Blood Monocyte Counts Research Articles

A 16S rDNA sequencing-based analysis of airway microecology in patients with an acute exacerbation of chronic obstructive pulmonary disease: A cross-sectional study in Inner Mongolia, China.

AimTo study the microecological characteristics of the airway and similarities and differences between healthy people and patients with the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Inner Mongolia, and analyze the correlation between the characteristics of the airway microecological structure and clinical indicators of AECOPD patients.MethodsSputum samples from 36 healthy volunteers and 34 patients with AECOPD were detected by 16S rDNA high-throughput sequencing, and the airway microecological characteristics of healthy people and AECOPD patients were revealed by an alpha diversity analysis, beta diversity analysis, and LefSe difference analysis.ResultsThere were differences in the airway microecological structure between healthy people and AECOPD patients in Inner Mongolia. The airway microbiota composition of AECOPD patients showed an increase in the abundance of common pathogens and a decrease in the abundance of commensal bacteria, and the airway microbial diversity in AECOPD patients was lower than that in healthy people. Long-term use of inhaled glucocorticoid + long-acting β2 agonist mixture (ICS + LABA), procalcitonin (PCT), blood monocyte count (MONO), hemoglobin (HGB), D-dimer (D-D), and body temperature were negatively correlated with the alpha diversity of the airway micro-ecosystem.ConclusionThe airway microecological composition of the AECOPD population in Inner Mongolia was different from that of the healthy population, and the airway microecological diversity was lower than that of the healthy population. The long-term use of ICS + LABA preparation by patients with AECOPD leads to lower alpha diversity. Alpha diversity was negatively correlated with inflammatory markers (PCT, MONO, D-dimer, body temperature) and HGB in AECOPD patients.

Blood Leukocyte Counts in Alzheimer Disease

Emerging evidence implicates a role for neuroinflammation in Alzheimer disease (AD) pathogenesis, predominantly involving the innate immune system. Blood leukocyte counts are easily accessible markers of immune function; however, their association with the risk of AD is unknown. To investigate the observational and genetic associations between types of blood leukocytes and risk of AD. In a cohort study comprising observational and genetic analyses, the Copenhagen General Population Study prospective cohort (n = 101 582) was used for the observational analyses. For the genetic studies, nonlinearity was first evaluated for the association between leukocyte cell counts and AD risk using individual-level data from the UK Biobank (n = 365 913). Subsequently, a 2-sample mendelian randomization framework was applied using genetic instruments for blood leukocyte counts (n = 563 085); for AD, the European Alzheimer & Dementia Biobank was used, including 85 934 individuals with AD and 401 577 controls and the International Genomics of Alzheimer's Project, including 21 982 individuals with AD and 41 944 controls. Observational and genetically determined types of blood leukocyte counts. Hazard ratios (HRs) and 95% CIs for AD of cell count percentile groups in observational studies and odds ratios (ORs) and 95% CIs for AD per 1 SD genetically determined cell counts. This cohort study included 101 582 participants (55 891 [55.0%] women) with a median age of 58 years (IQR, 48-67 years); of these, 1588 individuals developed AD. Multivariable-adjusted HRs for participants in the less than 5th vs the 25th to 75th (reference) percentile group were 1.24 (95% CI, 0.99-1.54) for blood monocytes and 1.25 for blood eosinophils (95% CI, 1.05-1.50). For participants in the greater than 95th vs the 25th to 75th percentile group, the HR was 1.30 (95% CI, 1.06-1.61) for blood neutrophils. Genetically, no evidence favored possible nonlinear associations. The ORs for AD per 1-SD decrease in genetically determined blood monocytes were 1.04 (95% CI, 1.00-1.10) in the European Alzheimer & Dementia Biobank consortium and 1.09 (95% CI, 1.01-1.17) in the International Genomics of Alzheimer's Project consortium. Using mendelian randomization, sensitivity analyses and multivariable analysis showed similar results. The findings of this study suggest that low blood monocyte counts are associated with increased AD risk. These findings highlight a potential role of the innate immune system in AD pathogenesis.

Short-term efficacy of decitabine-based therapy in JMML: a retrospective study from a single center in China.

Juvenile myelomonocytic leukemia (JMML) is an aggressive pediatric myeloproliferative disease, and newly diagnosed patients frequently cannot tolerate hematopoietic stem cell transplantation (HSCT) at diagnosis due to their poor condition. This retrospective analysis aimed to explore the short-term effect of decitabine-dominant therapy on improving the condition of JMML patients before HSCT. The subjects were 10 JMML patients. All patients were treated with decitabine after low-dose chemotherapy with an interval of 4weeks before bridging to HSCT. The median treatment course was 3 cycles, and the overall response rate (ORR) was 70.0% after one cycle and 71.4% after three cycles. White blood cell (WBC) and monocyte counts were significantly lower after treatment, and spleen volume was also lower, though not significantly lower. The 12month progression-free survival rate (PFS) was 80.0 ± 12.6%. Decitabine-dominant therapy was beneficial for reducing tumor burden and improving clinical condition.

The effects of administering different metaphylactic antimicrobials on growth performance and health outcomes of high-risk, newly received feedlot steers.

Bovine respiratory disease (BRD) is the primary animal health concern facing feedlot producers. Many antimicrobial mitigation strategies are available, but few studies have compared feedlot performance during both the receiving and finishing periods following application of different antimicrobials used as metaphylaxis at arrival. The objective of this study was to compare antimicrobial metaphylaxis methods on clinical health and growth performance across both the receiving and finishing periods. A total of 238 multiple-sourced steers in two source blocks were used in a generalized complete block design. The four treatments included: 1) a negative control, 5 mL of sterile saline injected subcutaneously (CON); 2) subcutaneous administration of florfenicol at 40 mg/kg of BW (NUF); 3) subcutaneous administration of ceftiofur in the posterior aspect of the ear at 6.6 mg/kg of BW (EXC); and 4) subcutaneous administration of tulathromycin at 2.5 mg/kg of BW (DRA). The morbidity rate for the first treatment of BRD was decreased for the DRA and EXC treatments compared to CON and NUF (P < 0.01). Additionally, average daily gain (ADG), dry matter intake (DMI), and gain-to-feed (G:F) were greater (P ≤ 0.02) in the DRA treatment during the receiving period compared to all other treatments. The ADG was also greater (P < 0.05) for EXC than the CON treatment throughout the finishing period. Nonetheless, other growth performance variables did not differ among metaphylactic treatments during the finishing period (P ≥ 0.14). Likewise, no differences in carcass characteristics or liver abscess score were observed (P ≥ 0.18). All complete blood count (CBC) variables were affected by day (P ≤ 0.01) except mean corpuscular hemoglobin concentration (P = 0.29). Treatment × time interactions were observed for platelet count, white blood cell (WBC) count, monocyte count and percentage, and lymphocyte percentage (P ≤ 0.03). However, there were no observed hematological variables that differed among treatment (P ≥ 0.10). The results indicate that some commercially available antimicrobials labeled for metaphylactic use are more efficacious than others in decreasing morbidity rate.

Neutrophil-to-lymphocyte ratio as a promising biomarker for the diagnosis of psoriasis in Pakistan

Background: Psoriasis is a skin inflammation characterized by papules and plaques on the skin surface. Almost 125 million people are affected by psoriasis worldwide. This study aimed to evaluate whether the neutrophil-to-lymphocyte ratio (NLR) can be used as a biomarker for the diagnosis of psoriasis. Methods: Blood samples of patients with psoriasis and healthy controls were collected for complete blood count testing. A t-test was applied to estimate the difference in the hematological parameters between the two groups. Results: The hemoglobin level (p &lt; 0.0001), hematocrit level (p &lt; 0.0001), red blood cell count (p &lt; 0.0001), mean corpuscular volume (p = 0.0002), platelet count (p = 0.0039), white blood cell count (p = 0.0002), neutrophil count (p = 0.0001), monocyte count (p &lt; 0.0001), and eosinophil count (p = 0.0467) significantly differed between the groups. Meanwhile, the mean corpuscular hemoglobin concentration (p = 0.3989) and lymphocyte count (p = 0.3842) did not. The patients with psoriasis had a higher neutrophil count and a lower lymphocyte count than the healthy controls. The NLR was significantly elevated in the patients with psoriasis. Conclusion: The NLR is a potential biomarker for the diagnosis of psoriasis.

Application of metagenomic next-generation sequencing in the diagnosis of pulmonary invasive fungal disease.

BackgroundMetagenomic next-generation sequencing (mNGS) is increasingly being used to detect pathogens directly from clinical specimens. However, the optimal application of mNGS and subsequent result interpretation can be challenging. In addition, studies reporting the use of mNGS for the diagnosis of invasive fungal infections (IFIs) are rare.ObjectiveWe critically evaluated the performance of mNGS in the diagnosis of pulmonary IFIs, by conducting a multicenter retrospective analysis. The methodological strengths of mNGS were recognized, and diagnostic cutoffs were determined.MethodsA total of 310 patients with suspected pulmonary IFIs were included in this study. Conventional microbiological tests (CMTs) and mNGS were performed in parallel on the same set of samples. Receiver operating characteristic (ROC) curves were used to evaluate the performance of the logarithm of reads per kilobase per million mapped reads [lg(RPKM)], and read counts were used to predict true-positive pathogens.ResultThe majority of the selected patients (86.5%) were immunocompromised. Twenty species of fungi were detected by mNGS, which was more than was achieved with standard culture methods. Peripheral blood lymphocyte and monocyte counts, as well as serum albumin levels, were significantly negatively correlated with fungal infection. In contrast, C-reactive protein and procalcitonin levels showed a significant positive correlation with fungal infection. ROC curves showed that mNGS [and especially lg(RPKM)] was superior to CMTs in its diagnostic performance. The area under the ROC curve value obtained for lg(RPKM) in the bronchoalveolar lavage fluid of patients with suspected pulmonary IFIs, used to predict true-positive pathogens, was 0.967, and the cutoff value calculated from the Youden index was −5.44.ConclusionsIn this study, we have evaluated the performance of mNGS-specific indicators that can identify pathogens in patients with IFIs more accurately and rapidly than CMTs, which will have important clinical implications.

Neutrophil to lymphocyte and monocyte to high-density lipoprotein ratios are promising inflammatory indicators of bipolar disorder

Aims The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), and monocyte to high-density lipoprotein (MHR) are indicators of inflammation. In this study, we aimed to examine the possible association between NLR, PLR, MLR, and MHR in the same patients with bipolar disorder (BD) during their manic, depressive, and euthymic episodes. Methods The participants of this study consisted of 61 patients with BD, aged between 18 and 65, who were hospitalized with a diagnosis of BD. Patients who were hospitalized during their manic and depressive episodes and medication free for at least 1 month before hospitalization were included. White blood cell, neutrophil, lymphocyte, platelet, and monocyte counts, high-density lipoprotein (HDL) cholesterol, and C reactive protein (CRP) levels were recorded. Results Leukocytes (p = 0.000), neutrophil (p = 0.009), monocyte counts (p = 0.012), CRP levels (p = 0.026), NLR (p = 0.025), and MHR (p = 0.011) values were significantly higher in their manic episode and depressive episode compared with the values in their remission period. There was no significant difference between manic and depressive episodes in terms of inflammation parameters. Significant positive correlations were found between the number of depressive episodes and patients’ CRP levels (p = 0.031). Conclusions This study was the first study to examine the inflammatory markers such as NLR, MLR, PLR, and MHR levels in same patients with BD during their three episodes of disorder. Both NLR and MHR values in manic and depressive episodes were higher than euthymic episodes. NLR and MHR were useful inflammatory markers to evaluate inflammation in bipolar patients.

Low Pre-ChemoradiotherapyPan-Immune-Inflammation Value (PIV) Measures Predict Better Survival Outcomes in Locally Advanced Pancreatic Adenocarcinomas.

ObjectiveThis study sought to determine whether pretreatment pan-immune-inflammation value (PIV) could be used to predict prognosis in patients with locally advanced pancreatic adenocarcinoma (LA-PAC) following definitive concurrent chemoradiotherapy (C-CRT).MethodsThe outcomes of 178 LA-PAC patients who received definitive C-CRT were analyzed retrospectively. For all patients, the PIV was calculated using the peripheral blood platelet (P), monocyte (M), neutrophil (N), and lymphocyte (L) counts obtained on the first day of C-CRT: PIV=P×M×N÷L. The optimum cutoff values for PIV connected to progression-free (PFS) and overall survival (OS) results were sought using receiver operating characteristic (ROC) curve analysis. The OS and PFS differences between the PIV groups constituted the primary and secondary endpoints, respectively.ResultsROC curve analysis indicated that the ideal PIV cutoff was 464 (AUC: 75.9%, sensitivity: 74.1%, specificity: 71.9%), which categorized patients into two groups based on PFS and OS results: low PIV (L-PIV; N = 69) and high PIV (H-PIV; N = 109). According to comparative survival analyses, patients in the L-PIV group had significantly longer median PFS (14.3 vs 7.3 months; HR: 3.04; P<0.001) and OS (25.9 vs 13.3 months; HR: 2.86; P<0.001) than those in the H-PIV group. Although none of the H-PIV patients could survive beyond 5 years, the estimated 5-year OS rate was 29.7% in the L-PIV cohort. In multivariate analyses, besides the L-PIV, N0 nodal stage, and CA 19–9 ≤ 90 U/mL appeared to be the independent predictors of better PFS (P < 0.05 for each) and OS (P < 0.05 for each) results.ConclusionThe present results indicated that pre-C-CRT L-PIV measures were associated with favorable median and long-term PFS and OS results in LA-PAC patients, suggesting that the PIV is a potent and independent novel prognostic biomarker.

Association between Routine Laboratory Parameters and the Severity and Progression of Systemic Sclerosis.

(1) Background: Systemic sclerosis (SSc) is a heterogeneous connective tissue disease with a high mortality and morbidity rate. Identification of biomarkers that can predict the evolution of SSc is a key factor in the management of patients. The aim of this study was to assess the association of routine laboratory parameters, widely used in practice and easily available, with the severity and progression of SSc. (2) Methods: In this retrospective monocentric cohort study, 372 SSc patients were included. We gathered clinical and laboratory data including routine laboratory parameters: C-reactive-protein (CRP), erythrocyte sedimentation rate (ESR), complete blood count, serum sodium and potassium levels, creatinin, urea, ferritin, albumin, uric acid, N-terminal pro-brain natriuretic peptide (NTproBNP), serum protein electrophoresis, and liver enzymes. Associations between these routine laboratory parameters and clinical presentation and outcome were assessed. (3) Results: Median (interquartile range) age was 59.0 (50.0; 68.0) years. White blood cell, monocyte, and neutrophil absolute counts were significantly higher in patients with diffuse cutaneous SSc and with interstitial lung disease (ILD) (p < 0.001). CRP was significantly higher in patients with ILD (p < 0.001). Hemoglobin and ferritin were significantly lower in patients with pulmonary hypertension (PH) including pulmonary arterial hypertension and ILD associated PH (p = 0.016 and 0.046, respectively). Uric acid and NT pro BNP were significantly higher in patients with PH (<0.001). Monocyte count was associated with ILD progression over time. (4) Conclusions: Overall, our study highlights the association of routine laboratory parameters used in current practice with the severity and progression of SSc.

The impact of pulmonary tuberculosis on immunological and metabolic features of diabetic patients.

Impaired immune responses have been observed in patients with type-2 diabetes mellitus (T2DM), which increases susceptibility to tuberculosis infection. However, the effect of the tuberculosis infection on the immunological and metabolic features of T2DM is largely unknown. To investigate this question, age- and sex-matched patients with pulmonary tuberculosis (PTB), T2DM, or T2DM combined with PTB were recruited from the Infectious Disease Hospital of Heilongjiang Province between January and September 2020. Healthy subjects were used as controls. Cytokines and chemokines in fasting serum samples were determined using the Quantibody Inflammation Array. Compared with T2DM alone, patients with T2DM combined with PTB have higher fasting blood glucose levels and monocyte counts in circulation. Among the four groups, circulating IL-10 levels peaked in patients with T2DM and PTB (p<0.05). Univariate linear analysis showed that serum IL-10 levels were positively associated with myeloid cells but negatively correlated with lymphocyte counts in these patients (p<0.05). Serum IL-6 levels were 1.6-fold higher in patients with T2DM plus PTB than in those with T2DM alone. In conclusion, PTB infection in patients with T2DM had distinct inflammatory profiles and sustained hyperglycaemia compared with PTB or T2DM alone. IL-10 levels and elevated monocyte counts could be hallmarks of patients with T2DM infected with PTB.

Effects of Lead and Cadmium Combined Heavy Metals on Liver Function and Lipid Metabolism in Mice.

Although a large number of studies have been conducted on lead (Pb) and cadmium (Cd) exposure individually, information regarding the toxicity of combined Pb and Cd exposure is relatively limited. The present study aims to investigate the toxicity of Pb-Cd combination exposure and the corresponding mechanism. A heavy metal exposure model was established in mice by subcutaneous intragastric administration of Pb-Cd (50:1) for 35days. Body weight, diet, hair state, mental state, liver index, haematological index, biochemical indicators and pathological section analysis were used to comprehensively evaluate toxicity. Then, classical oxidative stress indexes and lipidomics techniques were used to explore the potential mechanism. The results showed that Pb-Cd caused the mice to have low appetite, poor spirit, significantly reduced activity, slow weight gain and irritated or drying hair. Pb-Cd also caused liver enlargement, significantly increased aspartate aminotransferase (AST) and alanine aminotransferase (ALT) enzyme activities, and resulted in pathological changes to the liver. Prolonged Pb-Cd exposure led to significantly increased thrombocyte haematocrit (PCT), white blood cell (WBC), platelet (PLT) and monocyte (MON) counts and decreased red blood cell (RBC), haemoglobin (HGB), haematocrit (HCT) and lymphocyte (LYM) counts. Pb-Cd increased oxidative stress by increasing the activity of superoxide dismutase (SOD) and lactate dehydrogenase (LDH) and the content of malondialdehyde (MDA). Finally, Pb-Cd triggered lipid metabolism disorders by regulating linoleic acid, sphingolipid and glycerolipid metabolism.

Predictive value of hematological parameters in testicular salvage: A 12-year retrospective review.

PurposeThis study aimed to evaluate the predictive value of preoperative hematological parameters for testicular salvage in patients with testicular torsion.MethodsClinical data of patients with testicular torsion treated at Shenzhen Children's Hospital from January 2010 to December 2021 were analyzed retrospectively. The data collected included age, symptom duration, degree of spermatic cord torsion, the surgical approach adopted, hematological parameters, and ultrasound results during postoperative follow-up.ResultsThe study participants were classified into three groups as follows: the successful testicular salvage group (n = 43), failed testicular salvage group (n = 124), and control group (n = 100). Univariate analysis showed that testicular salvage was related to patient age, duration of symptoms, spermatic cord torsion degree, white blood cell count, lymphocyte count, monocyte count, platelet-lymphocyte ratio, and neutrophil-lymphocyte ratio. However, multivariate analysis revealed that symptom duration (OR = 0.948, P < 0.001), degree of spermatic cord torsion (OR = 0.994, P < 0.001), and monocyte count (OR = 0.020, P = 0.011) were independent risk factors for testicular torsion salvage. The monocyte count in the failed salvage group was significantly higher than in the successful salvage and control groups (P < 0.01).ConclusionMonocyte count is an independent predictor of testicular salvage. Therefore, clinicians can predict the success rate of testicular salvage in patients with testicular torsion based on the monocyte count.

Houttuynia cordata polysaccharide alleviates chronic vascular inflammation by suppressing calcium-sensing receptor in rats

The present study explored activities of orally administrated Houttuynia cordata polysaccharide (HCP) on vascular chronic inflammation which was established by a tail-vein injection of lipopolysaccharide (LPS) once weekly for 6 weeks in rats. Results showed that administration of HCP significantly alleviated chronic inflammation by reducing white blood cell and monocyte counts, together with repairing histological impairment of vascular tissue. Furthermore, vascular protections of HCP were in association with decrease of MDA content, pro-inflammatory cytokines interleukin-1beta (IL-1β) and tumor necrosis factor-α (TNF-α), and enhancement of the activities of antioxidant enzyme superoxide dismutase, catalase, glutathione peroxidase activities. Moreover, HCP exhibited anti-inflammatory responses evidenced by reducing the expressions of Toll-like receptor 4 (TLR4) and NF-kB P65. Meanwhile, the combination of HCP and LPS reduced calcium concentration and CaSR mRNA expression in the vascular tissue. Collectively, these results indicated that HCP suppressed LPS-induced chronic vascular inflammation via calcium-sensing receptor and TLR4/NF-kB pathways in rats.

Daily physical activity is negatively associated with thyroid hormone levels, inflammation, and immune system markers among men and women in the NHANES dataset.

The acute effects of exercise on metabolic energy expenditure and inflammation are well studied, but the long-term effects of regular daily physical activity on metabolic and endocrine effects are less clear. Further, prior studies investigating the impact of daily physical activity in large cohorts have generally relied on self-reported activity. Here, we used the U.S. National Health and Nutrition Examination Survey (NHANES) to investigate the relationship between daily physical activity and both thyroid and immune activity. Daily physical activity was assessed through accelerometry or accelerometry-validated survey responses. Thyroid activity was assessed from circulating levels of thyroid stimulating hormone (TSH) and thyroxine (T4). Immune function was assessed from circulating cytokines (C-reactive protein [CRP], immunoglobulin E [IgE], fibrinogen) and blood cell counts. In general linear models including body mass index, age, gender, activity and TSH as factors, active adults had a lower levels of T4 and reduced slope of the TSH:T4 relationship. Similarly, greater physical activity was associated with lower CRP and fibrinogen levels (but not IgE) and lower white blood cell, basophil, monocyte, neutrophil, and eosinophil (but not lymphocyte) counts. Daily physical activity was also associated with lower prevalence of clinically elevated CRP, WBC, and lymphocytes in a dose-response manner. These results underscore the long-term impact of daily physical activity on both systemic metabolic activity (thyroid) and on specific physiological tasks (immune). The regulatory effects of physical activity on other bodily systems are clinically relevant and should be incorporated into public health strategies promoting exercise.

Detection of Urinary schistosomiasis, the associated risk factors, and its impact on blood parameters among Almajiris in two selected rural communities of Kaduna State

Abstract&#x0D; This study aimed to detect the presence of urinary schistosomiasis, the associated risk factors and its impact on blood parameters among Almajiris in two selected rural communities of Kaduna State. Urine samples were collected from 193 Almajiri subjects and processed by sedimentation method and examined under the microscope. Blood samples were also collected from the subjects and processed using SWELAB auto analyser for full blood count. A well-structured knowledge, attitude and practice (KAP) questionnaire was administered to the subjects and used to obtain demographic and other associated risk factors. The overall prevalence of urinary schistosomiasis in the 2 study areas was 16.1%. Bomo recorded 17.5% while Rafin Guza recorded 22.9% prevalence respectively. Subjects in the age-group 11-16 years had a higher prevalence of 33% (p&lt;0.05). Among the risks factors assessed, subjects that visit the stream for swimming and used well water recorded a higher prevalence of (33.7%) and (17.2%) respectively (p&lt;0.05). Awareness about the disease revealed higher prevalence (p&lt;0.05). Prevalence of the infection among the subjects was also found to be significantly associated with White blood cell (WBC) count, Lymphocyte and monocyte count (p&lt;0.05). The present study identified the study areas to represent moderate–risk community for urinary schistosomiasis. The study advocates the use of mass treatment with Praziquantel to help in reducing the infection level and help to control transmission of the disease.

P761: MONOCYTOSIS IN PRIMARY CARE AND HEMATOLOGICAL MALIGNANCIES

Background: Monocytosis (blood monocyte count > 0.8 x109/L) is relatively often observed in routine blood work from primary care, however, the significance is not always apparent as monocytosis may be present in a spectrum of diseases spanning from mild infections to chronic myelomonocytic leukemia. Aims: We aimed to examine the predictive value of monocytosis in primary care by relating monocyte count to subsequent 3-year incidence of hematological malignancy. Methods: We included 663.184 adult patients from primary care in the greater Copenhagen Area who had a complete blood cell count (CBC) performed at any time between 2000-2016. For patients with multiple samples registered, a random sample was selected and samples predating the index CBC by 3 months were assessed to account for sustained monocytosis. Using the extensive Danish health data registers, we collected data on incident hematological malignancy for 3 years following the CBC. We modelled the association between monocyte count and hematological malignancies as well as all-cause mortality using multiple logistic regression analysis. Results: Monocytosis was observed in 4,6 % of CBCs. We saw an increased risk of myeloid malignancies with the most noticeable being an odds ratio (OR) for CMML > 100 with monocytosis > 1.0 x 109/L. Sustained monocytosis increased this risk to OR >140. The incidence was, however, still low with only 0.1% of patients with monocytosis developing CMML within 3 years. Risk of lymphoproliferative and M-component related diseases were also increased, however, other relevant cell line were affected as well in these cases. Summary/Conclusion: Monocytosis is a common finding in primary care, but even with monocytosis > 1 x 109/L hematological malignancies are rare. Optimized referral to secondary care remains a challenge and if the clinical presentation leaves doubt of the diagnosis, repeated measurements help demask if malignancy is the cause of the monocytosis.

P1036: VOLUMETRIC SPLENOMEGALY IN PATIENTS WITH POLYCYTHEMIA VERA

Background: At present, palpable splenomegaly is relatively uncommon in patients with polycythemia vera (PV), possibly because of early diagnosis facilitated by a lowering of the diagnostic thresholds for hemoglobin and hematocrit levels as well as the wide application of driver gene mutation tests. Radiological volumetric analysis of spleen size is now readily available. However, non-palpable splenomegaly in patients with PV has seldom been addressed. Aims: In this retrospective study, we evaluated non-palpable, volumetric splenomegaly defined based on age- and body surface area (BSA)–matched criteria in patients with PV diagnosed according to the 2016 World Health Organization diagnostic criteria. Methods: Patients with PV who underwent abdominal computed tomography (CT) and who had palpable splenomegaly at diagnosis from January 1991 to December 2020 at Chungnam National University Hospital were enrolled in the study. The spleen volume of each patient was determined by volumetric analysis of abdominal CT and adjusted for the patient’s age and BSA. And then the degree of splenomegaly was classified as follows: no splenomegaly, spleen volume less than the mean plus 2 SD of the reference volume based on both age and BSA; overt volumetric splenomegaly, spleen volume greater than the mean plus 3 SD of the reference volume based on both age and BSA; borderline volumetric splenomegaly, a spleen volume between no splenomegaly and overt splenomegaly; or palpable splenomegaly, spleen palpable below the left costal margin. Results: Of the 87 PV patients enrolled in the study, 15 (17.2%) had no splenomegaly, whereas 17 (19.5%), 45 (51.7%), and 10 (11.5%) had borderline volumetric, overt volumetric, and palpable splenomegaly, respectively. Spleen volume was significantly positively correlated with lactate dehydrogenase level (r = 0.227, P = 0.042) and tended to be positively related to white blood cell count (r = 0.209, P = 0.055) and monocyte count (r = 0.210, P = 0.059) at diagnosis. Spleen volume was not correlated with hemoglobin level, platelet count, or JAK2V617F burden at diagnosis. The degree of splenomegaly did not affect the cumulative incidence of thrombotic vascular events (10-year incidence: 7.7%, 0%, 22.3%, and 50.7%, respectively, P = 0.414). By contrast, splenomegaly tended to adversely affect myelofibrotic transformation (10-year cumulative incidence: 0%, 0%, 7.1%, and 30.3%, respectively, P = 0.062). Moreover, the cumulative incidence of myelofibrotic transformation was significantly higher in patients with overt volumetric or palpable splenomegaly than those with no or borderline volumetric splenomegaly (10-year incidence: 0% vs. 10.3%, respectively; 15-year incidence: 0% vs. 26.3%, respectively, P = 0.020). Overall survival (OS) differed among patients with different degrees of splenomegaly (15-year OS: 100%, 78.6%, 71.7%, and 51.9%, respectively, P = 0.021). The degree of splenomegaly was independent risk factor for both myelofibrotic transformation (hazard ratio [HR]: 7.75; 95% confidence interval [CI]: 1.87-21.10; P = 0.005) and OS (HR: 6.70; 95% CI: 1.89-23.72; P = 0.003). Summary/Conclusion: The degree of splenomegaly, including volumetric splenomegaly, based on age- and BSA-matched reference spleen volumes at diagnosis reflects disease progression in PV patients. Therefore, volumetric splenomegaly should be evaluated at the time of PV diagnosis and taken into consideration when predicting the prognosis of patients with this disorder.

Use of deep artificial neural networks to identify stroke during triage via subtle changes in circulating cell counts

BackgroundThe development of tools that could help emergency department clinicians recognize stroke during triage could reduce treatment delays and improve patient outcomes. Growing evidence suggests that stroke is associated with several changes in circulating cell counts. The aim of this study was to determine whether machine-learning can be used to identify stroke in the emergency department using data available from a routine complete blood count with differential.MethodsRed blood cell, platelet, neutrophil, lymphocyte, monocyte, eosinophil, and basophil counts were assessed in admission blood samples collected from 160 stroke patients and 116 stroke mimics recruited from three geographically distinct clinical sites, and an ensemble artificial neural network model was developed and tested for its ability to discriminate between groups.ResultsSeveral modest but statistically significant differences were observed in cell counts between stroke patients and stroke mimics. The counts of no single cell population alone were adequate to discriminate between groups with high levels of accuracy; however, combined classification using the neural network model resulted in a dramatic and statistically significant improvement in diagnostic performance according to receiver-operating characteristic analysis. Furthermore, the neural network model displayed superior performance as a triage decision making tool compared to symptom-based tools such as the Cincinnati Prehospital Stroke Scale (CPSS) and the National Institutes of Health Stroke Scale (NIHSS) when assessed using decision curve analysis.ConclusionsOur results suggest that algorithmic analysis of commonly collected hematology data using machine-learning could potentially be used to help emergency department clinicians make better-informed triage decisions in situations where advanced imaging techniques or neurological expertise are not immediately available, or even to electronically flag patients in which stroke should be considered as a diagnosis as part of an automated stroke alert system.

Perioperative lymphocyte-to-monocyte ratio changes plus CA199 in predicting the prognosis of patients with gastric cancer.

This study aimed to investigate the value of perioperative lymphocyte-to-monocyte ratio (LMR) changes in predicting postoperative survival among patients undergoing radical gastrectomy, and explore whether the combination of preoperative carbohydrate antigen 199 (CA199) and LMR changes would further improve the prognostic accuracy. A total of 456 patients who underwent radical gastrectomy at the Affiliated Hospital of Nantong University were included as the training set, and 210 patients from the Nantong Tumor Hospital were enrolled as the validation set. The patients' peripheral complete blood counts, including lymphocytes, monocytes, and tumor marker CA199 level, were checked regularly in all patients 1 week before and after radical gastrectomy by two technicians who were blinded to their clinical characteristics. The LMR was calculated by dividing the lymphocyte count by the monocyte count in the peripheral blood. ΔLMR could be obtained by subtracting the preoperative LMR from the postoperative LMR. The serum CA199 level was determined through a latex immunoassay (Mitsubishi Chemical Ltd., Japan). The survival curve was drawn according to the Kaplan-Meier method, and variables with P<0.05 in univariate analyses were transferred to multivariate Cox regression analysis. A nomogram was constructed using the finalized separated prognostic factors of gastric cancer (GC). The main prognostic indicator was overall survival (OS). In the training and validation sets, the prognostic predictive ability of CA199 and ΔLMR (postoperative LMR minus preoperative LMR) was independently evaluated (both P<0.05). ΔLMR and CA199 were used to establish the ΔLMR-CA199 score. The results showed that the higher the ΔLMR-CA199 risk score, the worse the prognosis, especially in patients with advanced GC. Postoperative adjuvant chemotherapy improved the long-term prognosis of patients with a ΔLMR-CA199 score of 1 but had no significant effect on the survival rate of patients with 0 and 2 points. ΔLMR-CA199 can better predict the long-time survival of patients with GC. In addition, it can also predict the response of postoperative adjuvant chemotherapy in patients with GC.

Blood monocyte and lymphocyte counts patient outcomes in non-small cell lung cancer after immune checkpoint inhibitor therapy: Real-world data of 12,416 patients.

e21023 Background: Immune checkpoint inhibitors (ICPi) are now commonly used in non-small cell lung cancer (NSCLC) treatment. Beyond PD-L1 status, no clinically validated predictive biomarkers guide therapeutic decision making regarding their use. Blood monocyte, lymphocyte counts, or their ratio might inform clinical utility of these expensive, potentially toxic agents. Methods: Adults with advanced/metastatic NSCLC receiving any ICPi after diagnosis from January 2015 to November 2020 were included. Treatment outcomes were followed until 31 May 2021. Data were sourced from structured fields of electronic health records from The US Oncology Network and non-Network practices. The primary end point was overall survival (OS), and time to treatment discontinuation (TTD) was secondary. Baseline absolute monocyte count (AMC), absolute lymphocyte count (ALC), and monocyte-to-lymphocyte ratio (MLR) were subdivided into quintiles (Q) with Q1 lowest and Q5 highest. Patient (pt) and treatment characteristics were described. Time-to-event outcomes were assessed by Kaplan-Meier methods. Univariate and multivariate Cox regression analyses described associations among baseline biomarkers, OS, and TTD. Results: For 12,416 pts with NSCLC, median OS and TTD were 13.6 months (mos) and 4.5 mos, respectively. For AMC, patients in Q2 and Q3 had the longest median OS of 15.9 mos. Median TTD by AMC was longest for Q1 and Q2 (5.1 mos), declining sequentially to 3.3 mos for Q5. For ALC, Q5 had longest median OS of 19.2 mos, as well as longest median TTD of 5.8 mos. For MLR, Q1 had the longest median OS and TTD of 22.3 and 6.2 mos., respectively. In univariate Cox regression, AMC, ALC, and MLR each associated with OS and TTD (p &lt; 0.0001). Pts in AMC Q5, compared with AMC Q1, had an OS hazard ratio (HR) of 1.48 (95% CI 1.38-1.60). For ALC, each successive increasing quintile, compared to ALC Q1, demonstrated a lower risk of death (p &lt; 0.0001). Pts in MLR Q5, compared with MLR Q1, had an OS HR of 2.21 (95% CI 2.04-2.39). Conclusions: This data set is the largest to date to examine interactions among baseline immune cell counts, ICPi use, and pt outcome in NSCLC. These data inform efforts to describe immune-based prognostic risk groups among NSCLC pts receiving immunotherapy.[Table: see text]