Hematologic Laboratory Parameters Research Articles

Assessing Pharmacokinetics and Safety of Therapeutic Alpha-1-Microglobulin in First-in-Human Kidney Transplantation: A Noncomparative Open-Label Multiple-Dose Phase 1b Study.

RMC-035 is a modified version of alpha-1-microglobulin, an endogenous protein developed as a renoprotective agent. Its intended use is to reduce the risk of irreversible loss of kidney function in cardiac surgery patients and to reduce delayed graft function in kidney transplant recipients. This first-in-human study aimed to evaluate the pharmacokinetics and safety of RMC-035 in kidney transplant recipients. Eight living-donor kidney transplant recipients were included in 2 dose cohorts. The study drug RMC-035 was administered starting with the first dose during transplantation. Four additional doses were administered once daily following transplantation. In the first cohort, all 5 doses of RMC-035 were equal, whereas in the second cohort, the last 3 doses were doubled. Safety monitoring, laboratory tests, and pharmacokinetic measurements were performed according to protocol for 4 d post-transplantation and during the 90-d follow-up period. All 5 administrations of the study drug were completed in 5 out of 8 treated participants. Pharmacokinetic concentrations were approximately dose proportional, and AUC0-24h decreased between the first and fifth doses, reflecting improved kidney function and RMC-035 renal clearance over time. No accumulation was observed between the administrations. No clinically significant changes were observed in the hematological or biochemical laboratory parameters, electrocardiogram findings, or vital signs. A total of 22 treatment-emergent adverse events (AEs) were reported in 6 subjects. Mild and transient AEs suggestive of infusion-related reactions, such as chills, were reported in 5 patients. There was a clinically significant reduction in serum creatinine levels, reflecting post-transplant improvement in kidney function. Based on the safety data obtained from 8 subjects in the 2 dose cohorts treated with RMC-035, the drug was considered safe. Safety and AE profiles were in line with expectations of the target population, and infusion-related reactions were short-lived and manageable. Dose-limiting toxicity signals were not observed.

Recombinant erythropoietin for the treatment of iron deficiency anemia in pregnancy: A systematic review.

Treatment options for severe, refractory iron deficiency anemia are limited in pregnancy. To review the available literature on the use of recombinant erythropoietin in the treatment of iron deficiency anemia in pregnancy. An electronic search of seven databases from inception to March 2022 was performed using a combination of keywords. We included all randomized controlled or observational studies of pregnant patients with iron deficiency anemia who received recombinant erythropoietin or control. The primary outcome was a change in hematologic parameters (hemoglobin or hematocrit) after treatment. Studies were appraised using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. Data were summarized using narrative synthesis and descriptive statistics as appropriate. This study was registered with PROSPERO, CRD42022313328. Of 234 studies screened, five studies met the inclusion criteria and had sufficient data for analysis (n = 103 recombinant erythropoietin and n = 104 controls). All patients in the intervention group received iron supplementation (intravenous or oral) in addition to recombinant erythropoietin. All patients in the control group received iron supplementation (intravenous or oral) alone. As the result of variance between studies in inclusion criteria, the timing of repeat blood draws, and data reporting, a meta-analysis could not be performed. Three studies found that serial recombinant erythropoietin combined with iron supplementation was more effective at raising hematologic laboratory parameters (hemoglobin or hematocrit) than iron alone. One study reported no difference in hemoglobin or hematocrit levels between groups at day 28. However, patients in this study only received one dose of recombinant erythropoietin, whereas those in the other studies received serial doses. Another study also found no difference in hemoglobin levels by day 28, but patients in the recombinant erythropoietin group had lower hemoglobin levels at baseline and a more rapid rise in hemoglobin than iron alone. This is demonstrated by a more significant rise in hemoglobin at day 11 in the recombinant erythropoietin group than in the control group. Serial recombinant erythropoietin administration and iron supplementation may be more effective at treating refractory iron deficiency anemia in pregnancy than iron supplementation alone.

Changes in Red Cell Morphology and Haematological Laboratory Parameters Associated With Alectinib.

Alectinib is a second-generation anaplastic lymphoma kinase (ALK) inhibitor indicated for ALK-mutated non-small-cell lung cancer. Recently, the association between alectinib and red cell morphological abnormalities has been reported in a few case series. This retrospective observational study aims to determine the frequency of occurrence of acanthocytosis in patients taking alectinib and to evaluate the red cell indices, biochemical markers of haemolysis and eosin-5-maleimide (EMA) binding assay results in patients receiving alectinib. Patients who were on alectinib and had a complete blood count test performed in Queen Elizabeth Hospital Haematology Laboratory between 1 May 2021 and 31 August 2021 were included in the study. Haematological investigations that had been performed before and after the commencement of alectinib were reviewed. Fifty patients receiving alectinib were evaluated in this analysis. One hundred per cent of patients showed 3+ acanthocytes on the peripheral blood smears. Compared with the test results before starting alectinib, the post-alectinib blood tests showed a significantly lower haemoglobin concentration, red blood cell count and haematocrit; and a significantly higher mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration and red cell distribution width. All the tested patients showed a marked reduction in EMA mean channel fluorescence compared with normal control. Our cohort revealed that alectinib caused significant acanthocytosis in all patients. Alectinib was also associated with changes in red cell indices and biochemical markers of haemolysis, compatible with a spherocytic and anisopoikilocytic morphology with haemolysis. Patients on alectinib had reduced EMA binding.

A study of morbidity and mortality markers in children diagnosed with severe dengue illness at a quaternary paediatric intensive care unit

Background: To identify the biochemical, haematological, and serological laboratory parameters and establish associations between mortality risk and children with severe dengue fever (DF). Methods: This retro-prospective study included 251 children who were dengue serology positive, aged between 1 month and 18 years, hospitalized in paediatric intensive care unit (PICU) with severe dengue illness from July 2019 to June 2021. Clinical, laboratory, and radiological data were extracted from hospital's electronic database and analyzed. Results: The majority had a mean age of 5.46 years with a significant female predominance (58.2%). Also, 80.1 per cent of children presented in the critical phase with an average PICU stay of 3.59 days. There was a significant mortality risk associated with presenting day of illness (risk 9.5%), ventilation requirements (risk 29.8%), and stay of more than a week in the PICU (risk 36%), with that of the severity of outcomes. The odds of increased mortality risk were associated with prolonged PICU stay exceeding a week and ventilation requirements by 10.03 and 20.19 times respectively. Investigation-wise, abnormal liver enzymes on admission such as SGOT (OR 5.39, p>0.0001); and serum SGPT (OR 5.54, p<0.001) were significantly associated with poorer outcomes. Interestingly, neither thrombocytopenia nor leucopenia was found to be a true marker of mortality and the overall mortality rate was found to be 8.4% (n=21). Conclusions: Any stay of more than a week, abnormal liver enzymes on admission, and ventilation requirements were all associated with higher mortality risk and potential predictors for poor clinical outcomes in the PICU.

Role Played by Biochemical and Hematological Parameters in the Prediction of Cardiovascular Risk

Introduction: The term “cardiovascular diseases” (CVDs) refers to any disease affecting the heart or blood vessels. CVDs are the most common cause of death worldwide and the most responsible reason for 10% of deaths in the early 20th century. These CVDs can emerge as myocardial infarction or ischemic heart disease, stroke, and congestive heart failure. For diagnosing CVDs, physical, radiological investigations, and laboratory investigations for cardiac enzymes and lipid profile are used. In clinical practices, cardiovascular risk prediction models are very important in the identification, prevention, and staging of the severity of CVDs. Framingham Risk Score-coronary heart disease, Framingham Risk Score-cardiovascular disease, QRESEARCH-cardiovascular risk algorithm, Joint British Society risk-calculator-3, WHO/ISH CVD risk prediction charts, and Atherosclerotic Cardiovascular Disease risk-estimator are some of the available CVD risk estimators. However, many of these estimators can be used only to evaluate individuals more than 40 years and to assess the risk for 10-years. Therefore, new risk estimators are needed to overcome the deficiencies of the available risk estimators. Research have been done in novel directions; on ratios of routinely performing hematological and biochemical laboratory parameters such as Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR), and Aspartate aminotransferase to Alanine aminotransferase ratio (AST/ALT). The outcomes indicate a relationship between the above-said ratios and the risk for CVDs. 
 Conclusion: On such grounds, this review describes the importance of developing a CVD risk estimator by amalgamating some of the biochemical and hematological parameters, including NLR, PLR, and AST/ALT ratios, aiming to overcome the existing shortcomings.

Long-term effects of levetiracetam and valproic acid on laboratory parameters in childhood epilepsy

Epilepsy is the most common neurological disorder in childhood which often requires long-term or sometimes lifelong treatment. In this study, we aimed to evaluate the change in hematological and biochemical laboratory parameters at the 24th month compared to the treatment baseline values in pediatric epilepsy patients receiving levetiracetam (LEV) and valproic acid (VPA) monotherapy. Complete blood count panel, biochemical and hormonal parameters were investigated retrospectively at baseline and at 24 months in patients diagnosed with epilepsy at the Balikesir University Medical Faculty pediatric neurology clinic, Türkiye, and started on LEV and VPA monotherapy between 01.08.2019 and 01.08.2022. Forty-nine patients were using LEV and 14 VPA. A statistically significant difference in terms of the complete blood count parameters mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) was observed in the cases using LEV between baseline and the 24th month of treatment (p=0.006, p=0.004). Among the cases using VPA, significant differences between baseline and the 24th month of treatment were determined in the complete blood count parameters red blood cell (RBC), MCV, and monocyte (MON)% values (p=0.004, p=0.022, and p=0.01). In conclusion, epilepsy treatment is a lengthy process in pediatric patients, and patients need to be monitored using hematological and biochemical parameters at specific intervals in terms of potential seizure drug side effects.

A scientifically validated combination of garcinol, curcuminoids, and piperine for mild to moderate nonalcoholic steatohepatitis patients-results from a randomized, double-blind, placebo-controlled study.

Garcinol is a naturally occurring compound from the fruit rind of the Garcinia indica, with antioxidant, anti-inflammatory, and anticancer properties. Curcuminoids are the active molecule from the rhizome of Curcuma longa, studied extensively for its health benefits as an anti-inflammatory and antioxidant activities. Non-alcoholic steatohepatitis (NASH) is the progressive form of nonalcoholic steatohepatitis characterized by liver fat and inflammation. To evaluate the clinical efficacy and safety of Garcinol, Curcuminoids and piperine (GCP) combination in patients with mild to moderate NASH in a randomized, double-blind, placebo-controlled study. The patients received one tablet (450 mg) of GCP containing garcinol-50 mg, curcuminoids -250 mg and piperine 5 mg or a placebo (450 mg of microcrystalline cellulose) twice daily for 90 days. Changes in circulating aspartate aminotransferase (AST), alanine transaminase (ALT) levels, liver stiffness measurement (LSM), and controlled attenuation parameter (CAP) using Fibroscan were compared from baseline to day 90. Anthropometric parameters, serum levels of lipids, Interleukin (IL-6), hsCRP, and adiponectin were estimated. Safety was evaluated by laboratory parameters and by monitoring adverse events. Seventy-two patients were randomized and 63 (GCP = 32, Placebo = 31) completed the study. The mean age of the patients was 48.3 ± 8.7 years (36 males and 27 females). The mean reduction in AST (U/L) was 9.53 in GCP and 3.16 in placebo (p < 0.001) and that of ALT (U/L) was 13.47 in GCP and 7.43 in Placebo (p = 0.002). The liver stiffness and CAP scores showed a better reduction in GCP (0.56 kPa and 12.38 db/m) compared to placebo (0.064 kPa and 10.42 db/m) p < 0.05. Consequently, the noninvasive Fibroscan-AST (FAST) score reduction was also found to be significant in GCP compared to placebo. Additionally, body weight, lipid levels, hsCRP, and IL-6 in serum decreased, while adiponectin levels increased in GCP-supplemented participants compared to placebo. The combination of garcinol and curcuminoids was well tolerated with no significant changes in hematological and clinical laboratory parameters during the 90-day supplementation. Our results suggest that GCP could be a possible supplement for the management of NASH.Clinical trial registration: https://clinicaltrials.gov/, identifier CTRI/2019/11/022147.

C-X-C Motif Chemokine Receptor 4-Targeted Radioligand Therapy in Hematological Malignancies-Myeloablative Effects, Antilymphoma Activity, and Safety Profile.

After C-X-C motif chemokine receptor 4 (CXCR4)-directed radioligand therapy (RLT), lymphoma patients are scheduled for conditioning therapy (CON) followed by hematopoietic stem cell transplantation (HSCT). We aimed to determine whether CXCR4-RLT can achieve bone marrow ablation and direct antilymphoma activity independent from CON/HSCT and also evaluated the safety profile of this theranostic approach in an acute setting. After CXCR4-directed 68 Ga-pentixafor PET/CT, 21 heavily pretreated patients with hematological malignancies underwent CXCR4-directed RLT using 90 Y-pentixather. The extent of myeloablative efficacy was determined by investigating hematologic laboratory parameters before RLT (day -1), at the day of RLT (day 0), 2 days after RLT (day 2), and before CON (median day 10). Serving as surrogate marker of antilymphoma activity, lactate dehydrogenase (LDH) levels were also assessed until CON. We also screened for laboratory-defined tumor lysis syndrome after the Cairo-Bishop definition and recorded acute laboratory adverse events using the Common Terminology Criteria for Adverse Events version 5.0. After RLT, we observed a significant decline of leukocyte levels by 79.4% ± 18.7% till CON (granulocytes, drop by 70.3% ± 21%; platelets, reduction by 43.1% ± 36%; P ≤ 0.0005 vs day 0, respectively). After RLT, LDH levels already reached a peak at day 2, which was followed by a rapid decline thereafter (peak vs day of CON, P = 0.0006), indicating that 90 Y-pentixather exhibits direct antilymphoma activity. At day of CON, LDH levels were also significantly lower when compared with day -1 ( P = 0.04), suggestive for durable response mediated by RLT. No patient fulfilled the criteria of tumor lysis syndrome, whereas 25 laboratory adverse events attributable to CXCR4-directed treatment were identified (≥grade 3 in 2/25 [8%]). During further treatment course, all patients (100%) received HSCT. CXCR4-directed RLT causes effective myeloablation, which allows for HSCT. In addition, it also exerts direct antilymphoma activity independent of subsequent therapeutic steps, whereas safety profile was acceptable.

Frequency of Iron Deficiency in Children With Hypochromia and Microcytosis on Blood Smears

Background: The relationship between iron deficiency and certain phenomenon like hematological alterations, inadequate growth, altered thermoregulatory function and reduced cognitive function have been well known.&#x0D; Objectives: To determine the frequency of iron deficiency in children with hypochromic and microcytic anemia on blood smears.&#x0D; Methods: This case-control study was performed in the department of pediatrics, Sahiwal Teaching Hospital, Sahiwal, Pakistan from May 2022 to April 2023. For cases, we included 179 children of both genders aged between 1 month and 15 years with hypochromia and microcytosis. Similar number of healthy children (n=179) of both gender and aged below 15 years were enrolled as controls. At the time of enrollment, socio-demographic information like gender, age and residential area were recorded. Local institutional laboratory was utilized for the hematological parameters. Hypochromia and microcytosis were labeled as MCV&lt; 76fl and MCHC &lt; 30 g/dl of red cells while blood film also depicted hypochromia and microcytosis. IDA was termed as serum ferritin &lt; 12 ng/dl.&#x0D; Results In a total of 358 children, there were 192 (53.6%) boys. The mean age was 7.8±3.2 years while 184 (51.4%) children were between 6-15 years. Residential status of 196 (54.7%) children was rural. Overall, iron deficiency was diagnosed in 209 (58.4%) children. Among cases, 171 (95.5%) children had iron deficiency while among controls, 38 (21.2%) children had IDA (p&lt;0.0001). Cases and controls were compared for various hematological laboratory parameters and statistically significant differences were observed for all parameters among cases and controls (p&lt;0.0001).&#x0D; Conclusion: The frequency of iron deficiency was 95.5% among children with hypochromia and microcytosis on blood smears. Hematological parameters were significantly deranged among children with hypochromia and microcytosis when compared to healthy children.

Venous blood parameters in determination of respiratory impairment in amyotrophic lateral sclerosis

This study aimed to investigate the relationship between venous blood parameters and respiratory functions in patients with amyotrophic lateral sclerosis (ALS) and develop a model to predict respiratory impairment for individual patients with ALS. A total of 416 ALS patients were included in the study, and various hematologic and biochemical laboratory parameters as well as demographic and clinical factors were collected and compared. A multivariable logistic regression model was constructed to assess the association between FVC and venous blood biomarkers and clinical factors. The results showed that along with onset age, bulbar-onset, disease duration, BMI, eosinophil count (EO#), basophil count (BASO#), creatinine (CREA), uric acid (URCI) and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL/HDL) ratio were associated with reduced FVC. The area under the ROC curve is 0.735 for the test set and 0.721 for the validation set. The study also developed a relatively acceptable model for predicting respiratory impairment in ALS patients. These findings suggest that EO#, BASO#, CREA, URIC and LDL/HDL ratio can be useful in assessing FVC in ALS and can be easily accessible, accurate, and low-cost parameters.

411 Long term laboratory safety of dupilumab in patients aged 6 months to 5 years with moderate-to-severe atopic dermatitis

Abstract Systemic treatments often require laboratory monitoring. Here we report 52-week laboratory safety data for dupilumab-treated children aged 6 months to 5 years with moderate-to-severe AD. LIBERTY AD PED-OLE (NCT02612454) is an open-label extension study of children aged 6 months to &amp;lt;18 years with moderate-to-severe AD. This analysis includes hematologic and chemistry laboratory parameters in children aged 6 months to 5 years treated with dupilumab every 4 weeks (q4w; 200 mg: ≥5 to &amp;lt;15 kg; 300 mg: ≥15 to &amp;lt;30 kg). Of the 180 patients enrolled, 122 (67.8%) completed up to 16 weeks and 30 (16.7%) completed up to 52 weeks. Mean (SD) eosinophil counts increased slightly from baseline [1.15 × 109/L (1.18) ] to Week 16 [1.5 × 109/L (1.91)], but then decreased below baseline by Week 52 [0.80 × 109/L (0.64)]. Mean (SD) platelet counts were relatively stable with a modest decrease from baseline [388.7 × 109/L (102.51)] to Week 52 [356.1 × 109/L (107.48)]. Chemistry parameters remained within the normal reference ranges. One patient (0.6%) reported a mild case of anemia, and one patient (0.6%) reported a mild case of thrombocytopenia, which were resolving and resolved at the time of this interim analysis, respectively. Overall safety was consistent with the known dupilumab safety profile. No clinically meaningful changes in hematologic and chemistry parameters were observed during 52 weeks of dupilumab treatment. As with adults, adolescents and older children, routine laboratory monitoring is unnecessary in children aged 6 months to 5 years with moderate-to-severe AD.

Measuring coagulopathy in pediatric craniofacial surgery.

The goal of this study was to describe hematologic and coagulation laboratory parameters and identify if these laboratory studies could predict blood loss in a cohort of pediatric patients undergoing complex cranial vault reconstruction (CCVR) for repair of craniosynostosis. We reviewed records from 95 pediatric CCVR patients between 2015 and 2019. Primary outcome measures were hematologic and coagulation laboratory parameters. Secondary outcome measures were intraoperative and postoperative calculated blood loss (CBL). Preoperative laboratory values were within normal limits and did not predict outcomes. Intraoperative platelet count and fibrinogen predicted CBL but without clinically relevant thrombocytopenia or hypofibrinogenemia. Intraoperative prothrombin time (PT) and partial thromboplastin time (PTT) predicted perioperative CBL, possibly reflecting surgically induced coagulopathy. Postoperative laboratory values did not predict postoperative blood loss. We found that standard hematologic and coagulation laboratory parameters predicted intraoperative and postoperative blood loss but provided limited mechanistic information to improve our understanding of coagulopathy in craniofacial surgery.

Brusellozlu Hastalarda Bakteriyeminin Makine Öğrenmesi Yöntemleri Kullanılarak Tahmin Edilmesi

Purpose: The correct and early diagnosis of brucellosis is very crucial to decelerate its spread and providing fast treatment to patients. This study aims to develop a predictive model for diagnosing bacteremia in brucellosis patients based on some hematological and biochemical markers without the need for blood culture and bone marrow and to investigate the importance of these markers in predicting bacteremia.&#x0D; Materials/Methods: 162 patients with diagnosing brucellosis, 54.9% of whom are non-bacteremic, 45.1% bacteremia were retrospectively collected. The 20 demographic, hematological and biochemical laboratory parameters and 30 classifiers are used to predict bacteremia in brucellosis. Classifiers were developed by using Python programming language. Accuracy (ACC), Area under the receiver operating characteristic curve (AROC), and F measure were employed to find the best fit classification method. Feature importance method was used to determine most diagnostic markers to predict the bacteremia. Results: Extratree classifier with criterion “entropy” (ETC1) showed the best predictive performance with Acc values ranging between 0.5 and 1.00, F values between 0.53 and 1, and AROC values between 0.62 and 1. The neutrophil%, lymphocyte%, eosinophil%, alanine aminotransferase, and C-reactive protein were determined as the most distinguishing features with the scores 0.723, 1.000, 0.920, 0.869, and 0.769, respectively.&#x0D; Conclusions: This study showed that the ETC1 classifier may be helpful in determining bacteremia in brucellosis patients and that elevated lymphocytes, alanine aminotransferase, and C-reactive protein and low neutrophils and eosinophils may indicate bacteremic brucellosis.

Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratio in Preterm Premature Rupture of Membranes.

This study aimed to investigate maternal hematological laboratory parameters of pregnancies complicated with preterm premature rupture of membranes (PPROM) compared to mothers of healthy-term infants (control group). This case-controlstudy included 158 mothers who were divided into PPROM (n=67) and control (n=91) groups, respectively. Laboratory parameters of platelet, lymphocyte, and neutrophil counts, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) were recorded at the time of diagnosis for the PPROM group and at the time of hospital admission for birth for the control group. NLR was significantly higher in the PPROM group than in the control group (p=0.001). The cutoff value of NLR to predict PPROM was 6.73 (AUC=0.671, 95% confidence interval=0.58-0.75,p=0.000). A cheap and routine NLR blood test can be used to predict PPROM before labor.

Predicting asphyxia in term fetus

This aim of this study was to investigate maternal hematological laboratory parameters of term infants before birth diagnosed with asphyxia compared to mothers of healthy term infants and predict asphyxia by these parameters. This study was conducted on 109 and 192 mothers of the fetus with asphyxia and healthy, respectively. Laboratory parameters of complete blood count, including PDW (platelet distribution width), PCT (procalcitonin) and NLR (neutrophil/lymphocyte ratio), were recorded before birth from pregnant women. PDW and basophil counts were significantly higher in the asphyxia group than healthy group (p: .000). The cut-off level of 19.425 accurately predicted the occurrence of asphyxia (AUC = 0.724 (95% confidence interval 0.65–0.78), p = .000). Basophil count could predict asphyxia, especially the cut-off level of> 0.15(10³/μL) (AUC = 0.67) (95% confidence interval 0.60–0.74, p = .000). To predict asphyxia before labor, a cheap and routine test of PDW can be used after more research in this area. IMPACT STATEMENT What is already known on this subject? Asphyxia is still an unsolved problem in neonatal mortality and morbidity, and it is seen in babies of mothers who carry some risks during pregnancy (such as multiple pregnancy, baby of mother with preeclampsia, meconium aspiration, diabetes); however, it is known that it is a subject that is still not fully understood as it can also occur as a result of labor that does not have any risk factors and goes well. What do the results of this study add? In term fetuses without risk factors, it can be predicted to a certain extent whether the fetus will be diagnosed with asphyxia from the hemogram test that can work from the blood of the mother before birth. What are the implications of these findings for clinical practice and/or further research? In clinical practice, asphyxia can be estimated with a cheap and simple test, without any extra examination, by looking at the routine blood tests taken from the mother before going into labor.

Predictable severity biomarkers in Covid-19

Introduction: The recorded studies suggest that there is clear evidence-based association between various laboratory biomarkers and COVID-19 disease severity. These marker levels reflect the intensity of the cytokine-mediated hyperinflammatory response, which is strongly associated with a poor outcome of SARS-CoV-2 infection. Conclusions: C-reactive protein is not only a systemic inflammatory marker, but also an important regulator of inflammatory processes. The level of this protein is positively correlated and can be widely used to predict the severity, prognosis and mortality in COVID-19 patients, additionally to vital signs monitoring, supportive care, oxygen therapy, ventilation and circulatory support. Procalcitonin is an indicator of disease severity, which can facilitate timely clinical decision-making, and determination of procalcitonin levels during COVID-19 patients’ follow-up, as well as being used in assessing risk, predicting prognosis, and improving patient survival. The assessment of hematological laboratory parameters upon admission, which help in differentiating between severe and non-severe cases, high-risk and low-risk cases of mortality, allows raising awareness, monitoring and timely treatment of patients with COVID-19, as well as their early improvement of clinical condition. Inflammatory biochemical and hemocytometric measures are feasible, easily interpretable, and widely available biomarkers in most healthcare settings, favorable for being used in treatment and severity determination, in predicting clinical outcomes, and in the prognosis of patients with COVID-19. However, the assessment of the accuracy of these biomarkers needs to be determined in further more relevant worldwide studies, showing a more precise design, more accurate performance, and having larger sample sizes.

Prediction of Poor Outcome after Successful Thrombectomy in Patients with Severe Acute Ischemic Stroke: A Pilot Retrospective Study

Several baseline hematologic and metabolic laboratory parameters have been linked to acute ischemic stroke (AIS) clinical outcomes in patients who successfully recanalized. However, no study has directly investigated these relationships within the severe stroke subgroup. The goal of this study is to identify potential predictive clinical, lab, and radiographic biomarkers in patients who present with severe AIS due to large vessel occlusion and have been successfully treated with mechanical thrombectomy. This single-center, retrospective study included patients who experienced AIS secondary to large vessel occlusion with an initial NIHSS score ≥ 21 and were recanalized successfully with mechanical thrombectomy. Retrospectively, demographic, clinical, and radiologic data from electronic medical records were extracted, and laboratory baseline parameters were obtained from emergency department records. The clinical outcome was defined as the modified Rankin Scale (mRS) score at 90 days, which was dichotomized into favorable functional outcome (mRS 0-3) or unfavorable functional outcome (mRS 4-6). Multivariate logistic regression was used to build predictive models. A total of 53 patients were included. There were 26 patients in the favorable outcome group and 27 in the unfavorable outcome group. Age and platelet count (PC) were found to be predictors of unfavorable outcomes in the multivariate logistic regression analysis. The areas under the receiver operating characteristic (ROC) curve of models 1 (age only model), 2 (PC only model), and 3 (age and PC model) were 0.71, 0.68, and 0.79, respectively. This is the first study to reveal that elevated PC is an independent predictor of unfavorable outcomes in this specialized group.

Hematological and Biochemical Laboratory Parameters in COVID-19 Patients: A Retrospective Modeling Study of Severity and Mortality Predictors.

It is well known that laboratory markers could help in identifying risk factors of severe illness and predicting outcomes of diseases. Here, we performed a retrospective modeling study of severity and mortality predictors of hematological and biochemical laboratory parameters in Iranian COVID-19 patients. Data were obtained retrospectively from medical records of 564 confirmed Iranian COVID-19 cases. According to the disease severity, the patients were categorized into two groups (severe or nonsevere), and based on the outcome of the disease, patients were divided into two groups (recovered or deceased). Demographic and laboratory data were compared between groups, and statistical analyses were performed to define predictors of disease severity and mortality in the patients. The study identified a panel of hematological and biochemical markers associated with the severe outcome of COVID-19 and constructed different predictive models for severity and mortality. The disease severity and mortality rate were significantly higher in elderly inpatients, whereas gender was not a determining factor of the clinical outcome. Age-adjusted white blood cells (WBC), platelet cells (PLT), neutrophil-to-lymphocyte ratio (NLR), red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), erythrocyte sedimentation rate (ESR), mean corpuscular hemoglobin (MCHC), blood urea nitrogen (BUN), and creatinine (Cr) also showed high accuracy in predicting severe cases at the time of hospitalization, and logistic regression analysis suggested grouped hematological parameters (age, WBC, NLR, PLT, HGB, and international normalized ratio (INR)) and biochemical markers (age, BUN, and lactate dehydrogenase (LDH)) as the best models of combined laboratory predictors for severity and mortality. The findings suggest that a panel of several routine laboratory parameters recorded on admission could be helpful for clinicians to predict and evaluate the risk of disease severity and mortality in COVID-19 patients.

Evaluation of neutrophil HDL-C ratio - a new inflammation marker in non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) is a global disease estimated to affect one-third of the world's population. NAFLD is the hepatic manifestation of metabolic syndrome. In recent years, formulations have been made using haematological laboratory parameters, and it has been reported to be associated with inflammation and fibrosis in the liver. In this study, we aimed to evaluate the neutrophil to high-density lipoprotein (HDL) cholesterol (HDL-C) ratio (NHR) in patients diagnosed with NAFLD by ultrasonographic imaging for the first time in the literature. The study was carried out by recruiting men and women between the ages of 18 and 65 years who applied to the check-up outpatient clinic of our hospital. Ultrasonography was used as the diagnostic method for hepatosteatosis in all cases. Venous blood samples were taken from the patients for haematological and biochemical measurements. The study population consisted of 155 patients, 115 of whom were fatty liver patients and 40 were controls. NHR was determined as 99.6 ± 56.8 in those with grade 1 fatty liver, 114.98 ± 39.2 in those with grade 2, 122.9 ± 51.1 in those with grade 3, and 86.17 ± 35.2 in the control group. In the analysis, NHR was statistically significantly higher in grade 2 and 3 fatty liver patients compared with the control group (p = 0.03 and 0.01, respectively). However, there was no statistical difference between grade 1 fatty liver patients and the control group (p = 0.53). We found higher NHR in patients with NAFLD. NHR is a cheap and easy to access parameter. An elevated NHR with FIB-4 in patients with NAFLD may be a marker of liver inflammation or fibrosis.

Evaluation of clinical laboratory parameters in COVID-19 positive cases admitted in Islamabad from May to July 2021.

Objective: To assess the variation of laboratory parameters in COVID-19 positive patients with different genders and age groups and clarify the consequences of COVID-19 infection on different patients. Study Design: Prospective study. Setting: IHITC (Isolation Hospital &amp; Infectious Treatment Center), Islamabad. Period: 20th May, 2021 to 25th July, 2021. Material &amp; Methods: With 222 participants was conducted in 119 were COVID positive serve as Case and 103 were COVID negative considered as control. Blood samples were drawn from all participants of study to measure biochemical and hematological laboratory parameters with demographic characteristics. Mean ± standard deviation (SD) of different lab parameters analyzed by using IBM SPSS Statistics 20. Results: Total 222 participants were analyzed having 115 (50.7%) male and 107 (49.3%) female having mean age 60±13.8. No significant variation has been seen in ALP, total bilirubin, creatinine and uric acid having mean values with in normal range. In 119 positive patients, ALT (p=0.001) (t=2.031), urea (p=0.001) (t=7.590), Ferritin (p=0.001) (t=7.13), CRP (p=0.001) (t=9.90) and D-dimer (p=0.001) (t=5.962) were elevated and good predictor of poor prognosis of disease. Pathological impacts of COVID-19 were also represented by hematological parameters including WBC count (p=0.001) (t=7.126), Neutrophil to Lymphocyte Ratio (p=0.001) (t=9.042) and Lymphocyte count (p=0.001) (t=-12.707). Conclusion: According to this research, males and old age population is more susceptible to SARS-2. Our study suggests that laboratory biomarkers including ALT, Urea, Ferritin, CRP, D-dimer and WBC count are significantly associated with poor prognosis in Covid-19 patients.