Leukocytosis In Patients Research Articles

Characterization of leukocytosis in patients with solid tumors with and without an infectious process

Introducción: La leucocitosis en el paciente oncológico con tumores sólidos constituye el segundo motivo de interconsulta y de forma general se indica la antibioticoterapia, si bien la leucocitosis es un signo común de las infecciones, particularmente bacterianas, existen otros estresores capaces de provocar una leucocitosis aguda que incluyen cirugías, ejercicio intenso, traumas, estrés emocional, neoplasias, entre otras, por lo cual la antibioticoterapia no debería generalizarse. Objetivo: Caracterizar de la leucocitosis en pacientes con tumores sólidos con y sin proceso infeccioso para quienes se solicitó, de enero de 2021 a agosto de 2023, interconsulta con Infectología del Instituto Nacional del Cáncer. Materiales y métodos: Diseño descriptivo, observacional, de corte transversal, con datos secundarios. Se procesaron datos de 144 casos de pacientes internados diagnosticados con tumores sólidos oncológicos o en espera de resultados confirmatorios, que solicitaron interconsulta con el especialista en infectología por presencia de leucocitosis en el hemograma en ausencia de clínica infecciosa o persistencia de la leucocitosis a pesar de un tratamiento antibiótico exitoso según parámetros clínicos. Se empleó la estadística descriptiva para el procesamiento de datos y se contó con aprobación del Comité de Ética del INCAN. Resultado: De los 144 pacientes, 44 (30,5%) presentaron algún proceso infeccioso evidenciable por clínica o métodos diagnósticos auxiliares. En 100 pacientes, (69,5%) no pudo evidenciarse la presencia de proceso infeccioso alguno con base en parámetros clínicos y métodos auxiliares diagnósticos. El fenómeno de leucocitosis y neutrofilia se observó en todos los casos en ambos grupos de pacientes, aun después del tratamiento con antibióticos en aquellos que lo precisaron. La trombocitosis se observó en 23/100 pacientes sin diagnóstico infeccioso (23%), versus 23/44 (52,2%) pacientes con proceso infeccioso activo. Conclusión: La reactividad leucocitaria es un fenómeno hematológico común en los procesos neoplásicos y persiste aún después de un tratamiento antibiótico exitoso. Los procesos infecciosos fueron evidentes, específicos, diversos y sin predominio significativo de alguna entidad en particular por lo que la antibioticoterapia empírica debe ser postergada.

Evaluation of Anticonvulsant-Induced Leukocytosis: A Review of Evidence for Carbamazepine, Lamotrigine, and Phenobarbital.

Objective: The objective was to determine the incidence of leukocytosis associated with carbamazepine, lamotrigine, and phenobarbital. Data sources: A comprehensive literature review was conducted with the assistance of a medical reference librarian on PubMed, MEDLINE, Embase, and Google Scholar through June 2023 using the following search terminology: "leukocytosis/chemically induced"[MeSH Terms] AND ("Anticonvulsants"[MeSH Terms] OR ("Anticonvulsants"[Pharmacological Action] OR "Anticonvulsants"[MeSH Terms] OR "Anticonvulsants"[All Fields] OR "anticonvulsant"[All Fields] OR "anticonvulsion"[All Fields] OR "anticonvulsive"[All Fields] OR "anticonvulsives"[All Fields]) OR ("Anticonvulsants"[Pharmacological Action] OR "Anticonvulsants"[MeSH Terms] OR "Anticonvulsants"[All Fields] OR "antiepileptic"[All Fields] OR "antiepileptics"[All Fields])). Study selection and data extraction: Thirteen reports were included from 64 potential results of our literature review following the application of inclusion and exclusion criteria: 7 of the reports involved carbamazepine, 4 of the reports involved lamotrigine, and 2 of the reports involved phenobarbital. Data synthesis: Drug-induced leukocytosis is commonly a diagnosis of exclusion and is a phenomenon that has numerous ramifications to patients and clinicians at the bedside, including mandating a full infectious evaluation, the identification of confounding variables, and the eventual discontinuation of the offending agent. Despite several medications and medication classes possessing this adverse drug effect, an evaluation of the specific clinical presentation and management strategies for drug-induced leukocytosis associated with anticonvulsant medications has not been elucidated in the literature. Conclusions: Clinicians should be judicious when evaluating leukocytosis in patients on potentially precipitating medications, including carbamazepine, lamotrigine, and phenobarbital.

Frequency of Occurrence of Leukocytosis in Patients with Acute Exacerbation of Copd at a Tertiary Centre

COPD is a major cause of chronic morbidity and mortality; it is currently the fourth highest cause of death in the world, and is predicted to be the third leading cause of mortality worldwide by the year 2020 [1-2]. COPD is identified mainly according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines; [post bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity ratio less than 0.7; severity determined by FEV1 alone] combined with a history of exposure to risk factors [2]. Exacerbations of respiratory symptoms in COPD are of major importance because of their profound and long lasting adverse effects on patients [3]. Frequent episodes accelerate loss of lung function, affect the quality of life of patients, and are associated with poor survival. There are some specific blood biomarkers for predicting lung function decline, acute exacerbation, or even mortality from big longitudinal cohort studies. However, their performance is depressing [4] . Peripheral blood leukocytosis has already been well investigated in the aspect of inflammatory biomarkers for COPD. The level of leukocytes is a key parameter in the clinical assessment of patients with COPD exacerbation, with and without fever. The presentation of high WBC count makes it important to distinguish the effect of the glucocorticosteroid from the effect of the possible infection [5-7].

Valproate-related neutropenia and lithium-related leukocytosis in patients treated with clozapine: a retrospective cohort study

BackgroundNeutropenia is a noteworthy side effect of clozapine, which might warrant this drugs’ discontinuance for safety. Studies have revealed that the risk of neutropenia increases with concurrent administration of valproate, but the evidence was limited. Conversely, lithium may have an ameliorating effect on clozapine-induced neutropenia. This study explored the effects of valproate and lithium on white blood cell counts in patients treated with clozapine.MethodsWe retrospectively investigated the electronic medical records from one tertiary psychiatric hospital in Taiwan and enrolled patients discharged between January 1, 2006, and December 31, 2017, with clozapine prescriptions. We scrutinized their demographic data, medications, and hematological results at discharge and during follow-up outpatient clinic visits over the subsequent 3 years. Patients were classified into four groups: clozapine only (CLO), clozapine and valproate (CLO + VAL), clozapine and lithium (CLO + Li), and clozapine, valproate, and lithium (CLO + VAL + Li). We also identified hematological events (neutropenia or leukocytosis) of these patients during outpatient follow-ups.ResultsOf the included 1084 patients, 55(5.1%) developed neutropenia. Concurrent valproate use (odds ratio [OR] = 3.49) and older age (p = .007) were identified as risk factors. Moreover, 453 (41.79%) patients developed leukocytosis. Younger age; male sex; and concurrent use of lithium (OR = 3.39, p < .001), clozapine daily dosage, and benzodiazepines were the risk factors for leukocytosis.ConclusionConcurrent valproate use and older age are associated with the development of neutropenia in patients treated with clozapine. Concurrent lithium usage, younger age, male sex, and concurrent benzodiazepine use might be related to leukocytosis.

Long-lasting leukocytosis in patients with schizophrenia treated with clozapine after electroconvulsive therapy : ECT stabilizes white blood cell count.

The present study was conducted to investigate the possible hematologic impact of long-term electroconvulsive therapy (ECT) in patients with drug-resistant schizophrenia and receiving clozapine therapy. In this retrospective study, clinical charts of 57 hospitalized patients with schizophrenia who required clozapine therapy because of active psychotic symptoms resistant to other antipsychotics were examined. For 18 who underwent ECT, the first assessment was conducted at the end of that therapy (average two months after start, 7.68 sessions) and the second two months later. As for the 39 patients who did not undergo ECT, the first and second assessment points were at two and four months, respectively, after a randomly chosen time point. Multiple regression analysis revealed that modified ECT (m-ECT) (ß = 0.346, p = 0.005), gender (males showed greater increase) (ß = 0.273, p = 0.023), and disease duration (longer associated with greater increase) (ß = 0.258, p = 0.033) were correlated with a change in white blood cell (WBC) count (ΔR2 = 0.277, p < 0.001) at the first assessment point. At the second assessment point, multiple regression analysis showed that m-ECT (ß = 0.262, p = 0.039), gender (males showed greater increase) (ß = 0.264, p = 0.036), and disease duration (longer associated with greater increase) (ß = 0.234, p = 0.068) were again correlated with changed WBC count (ΔR2 = 0.203, p < 0.007). An increase in leukocytes may have a protective influence against the adverse myelosuppressive effects of clozapine. However, a simple mobilization of leukocytes from bone marrow to peripheral circulation may not enhance the immune system, leading to only a masking of the effects of a potential immuno-insufficient state in the treated patient. In either case, should leukocytosis be induced and then remain for an extended period, hematologists, as well as psychiatrists involved in electroconvulsive intervention for clozapine-treated patients, must keep this factor in mind.

Frequency of leukocytosis in culture proven enteric fever in children.

Objective: To determine the frequency of leukocytosis in patients of culture proven enteric fever in children over one year period. Study Design: Retrospective Cross-sectional study. Setting: Department of Paediatrics, at Fatima Memorial Hospital, Shadman Lahore. Period: January 2020 to December 2020. Material &amp; Methods: The case record of patients diagnosed with enteric fever on blood culture were reviewed. All patients in the age group of one year to 15 years with a discharge diagnosis of enteric fever for admitted inpatient or from Outpatient Department (OPD) were included in the study. Results: Median age was 61.3 (IQR 38) months and slight female preponderance 61 out of 110 patients (55.5%) was observed. Median duration of fever before presentation was eight days with IQR of 7.3 days and 95 patients has shown anorexia (86.4%), which was the most common symptom after fever. S. Typhi was found in 76.4% (84 patients out of 110) of positive blood cultures and 23.6% of positive culture (26 cases) found S. Paratyphi A,B,C. Only 8 cases (5 %) of enteric fever were multisensitive with 93% of isolates (102 cases) were either multidrug resistant (45 cases (41%) or 57 cases Extended drug resistant (52%).18 out of 110 patients (16%) has shown leukocytosis and leukocyte count was normal in 73% patients (80 out of 110). Among leukocytosis group strikingly, 89% of patients (16 out of 18) had shown extended drug resistant pattern (XDR). Conclusion: Leukocytosis in Typhoid fever is not uncommon and culture proven Typhoid Fever can be associated with leukocytosis in children. Once there is leukocytosis in culture proven Typhoid fever, there is a high incidence of XDR typhoid.

Hubungan Gambaran X-RAY Thorax Bronkopneumonia dengan Leukositosis Pada Pasien Intensive care unit di RSUD dr. Chasbullah Abdul Madjid Kota Bekasi

Bronchopneumonia is the most common picture of pneumonia found, especially in the ICU. Bronchopneumonia occurs due to the interaction between infection and cellular immunity which causes peribronchial consolidation. This process can result in leukocytosis in the patient. This research is an observational analytic study with a cross sectional method which was carried out in RSUD dr. Chasbullah Abdulmajid Bekasi City, West Java with secondary data from patient medical records in the period 1 November 2021 – 19 December 2021. Samples were taken using the total sampling method from population being treated at the ICU Cattleya. The variables taken were age, gender, the diagnosis to be taken, the results of a chest X-ray, and the value of the patient. The sample used was 101 patients. The most demographic characteristics were men at 49.5%, the 18-64 year group at 68.3%, and the basic diagnosis of ICU care for cerebrovascular disease was 24.8%. Statistical test using Chi-square test found that there was no relationship between bronchopneumonia and leukocytosis (p=0.172; p&gt;0.05). This study showed that there was no association between chest x-ray bronchopneumonia and leukocytosis in ICU patients

Monocytosis in patients with coronavirus pneumonia after treatment with glucocorticoids

Features of variation of peripheral blood leukocyte formula parameters in 86 patients with coronavirus pneumonia with leukocytosis with a background of glucocorticoid treatment were investigated. All patients were divided into 2 groups. Group 1 was 22 individuals who showed clinical signs of the bacterial infection (purulent sputum cough in combination with neutrophilic leukocytosis at hospital the admission). The 2nd group was made up of 64 patients with the glucocorticoids developed against the background of treatment with glucocorticoids (dexamethasone 20 mg/day or prednisolone 150 mg/day, intravenously for 3 days) leukocytosis 10 109/l without signs of a bacterial infection. It was found that in patients of the 1st group compared to the 2nd group, levels of the white blood cells and neutrophils significantly (p 0.001) exceeded the reference values in the absence of a significant change in the number of monocytes. In patients of the 2nd group after a three-day intravenous application of the glucocorticoids on the 4th day of hospitalization, a statistically significant (p 0.001) increase in the number of neutrophils and monocytes was established. When comparing the quantitative parameters of the leukocyte formula between the 2nd group on the 4th day of the hospitalization and the 1st group at admission, there were no differences in the level of leukocytes and neutrophils. Number of monocytes in group 2 (1.11 (0.90; 1.34) 109/l), on the contrary, statistically significantly (p 0.001) exceeded their level in the 1st group (0.59 (0.50; 0.77) 109/l). Thus, an indicator of the number of monocytes in the peripheral blood could be a promising differential diagnostic criterion for the genesis of the leukocytosis in patients with the COVID-19. This parameter may be one of the factors influencing the decision to prescribe the antibacterial therapy.

Adult-onset immunodeficiency due to anti-interferon-gamma autoantibody-associated Sweet syndrome: A distinctive entity.

Sweet syndrome (SS) has been increasingly reported in patients with adult-onset immunodeficiency (AOID) due to anti-interferon-γ autoantibody who also have concomitant opportunistic infections, especially disseminated non-tuberculous mycobacterial infection (dNTMI). A retrospective study retrieving data from 2011 through 2020 was conducted. We compared clinical characteristics of SS with and without AOID and generated the prediction model and examined the interaction between AOID and dNTMI in the occurrence of SS. Lymphadenopathy, pustular lesions, and leukocytosis are the significant predictors for AOID-associated SS. Adjusted risk differences were 0.58 (95% confidence interval [CI], 0.33-0.83), 0.21 (95% CI, 0.02-0.39), and 0.24 (95% CI, 0.01-0.47), respectively. Based on the analysis of aggregated cross-sectional data, both the overall and the direct effect of AOID increased the prevalence of SS. The indirect effect of AOID on the occurrence of SS might also be mediated through dNTMI or other common opportunistic infections. In addition, there was a trend of positive additive interaction between AOID and dNTMI. Although the test of additive interaction did not reveal statistically significant results, a deviation from additivity of isolated effects might suggest potential causal interaction between AOID and dNTMI. The distinctive clinical syndrome comprising lymphadenopathy, pustular lesions, and leukocytosis in patients with SS should raise the awareness of clinicians to the potential of underlying AOID.

Значение моноцитоза в рациональном выборе эмпирической антибактериальной терапии при среднетяжелых формах COVID-19

Microbiologically confirmed bacterial co-infection occurs in 1.2%–7% of hospitalized patients with COVID-19. The study of rational approaches to empirical antibacterial therapy (ABT) of SARS-CoV-2 virus-induced pneumonia continues. Glucocorticoid (GCS) therapy, the main method for pathogenetic treatment of moderate forms of CОVID-19, can lead to the development of neutrophilic leukocytosis. The criterion for the differential diagnosis of leukocytosis could be determining the quantity of peripheral blood monocytes. Assessing the significance of identifying the monocyte quantity can serve as an additional criterion for assigning empirical ABT in the treatment of pneumonia caused by the new coronavirus infection. The aim of the study was to identify the characteristics of glucocorticoid-induced leukocytosis in patients with moderate COVID-19. The study included 86 patients with a confirmed diagnosis of COVID-19 (ICD codes: U07.1, U07.2) of moderate severity. The patients were divided into 2 groups. The comparison group consisted of 40 patients who were prescribed ABT after the manifestation of leukocytosis on the background of glucocorticoid therapy. The control group included 46 people who were not prescribed ABT after the manifestation of leukocytosis on the background of glucocorticoid therapy and until the end of their stay in the hospital. We compared the parameters of the clinical blood tests (the absolute number of white blood cells, neutrophils and monocytes (×109/L)) on days 3, 6 and 9 from the start of GCS therapy. As a result, on the 3rd day, both groups had neutrophilic leukocytosis (&gt;9.0×109/L) and absolute monocytosis (&gt;0.8×109/L). There was a statistically signif icant decrease in the absolute number of white blood cells, neutrophils and monocytes by days 6 and 9, compared with day 3 from the start of glucocorticoid therapy. When comparing blood parameters between the groups, there was no statistically significant difference in the number of cells on the 3rd, 6th and 9th day of GCS therapy (p&gt;0.05). Glucocorticoid-induced leukocytosis is associated with absolute monocytosis. The administration of ABT in response to the occurrence of leukocytosis in this study did not affect the change in the level of white blood cells. At the same time, a likely factor in reducing these indicators was a decrease in the daily dosage of corticosteroids.

Clinical Significance of Emergent Leukocytosis in Patients with Myelofibrosis Receiving JAK Inhibitor Therapy

Ruxolitinib is the first available JAK inhibitor (JAKi) therapy for amelioration of constitutional symptoms or splenomegaly in myelofibrosis (MF). Duration of response varies, as patients discontinue ruxolitinib due to disease progression or drug toxicity. Ruxolitinib failure is a poorly defined clinical entity, but may include suboptimal or lost spleen response, worsening cytopenias, accelerated or blast phase (AP/BP) progression, or non-hematologic side effects. It is not clear what other clinical parameters should be considered indicative of JAKi failure. Leukocytosis is a known prognostic factor in MF and is included in various prognostic models. We have observed that some patients on stable doses of JAKi therapy develop progressive leukocytosis in the absence of other signs of MF progression. The significance of this event is not known, and it is not clear whether the onset of leukocytosis should prompt changes in clinical management. To assess the clinical significance of emergent leukocytosis, we evaluated leukocyte counts in our database of MF patients receiving Ruxolitnib or Momelotinib as first-line JAKi therapy. We defined emergent leukocytosis as any of:New onset of WBC ≥25 x 109/L in patients with WBC ≤12.5 x 109/L at JAKi start.Doubling of WBC from the nadir value in patients with WBC &amp;gt;12.5 x 109/L at JAKi start and nadir WBC &amp;gt;12.5 x 109/L.WBC ≥25 x 109/L in patients with WBC &amp;gt; 12.5 x 109/L at JAKi start after attaining a nadir WBC ≤12.5 x 109/L. Leukocytosis had to be sustained over consecutive blood counts at least one month apart and had to occur in the absence of infection, steroid therapy, AP/BP transformation, splenectomy or JAKi dose reduction. Exclusion criteria included concurrent hematologic diagnoses, and splenectomy or AP/BP MF preceding JAKi initiation. Of 290 patients with MF receiving JAKi therapy, 217 met study criteria. Of these 217 patients, 27 developed emergent leukocytosis while receiving JAKi. The cumulative incidence of leukocytosis was 4%, 10% and 15% at 1, 3, and 5 years from the start of JAKi therapy, respectively. Transformation to AP/BP, splenectomy, bone marrow transplant, or death from any cause were considered as competing risks in the calculation of cumulative incidence. In a multivariate analysis, clinical parameters associated with emergent leukocytosis included presence of baseline anemia (HR 4.94 [95% CI, 1.13-21.53]; p = 0.03) or leukocytosis (HR 5.01 [95% CI, 1.44-17.41]; p = 0.01) at JAKi start and female gender (HR 0.21 for male [0.08-0.06]; p=0.002). Baseline leukocytosis as WBC ≥25 x 109/L, and anemia was as a hemoglobin &amp;lt;100g/L. In patients with available targeted sequencing performed prior to JAKi therapy (n=141, 65%), TET2 mutations were associated with increased risk of leukocytosis (HR 5.48 [95% CI, 1.73-17.35]; p=0.004), but JAK2, CALR, MPL or ASXL1 mutations were not. Among 27 patients who experienced emergent leukocytosis, 21 were deceased while 6 are in ongoing follow-up. Median overall survival calculated from the date of leukocytosis was 14 months [95% CI, 8.6-27.9]. Overall, 7 patients transformed to AP/BP, 7 died from progressive MF, 4 underwent transplant, one underwent splenectomy, 6 died of miscellaneous causes and two remain on first-line JAKi without any complicating events. Among 27 patients experiencing leukocytosis, paired samples for molecular analysis at JAKi initiation and at the time of leucocytosis were available in 21 (78%). Results from targeted sequencing of a panel of 49 myeloid genes were available from 4 patients with paired samples (Table 1). New mutations at leukocytosis were seen in NRAS and CEBPA in the first patient, KRAS and SH2B3 in the second, and CBL in the third. The fourth patient acquired no new mutations but demonstrated marked expansion of a dominant clone. The remaining 17 paired samples have been submitted for sequencing with results pending. In summary, MF patients with baseline anemia, leukocytosis, or female gender are at higher risk for emergent leucocytosis while on JAKi therapy. The median overall survival of 14 months in patients who experience emergent leukocytosis is comparable to that observed in patients following ruxolitinib failure. Our data also suggest that onset of leukocytosis may be indicative of underlying clonal evolution, which will need to be confirmed in a larger number of patients. These findings suggest consideration of emergent leukocytosis as a criterion for JAKi failure in MF. Disclosures Maze: Novartis: Honoraria; Pfizer: Consultancy; Takeda: Research Funding. Gupta:Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sierra Oncology: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bristol MyersSquibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy; Incyte: Honoraria, Research Funding.

A study to assess the role of raised total leucocyte count in diagnosis of acute appendicitis

Introduction: Total Leucocyte Count (TLC) is an easily available and commonly performed investigation and studies have reported various degrees of leucocytosis in patients with acute appendicitis. This study was performed with the aim to assess the diagnostic validity of raised TLC count in acute appendicitis.Methods: This was a cross sectional study conducted from 2013 to 2015, in the Department of General Surgery, Indira Gandhi Medical College, Shimla. A clinical diagnosis of acute appendicitis was made based on detailed history taking, clinical examination, and laboratory investigations including TLC count. 50 patients with acute appendicitis were enrolled in the study by convenience sampling, after taking a written, informed consent. Appendicectomy specimen were sent for histopathological examination (HPE).Results: The mean age of the patients was 26.48 ± 12.28 years. 29 (58%) patients were male, and 21 (42%) were female. The negative appendicectomy rate in the present study was 14%. 7 (14%) were normal appendices, 31 (62%) inflamed appendices, 4 (8%) perforated appendices, and 8 (16%) gangrenous appendices as per HPE report. In our study, there were 12 (24%) cases of complicated appendicitis i.e., 8 (16%) cases of gangrenous appendicitis and 4 (8%) cases of perforated appendicitis). TLC had a sensitivity 76.74%, specificity 51.14%, positive predictive value 91.66%, and negative predictive value 28.57%.Conclusion: In our study, TLC was found to have low sensitivity and specificity for acute appendicitis. Hence, used alone, TLC may not be diagnostic of acute appendicitis. However, used in conjunction with other laboratory parameters, it will lead to improvement of diagnostic accuracy.

The Effect of the Diameter of Aneurysm of Abdominal Aorta on Post-operative Leukocytosis in Patients Treated With Endovascular Aneurysm Repair

Introduction: Endovascular Aneurysm Repair (EVAR) is the routine method of treatment for Abdominal Aortic Aneurysm (AAA). Post-Implantation Syndrome (PIS) is benign systemic inflammatory response seen after EVAR as biochemical and clinical expression of inflammation without infection. Laboratory parameters are part of diagnostics. Differentiation from infection is fundamental. There is no consensus among vascular surgeons how to define PIS - febrile pyrexia is stable paradigm, but cut-off value of leukocytosis varies, thus influencing on the incidence. Negative microbiological cultures are known strongly to dominate early post-operative period in febrile leukocytotic patients. Factors influencing the severity of PIS are not clear. The aim of the study was to observe the behaviour of leukocytes in relation to the diameter of AAA in patients treated with EVAR during stationary post-operative recovery. Methods: The operator issued surgical descriptions and laboratory results of the all 26 AAA patients treated with EVAR in our tertiary level clinical university hospital during 2017-2018 were systematically reviewed. Three patients were excluded from the study due to insufficient documentation in their patient histories. 23 patients were included in this retrospective study. Diameter of AAA and leukocytes were analyzed retrospectively. Correlations between these parameters were analyzed by calculating Pearson correlation coefficient and p-value. As a null hypothesis was assumed that diameter of AAA doesn't have correlation with the post-operative level of leukocytosis. Results: Among patients were 3 females and 20 males aged from 52 to 88. Diameter of AAA was varied from 5,0 cm to 10,1 cm, median 6,5 cm, mean 6,8 cm and SD± 1,6 cm. Post-operatively during the first 24 hours leukocyte count varied from 5260/mm3 to 17450/mm3, median 9350/mm3, mean 9622/mm3, SD± 2659/mm3 and highest leukocyte counts occurred in 78,3% during this period. Leukocytosis > 9000/mm3 occurred in 56,5% during the first 24 hours and in 65,2% during the whole period of hospital stay with maximum leukocytosis being 17450/mm3. Pearson's correlation coefficient was calculated to be r = -0,012 between parameters: diameter of AAA and leukocytosis within 24 hours post-operatively, this resulted with a p-value > 0,05. Correlation between the diameter of AAA and maximal leukocytosis during the post-operative hospital stay was also analyzed, which resulted in Pearson's coefficient r = -0,019 with a p-value > 0,05. Conclusion: Leukocytosis occurred in majority of patients post-operatively. Both obtained Pearson's correlations coefficients r = -0,012 and r = -0,019 suggest very weak negative correlation between the measured parameters, but respectively obtained p-values in both cases were > 0,05 enforce that the null hypothesis cannot be rejected. It seems that the diameter of AAA has no correlation with severity of leukocytosis. PIS needs further studies in correlations of factors triggering it. Disclosure: Nothing to disclose

P3428Algorythm for estimation of long-term prognosis for patients with AMI complicated with acute cardiorenal syndrome

Abstract Objective To develop medical and statistical model to assess the long-term prognosis (1,5 years) in patients with myocardial infarction (MI) and acute kidney injury (AKI). Materials and methods 227 patients treated in our Institute of emergency care were examined. in 2016 about MI. Sex distribution included 60,2% males and 39,8% females. Average age: 67,1±4,2 years. 1st group included 105 patients with MI had AKI, 2nd one – 122 patients without AKI. Cohorts were comparable by sex and age. Patients were followed-up for 18 months: 15 patients died (12 with in the 1st group, 3 in the 2-nd).At the hospital biochemical and haematological tests (glucose, serum creatinine and WBC levels) were performed, as well as polymorphisms of the NOS3 gene T786C were detected. Results were statistically processed. Results and discussion Medico-statistical model was created for the total sample of deaths in the long term period using the method of the classification trees (see Fig. 1). Data obtained showed that the first order node was the distribution of genotypes of polymorphism T786C of NOS3 gene. Patients with the homozygous genotype CC died 10 times more often - 27,8%, people's with the genotypes TT and TC mortality was 2,6%. In patients with the genotype CC elevated levels of WBC in the blood was found, and their levels in frames of 9,9–12,0×109/l were correlated with mortality increased by 97,8%, and further WBC elevation up to 12 ×109/l led to 100% mortality. A third-order node can be considered as the level of serum creatinine at the time of discharge. It's elevation &gt;127 μmol/l correlated with increased mortality in patients with TT and TC genotype by 21,4%, and with associated hyperglycemia &gt;9,3 mmol/l reached 100%. Leukocytosis in patients with TT and TC genotype and serum creatinine &gt;127 μmol/l increased mortality up to 15,5%. The obtained model was tested with the use of ROC-analysis. The area under the curve was – 0,97, which corresponds to the expert assessment as “excellent”. The sensitivity of the model was 93,9%, specificity 83,5%. Figure 1. Model of long-term prognosis assessment Conclusion The proposed medical-statistical model, which includes biochemical (serum creatinine), haematological (WBC) and genetic (polymorphism T786C of NOS3 gene) markers, allows to predict unfavorable outcomes in patients with MI and AKI for a long-term period up to 1,5 years.

Polycythemia vera: Perioperative anesthetic challenges and review of literature

Among the hematopoietic stem cells disorders, polycythemia vera (PV) constitutes a rare entity. The excess production of erythrocytes with thrombocytosis and leukocytosis in patients lead to both thrombotic and hemorrhagic complications. These complications may cause significant perioperative morbidity and mortality. Anesthetic challenges in a patient of PV and brief review of literature are described in this report.

Comparison of the use of neutrophil: lymphocyte count ratio (NLCR) to total leukocyte count in diagnosing appendicitis in adults with right iliac fossa pain

Introduction: Diagnosis of acute appendicitis (AA) is purely based on history, examination and few laboratory investigations. However, it is often a perplexing diagnostic problem during the early stages of the disease. Failure to make an early diagnosis is a primary reason for morbidity and mortality. Elevated leukocyte count is one of the indicators of appendiceal inflammation in patients with right iliac fossa pain and most of the patients with acute appendicitis present with leucocytosis. Recently, it has been seen that the neutrophil: lymphocyte count ratio (NLCR) is a more sensitive marker than leukocytosis in patients with acute appendicitis.&#x0D; Method: This is a prospective observational study conducted over a period of one year in the department of surgery at the Tribhuvan University Teaching Hospital, from September 2013 to August 2014. The clinical diagnosis of Acute appendicitis was made by history and clinical examinations and laboratory investigations. Total leukocyte count (TLC) and NLCR of patients diagnosed as AA were measured and recorded in the pro forma. Histological diagnosis was taken as the final diagnosis.&#x0D; Results: A total of 106 patients were included in the study. Two third of the patients were male. Right iliac fossa tenderness was the most common sign. Ultrasound was able to diagnose acute appendicitis in 40.65% of the cases. NLCR&gt; 3.5 was observed in 90.56% of patients with acute appendicitis, whereas 78.3% of patients had leukocytosis only. High NLCR (5.60) is associated with complicated AA.&#x0D; Conclusion: NLCR is a more sensitive laboratory parameter than TLC in patients with RIF pain to diagnose acute appendicitis. A high NLCR ratio has a high likelihood of a complicated AA.

The Significance of Leukocytosis in Malignancies: A Novel Paradigm Between Leukocytosis, G-CSF, Myeloid-Derived Suppressor Cells and Prognosis

In clinical practice, leukocytosis is often overlooked after infectious and hematologic disease are ruled out, particularly in patients with solid tumors. This is unfortunate, as the mechanisms that mediate paraneoplastic leukocytosis may play a significant role in the underlying pathophysiology of cancer progression and prognosis. The relatively new discovery of neutrophilic and monocytic myeloid-derived suppressor cells (MDSCs) and their role in mediating tumor metastasis has particularly shed light into this process [Annu Rev Med, 66:97-110 (2015)].Here, we present the case of a 58-year old gentleman with non-small cell lung cancer complicated by brain metastasis, status post resection who presented with sepsis and acute kidney injury (AKI) requiring ICU care for worsening AKI, hypoxic respiratory failure and leukocytosis. His peak WBC count, absolute neutrophilia and monocytosis were: 178.1, 172.7 and 4.2k/µL, respectively. His peripheral blood smear revealed mature neutrophils with left-shift and no blast forms. The underlying etiology of his leukocytosis was initially attributed to steroids administration and infection (Figure 1). His leukocytosis progressed, however, despite improvement in his sepsis and tapering of his steroids. Thus, we suspected either an evolving hematologic neoplasm or exogenous secretion of G-CSF by his tumor. Nonetheless, given his worsening clinical status, we initiated empiric hydroxyurea and leukapheresis. His FISH and PCR for BCR-ABL were negative in addition to the absence of leukemia-associated mutations and gene fusions and a normal phenotype by flow cytometry. However, we detected the highest documented level of G-CSF secreted by any tumor in the literature at 41,108.6pg/mL (normal <39.1pg/mL), confirming that the etiology of his marked leukocytosis was indeed exogenous secretion of G-CSF by his cancer.On evaluation of this patient's clinical history, his malignancy and white count were stable until day 388 of his diagnosis when he developed new onset leukocytosis and neutrophilia associated with disease progression and metastasis. Furthermore, he died within 23 days of developing peak leukocytosis, neutrophilia and monocytosis and the discovery of his profoundly elevated G-CSF level. The association between the onset of his leukocytosis with the discovery of his disease progression and metastasis suggest that G-CSF secretion and leukocytosis may have been linked to his poor prognosis.We performed an extensive literature review and found that neutrophilic and monocytic MDSCs may provide a potential explanation for this phenomenon. We believe that leukocytosis in the setting of solid neoplasms may be driven by increased G-CSF secretion by tumors or tumor microenvironments. Additionally, G-CSF secretion fosters the expansion of neutrophilic and monocytic MDSCs, which play a significant role in tumor progression and metastasis and may contribute to poor prognosis [PNAS 106(16): 6742-7 (2009), PNAS 107(50): 21248-55 (2010)]. Consequently, we believe that the significance of leukocytosis in patients with solid tumors should not be overlooked and that there may exist a novel, untapped paradigm between paraneoplastic G-CSF secretion, leukocytosis, neutrophilic and monocytic MDSCs and prognosis. DisclosuresMauro:Novartis: Consultancy, Research Funding; Pfizer: Consultancy; Takeda: Consultancy; Bristol-Myers Squibb: Consultancy.

Early predictors of mortality in parkinsonism and Parkinson disease: A population-based study.

ObjectiveTo examine mortality and associated risk factors, including possible effects of mild cognitive impairment, imaging, and CSF abnormalities, in a community-based population with incident parkinsonism and Parkinson disease.MethodsOne hundred eighty-two patients with new-onset, idiopathic parkinsonism were diagnosed from January 2004 through April 2009, in a catchment area of 142,000 inhabitants in Sweden. Patients were comprehensively investigated according to a multimodal research protocol and followed prospectively for up to 13.5 years. A total of 109 patients died. Mortality rates in the general Swedish population were used to calculate standardized mortality ratio and expected survival, and Cox proportional hazard models were used to investigate independent predictors of mortality.ResultsThe standardized mortality ratio for all patients was 1.84 (95% confidence interval 1.50–2.22, p < 0.001). Patients with atypical parkinsonism (multiple system atrophy or progressive supranuclear palsy) had the highest mortality. In early Parkinson disease, a mild cognitive impairment diagnosis, freezing of gait, hyposmia, reduced dopamine transporter activity in the caudate, and elevated leukocytes in the CSF were significantly associated with shorter survival.ConclusionAlthough patients presenting with idiopathic parkinsonism have reduced survival, the survival is highly dependent on the type and characteristics of the parkinsonian disorder. Patients with Parkinson disease presenting with normal cognitive function seem to have a largely normal life expectancy. The finding of a subtle CSF leukocytosis in patients with Parkinson disease with short survival may have clinical implications.

Estimations of a degree of steroid induced leukocytosis in patients with acute infections

BackgroundGlucocorticosteroids (GCS) are known to cause the hematologic effect of leukocytosis and neutrophilia. Leukocytosis is a key parameter in establishing the diagnosis of sepsis and in the estimation of its severity. ObjectiveTo quantify the effect of chronic or acute GCS treatment on the level of leukocytosis in patients with acute infectious process. MethodsWe conducted a retrospective cohort study of patients with an acute infection hospitalized in tertiary medical center between the years 2003–2014. Patients were classified into three categories: chronic GCS treatment, acute GCS treatment, no GCS treatment. The primary outcome was the maximal WBC count within the first 24h from admission. ResultsWe identified 5468 patients with acute infection: 333 of them with chronic GCS treatment, 213 with acute GCS treatment and 4922 with no GCS treatment. The overall maximal leukocytes count was higher in GCS therapy groups: 15.4±8.3×109/L for the acute GCS treatment, 14.9±7.4×109/L for chronic GCS treatment and 12.9±6.4×109/L for the no GCS group (P<0.001). ConclusionIn patients with acute infections chronically treated with GCS, an increase in the WBC is at average of 5×109/L. These data must be taken into consideration while using the level of leukocytosis as a parameter in the diagnosis of the infectious process.

The Prognostic Value of Pre-Treatment Leukocytosis in Patients with Previously Treated, Stage IIIB/IV Non-Small Cell Lung Cancer Treated with the IGF-1R Pathway Modulator AXL1717 or Docetaxel; a Retrospective Analysis of a Phase II Trial

Background:The aim of the present study was to investigate any prognostic value of pre-treatment anemia, leukocytosis and thrombocytosis in patients with advanced pretreated NSCLC.Methods:A randomized, multicenter phase II study comparing the IGF-1R modulator AXL with standard docetaxel in the treatment of previously treated stage IIIB or IV NSCLC patients was conducted in 2011-2013. Clinical and laboratory data were collected, including serum values for hemoglobin (Hgb), white blood cells (WBC) and platelets (Plt) at baseline. These hematological parameters were studied in relation to overall survival using Kaplan–Meier product-limit estimates and multivariate Cox proportional hazards regression models.Results:The median overall survival for all patients was 8.9 months. Patients with leukocytosis (WBC > 9 x 109/L) had a significantly shorter median overall survival (4.2 months) as compared with those with a WBC ≤ 9 x 109/L at baseline (12.3 months) with a corresponding of HR 2.10 (95% CI: 1.29-3.43). Patients with anemia (Hgb < 110 g/L) had a non-significant (p = 0.097) shorter median overall survival (6.1 months) as compared with their counterparts with Hgb ≥ 110 g/L at baseline (9.4 months). As for thrombocytosis (Plt > 350 x 109/L), there was no statistically significant impact on overall survival. Leukocytosis retained its prognostic significance in a multivariate model where other clinical factors such as age, sex and WHO performance status were taken into consideration (HR: 1.83, 95% CI: 1.06-3.13, p = 0.029).Conclusion:Pre-treatment leukocytosis is a strong and independent prognostic marker for shorter overall survival in previously treated stage IIIB or IV NSCLC patients receiving docetaxel or AXL1717. Combined use of pre-treatment leukocytosis assessments together with established prognostic factors such as performance status could be of help when making treatment decisions in this clinical setting.