Hemoglobin Ratio Research Articles

The U-shaped association of fasting plasma glucose to HbA1c ratio with mortality in diabetic and prediabetic populations: the mediating role of systemic immune-inflammation index

BackgroundsThis study aimed to assess the association between fasting plasma glucose to glycated hemoglobin (FPG/HbA1c) ratio and mortality and to explore the mediating role of immunity and inflammation in diabetic and prediabetic populations.MethodsOur analysis included 10,267 participants with prediabetes or diabetes from the NHANES (1999-2018). The association between the FPG/HbA1c ratio and all-cause and cardiovascular(CVD) mortality was assessed using multivariate Cox proportional hazards models, restricted cubic splines(RCS), two-piecewise Cox proportional hazards models and sensitivity analysis. Mediation analysis was conducted to evaluate the systemic immune-inflammation index (SII) as a potential mediator.ResultsOver a median follow-up of 103 months, there were 535 CVD deaths and 1918 all-cause deaths. After multivariate adjustment, a U-shaped relationship was observed between the FPG/HbA1c ratio and both CVD and all-cause mortality, with threshold points at 1.080 and 1.013, respectively. Below the thresholds, the FPG/HbA1c ratio was negatively associated with CVD mortality (HR:0.200, 95% CI: 0.072, 0.559) and all-cause mortality(HR: 0.242, 95% CI: 0.118, 0.494). Above the thresholds, the ratio was positively associated with CVD mortality (HR=3.691, 95% CI: 2.011, 6.772) and all-cause mortality (HR=3.025, 95% CI: 2.279, 4.016). Mediation analysis revealed that SII mediated 19.02% of the association with CVD mortality and 8.86% with all-cause mortality (P < 0.05).ConclusionsIn the prospective cohort, the FPG/HbA1c ratio demonstrated a U-shaped association with mortality in diabetic and prediabetic adults, with SII playing a significant mediating role. These findings suggest that interventions targeting immunity and inflammation may improve clinical outcomes in these populations.

Exploring the hemoglobin-to-red blood cell distribution width ratio (HRR) to peripheral arterial disease nexus: a comprehensive analysis of NHANES data from 1999 to 2004

ObjectiveThis study aimed to investigate the correlation between the Hemoglobin-to-Red Blood Cell Distribution Width Ratio (HRR) and Peripheral Artery Disease (PAD) prevalence, utilizing data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2004.MethodsThe study employed a cross-sectional design, analyzing data from 5,196 participants aged 40 and above. PAD was diagnosed using the Ankle-Brachial Index (ABI), with ABI less than 0.9 indicating PAD. HRR, calculated as the ratio of hemoglobin (HB) to red blood cell distribution width (RDW), was stratified into quartiles. Covariates included demographic and clinical variables such as BMI, lipid profiles, and diabetes status. Logistic regression analysis was conducted to assess the relationship between HRR and PAD, adjusting for potential confounders.ResultsThe study found that higher HRR quartiles were associated with a decreased risk of PAD. After adjusting for confounders, the odds ratios for PAD in relation to the second, third, and fourth quartiles of HRR compared to the first quartile were 0.71, 0.62, and 0.44, respectively (P < 0.001). A one-unit increase in HRR corresponded to a 56% reduction in the probability of PAD. ROC analysis indicated HRR as a stronger protective factor for PAD compared to other variables. Stratified analyses revealed that younger age and lower BMI amplified the protective effect of HRR on PAD.ConclusionThe study demonstrated a significant inverse relationship between HRR and PAD, suggesting that HRR may serve as a protective factor against PAD. This finding highlights the potential role of HRR in the pathogenesis of PAD and its clinical implications.

Perioperative Free Plasma Hemoglobin Level and the Development of Acute Kidney Injury Following Cardiac Surgery at Dr Sardjito Hospital

Introduction: Cardiac surgery-associated acute kidney injury (CS-AKI) is a common and lethal complication of cardiac surgery. The cardiopulmonary bypass (CPB) machine breaks erythrocytes and releases free hemoglobin (FHb) into plasma, leading to acute kidney injury (AKI). The ratio of free hemoglobin before and after cardiac surgery (post/pre-CPB FHb ratio) is a promising parameter for detecting hemolysis and predicting CS-AKI. Objectives: The study aims to determine the relationship between the post/pre-CPB FHb ratio and CS-AKI and evaluate risk factors for CS-AKI. Methods: A prospective cohort study was conducted on patients undergoing open heart surgery at Dr. Sardjito Hospital, Yogyakarta, Indonesia. Serial perioperative free hemoglobin levels were obtained, and all subjects were followed through to identify whether they developed CS-AKI. The appropriate statistical analyses were executed. A p-value of <0.05 was considered significant. Results: A total of 21% of subjects experienced CS-AKI. The post/pre-CPB FHb ratio of ≥1.86 predicted CS-AKI with moderate discrimination (AUC 0.751; p=0.016). Notably, the CPB duration and mean arterial pressure were identified as independent risk factors for CS-AKI, underscoring the importance of these factors in predicting and managing CS-AKI.Conclusion: When considered alongside other risk factors, the post/pre-CPB FHb ratio ≥1.86 emerges as a potent predictor for CS-AKI. This finding underscores the potential of measuring perioperative free hemoglobin levels, monitoring blood pressure, and optimizing the duration of CPB as valuable strategies to mitigate CS-AKI and improve patient outcomes.

EFFECT OF COMBINATION OF DILL AND YOGURT ON GROWTH PERFORMANCE AND SOME PHYSIOLOGICAL TRAITS IN LOCAL QUAILS

The current study aimed to determine the effect of adding mixture of dried dill (Anethum gravelens) powder at levels 0.2 % with yogurt to the quail diet on the productive and physiological characteristics of male and female quails. The experimental birds were divided into four treatments, and each treatment was divided into three replicates, with 8 birds for each replicate. The results showed a significant superiority of quail birds in the fourth treatment in the body weight at 42 days (210.08±3.34 g/bird), carcass weight (125.50±1.9 g/bird), highest value of HDL (14.50 ± 0.33 mg/dL) and the number of white blood cells (123.21 ± 5.66100/µL). While the birds of the second treatment excelled in the hemoglobin ratio in the blood (22.50 ± 0.31 g/dL) and recorded the lowest percentage of total cholesterol (188.63 ± 47 mg/dL) and the lowest LDL value (22.58 ± 1.66 mg/dL). Female quail were significantly superior in body and carcass weight at 42 days of age, while males were superior to females in most of the physiological traits studied. Brown quails also significantly outperformed white quails in body weight at 42 days (215.52 ± 4.83 g/bird), carcass weight (127.66 ± 2.33 g/bird), and white blood cell count (120.49 ± 4.16µL/100).

ASSESSING THE PROGNOSTIC VALUE OF THE HEMOGLOBIN-TO-RED CELL DISTRIBUTION WIDTH RATIO IN EMERGENCY DEPARTMENT PATIENTS WITH ACUTE CORONARY SYNDROME

Objective: Acute coronary syndrome (ACS) is a critical condition requiring rapid evaluation in the emergency department. The hemoglobin-to-red cell distribution width ratio (HRR) has emerged as a potential prognostic biomarker, reflecting the combined effects of hemoglobin and red cell distribution width. This study aims to evaluate the prognostic value of HRR in patients presenting to the emergency department with ACS. Material and Methods: A retrospective cohort study was conducted at a single center, involving adult patients who were diagnosed with acute coronary syndrome upon presentation to the emergency department. HRR was calculated as the ratio of hemoglobin to red cell distribution width, and its association with 30-day cardiac mortality (CM), all-cause mortality (ACM), and major adverse cardiovascular events (MACE) was analyzed using Receiver Operating Characteristics (ROC) curve analysis. Results: The study included 688 patients, with a mean age of 61.9±12.3 years and 57% males. Lower HRR was significantly associated with higher 30-day CM, ACM, and MACE rates. ROC curve analysis showed HRR had acceptable discriminatory power with AUC values of 0.764 for 30-day CM, 0.718 for 30-day ACM, and 0.739 for 30-day MACE. An HRR cut-off value of 0.9 was determined, with sensitivities of 87.8%, 90.2%,and 88.7%, and specificities of 47.6%, 48.4%, and 48.9% for CM, ACM, and MACE, respectively. Conclusion: HRR is a useful prognostic marker for 30-day outcomes in ACS patients. Its easy accessibility and rapid availability makes it a practical tool for risk stratification in the emergency department.

Prognostic Impact of the Ratio of Hemoglobin to Red Blood Cell Distribution Width in Patients after Acute Decompensated Heart Failure.

Objective The ratio of hemoglobin to red blood cell distribution width (Hb/RDW) is a simple and readily available tool associated with adverse outcomes in chronic heart failure (HF). However, the association between the Hb/RDW ratio and mortality in patients with acute decompensated HF (ADHF) is unclear. The goal of this study was to investigate the relationship between the Hb/RDW ratio and mortality in patients after ADHF. Methods This single-center study included clinical and laboratory data collected at baseline, with patients prospectively followed-up for a median period of 3.1 years. The patients were divided into two groups based on their median Hb/RDW ratio. Patients We evaluated 250 consecutive patients hospitalized for ADHF at Shinshu University Hospital between July 2014 and March 2019. Results In our study cohort (median age, 76 [66-83] years; 62.8 % male), all-cause death was observed in 91 patients (incidence rate: 12.7 per 100 patient-years). A Kaplan-Meier analysis revealed that patients in the lower Hb/RDW ratio group (<0.24, n=131) had worse outcomes compared to those in the higher group (≥0.24, n=119) (cumulative incidence 44.1% vs. 19.5%, respectively; log-rank, P <0.001). After adjusting for demographics, HF severity, and laboratory biomarkers, a lower Hb/RDW ratio was significantly associated with a higher risk of mortality (hazard ratio, 1.89; 95% confidence interval, 1.04-3.45; P = 0.038). Conclusion A lower Hb/RDW ratio is associated with an increased risk of mortality in patients after ADHF, thus indicating its potential utility in identifying patients at an elevated risk for future cardiovascular events.

Independent effects of the glucose-to-glycated hemoglobin ratio on mortality in critically ill patients with atrial fibrillation

BackgroundThe glucose-to-glycated hemoglobin ratio (GAR) represents stress hyperglycemia, which has been closely associated with adverse outcomes in cardio-cerebrovascular diseases. No studies have examined the association between stress hyperglycemia and atrial fibrillation (AF) in critically ill patients. This study aims to explore the relationship between GAR and the prognosis of critically ill patients with AF.MethodsA retrospective cohort of patients was selected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The GAR was calculated based on fasting blood glucose and glycated hemoglobin levels measured after admission. The primary outcome was the 30-day mortality rate, with secondary outcomes being the 90-day and 365-day mortality rates. The GAR was divided into tertiles, and Kaplan–Meier analysis was employed to compare differences in mortality rates between groups. The Cox proportional hazards model and restricted cubic splines (RCS) were utilized to evaluate the relationship between the GAR and mortality. Subsequently, a segmented regression model was constructed to analyze threshold effects in cases where nonlinear relationships were determined.ResultsIn this cohort, the second tertile of the GAR exhibited lower mortality rates at 30 days (10.56% vs 6.33% vs 14.51%), 90 days (17.11% vs 10.09% vs 17.88%), and 365 days (25.30% vs 16.15% vs 22.72%). In the third tertile, the risk of mortality at 30 days increased by 165% (HR = 2.65, 95% CI 1.99–3.54, p < 0.001), at 90 days increased by 113% (HR = 2.13, 95% CI 1.68–2.70, p < 0.001), and at 365 days increased by 70% (HR = 1.70, 95% CI 1.68–2.70, p < 0.001). The association between the GAR and patient mortality demonstrated a “J-shaped” non-linear correlation. Once the GAR exceeded 15.915, each incremental unit increase in the ratio was associated with a 27.2% increase in the risk of 30-day mortality in critically ill atrial fibrillation patients (HR = 1.262, 95% CI 1.214–1.333, p < 0.001).ConclusionThe GAR is associated with both short-term and long-term mortality in critically ill patients with AF in a J-shaped relationship. Both low and excessively high GAR values indicate poor prognosis.

Hazard functioning modeling for dextrose fluids associated hemodilution; Cox-regressional analysis for patients’ Hematocrit Hemoglobin Ratio

Aims: This study looks at the cox-regressional relationships between hematocrit to hemoglobin ratio (HHR) and a group of outcomes of interest (cOI). These outcomes include death from any cause, acute myocardial infarction, stroke, and severe dilutional hyponatraemia incidence. Additionally other outcome of interest in this study will be prolongation of admission days, infection rate, acute kidney injury, and mandating the transition to the critical unit and mechanical ventilation intubation. The study also will investigate the performances of the tested ratio and will explore their sensitivity, specificity, and accuracy indexes. Methods: Between 2018 and 2022, a retrospective study was conducted at the King Hussein Medical Centre in Amman, Jordan, involving 926 patients. The study aimed to determine the potential risk of dilution of red blood cells in circulation caused by dextrose-containing fluids in patients with chronic kidney disease. The study aimed to determine the ideal threshold levels of the investigated ratio (HHR) to enhance clinical outcomes and safety margins, particularly in patients with severe renal impairment or chronic kidney disease in a hospital setting. The study included patients with fluctuating kidney function, renal replacement therapy, uncontrolled diabetes, and conditions necessitating specific fluid regimens. The study used binary logistic regression and cox-regression proportional hazard modelling to examine the correlation between the hematocrit to haemoglobin ratio and the composite outcomes of interest (cOI) in patients from Jordan. The findings suggest that higher cOI likelihood indicates a more advantageous condition, while lower values suggest a less advantageous condition. Results: A retrospective study at the KHMC in Amman, Jordan, involved 1306 patients from 2018 to 2022. The study focused on the hematocrit to haemoglobin ratio (HHR) and achieved correct classification rates of 70.8%. The best HHR was 2.555:1, with a 42.8% chance of occurring at this level. Cox-Regression Proportional Hazard Modelling revealed a censored percentage of 83.4% in HHR&gt;2.555 stratum and 51.5% in HHR≤2.555 stratum. The study found a high percentage of HD patients processed in the analysis. Conclusion: Intravenous dextrose fluids associated hemodilutional state is linked to all-cause mortality in admitted medically and surgically patients and cardiovascular death. Low ratio increases the risk. Factors such as malnutrition and kidney function loss contribute to prognosis. Future studies should focus on mechanistic pathways, optimal targets, age, and sociodemographic factors.

Investigation of a multicomponent mycotoxin detoxifying agent for aflatoxin B1 and ochratoxin A-induced blood profile in broiler chickens.

Mycotoxins such as aflatoxin B1 and ochratoxin A (OTA) are secondary metabolites in molds that grow in raw materials or commercial feed. This interaction has a synergistic effect on mortality, body weight, feed intake, embryo abnormalities, egg production, and lymphoid organ atrophy. This study was conducted to determine the effect of a mycotoxin detoxifier on the blood profile of broilers that were given feed contaminated with mycotoxin, such as the number of heterophils, lymphocytes, monocytes, mean corpuscular hemoglobin (MCH), and MCH concentration (MCHC). A total of 20 day-old chicks (DOC) of Cobb broilers were given four treatments with five replicates. The number of chickens used in this research was determined using statistical calculations, and the data obtained was homogeneous so that the population was represented. Treatments included negative control with basal feed (C-), positive control with mycotoxins contamination (C+), treatment 1: Mycotoxins contamination and mycotoxin detoxification 1.1 g/kg (T1), and treatment 2: Mycotoxins contamination and mycotoxin detoxification 1.6 g/kg (T2). Mycotoxin contamination comprised 0.1 mg/kg aflatoxin B1 and 0.1 mg/kg OTA. The treatment period for chickens was 28 days, from 8 to 35 days. A battery cage was used in this study. Chickens were kept in a closed, ventilated room and the room temperature (27°C) was monitored during the treatment period. Based on the results of statistical data processing, a significant difference (p < 0.05) was observed between chickens fed mycotoxin-contaminated feed (C+) and chickens not fed mycotoxin-contaminated feed (C-) and chickens given 1.6 g/kg mycotoxin detoxification (T2). Mycotoxin detoxification at a dose of 1.6 g/kg had a significant (p < 0.05) effect on the heterophil, lymphocyte, and heterophil lymphocyte ratio, leukocyte, erythrocyte, and hemoglobin levels of the blood broiler in this experiment. On other parameters such as monocytes, MCH, and MCHC, treatment 2 at dose 1.6 g/kg was the best treatment, although there was no significant effect with C- and T1. The administration of mycotoxin detoxifiers at a dose of 1.6 g/kg increased the number of heterophils and the ratio of heterophil lymphocytes, leukocytes, erythrocytes, and hemoglobin in broilers fed mycotoxin-contaminated feed.

Stress hyperglycemia is associated with futile recanalization in patients with anterior large vessel occlusion undergoing mechanical thrombectomy.

Mechanical thrombectomy (MT) is the standard treatment for acute ischemic stroke (AIS) due to anterior large vessel occlusion (LVO). Despite successful recanalization, some patients remain disabled after 3 months. Mechanisms that can cause futile recanalization (FR) are still largely unknown. We investigated if stress hyperglycemia might be associated with FR. This is a retrospective analysis of consecutive patients with successful recanalization treated in four participating centers between January 2021 and December 2022. According to the modified Rankin scale (mRS) status at 3 months, patients were divided into two groups: FR, if mRS score >2, and useful recanalization (UR), if mRS score ⩽2. Stress hyperglycemia was estimated by the glucose-to-glycated hemoglobin ratio (GAR) index. A total of 691 subjects were included. At 3 months, 403 patients (58.3%) were included in the FR group, while the remaining 288 patients (41.7%) were included in the UR group. At the multivariate analysis, variables independently associated with FR were the following: age (OR 1.04, 95% CI 1.02-1.06, p < 0.001), GAR index (OR 1.08, 95% CI 1.03-1.14, p = 0.003), NIHSS at admission (OR 1.16, 95% CI 1.11-1.22; p < 0.001), and procedure length (OR 1.01, 95% CI 1.00-1.02; p = 0.009). We observed that the model combining age, GAR index, NIHSS at admission, and procedure length had good predictive accuracy (AUC 0.78, 95% CI 0.74-0.81). Stress hyperglycemia predicts FR in patients with successful recanalization after MT. Further studies should explore if managing stress hyperglycemia may reduce futile recanalization. Additionally, we recommend paying close attention to AIS patients with a GAR index greater than 24.8 who exhibit a high risk of FR.

The relationship between hemoglobin-to-red cell distribution width (RDW) ratio (HRR) and mortality in stroke patients.

In recent years, many studies have shown that hemoglobin to red cell distribution width ratio (HRR), which is the ratio of hemoglobin (Hb) to red cell distribution width (RDW), is associated with inflammation. Inflammation is linked to both the development of stroke and the severe effects that follow. Therefore, the relationship between the HRR and mortality in patients with stroke was investigated in our study. 127 stroke patients who visited the emergency department between March 1, 2023, and June 1, 2023, were retrospectively evaluated. The National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity. All stroke patients were divided into four groups: patients with atrial fibrillation (AF), those without AF, and those with low and high HRR. HRR levels were compared between patients with and without AF. The relationship between HRR and mortality was also analyzed. HRR levels were found to be significantly lower in patients with AF compared to those without AF (p<0.05 for all). NIHSS, requirement for mechanical ventilation, and mortality rate were significantly higher in the low HRR (HRR≤0.795) group compared to the high HRR group (HRR>0.795) (p<0.05 for all). HRR outperformed Hb and RDW alone in predicting mortality (AUC; 0.975, 0.952, 0.911, respectively). Additionally, a significant positive correlation was found between HRR levels and NIHSS (p<0.001). Low HRR measured on admission is a useful marker for predicting mortality and determining the severity of stroke.

Stress hyperglycemia increases short-term mortality in acute ischemic stroke patients after mechanical thrombectomy

Background and purposeGlucose-to-glycated hemoglobin ratio (GAR) is considered a more reliable marker of stress hyperglycemia by correcting for basal blood glucose levels. This study aimed to investigate the extent to which GAR is associated with 3 month and 1 year all-cause mortalities in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT).MethodsWe retrospectively followed 553 AIS patients who underwent MT. The degree of stress hyperglycemia was quantified as the GAR, defined as fasting plasma glucose (mmol/L)/hemoglobin A1c (HbA1c) (%) on the second day after admission. According to the GAR quartiles, the patients were further categorized into four groups (group 1-group 4). We assessed the association between GAR and all-cause mortalities, clinical outcomes during hospitalization and function outcomes at 3 months. The associations between stress hyperglycemia and all-cause mortalities were analyzed using a Cox proportional-hazards model, while other outcomes were analyzed using multiple logistic regression analysis.ResultsThe follow-up lasted a median of 18 months (range 0–66 months). The 3 month mortality rate was 9.58% (n = 53) and the 1 year mortality rate was 18.62% (n = 103). The Kaplan–Meier analysis revealed a significant inverse relationship between GAR and mortality (P < 0.001). In the Cox proportional-hazards model at 3 months, compared with group1, group 4 of GAR was associated with a significant increase in the risk of 3 month mortality (hazard ratio [HR] = 4.11, 95% confidence interval [CI] 1.41–12.0, P = 0.01) after adjusting for potential covariates. On multivariate logistic regression analysis, GAR was strongly associated with an increased risk of 3 month poor function outcome.ConclusionsStress hyperglycemia, quantified by a higher GAR, is associated with all-cause mortality and poor functional outcomes in patients with AIS who undergo MT. Furthermore, GAR may contribute to improving the predictive efficiency of all-cause mortality in patients with AIS after MT, especially short-term all-cause mortality.

Predictive Value of the Hb/RDW Ratio for the Risk of All-Cause Death in Patients with Heart Failure with Different Ejection Fractions

Introduction: The prognostic value of the ratio of haemoglobin to red cell distribution width (HRR) in different types of heart failure (HF) is not well known. Method and Results: We analysed the long-term prognostic value of HRR in patients with HF using the Cox proportional risk model and Kaplan-Meier method. We reviewed consecutive 972 HF patients. The overall mortality rate was 45.68%. Mortality was 52.22% in the HFrEF group and 40.99% in the HFpEF + HFmrEF group. Cox regression showed that when HRR increased by 1 unit, the risk of all-cause death in all HF patients decreased by 22.8% (HR: 0.772, 95% CI: 0.724, 0.823, p < 0.001), in the HFpEF + HFmrEF group it decreased by 15.5% (HR: 0.845, 95% CI: 0.774, 0.923, p < 0.001), and in the HFrEF group it decreased by 36.1% (HR: 0.639, 95% CI: 0.576, 0.709, p < 0.0001). Subgroup analysis showed that there were interactions between the EF and HRR groups. The group in which HRR best predicted all-cause death from HF was group 1 (EF <40%, HRR <9.45), followed by group 2 (EF <40%, HRR ≥9.45), and group 3 (EF ≥40%, HRR <9.45). HRR had no predictive value in group 4 (EF ≥40%, HRR ≥9.45). Conclusion: HRR is an important predictor of all-cause mortality in patients with HF, especially HFrEF. There is an interaction between HRR group and LVEF group.

Prognostic value of preoperative white blood cell to hemoglobin ratio and fibrinogen to albumin ratio in patients with colorectal cancer.

The prognostic value of preoperative white blood cell to hemoglobin ratio (WHR) and fibrinogen to albumin ratio (FAR) in colorectal cancer (CRC) is unknown. The purpose of this study was to analyze the correlation between preoperative WHR and FAR and the prognosis of CRC patients. The retrospective study analyzed the medical records of 207 patients with colorectal cancer who were admitted to Linyi People's Hospital between June 1, 2017 and June 1, 2021. The receiver operator curve was used to determine the cutoff value of 4.604 for WHR and 0.086 for FAR, and the patients were divided into high and low groups for comparative analysis of clinical data. Cox proportional hazards regression models were used to assess independent risk factors for disease-free survival (DFS) and overall survival (OS) in univariate and multifactorial analyses. Kaplan-Meier methods were used for survival analysis and logrank tests were used to assess survival differences. Multifactorial Cox analysis showed that tumor pathological stage (HR = 6.224, 95% CI:3.063-12.647, P < .001), and WHR (HR = 3.681, 95% CI:1.768-7.401, P < .001) were the independent risk factors for DFS in CRC patients. Tumor pathological stage (HR = 4.080, 95% CI:1.992-8.360, P < .001), and WHR (HR = 3.397, 95% CI:1.662-6.940, P = .001) were independent risk factors for OS. High levels of WHR and high levels of FAR were associated with lower DFS (P < .001) and OS (P < .001).CRC patients with both higher WHR and FAR had significantly lower DFS (P < .001) and OS (P < .001). DFS and OS may be shorter in CRC patients with high WHR and high FAR, perhaps associated with poor prognosis in CRC patients, and WHR and FAR may be potential CRC prognostic markers.

Predictive value of white blood cell to hemoglobin ratio for 30-day mortality in patients with severe intracerebral hemorrhage.

To explore the predictive value of white blood cell to hemoglobin ratio (WHR) for 30-day mortality in patients with intracerebral hemorrhage (ICH). In this cohort study, 2,848 patients with ICH were identified in the Medical Information Mart for Intensive Care (MIMIC)-III and MIMIC-IV. Least absolute shrinkage and selection operator (LASSO) regression screened covariates of 30-day mortality of ICH patients. COX regression analysis was used to study the association of different levels of WHR, white blood cell (WBC), and hemoglobin (Hb) with 30-day mortality. The median follow-up time was 30 (20.28, 30.00) days. In total, 2,068 participants survived at the end of the follow-up. WHR was negatively correlated with the Glasgow Coma Score (GCS) (spearman correlation coefficient = -0.143, p < 0.001), and positively associated with the Sepsis-related Organ Failure Assessment (SOFA) score (spearman correlation coefficient = 0.156, p < 0.001), quick SOFA (qSOFA) score (spearman correlation coefficient = 0.156, p < 0.001), and Simplified Acute Physiology Score II (SAPS-II) (spearman correlation coefficient = 0.213, p < 0.001). After adjusting for confounders, WHR >0.833 (HR = 1.64, 95%CI: 1.39-1.92) and WBC >10.9 K/uL (HR = 1.49, 95%CI: 1.28-1.73) were associated with increased risk of 30-day mortality of patients with ICH. The area under the curve (AUC) value of the prediction model based on WHR and other predictors was 0.78 (95%CI: 0.77-0.79), which was higher than SAPSII (AUC = 0.75, 95%CI: 0.74-0.76), SOFA score (AUC = 0.69, 95%CI: 0.68-0.70) and GCS (AUC = 0.59, 95%CI: 0.57-0.60). The level of WHR was associated with 30-day mortality in patients with severe ICH, and the WHR-based prediction model might provide a tool to quickly predict 30-day mortality in patients with ICH.

Biological response of nonhuman primates to controlled levels of acute blood loss.

The global shortage of human blood for medical use has prompted the development of alternative blood sources. Nonhuman primates (NHPs) are commonly used owing to their physiological similarities to humans. The objective of the current study was to establish a controlled-blood-loss model in NHPs to explore their clinical and biological responses. Blood was sequentially withdrawn from 10 cynomolgus monkeys (10, 14, 18, 22, and 25% of the total blood volume); their vital signs were monitored, and blood parameters were serially analyzed. Humoral mediators in the blood were measured using flow cytometry and enzyme-linked immunosorbent assays. In NHPs subjects to 25% blood loss and presenting with related clinical symptoms, the systolic blood pressure ratio on day 0 after bleeding was significantly lower than that of the animals from the other groups (median: 0.65 vs. 0.88, P = 0.0444). Red blood cell counts from day 0-14 and hematocrit levels from day 0-7 were markedly decreased relative to the baseline (P < 0.01). These parameters showed a direct correlation with the extent of blood loss. The levels of creatine phosphokinase, aspartate aminotransferase, and alanine aminotransferase exhibited increases in response to blood loss and had a stronger correlation with the hemoglobin ratio than the volume of blood loss. The levels of C3a and C4a, as well as interleukin (IL)-1α and IL-15, displayed a strong correlation, with no apparent association with blood loss. The findings of the present study showed that only NHPs with 25% blood loss exhibited clinical decompensation and significant systolic blood pressure reduction without fatalities, suggesting that this level of blood loss is suitable for evaluating blood transfusion efficacy or other treatments in NHP models. In addition, the ratio of hemoglobin may serve as a more dependable marker for predicting clinical status than the actual volume of blood loss. Thus, our study could serve as a basis for future xenotransfusion research and to predict biological responses to massive blood loss in humans where controlled experiments cannot be ethically performed.

Calculated haemorheological profile and laboratory parameters in new diagnosed multiple myeloma patients: retrospective analysis according to survival.

Multiple myeloma is a malignant haematological neoplasm characterised by clonal proliferation of plasma cells, with a complex clinical picture, and a significant impact on patient survival, in which the prognosis evaluation of patients is of great importance. In this single-centre retrospective analysis, performed in a group of newly diagnosed multiple myeloma patients, we examined several clinical and laboratory parameters in order to evaluate their trend according to survival of patients. We collected data from 190 newly diagnosed multiple myeloma evaluated at the Hematology Division of the 'Paolo Giaccone' University Hospital of Palermo from 1 January 2017 to 30 September 2022. Specifically, we performed our analysis in the entire cohort of patients and also in the specific disease isotype. We evaluated simple and low-cost laboratory and haemorheological parameters, the latter obtained in a calculated way. The primary endpoint was to evaluate the trend and the differences of these parameters in the study population, divided into two specific groups, deceased and survivors after a specific observation period of almost 7 years. In the entire cohort of multiple myeloma patients, we observed a mortality rate of 40%, of whom 36.4% were men and 43.1% were women. Among the patients who died, in comparison with those who survived, it is significantly evident the increase in age, in red cell distribution width (RDW), RDW%/albumin ratio and in the RDW%/haemoglobin ratio; moreover, in the same patients subgroup, we observed a reduction in haematocrit, total serum protein, calculated whole blood viscosity (evaluated according to the de Simone formula), serum albumin, albumin/fibrinogen ratio and in haemoglobin levels. The obtained data can represent a possible starting point for subsequent targeted analyses, aimed at studying the prognostic value of each individual parameter considered, favouring an increasingly complete and immediate prognostic evaluation of patients.

Prognostic value of serum phosphoglycerate dehydrogenase and glycine levels in breast cancer.

Breast cancer (BC) is the most frequent cancer in women and is a serious worldwide health issue. Phosphoglycerate dehydrogenase (PHGDH) is an enzyme that catalyses the first steps in the serine biosynthetic pathways downstream of glycolysis. Phosphoglycerate and glycine are produced by a series of enzymatic processes from the glycolysis intermediate 3-phosphoglycerate. The aim of the study was to indicate the levels of PHGDH and glycine in patients with breast cancer. The study was performed from December 2022 to March 2023. The total number of samples was 135 samples - 65 samples were collected from women with breast cancer, and 70 samples were from healthy women as a control group. Blood samples (5 ml) were obtained from all study group members. The complete blood count (CBC) neutrophils/lymphocytes, and haemoglobin ratio analysis was done on a CBC haematology analyser (Sysmex, Japan). Serum PHGDH and glycine were measure by enzyme-linked immunosorbent assay. The study findings revealed a significant increase in the neutrophil/lymphocytes ratio and a decrease in PHGDH level in patients with BC compare to controls (p < 0.01), while the serum glycine level showed a significant increase in patients with BC compare to the control group (p < 0.01). Reduced PHGDH level and high glycine concentration in patients with BC could act as a prognostic factor in cancer development.

Ratio of hemoglobin to mean corpuscular volume: A new index for discriminating between iron deficiency anemia and thalassemia trait.

Iron deficiency anemia (IDA) and thalassemia trait (TT) are the most common microcytic and hypochromic anemias. Differentiation between mild TT and early IDA is still a clinical challenge. To develop and validate a new index for discriminating between IDA and TT. Blood count data from 126 patients, consisting of 43 TT patients and 83 IDA patients, was retrospectively analyzed to develop a new index formula. This formula was further validated in another 61 patients, consisting of 48 TT patients and 13 IDA patients. The new index is the ratio of hemoglobin to mean corpuscular volume. Its sensitivity, specificity, accuracy, Youden's Index, area under the receiver operating characteristic curve, and Kappa coefficient in discriminating between IDA and TT were 93.5%, 78.4%, 83.3%, 0.72, 0.97, and 0.65, respectively. This new index has good diagnostic performance in discriminating between mild TT and early IDA. It requires only two results of complete blood count, which can be a very desirable feature in under-resourced scenarios.

Association between anaemia and long-term prognosis in patients with non-ST segment elevation myocardial infarction

Background The majority of existing studies examining the association between anaemia and the prognosis of patients with acute coronary syndrome (ACS) have focused on all patients with ACS without further categorisation. As a result, there is a dearth of research specifically exploring the relationship between anaemia and the long-term prognosis of patients with non-ST segment elevation myocardial infarction (NSTEMI). To address this gap, this study aimed to investigate the correlation between anaemia and the long-term prognosis of NSTEMI patients. Methods This study included 482 NSTEMI patients who underwent percutaneous coronary intervention (PCI) at the First Affiliated Hospital of Chongqing Medical University from September 1, 2016 to May 31, 2022, and the patients were classified into the major adverse cardiovascular events (MACE) group and non-MACEs group according to whether or not they had developed MACE as of February 28, 2023 at follow-up.COX regression analysis was used to assess whether anaemia was an independent factor influencing MACE occurrence in patients with NSTEMI. Receiver operating characteristic (ROC) curve analysis was conducted to determine if haemoglobin levels could enhance the predictive capacity of the Global Registry of Acute Coronary Events (GRACE) score for the prognosis of NSTEMI patients. Haemoglobin levels were categorised into two groups based on the optimal cut-off value and transformed into binary data. The log-rank test was performed to compare the two groups, and a risk function was plotted. Results During a median follow-up period of 31 months, 124 (25.7%) MACE were identified. Univariate and multivariate COX regression analyses revealed that sex, age, smoking history, diabetes, creatinine, erythrocyte count, and haemoglobin level were independent risk factors that significantly influenced survival time. Subsequently, ROC curve analysis was performed to evaluate the predictive accuracy of specific variables. When the cut-off value for the decline ratio of haemoglobin was set at 128.50, the area under the curve (AUC) was determined to be 0.604, with a sensitivity of 0.403 and a specificity of 0.771. Similarly, setting the cut-off value for the reduction ratio of the GRACE score at 141.5 yielded an AUC of 0.700, with a sensitivity of 0.645 and a specificity of 0.709. Furthermore, when the cut-off value for the predicted probability of haemoglobin combined with the GRACE score was 0.270, the AUC was calculated as 0.702, with a sensitivity of 0.677 and a specificity of 0.696. Conclusion Haemoglobin levels were identified as an independent factor influencing the survival duration of patients with NSTEMI.