and monocytes-to-lymphocytes ratio (MLR) with disease severity in hospitalized patients with Coronavirus disease 2019 (COVID-19)

Background: Early intervention of cases with potential progression to severe disease is essential to improve survival probability in Coronavirus disease 2019 (COVID-19). Systemic inflammation plays an essential role in the process of disease aggravation. This study aimed to assess the correlation of systemic inflammatory response related biomarkers neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR) on time to admission with the disease severity of inpatients with COVID-19.Methods: We performed a retrospective study using secondary data from medical records of inpatients with COVID-19 at Murni Teguh Memorial Hospital, Medan, Indonesia, from June 1 to September 30, 2020. The demographic data were collected from the medical record and the hematologic parameter from the laboratory. NLR and MLR were calculated by dividing the absolute neutrophils and monocytes counts by the absolute lymphocyte counts. The data were tabulated and analyzed by univariate and bivariate analysis with a significance level of p&lt;0.05.Results: Study subjects consisted of 55 non-severe cases and 40 severe cases. The median NLR and MLR of severe and non-severe groups were 7.65 vs 2.92 (p&lt;0.001) and 0.46 vs 0.25 (p=0.013). The correlation coefficients of NLR and MLR with disease severity were 0.564 (p&lt;0.001) and 0.257 (p=0.012). The AUC of ROC analysis was 0.830 (cut-off:&gt;4.81;p&lt;0.001) in NLR and 0.650 (cut-off:&gt;0.31; p=0.013) in MLR to predict the severe disease.Conclusion: NLR and MLR had a significant positive correlation with the disease severity. NLR is better than MLR in predicting severe disease in hospitalized patients with COVID-19.

​Haematological and Blood Chemistry Values in Red Fox (Vulpes vulpes) from Ladakh, India

Background: Red fox (Vulpes vulpes) is a pervasive carnivore species across most of Eurasia and parts of North Africa. The current study was aimed to evaluate baseline values for selected haematological and biochemical variables for red fox in Ladakh, India. Methods: Blood samples were collected from a female red fox with a drug combination of Xylazine and Ketamine. Selected haematological and biochemical variables were assessed for red fox in Ladakh, India. Result: The total leucocytic count was found as 6.37 10^3/uL, Differential Neutrophil count was found as 4.86 10^3/uL, absolute lymphocyte count, monocytes, eosinophil and basophils were found as 1.08 10^3/uL, 0.42 10^3/uL, 0 10^3/uL and 0.01 10^3/uL respectively. Differential count for neutrophil lymphocytes, monocytes, eosinophil and basophils were found as 76.1%, 17%, 6.6%, 0.1% and 0.2% respectively. Total erythrocytic count was found as 8.710^6/uL, hematocrit as 12 g/dL, mean corpuscular volume was 47.4 fL and platelet as 212 10^3/uL. Serum biochemical analysis revealed serum glutamic-oxaloacetic transaminase/ aspartate aminotransferase as 316 U/Lt, serum glutamic-pyruvic transaminase/alanine aminotransferase as 260 U/Lt and alkaline phosphatase as 46 U/Lt.

Correlation between systemic immune-inflammation index and routine hemogram-related inflammatory markers in the prognosis of retinopathy of prematurity

Purpose:To evaluate the prognostic potential of systemic inflammatory index in the course of retinopathy of prematurity (ROP).Methods:This is a retrospective case-control study. 303 infants with a gestational age of ≤35 weeks were screened with and without ROP at birth and 1 month after the birth of complete blood counts (CBC) were included in this study. Serum neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte (PLR), and systemic immune-inflammation index (SII) was calculated at birth and one month after. LMR was calculated by dividing the absolute lymphocyte count by the absolute monocyte count. NLR and PLR were determined by dividing the absolute neutrophil count or the absolute platelet count by the absolute lymphocyte count, respectively. The SII was calculated by the formula = neutrophilxplatelet/lymphocyte. All statistical analyses were performed using SPSS 22 (SPSS for Windows, version 22.0; SPSS, Inc. Chicago, IL, USA).Results:A total of 303 infants were included 145 with ROP and 158 without ROP. The NLR, LMR, PLR and SII values were 0.56 ± 1.17/0.51 ± 1.04 (P = 0.997), 13.7 ± 18/9.49 ± 13.1 (P = 0.014), 31.69 ± 68/24.1 ± 37.7 (P = 0.268), 131.42 ± 326/124.66 ± 267 (P = 0.935) in with ROP and without ROP infant at birth respectively. The NLR, LMR, PLR, and SII values were 0.68 ± 1.27/0.34 ± 0.99 (P = 0.001), 2.58 ± 6.01/2.46 ± 14.5 (P = 0.706), 47.5 ± 78.33/33.55 ± 42.4 (P = 0.035), and 253 ± 681/114 ± 345 (P = 0.001), respectively in with ROP and without ROP infant at 1 month after birth.Conclusion:The NLR, PLR, and SII seem an independent predictor of the development of ROP.

Are Absolute Monocyte Count and The Lymphocyte-Monocyte Ratio (LMR) Valid Prognostic Factors In Classical Hodgkin Lymphoma? An Evaluation Based On Data From 1079 Patients

IntroductionThere is an increasing amount of data showing that both host immunity and tumor microenvironment play an essential role in determining the clinical course in patients with Hodgkin lymphoma (HL) and may also influence their response to therapy. Some investigators have considered the absolute lymphocyte count (ALC) as a surrogate bio-marker of tumor-infiltrating lymphocytes reflecting systemic host immunity, while the absolute monocyte count (AMC) is regarded as a surrogate bio-marker of tumor-associated macrophages reflecting the tumor microenvironment. For many years lymphopenia has been considered as a negative factor predicting poor outcome in HL. Recently monocytosis and the lymphocyte-monocyte ratio (LMR= ALC/AMC), which combines these two surrogate bio-markers, have also been shown to be useful prognostic parameters in HL, particularly in terms of progression free survival (PFS). AimsThe aim of the present study was to verify whether AMC and LMR are indeed valid prognostic parameters in HL, utilizing a large cohort of patients with the disease. Materials and MethodsWe collected data from 1079 patients with classical Hodgkin's lymphoma (cHL) enrolled in different clinical trials of “Gruppo Italiano Studio Linfomi (GISL)” during 1988-2007. Previously we had evaluated a database of 371 patients with cHL and examined different AMC and LMR cut-off levels using the maximum log rank test and c-Harell (area under the curve). We identified AMC of 600/mm3 and LMR of 3.5, as optimal cut-off values. ResultsPatients in our current study had the following characteristics: median age 32 years (range 17-71), 51% males, 15% stage IV disease, 74% with International Prognostic Score (IPS) 0-2, 72% nodular sclerosis and 18% mixed cellularity; 43% were treated with ABVD and 29% with BEACOPP/BEACOPP-like regimens. Radiotherapy (RT) was administered to 66% of cases. Median follow-up was 6.8 years (range 0.1-19), and 5-years and 10-years overall survival (OS) was 89 and 83%, respectively; 5-years PFS was 79%. In an earlier evaluation the 10-years PFS for patients with AMC >600/mm3 and LMR <3.5 was significantly worse, compared to the group with AMC <600/mm3 and LMR >3.5 (p-value: 0.032 and 0.005). However now after applying the same cut-off values to the larger database, we found no statistical differences in PFS ,and both threshold values for AMC (600/mm3) and LMR (3.5) lost their prognostic power. Using the same statistical methods for the cohort of 1079 patients, we found different cut-off values for AMC and LMR, that were equally effective in splitting different survival patterns. For AMC the value of 750/mm3 (26% of patients with AMC >750/mm3), and for LMR a ratio of 1.5 (19% of patients with LMR <1.5) revealed a difference in PFS which was statistically significant (p-value 0.003 and 0.001, respectively), as shown in Figure 1. In multivariate analysis after adjusting by IPS, RT and type of chemotherapy regimen administered, AMC and LMR maintained their prognostic significance for PFS (HR 1.37, p 0.022 and 1.37, p 0.037). After interaction with IPS (Figure 2) LMR showed an uniform pattern within the two risk -groups (overall: HR=1.42, p 0.019; IPS 0-2: HR=1.34, p 0.181; IPS 3-7: HR=1.49, p 0.048). [Display omitted] [Display omitted] ConclusionsOur study of 1079 patients confirms that peripheral monocyte and lymphocyte counts have an important prognostic impact in cHL. The cut off-values we used, although different from those utilized previously, were able to distinguish patients with different PFS. The cut-offs reported in the literature vary according to the different authors and the various sets of patients examined. At present we feel there is still a clear need to finally establish definitive and more appropriate cut-off levels that can be used for all future studies. In order to achieve this goal, it is essential to study an even larger series of patients within the framework of an international collaborative study. Disclosures:No relevant conflicts of interest to declare.

Neurological Consequences of Cytokine Release Syndrome Following Subcutaneous Recombinant IL-15 and Haploidentical Donor Natural Killer Cell Therapy for Advanced Acute Myeloid Leukemia

Abstract Cytokine Release Syndrome (CRS) is associated with elevated cytokine levels, macrophage activation, and IL-6 production after antibody or cell-based immunotherapy. We have observed over 200 patients with no CRS following adoptively transferred haploidentical donor natural killer (haplo-NK) cell products after lymphodepleting chemotherapy plus IL-2; and achieved complete remission in 30-50% of patients with refractory AML. To promote NK cell expansion without stimulation of Treg that may compromise NK function, we tested the substitution of IL-2 with the NCI manufactured rIL-15. Using the same lymphodepleting preparative regimen (Fludarabine 25 mg/m2IV for 5 days and Cyclophosphamide 60 mg/kg IV for 2 days) we infused CD3- and CD19-depleted haplo-NK incubated overnight with rIL-15 (10 ng/mL) prior to infusion. Two cohorts received rIL-15; either intravenously x 12 daily doses (at the Phase I MTD of 0.75 mcg/kg) or subcutaneously x 10 doses (5 days on, 2 days off, 5 days on at 2 mcg/kg SQ, the MTD when used as monotherapy in solid tumor patients). CRS was defined by modified CRS grading criteria (Lee et al. Blood, 2014). Results: Forty patients with relapsed/refractory AML were treated with haplo-NK plus IV rIL-15 (n=24) or SQ rIL-15 (n=16). Patients received an average of 11.6 IV doses [9-12, 96% of planned doses] or 7.5 SQ doses [1-10, 75% of planned doses]. Dosing was stopped for toxicity. No CRS events were observed after IV dosing. However, after SQ dosing, 9 of 16 patients [56%] had grade 1-4 CRS; [4 (25%) with grade 3-4 CRS) (Table 1). The median time from NK infusion to onset of CRS was 8 days [2-44]. Six of the 9 CRS patients (66%) had neurological events. Neurological toxicities included grade 1-2 encephalopathy (n=2), intracranial hemorrhage (ICH) (n=2, grade 1 and grade 5), and grade 4 seizures (n=2). One additional event (a patient with a fall resulting in ICH due to pre-existing gait abnormality) without evidence of CRS was not considered as IL-15 associated neurotoxicity CRS. Symptoms resolved in 4 of 5 patients who received treatment for neurologic CRS (3 received both steroids and Tocilizumab, 1 received steroids only, 1 patient did not require treatment as symptoms resolved with stopping IL-15). Non-neurologic toxicity included hypoxia (n=2) and hypotension (n=3). No significant correlations were found between development of CRS and absolute lymphocyte or monocyte count, presence or absence of haplo-NK expansion at day 14, number of rIL-15 doses received, or disease burden at baseline as measured by blast percentage in bone marrow. In the IV rIL-15 cohort, only 2 of 14 patients at the MTD (14%) cleared leukemia and underwent transplantation. In contrast, 8 of 16 patients (50%, P=0.04) in the SQ rIL-15 cohort achieved CR (n=7) or CRp (n=1), with 6 patients proceeding to alloHCT consolidation. CRS did not limit the clinical benefit in the SQ cohort as 4 of 9 [44%] patients with CRS achieved CR/PR compared to 4 of 7 [57%] patients without CRS. Pharmacokinetic data showed slower clearance of rIL-15 in SQ compared to IV dosing, as shown by higher trough levels prior to dose 2 (501 vs. 233 pg/mL, p Download : Download high-res image (163KB) Download : Download full-size image Disclosures Bachanova: Novartis Pharmaceuticals Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding; Juno: Membership on an entity's Board of Directors or advisory committees; Seattle-Genetics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Zymogen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Oxis: Membership on an entity's Board of Directors or advisory committees, Research Funding. Miller: Celegene: Consultancy; Oxis Biotech: Consultancy; Fate Therapeutics: Consultancy, Research Funding.

High Absolute Monocyte Count at Diagnosis Predicts Adverse Outcome Among Very Good and Good R-IPI Diffuse Large B Cell Lymphoma

Introduction:Diffuse Large B Cell Lymphoma (DLBCL) is an aggressive lymphoma with a heterogeneous clinical, histological, immunophenotypic and cytogenetic features that translate into variable prognosis. The Rituximab-International Prognostic Index (R-IPI) score considers patient´s and tumor´s characteristics and identifies 3 prognostic groups. However among patients in the same risk group, outcomes are diverse, even with the use of modern immunochemotherapy regimens and there is a subgroup of patients with a 5-year overall survival (OS) probability of less than 50%.Therefore, the recognition of prognostic biomarkers capable to better stratify patient´s risk has been the focus of extense research, and identifying cheap, easily available and simple tools seems a valious goal. Monocytes act as host anti-tumor immunity suppressors and as promoters of malignant lymphocyte´s growth and survival and there is evidence that elevated absolute monocyte count (AMC) is independently associated with inferior PFS and OS in patients with DLBCL. The objective of this study is to evaluate the prognostic value of the AMC at diagnosis in our population of patients with DLBCL treated with chemoimmunotherapy.Materials and Methods:Retrospective analysis of 202 patients with newly diagnosed DLBCL between 2002 and 2017 treated at Hospital de Clínicas and Hospital Maciel, the two main health public reference services in Montevideo-Uruguay.AMC was determined from routine automated complete blood count (CBC) at diagnosis, prior to therapy administration. The cut off value considered for AMC was 630/mm3, according to Wilcox et al. Leukemia (2011) 25, 1502-1509. Treatment response was defined according to the International Workshop criteria. This study complied with all provisions of the Declaration of Helsinki and its current amendments and was conducted in accordance with Good Clinical Practice Guidelines.Results:Among the entire population, 177 patients received immunochemotherapy (R-CHOP or R-CHOP like) with a median of rituximab cycles of 6 (1-6). Median age was 61 (17-85); 99 (56%) were female; 74 patients (42%) had stage I-II, 103 (58%) stage III-IV. According to RIPI score; 10 (5,6%) had very good prognosis, 97 (54,8%) good prognosis and 70 (39,6%) adverse prognosis. Four percent were HIV positive. Median AMC at diagnosis was 620 (40-3720). At the end of treatment 118 patients (66,7%) achieved Complete Remission (CR). Forty percent were refractory or relapsed. According to AMC, CR rates were 63% when AMC was ≥ 631/mm3 and 71,8% with AMC < 631/mm3 (p=0,25) There was no difference in the median cycles of rituximab among these groups. When grouped according to RIPI score, AMC was associated with different RC rates. In very good and good RIPI score (0-2) CR was 80,8% in AMC <631/mm3 and 62,7% in AMC ≥ 631/mm3 (p=0,042). No difference was found in CR among adverse RIPI score according to AMC (57,6% vs 64,7% p=0,54). With a median follow up of 27,8 months (0,6-149) median OS in the group of patients with high AMC was 79,7 months (47-112) vs 131 months (20,6-242,6) in low AMC (p=0,016) This population was comparable in terms of RIPI score. In the subgroup of patients with very good and good RIPI the median OS in patients with low AMC has not been reached and was 79,7 months in high AMC (55,7-103,8 p=0,002). There was no statistically significant difference in median OS in patients with adverse RIPI score according to AMC (131 vs 101 months p=0,94). The Relapse Free Survival (RFS) among RIPI 0-2 was not reached in those with low AMC and was 55 months (35,7-74-8) with high AMC (p=0,039)In high risk RIPI patients, there was no difference in RFS among both groups (16,7 months vs 28,1 p=0,58). No significant difference was found in RFS and OS when patients with RIPI 0-2 with high AMC were compared to those with RIPI 3-5 (55 vs 28 months p= 0,55 and 79,7 vs 101 months p=0,82 respectively)Discussion:Outcome of patients with DLBCL is variable even among the same prognostic group according to traditional scores. In our study high AMC was associated with inferior CR rates, RFS and OS. This difference was statistically significant in very good or good prognosis RIPI and patients in this group with high AMC had similar OS than adverse prognostic RIPI patients. This results suggest that a low cost and accessible test as AMC could improve prognostication of patients with DLBCL, particularly in the group of good prognosis. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.