Higher Neutrophil Research Articles

Association of maternal neutrophil count in early pregnancy with the development of gestational diabetes mellitus: a prospective cohort study in China

Objective We evaluated the potential role of maternal serum levels of neutrophils in the first trimester of pregnancy in the prediction of gestational diabetes mellitus (GDM). Methods This prospective cohort study enrolled singleton pregnant women before gestational weeks 16 and evaluated them until delivery. Among the 1467 pregnant women who performed prenatal care before 14 weeks of gestation in the cohort, a total of 731 were eligible for the final analysis. The associations between neutrophil counts, white blood cell count, neutrophil to lymphocyte ratio, and GDM (assessed by a 75-g oral glucose tolerance test between 24 and 28 weeks) were evaluated by multivariate logistic regression. Results Neutrophil count outperformed the neutrophil to lymphocyte ratio and white blood cell count in predicting GDM occurrence. We applied a smoothing function and found that neutrophil count was associated with both fasting blood glucose (FBG) (p=.0149) and 1-h postprandial blood glucose (PBG) (p=.0187) after adjustment pre-pregnancy body mass index, family history of diabetes, and age. Logistic regression analysis found that the highest neutrophil count level (6.28–14.73 × 109/L) had a 1.85-fold (95% CI 1.10, 3.09) increased risk of GDM compared with that of the lowest tertile (1.47–4.82 × 109/L). Conclusions The results indicated an association between higher neutrophil levels and GDM occurrence.

Disease characteristics and serological responses in patients with differing severity of COVID-19 infection: A longitudinal cohort study in Dhaka, Bangladesh.

BackgroundCOVID-19 caused by SARS-CoV-2 ranges from asymptomatic to severe disease and can cause fatal and devastating outcome in many cases. In this study, we have compared the clinical, biochemical and immunological parameters across the different disease spectrum of COVID-19 in Bangladeshi patients.Methodology/Principal findingsThis longitudinal study was conducted in two COVID-19 hospitals and also around the community in Dhaka city in Bangladesh between November 2020 to March 2021. A total of 100 patients with COVID-19 infection were enrolled and classified into asymptomatic, mild, moderate and severe cases (n = 25/group). In addition, thirty age and sex matched healthy participants were enrolled and 21 were analyzed as controls based on exclusion criteria. After enrollment (study day1), follow-up visits were conducted on day 7, 14 and 28 for the cases.Older age, male gender and co-morbid conditions were the risk factors for severe COVID-19 disease. Those with moderate and severe cases of infection had low lymphocyte counts, high neutrophil counts along with a higher neutrophil-lymphocyte ratio (NLR) at enrollment; this decreased to normal range within 42 days after the onset of symptom. At enrollment, D-dimer, CRP and ferritin levels were elevated among moderate and severe cases. The mild, moderate, and severe cases were seropositive for IgG antibody by day 14 after enrollment. Moderate and severe cases showed significantly higher IgM and IgG levels of antibodies to SARS-CoV-2 compared to mild and asymptomatic cases.Conclusion/SignificanceWe report on the clinical, biochemical, and hematological parameters associated with the different severity of COVID-19 infection. We also show different profile of antibody response against SARS-CoV-2 in relation to disease severity, especially in those with moderate and severe disease manifestations compared to the mild and asymptomatic infection.

Latent class analysis of 216 patients with adult-onset Still\u2019s disease

BackgroundAdult-onset Still’s disease (AOSD) is a rare systemic autoinflammatory disease which encompasses patients with heterogenous presentation and a wide range of clinical courses. In this study, we aimed to identify potential subgroups of AOSD and reveal risk factors for relapse.MethodsWe included a total of 216 AOSD patients who received treatment in nine hospitals between 2000 and 2019. All patients fulfilled the Yamaguchi classification criteria. We retrospectively collected information about baseline characteristics, laboratory tests, treatment, relapse, and death. We performed latent class analysis and time-to-event analysis for relapse using the Cox proportional hazard model.ResultsThe median age at disease onset was 51.6 years. The median follow-up period was 36.8 months. At disease onset, 22.3% of the patients had macrophage activation syndrome. The median white blood cell count was 12,600/μL, and the median serum ferritin level was 7230 ng/mL. Systemic corticosteroids were administered in all but three patients (98.6%) and the median initial dosage of prednisolone was 40mg/day. Ninety-six patients (44.4%) were treated with concomitant immunosuppressants, and 22 (10.2%) were treated with biologics. Latent class analysis revealed that AOSD patients were divided into two subgroups: the typical group (Class 1: 71.8%) and the elderly-onset group (Class 2: 28.2%). During the follow-up period, 13 of 216 patients (6.0%) died (12 infections and one senility), and 76 of 216 patients (35.1%) experienced relapses. Overall and relapse-free survival rates at 5 years were 94.9% and 57.3%, respectively, and those rates were not significantly different between Class 1 and 2 (p=0.30 and p=0.19). Time-to-event analysis suggested higher neutrophil count, lower hemoglobin, and age ≥65 years at disease onset as risk factors for death and age ≥65 years at disease onset as a risk factor for relapse.ConclusionsAOSD patients were divided into two subgroups: the typical group and the elderly-onset group. Although the survival of patients with AOSD was generally good, the patients often experienced relapses. Age ≥65 years at disease onset was the risk factor for relapse.

A study to evaluate the role of eosinophil count as a prognostic marker for assessing the outcome in patients with COVID-19 infection.

The triaging of COVID-19 patients is of paramount importance to plan further management. There are several clinical and laboratory parameters that help in categorizing the disease severity, triaging, and prognostication. Little is known about the prognostic significance of eosinopenia in predicting the severity of COVID-19 from large hospital data, especially from low- and middle-income countries. The objective of this study is to evaluate the level of eosinopenia as an early prognostic marker for assessing the outcomes in COVID-19 patients and to assess the superiority of eosinopenia as a prognostic marker for assessing the outcomes in COVID-19 patients compared to lymphopenia and neutrophil-to-lymphocyte ratio (NLR). The study was carried out in a tertiary care hospital. A retrospective longitudinal approach was adopted wherein the hospital records of COVID-19 patients were analyzed. In our study, two separate groups of patients were included for analysis to describe the association between initial eosinophil counts of the patients and the clinical outcomes. In the first group, the disease severity in terms of clinical and radiological parameters was compared in patients of COVID-19 presenting with and without the presence of initial eosinopenia. Commonly used markers for triage, namely lymphopenia and NLR, were compared with the presence of initial eosinopenia among the patients who progressed to moderate and severe disease. In the second group, an analysis of eosinopenia was made among the patients who succumbed to the illness. It was seen that 29.6% of patients with eosinopenia had moderate and severe disease compared to those without eosinopenia where only 10.8% had moderate disease, none had severe disease. It was seen that 19.7% of patients with eosinopenia but no lymphopenia had more severe disease compared to patients with lymphopenia but no eosinopenia where 10.8% of the patients had moderate disease, none had severe disease. In patients younger than 60 years who died of COVID-19, it was found that initial eosinopenia was found in 86%, whereas a high NLR >17 was seen in only 25.6% of patients who died, thus implying that is eosinopenia is an important marker of disease severity in COVID-19. Eosinopenia is an important parameter in the evaluation of COVID-19 and the presence of it should alert the clinicians regarding the further progression of the disease. It is not only an important marker but also an early marker for severe disease.

HEMORRHAGIC STROKE PROFILE ON SALATIGA REGIONAL PUBLIC HOSPITAL PATIENTS

Introduction: There is an increasing number of new hemorrhagic stroke cases from 2017 to 2018 on The Province of Central Java and Salatiga. A study of demographics, laboratory examination, radiology, outcome, risk factor, and clinical presentation on hemorrhagic stroke patients are rarely done at Salatiga Regional Public Hospital. Objectives: This study aims to describe the hemorrhagic stroke profile on Salatiga Regional Public Hospital patients. Materials and Methods: Hemorrhagic stroke inpatient of Salatiga Regional Public Hospital in the period between October 2018 and October 2019 is studied. Demographic, laboratory examination, radiology, outcome, risk factor, and clinical presentation data are reported. Results: From a total of 192 data gathered, 120 meet the inclusion and exclusion criteria. 47,5% male and 52,5% female with highest age range (55-64) 33%. The majority of patients came from outside of Salatiga city 71,7%. Patients with blood pressure classification stage 1 11,7%; stage 2 80%. Laboratory examination data shows 52,5% high leucocyte count; normal thrombocyte count; normal lymphocyte count; normal monocyte count; 72,5% high neutrophil count; 71,7% high Neutrophil-Lymphocyte Ratio; 89,2% high ureum level; normal creatine serum; 80% not at risk based on eGFR. Types of hemorrhages are ICH, IVH, and SAH with percentages 68,7%; 25,3%; 6% respectively. Basal Ganglia (48,1%) are the most common location for ICH and lateral ventricle (61,9%) are the highest for IVH. Clinical presentation for GCS (14-15) are the highest 58%. Patients with mortality are dominant in males with mean age 59,61 (year); followed by high counts of leucocyte, neutrophil, NLR, and ureum. Conclusion: Hemorrhagic stroke patients at Salatiga Regional Public Hospital are mainly female with the age range of 55-64 are the highest, came from outside of Salatiga city. The most frequent risk factor is hypertension. Most patients have GCS of 14-15 and stage 2 blood pressure classification. Most of the patient have leucocytosis, neutrophillia, high NLR and ureum level. ICH is the highest stroke subtype with the most frequent location of basal ganglia. More patients with good outcomes compared with a bad outcome.

Inflammatory Phenotypes of Cough Variant Asthma as Response Predictors to Anti-Asthmatic Therapy.

BackgroundEosinophilic inflammatory phenotype was thought to be the most common phenotype of cough variant asthma (CVA), nevertheless other phenotypes were also reported.PurposeThe study aimed to analyze the inflammatory phenotypes of CVA in relation to treatment response to the stepwise anti-asthmatic treatment.Patients and MethodsThe study included 45 patients with chronic cough (CC) and suspicion of CVA (normal chest X-ray, presence of bronchial hyperresponsiveness and no history of wheezing or dyspnea) in whom induced sputum was successfully collected. Based on the cellular composition of the sputum, patients were divided into major inflammatory phenotypes: eosinophilic, neutrophilic, paucigranulocytic or mixed granulocytic. A stepwise treatment, including inhaled corticosteroids with long-acting β2-agonist, montelukast and short-term therapy with prednisone was initiated. Good treatment response was defined as the reduction in cough severity at least 20 mm from the baseline in visual analogue scale and improvement in cough-related quality of life assessed by the Leicester cough questionnaire at least 1.3 points after any of three steps.ResultsFinally, 40/45 (88.9%) patients improved after therapy. Eosinophilic asthma was found in 13/40 (32.5%) patients, neutrophilic in 6/40 (15.0%) and paucigranulocytic pattern in 21/40 (52.5%) patients. No one demonstrated a mixed granulocytic phenotype. The response to the treatment was similar in all groups. However, the reduction in cough severity was inversely related to the percentage of sputum neutrophils (r = −0.44, P = 0.003). We showed that the percentage of neutrophils in sputum >46% may be considered as a predictor of poor response to anti-asthmatic therapy.ConclusionThe diversity of inflammatory phenotypes with paucigranulocytic preponderance was found in subjects with CVA. The response to anti-asthmatic treatment in patients with CVA was not related to the inflammatory phenotype. High neutrophil count in sputum may predict poor response to anti-asthmatic therapy in patients with CC and bronchial hyperresponsiveness.

Clinico-pathological study among COVID-19 patients during the second wave of COVID-19 pandemic in Andaman Nicobar Island- "A retrospective cross-sectional study".

Andaman and Nicobar Islands, a Union Territory of India is Tropical Island, has better air quality and since its specific geographic location that may have an impact on the clinical and pathological features. So, this study is intended to describe the clinical and pathological features of COVID-19 infection and its association with the severity of the disease among adult COVID-19 patients. A cross-sectional study done retrospectively among 100 adult COVID-19 RT PCR positive in Tertiary Hospital, tropical Islands by reviewing medical records. The clinical, laboratory parameters were assessed. In the study 65% of the population were male, and 55% of COVID-19 cases were between the age group of 25 to 50 years of age. At presentation, 96% had respiratory symptoms, 91% had fever, 33% had gastrointestinal symptoms, 10% had musculoskeletal symptoms, and 6% have a history of contact with COVID-19 positive patients. The severe COVID-19 patients had longer duration of fever (P-value 0.041), duration of cough (P 0.016), duration of breathlessness (P 0.002), high pulse rate (P = 0.031) at presentation, had high neutrophil/lymphocyte ratio (P = 0.001), high neutrophil count (P < 0.001), low lymphocyte count (P < 0.001), high CRP (P < 0.001), and high D-dimer (P < 0.001) at presentation. Severe COVID-19 patients at presentation had longer duration of fever, cough, and breathlessness, hence should seek early medical care. Lab parameters is a great tool in the assessment of patient who can go to have severe disease and thus help in formulating Guidelines.

Predictors of recurrence of venous thromboembolic disease after discontinuing of anticoagulation: a prospective cohort study.

We aim to evaluate factors associated with the recurrence of thromboembolic episodes among patients with a first episode of venous thromboembolic disease during anticoagulation treatment and at least one year after treatment suspension. A prospective cohort of patients with a first episode of deep vein thrombosis confirmed by Doppler ultrasound and initiated anticoagulation treatment. Participants were registered in the Institutional Registry of Thromboembolic Disease between June 2015 and March 2019. Patients with cancer, with permanent inferior vena cava filter implant, and those who refused to participate or did not provide informed consent were excluded. All patients were evaluated within treatment at 30 days and at least one year after the suspension of anticoagulation with a D-dimer study and an ultrasound. All patients were evaluated for recurrence, bleeding (major and minor), and death. A total of 304 patients were recruited during the study period. Seventy-three percent were female, and the median age was 80 years. The rate of recurrence rate during anticoagulation treatment was 5% (N = 16/303; 95% confidence interval: 3 to 8), and 5% during post-suspension follow-up (N = 11/202; 95%CI: 3 to 9). The overall bleeding rate was 13% (N = 39; 95%CI: 9 to 17), and 5% for major bleeding. Patients who recurred had higher basal D-dimer mean, higher neutrophils and monocytes, and a higher prevalence of age-adjusted D-dimer ratio greater than 0.5 before discontinuation. In addition, they more frequently had complete leg involvement by ultrasound and received a shorter treatment. Although some baseline and pre-suspension parameters had a higher recurrence incidence, statistical significance was not reached, probably due to small statistical power and a short-term follow-up.

Should We Expand the Use of Granulocyte-Colony Stimulating Factors (G-CSF) during the COVID-19 Pandemic?

Cancer patients are considered more susceptible to the SARS-CoV-2 infection. Higher rates of respiratory failure and death were reported in cancer patients and COVID-19, compared with the general population. Among other measures deemed to protect this vulnerable subcategory, both ASCO and ESMO recommended the extension of G-CSF use, to include prophylactic administration in all patients receiving regimens with 10%-20% risk of febrile neutropenia (FN) and also in regimens with risk of FN &lt;10%, if patients were considered with poor bone marrow reserve due to comorbidities or advanced age. However, accumulating data reported in several recent publications suggested a direct involvement of the high neutrophil count, due to G-CSF stimulation, in the development of the adult respiratory distress syndrome (ARDS), the hallmark of the severe COVID-19 disease. In addition, some recent evidences suggest that G-CSF may hamper the efficacy of the mRNA vaccine. This paper reviews the most important data reporting higher rates of respiratory failures and death associated with G-CSF treatment in cancer patients and SARS-CoV-2 infection. Therefore, we consider that the current recommendation of expanding the G-CSF use in cancer patients during the COVID-19 pandemic should be reconsidered. The most important protective measures for cancer patients remain specific vaccination and a rigorous compliance with the general protective measures, whereas the G-CSF should be administrated as traditionally recommended by the current guidelines.

Relationship Between Exposure to Sulphur Dioxide Air Pollution, White Cell Inflammatory Biomarkers and Enzymatic Infarct Size in Patients With ST-segment Elevation Acute Coronary Syndromes.

Aims: To analyse the relationship among air pollutants, markers of inflammation and infarct size in patients with acute coronary syndrome (ACS). Methods: This was a prospective analysis of consecutive patients admitted to hospital because of ACS. Cardiac biomarkers were drawn. The daily mean values of the air pollutants from the day before until 7 days before admission were analysed. The study population was stratified according to infarct size, based on median peak troponin value. Results: Patients were divided into two groups of 108 subjects each, according to median peak troponin value. Patients with extensive MIs had a higher neutrophil:lymphocyte ratio and leukocyte and neutrophil counts than patients with smaller MIs. In addition, they were exposed to higher concentrations of sulphur dioxide (9.7 ± 4.1 versus 8.4 ± 3.1 μg/m3; p=0.009) and lower concentrations of ozone (33.8 ± 13.7 versus 38.6 ± 14.5 μg/m3; p=0.014). Multivariate analysis showed that sulphur dioxide levels (OR 1.12; 95% CI [1.031–1.21]; p=0.007) and neutrophil/lymphocyte ratio (OR 1.08; 95% CI [1.011–1.17]; p=0.024) were independent predictors of infarct size. Conclusion: Patients with extensive MIs had higher white cell inflammatory levels and had been exposed to higher sulphur dioxide concentrations in the ambient air.

The Prognostic Role of Blood Inflammatory Biomarkers and EGFR Mutation Status in Stage IIIA/N2 Non-Small Cell Lung Cancer Patients Treated With Trimodality Therapy.

ObjectivesVarious blood inflammatory biomarkers were associated with treatment response and prognosis of non-small cell lung cancer (NSCLC) in previous studies. In this study, we retrospectively evaluated the prognostic role of pretreatment blood inflammatory biomarkers and epidermal growth factor receptor (EGFR) mutation status in stage IIIA/N2 NSCLC patients with trimodality therapy.MethodsCompletely resected stage IIIA/N2 NSCLC patients with adjuvant chemotherapy and postoperative radiotherapy (PORT) were assessed in this study. Cutoff values of blood inflammatory factors were calculated by the R package SurvivalROC of R software. SPSS Statistics software was used for survival analyses. Kaplan-Meier survival curve and log-rank test were used to compare the survival difference between every two groups. Univariate and multivariate analyses of predictive factors were performed by Cox proportional hazards regression model.ResultsThe univariate analysis showed that T stage (p=0.007), EGFR mutation status (p=0.043), lymphocyte-to-monocyte ratio (LMR) (p=0.067), and systemic immune-inflammation index (SII) (p=0.043) were significant prognostic factors of disease-free survival (DFS). In the multivariate analysis, T2 (HR=0. 885, 95% CI: 0.059-0.583, p=0.004), EGFR mutation-positive (HR=0.108, 95% CI: 0.023-0.498, p=0.004) and elevated pretreatment SII (HR=0.181, 95%CI: 0.046-0.709, p=0.014) were independently related to shorter DFS. High pretreatment neutrophil counts (HR=0.113, p=0.019) and high systemic inflammation response index (SIRI) (HR=0.123, p=0.025) were correlated with worse overall survival (OS) by the univariate analysis. In the multivariate analysis, only high pretreatment SIRI was an independent predictor for poorer OS (HR=0.025, 95% CI: 0.001-0.467, p=0.014).ConclusionsIn conclusion, we identified that high pretreatment SII and SIRI were unfavorable prognostic factors in stage IIIA/N2 NSCLC patients treated with surgery, adjuvant chemotherapy and PORT. Patients with high pretreatment SII, high pretreatment SIRI, T2, and EGFR mutation-positive may need more forceful adjuvant treatment. Further prospective studies with large-scale are needed to validate our results and identify the proper cut-off values and optimum adjuvant treatment for distinct patient population.

Role of Biomarkers in the Stratification of COVID-19 Disease Severity – A Review

Background: There have been a wide variety of clinical publications on coronavirus disease 19 (COVID-19) focused on specific biomarkers. Acute-phase reactants, such as C-reactive protein (CRP), ferritin, serum amyloid A (SAA), and procalcitonin, have been identified as sensitive markers of acute COVID-19 illness, even though they are nonspecific markers. Objective: The purpose of this study is to summarize the role of several biomarkers in the stratification of COVID-19 disease severity. Methods: This study followed systematic literature review method. The systematic review followed the review process as it was well developed and planned to reduce biases and eliminate irrelevant and low-quality studies. The steps for implementing a systematic review include correctly formulating the COVID-19 question to answer, developing a protocol based on inclusion and exclusion criteria, performing a detailed and broad literature search and screening the abstracts of the studies identified in the search and subsequently of the selected complete texts. After selecting the study, the next steps were synthesis of the evidence like extract the necessary data into a form designed in the protocol to summarise the included studies, assess the biases of each study, identifying the quality of the available evidence, and develop tables and text that synthesise the evidence. The secondary sources of data for this study included different published topics from national &amp; international journals. Good number of Journal articles was taken regarding “Role of Biomarkers in the Stratification of COVID-19”. Published articles were collected from renowned indexing data source like PubMed, Medline, and Scopus. Etc. Conclusion: Significantly increased white blood cell count, lymphopenia, decreased CD3, CD4, or CD8 T-lymphocyte counts, high neutrophil count, thrombocytopenia, and dramatically elevated inflammatory biomarkers were all linked to severe disease and the probability of developing sepsis as the disease progressed. Progressive decreases with lymphopenia, thrombocytopenia, elevated CRP, procalcitonin, increased liver enzymes, impaired renal function, and coagulation derangements were more common in critically sick patients and were linked to a higher rate of clinical sequelae. In seriously and critically ill patients, elevated interleukin levels and significantly increased SAA were most frequently reported. The neutrophil to lymphocyte ratio, the systemic immune inflammation index, and the COVID-19 Severity Score are all indicators of systemic inflammation that can be used to predict disease severity, outcome, and death.

Circulating low density neutrophils of breast cancer patients are associated with their worse prognosis due to the impairment of T cell responses.

Neutrophils are prominent immune components of tumors, having either anti-tumor (N1) or pro-tumor activity (N2). Circulating neutrophils, divided into high density neutrophils (HDN) and low density neutrophils (LDN), functionally mirror those N1 and N2 cells, respectively. LDN are rare in non-pathological conditions, but frequent in cancer, exhibiting a pro-tumor phenotype. These findings have been mainly demonstrated in animal models, thus proper validation in humans is still imperative. Here, we observed that LDN were increased in the blood of breast cancer (BC) patients, particularly with metastatic disease. Within the population of non-metastatic patients, LDN were more prevalent in patients with poor response to neoadjuvant chemotherapy than patients with a good response. The higher incidence of LDN in BC patients with severe disease or resistance to treatment can be explained by their pro-tumor/immunosuppressive characteristics. Moreover, the percentage of LDN in BC patients’ blood was negatively correlated with activated cytotoxic T lymphocytes and positively correlated with immunosuppressive regulatory T cells. The ability of LDN to spoil anti-tumor immune responses was further demonstrated ex vivo. Hence, this study reveals the potential of LDN as a biomarker of BC response to treatment and opens new avenues for developing new immunotherapies.

Epigenetic quantification of circulating immune cells in peripheral blood of triple-negative breast cancer patients

BackgroundA shift in the proportions of blood immune cells is a hallmark of cancer development. Here, we investigated whether methylation-derived immune cell type ratios and methylation-derived neutrophil-to-lymphocyte ratios (mdNLRs) are associated with triple-negative breast cancer (TNBC).MethodsLeukocyte subtype-specific unmethylated/methylated CpG sites were selected, and methylation levels at these sites were used as proxies for immune cell type proportions and mdNLR estimation in 231 TNBC cases and 231 age-matched controls. Data were validated using the Houseman deconvolution method. Additionally, the natural killer (NK) cell ratio was measured in a prospective sample set of 146 TNBC cases and 146 age-matched controls.ResultsThe mdNLRs were higher in TNBC cases compared with controls and associated with TNBC (odds ratio (OR) range (2.66–4.29), all Padj. < 1e−04). A higher neutrophil ratio and lower ratios of NK cells, CD4 + T cells, CD8 + T cells, monocytes, and B cells were associated with TNBC. The strongest association was observed with decreased NK cell ratio (OR range (1.28–1.42), all Padj. < 1e−04). The NK cell ratio was also significantly lower in pre-diagnostic samples of TNBC cases compared with controls (P = 0.019).ConclusionThis immunomethylomic study shows that a shift in the ratios/proportions of leukocyte subtypes is associated with TNBC, with decreased NK cell showing the strongest association. These findings improve our knowledge of the role of the immune system in TNBC and point to the possibility of using NK cell level as a non-invasive molecular marker for TNBC risk assessment, early detection, and prevention.

Neutrophil count, lymphocyte count and neutrophil-to-lymphocyte ratio in relation to response to adjunctive dexamethasone treatment in community-acquired pneumonia

BackgroundIt is hypothesised that community-acquired pneumonia (CAP) patients with more severe disease or inflammation might benefit more from adjunctive corticosteroid treatment. Neutrophil count, lymphocyte count and neutrophil-lymphocyte ratio (NLR) have been associated with inflammation and disease severity in CAP. We investigated the interaction between these parameters and adjunctive dexamethasone effects on clinical outcomes in CAP. MethodsWe conducted a post hoc analysis of the randomised placebo-controlled Santeon-CAP trial (n = 401), which showed a positive effect of adjunctive oral dexamethasone on length of stay (LOS) in CAP patients. White blood cell (WBC) count, neutrophil count, NLR (highest tertile vs. lowest two tertiles) and lymphocyte count (lowest tertile vs. highest two tertiles) were examined as potential effect modifiers of treatment with dexamethasone on LOS (primary outcome) and ICU-admission, 30-day mortality and hospital readmission. ResultsWBC differential counts were available for 354 patients. The effect of dexamethasone on LOS was more pronounced in high WBC count, high neutrophil count or high NLR subgroups (difference in median LOS of 2 days versus zero days in the reference subgroups, p for interaction < 0.05). There was no effect modification for the other outcomes. Patients with low WBC and low neutrophil counts did not benefit from dexamethasone, while hospital readmission rate was higher in those treated with dexamethasone (6% vs. 11%). ConclusionsWBC count and/or neutrophil might be easily available biomarkers to guide selection of CAP patients who are more likely to benefit from adjunctive dexamethasone treatment. Future prospective trials are needed to confirm this predictive potential.

High Neutrophil to Lymphocyte Ratio, C-Reactive Protein, Procalcitonin and D-dimer as Risk Factors for Severe COVID-19

Background: COVID-19 is caused by the SARS-CoV2 virus which is a new type of virus that causesglobal morbidity and mortality. Several studies are needed to determine biomarkers to identify theseverity of COVID-19. Objective: to analyze the correlation between Neutrophil to lymphocyte rate(NLR), C-Reactive Protein (CRP), D-dimer, dan Procalcitonin (PCT) on the severity of COVID-19.Method: A retrospective case-control study was done in our institution using data from June 2020 toMarch 2021. Data collected were serum NLR, CRP, d-dimer and PCT. Data were analysed using SPSS.Participants were divided into 2 groups, severe COVID-19 as case and mild to moderate as controlgroup. The data collection was carried out in June 2020 – March 2021, included NLR, CRP, D-dimer,and PCT in patient serum. Data analysis using Chi-Square test and logistic regression with p &lt; 0.05.Result: The NLR value of participants in case group is 11.4 ± 9.7 and in control group is 8.2 ± 8.5(95% CI 1.081 – 4.641; p = 0.023). The PCT value of participants in case group was 10.3 ± 75.4 andin control group was 6.9 ± 41.4 (95% CI 1.495 – 6.908; p &lt; 0.001). CRP values in case group (123.7± 108.9) were higher than control group (61.3 ± 60.8; 95% CI 1.181 – 5.063; p &lt; 0.001). Meanwhile,the value of D-dimer participants in case group was 3.5 ± 3.7 and control group was 2.7 ± 4.6 (95% CI0.604 – 2.958; p = 0.473). Conclusion: increased values of NLR, CRP, and D-dimer are risk factorsfor severe COVID-19.

Persistence of Chronic Inflammation Despite Years of Transfusion Program in SCD Patients: Changing Red Blood Cells Is Not Sufficient to Treat Sickle Cell Disease

▪Sickle cell disease (SCD) is a severe hemoglobinopathy due to abnormal hemoglobin S (HbS). Although red blood cell dysfunction is at the core of the SCD pathophysiology, several studies have highlighted the important role of inflammatory cells like neutrophils. One of the most serious complications of SCD is cerebral vasculopathy (CV), due to the occlusion of one or more intracranial or cervical arteries. In 1998, the STOP study demonstrated that monthly blood transfusions could reduce the risk of stroke by 90% in children with CV. However, there is large heterogeneity in the evolution of CV under chronic transfusion, sometimes requiring exchange transfusion (ET) program for years without succeeding in healing the CV.The aim of the study is to investigate the impact of long-term transfusion program on neutrophil dysfunction, in order to understand if persistent inflammation could contribute to the non-healing of CV despite HbS permanently below 40%. In SCD children undergoing ET program for at least 1 year, we analysed i)the phenotype of neutrophils with 8 markers of activation/adhesion/ageing, ii)the plasmatic levels of elastase, witnessing the NETose activity of neutrophils, and iii)the ex-vivo adhesion of neutrophils on activated endothelial cells.One hundred and two SCD children with an ET transfusion program for at least 6 months because of CV were included in the study. ET session, carried out every 5 weeks and most of the time by erythrapheresis, reached their biological objectives with a mean HbS rate after ET session of 14.1%, and 35.4% before the next ET session, which means that these patients globally live at an average HbS level of 24% for at least 1 year. We managed to limit iron overload with a mean ferritinemia of 207 µg/L in the whole cohort. Despite these satisfactory results in terms of HbS reduction, the efficiency in curing the CV was modest in accordance with the previously described efficiency of ET program in SCD children: after a mean ET program duration of 4.4 years only 22% of them had an improvement of their CV since the beginning of the ET program, while 60% of them had a stagnation of their CV, and 18% of them worsened their vascular lesions. Considering inflammatory parameters, the patients had persistence of high leukocytosis and high neutrophils count (respective mean of 9810 G/L and 5742 G/L), significantly not different of neutrophils count before inclusion in the ET program. In a random subgroup of 20 patients, we analysed neutrophils phenotype, NETose and endothelial adhesion and compared them to healthy controls and SCD children without ET, treated or not with Hydroxyurea (HU). Overall, we observed as expected an activated, aged and adherent profile of neutrophils from untreated SCD children compared to healthy controls, characterized by an overexpression of CD18/CD11b (p=0,03), CD18/CD11a (p=0,02), CD162 (p=0,01), CD66a (p=0,01) and the ageing markers CD184 high/CD62Llow (p=0,04) as well as a higher plasmatic level of elastase (p=0. 01) and higher adhesion of neutrophils to endothelial cells. All these parameters were alleviated in SCD patients treated with HU. In SCD patient undergoing ET program, we found a similar profile of activated neutrophils to that of untreated SCD patients with a similar expression of activation molecules, high level of elastase and the same increase of neutrophils adhesion to endothelial cells compared to controls, witnessing a persistence of chronic inflammation despites years of ET.Overall, our study highlights that the replacement of sickle red blood cells, even for years, is not sufficient to reverse the deleterious inflammatory phenotype of neutrophils. Given the major role of inflammation in endothelial dysfunction, these could contribute to the persistence of CV in a majority of patients despite efficient ET programs. This raises the question of systematically combining ET program with anti-inflammatory treatment such as HU or P-selectin inhibitors in children with CV. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Prognostic value of neutrophil-to-lymphocyte ratio in COVID-19 compared with Influenza and respiratory syncytial virus infection

A high neutrophil to lymphocyte ratio (NLR) is considered an unfavorable prognostic factor in various diseases, including COVID-19. The prognostic value of NLR in other respiratory viral infections, such as Influenza, has not hitherto been extensively studied. We aimed to compare the prognostic value of NLR in COVID-19, Influenza and Respiratory Syncytial Virus infection (RSV). A retrospective cohort of COVID-19, Influenza and RSV patients admitted to the Tel Aviv Medical Center from January 2010 to October 2020 was analyzed. Laboratory, demographic, and clinical parameters were collected. Two way analyses of variance (ANOVA) was used to compare the association between NLR values and poor outcomes among the three groups. ROC curve analyses for each virus was applied to test the discrimination ability of NLR. 722 COVID-19, 2213 influenza and 482 RSV patients were included. Above the age of 50, NLR at admission was significantly lower among COVID-19 patients (P < 0.001). NLR was associated with poor clinical outcome only in the COVID-19 group. ROC curve analysis was performed; the area under curve of poor outcomes for COVID-19 was 0.68, compared with 0.57 and 0.58 for Influenza and RSV respectively. In the COVID-19 group, multivariate logistic regression identified a high NLR (defined as a value above 6.82) to be a prognostic factor for poor clinical outcome, after adjusting for age, sex and Charlson comorbidity score (odds ratio of 2.9, P < 0.001). NLR at admission is lower and has more prognostic value in COVID-19 patients, when compared to Influenza and RSV.

THE HEMATOLOGICAL REPRESENTATION OF PREGNANT WOMAN IN THE THIRD TRIMESTER WITH CONFIRMED COVID-19 POSITIVE IN RSUD DR. SOETOMO

Background: The world is faced with the reality of preparing to live side by side with COVID-19. During pregnancy, there are physiological and mechanical changes in the body that can have an impact on the ability of the immune system to decrease. Laboratory tests such as hematology examinations play an important role in screening patients who have the potential to lead to COVID-19. The purpose of the study was to describe the results of blood tests in pregnant women in the third trimester who were confirmed positive for Covid-19. Methods: type of descriptive research with a retrospective study, using secondary data in the form of medical record status. The sampling technique used total sampling with the results of 102 3rd-trimester pregnant women with positive Covid-19 RT-PCR test results. The inclusion criteria were data on pregnant women in the third trimester who were confirmed positive for Covid-19 which were recorded in the medical record at the SMF Obstetrics and Gynecology inpatient unit, RSUD Dr. Soetomo. Results: 56.9% low basophil value; 71.6% low eosinophils; 54.9% normal hemoglobin; 94.1% low lymphocyte; 68.6% of normal monofil; 94.1% high neutrophil; 90.2% normal platelets; white blood cell count (WBC) 77.5% high. Conclusion The haematological representation shows a decrease in basophil, eosinophil, lymphocytes or also known as lymphopenia. More than half of the normal monocyte, platelet, and hemoglobin values, an increase in neutrophil or also called neutrophilia and an increase in the leukocyte count or WBC value indicate leukocytosis.

Evaluation of risk factors associated with first episode febrile seizure.

Febrile convulsion (FC) is one of the most common neurological findings in children. This study was aimed to investigate the difference in laboratory parameters between Febrile Seizure and control groups. In this study, 169 children admitted to the pediatric emergency department with their first episode of FS and 189 control groups were retrospectively analyzed. The demographic characteristics and laboratory parameters of children were obtained from their files. Upper respiratory tract infection (URTI) was determined the most common disease (81.6%) in the FC group followed by acute gastroenteritis (AGE) (15.4%) and urinary tract infection (UTI) (3%), respectively. Similarly, URTI was detected as the most common disease (81.8%) in control groups. It was determined that there was no statistically significant difference between the two groups in terms of diseases. The leukocyte and neutrophil counts of the children with FC were significantly higher but the mean corpuscular volume of lenfosit and lenfosit/neutrophil ratio was significantly lower than the control groups (p= 0.009, <0.001, 0.001, <0.001, <0.001, respectively). Children with FC had significantly higher blood glucose, urea, creatinine, creatine kinase, alkaline phosphatase and albumin levels compared with the control groups (p<0.001, in all parameters). On the other hand, the potassium, sodium and chlorine levels of the Children with FCs were significantly lower than control groups (p=0.017, <0.001, p <0.001, respectively). To conclude, febrile patients with high leukocyte counts, high neutrophil counts, and several biochemical parameters should be carefully monitored for FCs due to the increasing seizure risk.