Higher White Blood Cell Count Count Research Articles

The Value of Complete Blood Count Parameters in Predicting Complicated Acute Appendicitis; a Prognostic Accuracy Study.

Low accuracy of clinical variables can result in delayed diagnosis and increase the incidence of complicated appendicitis in some cases. This study aimed to determine the value of simple complete blood count (CBC) biomarkers in predicting complicated appendicitis. This is a single-center retrospective cross-sectional study, which was conducted on cases referred to emergency department following acute appendicitis who underwent appendectomy, to evaluate the accuracy of some cell blood count variables (white blood cell count (WBC), neutrophil percent, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV)) in predicting complicated cases (gangrenous and ruptured appendicitis). There were 252 (68.3%) patients in the uncomplicated appendicitis group and 117 (31.7%) patients in the complicated appendicitis group. The mean age of patients was 34.1 ± 1.09 (Range: 18 -79) years (55.3% male). There were no differences between groups regarding the mean age (p = 0.053), gender distribution (p=0.07), Alvarado score (p = 0.055), platelet count (p =0.204), PLR (p = 0.115), and MPV (p = 0.205). The complicated appendicitis cases had longer onset of symptoms (p <0.001), higher WBC count (p = 0.011), higher neutrophil count (p < 0.001), and higher NLR (p < 0.001). Neutrophil count (area under the curve (AUC) = 0.61, 95% confidence interval (CI) = 0.56-0.66; p = 0.001) and NLR (AUC = 0.65, 95% CI = 0.60-0.69; p = 0.001) had higher level of accuracy in this regard. In contrast, the area under the curve of WBC count (AUC = 0.57, 95% CI = 0.52-0.63; p = 0.22), platelet count (AUC = 0.44, 95% CI = 0.38-0.49; p = 0.049), PLR (AUC = 0.57, 95% CI = 0.52-0.62; p = 0.026), and MPV (AUC = 0.54, 95% CI = 0.49-0.60; p = 0.193) showed low accuracy in predicting complicated acute appendicitis. Based on the findings of present study it seems that WBC, neutrophil percent, NLR, PLR, and MPV have failed to poor accuracy in predicting cases with complicated appendicitis in emergency department.

The superiority of 72 h leukocyte descent over CRP for mortality prediction in patients with sepsis

BackgroundDetection of an eventful course in the early days of sepsis treatment is clinically relevant. The white blood cell count (WBCC) and C-reactive protein (CRP) are used in daily practice to monitor the intensity of the inflammatory response associated with sepsis. It is not entirely clear which of the two might better discriminate the outcomes of patients with sepsis. Methods30-day mortality was assessed in a cohort of patients who were hospitalized with sepsis in the departments of Internal Medicine in a tertiary medical center. Admission and 72-hour time points were analyzed to discriminate between patients with increased versus decreased 30 days mortality risk. ResultsThe study included 195 patients. Higher 72 h CRP, WBCC, neutrophil counts and neutrophils to lymphocyte ratio were associated with increased mortality (p < 0.02). Baseline WBCC and CRP failed to discriminate between patients who died and those who survived (AUC = 0.551, 0.479). In multivariate analysis of the 72 h tests, higher WBCC count (OR = 1.12, 95%CI 1.05–1.20, p = 0.001), was associated with increased mortality whereas CRP was not (OR = 1.004, 95%CI 0.998–1.01, p = 0.146). ConclusionPatients who presented a 72-hour leukocyte descent had a better outcome and in this regard, WBCC was superior to 72-hour CRP in predicting 30 days mortality.

Venous Thromboembolism (VTE) in Sickle Cell Disease (SCD) Is Associated with Neutrophilia

Introduction Venous thromboembolic events (VTE) are a frequent complication of patients with sickle cell disease (SCD). The estimated incidence of thrombosis is 25% and is associated with increased morbidity and mortality. Recent studies have implicated leukocytes and their subsets in development and propagation of VTE in malignancies and inflammatory diseases. However the role of leukocytes have not been elucidated in SCD. We conducted a retrospective study to precisely study the association of leukocytes and their subsets in VTE. Methods We accessed the medical records of patients with SCD who presented to University Hospitals Seidman Cancer Center from 2004 to 2018. Information collected included demographic characteristics, comorbidities, laboratory parameters as well as treatment details. Patient records were reviewed for VTE with radiographic confirmation. Cases were defined as patients with SCD with diagnosed VTE and controls were SCD patients without VTE. Cases and controls were matched for age, gender, red blood cell (RBC) genotype and treatment. We included twice as many controls as cases for the study. Inclusion criteria were age greater than 18 years and were followed up at the outpatient sickle cell clinic. Patients were excluded if they had infection, thrombophilia, neoplasm, pregnancy or arterial thrombosis. For cases, lab parameters at the time of the VTE were recorded. Since most patients with VTE were diagnosed during an admission, lab parameters for controls were also recorded during an admission for pain crises. For both cases and controls, steady state lab data 3 months prior to their admission was also recorded and compared. Data was analyzed using STATA SE 15 version. Mann-Whitney U test was used to analyze continuous variables and Fischer's exact test was used to analyze discrete variables. P-values less than 0.05 were considered significant. Results A total of 263 records were reviewed of which 97 patients were eligible for the study. There were 35 patients with VTE and 62 patients without VTE. Baseline characteristics are presented in Table 1. Compared to controls, patients with VTE had more comorbidities such as avascular necrosis (AVN; p = 0.0038), pulmonary hypertension or albuminuria (pHTN; p= 0.032), higher body mass index (BMI) (p = 0.038) and had more hospitalizations (p &amp;lt; 0.001). Due to small number of patients, the comorbidities were analyzed as a group across all genotypes. A complete list of comparison of comorbidities is summarized in Table 2. When compared to controls, patients with VTE as a group had higher total white blood cell count (WBC) and neutrophil count (p=0.0032 and p = 0.0006 respectively) at the time of event. When RBC genotype was taken into account, patients with SC and SS genotype had a significantly elevated neutrophil count whereas only patients with SS genotype had a higher WBC count compared to controls (Please refer to Table 3). When compared to controls, cases as a group also had WBC and neutrophil count 3 months prior to the event (p=0.025 and p=0.020 respectively). Patients with SS and SC patients had a significantly higher WBC count 3 months prior compared to their non VTE counterparts (Please refer to Table 4) No other comorbidity or lab parameter was found to be significantly different between cases and controls. A multivariate analysis could not be performed due to small study numbers. Conclusion Our study is the first to show that VTE in SCD was associated with higher neutrophil counts 3 months prior to the event suggesting that patients with baseline or steady state leukocytosis and neutrophilia are at increased risk of thrombosis. Larger studies are needed to confirm this association. In addition, patients with VTE also had higher incidence of comorbidities such as AVN, pHTN or albuminuria and increased hospitalizations. Given the small number of patient, a multivariate analysis was not possible. While the association between pHTN and VTE is well documented; the association of AVN and higher BMI with VTE described here is novel and needs further exploration with larger studies. Disclosures Little: Hemex Health, Inc.: Patents &amp; Royalties; GBT: Research Funding.

Abstract WP211: Prognostic Significance of White Blood Cell Count in Acute Ischemic Stroke With Nonvalvular Atrial Fibrillation: The SAMURAI-NVAF Study

Background and Purpose: White blood cell count (WBC), a marker of the atherosclerotic burden, has reportedly been a predictor of poor outcome in the general stroke population. The purpose of this study was to clarify associations between WBC on admission and outcomes among patients having acute ischemic stroke with nonvalvular atrial fibrillation (NVAF), that was principally cardioembolic. Methods: Of those enrolled in the multicenter observational Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-NVAF study, acute ischemic stroke/TIA patients (within 7 days of onset) with NVAF with premorbid modified Rankin Scale (mRS) score of 0-2 were included in the analysis. WBC on admission was categorized into quartiles. Associations between WBC count and major disability or death (mRS score of 3-6) at 90 days and 2 years were analyzed using logistic and proportional odds regression models. Results: A total of 789 patients were studied (306 women, 76.2±9.5 years old, the median NIHSS score was 6 [IQR, 2-16], the median WBC count was 6700 [IQR, 5475-8300], the median mRS score at 90 days was 2 [IQR, 1-4], the median mRS score at 2 years was 2 [IQR, 0-5]). WBC had a significant linear association with major disability or death at 90 days (adjusted odds ratio [OR] for highest versus lowest quartile 3.53; 95% confidence interval [CI] 2.07-6.13; P for trend&lt;0.001). Associations were similar for the outcome at 2 years (adjusted OR for highest versus lowest quartile 2.16; 95% CI 1.31-3.56; P for trend&lt;0.001). Conclusions: Higher WBC count on admission seems to predict a short- and long-term poor outcome in acute ischemic stroke patients with NVAF. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01581502.

The Incidence of Central Nervous System Involvement in AML: A SAL-Tor Vergata Analysis

Abstract 4236 Background:Acute myeloid leukemia (AML) involves infrequently the central nervous system (CNS). However, most studies examined paediatric patients. Thus little is known regarding CNS-involvement in adult AML. Therefore, we analyzed the data of patients with AML treated in SAL study group and Tor Vergata study group for CNS involvement. Methods:In this retrospective analysis in adult AML patients included in the prospective AML96- (NCT00180115), AML2003- (NCT00180102), AML60+ trials (NCT00180167) of the SAL study group and patients that were admitted to the University Hospital of Rome Tor Vergata from 2005 to 2011, 3863 patients were evaluated for CNS involvement of AML. The median age of the patients was 49 years (range, 18 –74 years). A total of 30 patients had CNS involvement at time of initial presentation and 30 patients had CNS involvement at first, second or third relapse. CNS involvement was proven depending on morphology and/ or flow cytometry of the Cerebrospinal fluid (CSF). Clinical variables of statistical significance were compared using the χ2-test for dichotomized variables and the Mann-Whitney U-test for continuous variables. The method of Kaplan Meier was used to estimate OS and event-free survival (EFS). Survival distributions were compared using the log-rank test. Results:21 of 1862 patients (1%) in the AML96-trial, 26 patients of 1182 (2.2%) in the AML2003 trial, 3 of 486 patients (0.6%) in the AML60+ trial, and 10 of 270 patients (3.7%) in the University of Rome Tor Vergata studies had CNS involvement resulting to a total of 60 patients with a combined overall incidence of 1.6%. 30 patients had CNS involvement at the initial presentation and 30 patients at relapse of AML. The majority of patients (n=53, 88%) had de novo AML. Data from the Tor Vergata study group need further analysis therefore in this abstract patients from SAL study group were included. Extramedullary AML other than CNS involvement was observed in 21 patients (42 %) as compared to 246 (7%) in patients without CNS involvement, p < 0.001. Complex aberrant karyotype was not significantly higher in patients with CNS involvement as compared to those without, whereas patients with CNS involvement had a higher tendency for trisomy of chromosome 8 (n=8, 16%) in comparison with patients without CNS involvement (n= 277, 8%), p=0.03. AML FAB M5 occurred more frequently in patients with CNS involvement (n= 15, 30%) as compared to those without (n=459, 13%), p=0.01. Patients with CNS involvement at diagnosis had significantly higher lactate dehydrogenase (LDH) levels (1318 vs. 665 IE/l, p< 0.001) and higher white blood cell count (WBC) (64 vs. 35 Gpt/l, p<0.001). Only 7 of 30 patients (23%) with CNS involvement at initial diagnosis developed relapse and none of them had CNS involvement at the time of relapse, whereas almost all patients with CNS involvement at relapse developed again systemic and CNS-relapse. On the other hand, there was no significant difference in the number of patients who achieved complete remission between these two groups. Comparing patients with CNS involvement with patients without CNS involvement at the initial diagnosis no significant difference in overall survival at 2 years (40% vs. 41%) and event free survival at 2 years (20% vs. 26%) was observed. Conclusion:CNS involvement in AML is a rare entity and it is accompanied with higher incidence of other extramedullary AML. This represents the largest analysis of AML patients with CNS involvement studied in the literature. Factors associated with an increased risk of CNS involvment include: trisomy of chromosome 8, FAB M5, higher LDH levels and higher WBC count at diagnosis. Patients with CNS disease at initial diagnosis of AML have similar survival outcomes as compared to those without CNS disease if treated by intrathecal therapy, whereas extramedullary relapse within the CNS is associated with poor outcome. Disclosures:No relevant conflicts of interest to declare.

Factors associated with hypoxemia in children infected with pandemic H1N1 2009 influenza virus

Hypoxemia was found to be a major cause of death from pandemic H1N1 2009 influenza (pH1N1) infection. There are limited data on factors associated with hypoxemia in children infected with pH1N1 influenza virus. Factors associated with hypoxemia were investigated using univariate and multivariate analysis in 76 hospitalized pediatric patients with laboratory-confirmed H1N1 influenza virus infection at Gyeongsang National University Hospital in Jinju, South Korea, from August 2009 to January 2010 by retrospective chart review. Hypoxemia occurred in 17 children (22%), of whom three were admitted to an intensive care unit and one died. Hypoxemic patients were significantly more likely to have a higher respiratory rate, pulse rate, white blood cell count (WBC), and C-reactive protein level, as well as a longer hospital stay. Respiratory rate and WBC count at admission were independently associated with hypoxemia as determined on multivariate analysis, and this association was found to be clinically significant. Although a higher WBC count and respiratory rate may not be specific for pHINI but represent the degree of disease severity for any infectious respiratory disease in general, clinicians can use these parameters at admission as useful, early indicators of disease severity in pediatric pH1N1 infection.

Prognostic Factors and Outcomes of Patients with Acute Myeloid Leukemia (AML) Receiving Non Intensive Chemotherapy (NIC) or Best Supportive Care (BSC).

Background: AML in older adults poses therapeutic challenges, as many patients are not candidates for intensive chemotherapy (IC), and it is not clear that IC provides a survival benefit compared to NIC/BSC. While risk factors and outcomes of patients treated with IC are well-defined, few data support similar prognostication in patients treated with NIC or BSC.Methods: We conducted a retrospective review of all patients with AML receiving NIC or BSC at the Cleveland Clinic between January 1997 and December 2005. NIC consisted of treatment with hydroxyurea, low-dose cytarabine, or azacitidine. The choice and decision of therapy was dictated by patient and physician preferences. Data on known prognostic factors (age, white blood cell count (WBC) at diagnosis, cytogenetic risk groups (as defined by CALGB 8461) and AML etiology (de novo vs. secondary AML)) were collected and controlled for in multivariable analyses, and survival determined using the log-rank test, measured from the time of diagnosis. Race and residential zipcodes were obtained from information disclosed by patients in their electronic medical records. Average annual household income in a zipcode was obtained using a web-based database, www.melissadata.com.Results: Fifty-three patients were identified. The median age was 74 years (range 33–92), and 26 patients (49%) were female. Eight patients (15%) were African American (AA), while 44 patients were Caucasian (C) and 1 patient was neither AA nor C. The median WBC at presentation was 6.0 ×103/μL. Cytogenetics were favorable in 1 patient (2%), intermediate in 10 (19%), unfavorable in 19 (36%), and unknown in 23 (43%). Most patients (60%) had secondary AML. The median average annual income was $39,332 (range 23,375–82,806). The median survival was 54 days (95% CI 33–80 days) for all patients, and the 1 year survival was 7%. Known prognostic factors for AML (WBC at presentation, de novo vs. secondary AML, cytogenetics, and age at diagnosis) were not predictors of overall survival in multivariable analyses in patients not receiving intensive chemotherapy, though higher WBC count was predictive in univariable analyses. Race was a predictor for outcomes, with AA patients experiencing a worse median survival than their C counterparts (22 days versus 64 days, log rank p=0.03, figure 1) despite similar baseline characteristics. SES, however, had no impact on outcome.Conclusions: AML patients receiving NIC or BSC have a median survival of almost 8 weeks, with AA patients experiencing worse outcomes. A small but significant percentage of patients remain alive at one year. Prognostic variables useful in treatment decision-making in patients receiving IC are less valuable for NIC/BSC patients. This information can be used for patient counseling and to help guide treatment decisions. [Display omitted]