Neutrophil Platelet Research Articles

Analysis of Mean Corpuscular Volume and Red Cell Distribution Width in Patients with Aplastic Anemia

To explore the characteristics of hemogram in patients with aplastic anemia (AA), especially mean corpuscular volume (MCV) and red cell distribution width (RDW). We examined the blood routine of 180 new-onset AA patients and used 166 patients with myelodysplastic syndrome (MDS) as controls. Among the 180 AA patients, 105 (58.3%) were diagnosed with severe AA (SAA), while 75 (41.7%) were diagnosed with non-severe AA (NSAA). Compared to MDS, patients with SAA generally had unfavorable hemogram, including significantly lower white blood cell (WBC), absolute neutrophil count (ANC), hemoglobin (Hb), platelet (PLT) and reticulocyte counts (RET). However, WBC, ANC and lymphocyte counts were higher in the NSAA group than in the MDS group; Hb and Ret were comparable between the two groups. 8.5% of SAA patients and 58.1% of NSAA patients presented with macrocytic anemia, whereas 25.7% of SAA and 64.0% of NSAA had a high RDW. In the MDS group, 54.7% of patients presented with macrocytic anemia, and 84.7% had increased RDW. WBC, ANC, PLT, and Ret in a high-RDW group (25.7% of SAA) were significantly higher than in a normal-RDW group (74.3% of SAA). Overall, most SAA patients exhibited normocytic–normochromic anemia, and their hemograms decreased more significantly; more than half of NSAA patients showed macrocytic-heterogeneous anemia, and their hemograms were similar to those of MDS. Patients with elevated RDW may have better residual bone marrow hematopoietic function than those with normal RDW but with more severe anemia.

Short-term exposure of female BALB/cJ mice to e-cigarette aerosol promotes neutrophil recruitment and enhances neutrophil-platelet aggregation in pulmonary microvasculature

ABSTRACT Despite the perception that e-cigarettes are safer than conventional cigarettes, numerous findings demonstrated that e-cigarette aerosol (EC) exposure induced compromised immune functionality, vascular changes even after acute exposure, and lung injury. Notably, altered neutrophil functionality and platelet hemodynamics have been observed post-EC exposure. It was hypothesized that EC exposure initiates an inflammatory response resulting in altered neutrophil behavior and increased neutrophil-platelet interaction in the pulmonary microvasculature. Neutrophil and platelet responses were examined up to 48 hrs following whole-body, short-term EC exposure without flavorants or nicotine in a murine model, which most closely modeled secondhand exposure. This study is the first to investigate the impact of EC exposure through lung intravital imaging. Compared to room air-exposed mice, EC-exposed mice displayed significantly increased 1.7‒1.9-fold number of neutrophils in the pulmonary microvasculature associated with no marked change in neutrophils within whole blood or bronchoalveolar lavage fluid (BALF). Neutrophil-platelet interactions were also significantly elevated 1.9‒2.5-fold in exposed mice. Plasma concentration of myeloperoxidase was markedly reduced 1.5-fold 48 hr following exposure cessation, suggesting suppressed neutrophil antimicrobial activity. Cytokine expression exhibited changes indicating vascular damage. Effects persisted for 48 hr post-EC exposure. Data demonstrated that EC exposure repeated for 3 consecutive days in 2.5 hr intervals in the absence of flavorants or nicotine resulted in modified pulmonary vasculature hemodynamics, altered immune functionality, and a pro-inflammatory state in female BALB/cJ mice.

Neutrophil to lymphocyte ratio may be a useful marker in distinguishing MOGAD and MS and platelet to lymphocyte ratio associated with MOGAD activity.

Clinical overlap is observed between multiple sclerosis (MS) and myelin oligodendrocyte glycoprotein immunoglobulin-G (MOG-IgG) associated disease (MOGAD) and the difficulty in distinguishing between the two diseases. Here, we measured and compared the readily available neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR) to determine whether these three biomarkers can help to distinguish MOGAD and MS at disease onset. The impact of these three biomarkers on MOGAD and MS relapse also needs to be explored. In this retrospective analysis, we obtained clinical and paraclinical data from the first attacks of MOGAD (N=31) and MS (N=50). Electronic medical records were used to collect demographic data (gender, age at onset), clinical symptoms, EDSS at onset, and medical treatments. The primary outcome was relapse within one year of onset. Four hematological parameters were recorded, including neutrophil count, platelet count, lymphocyte count, and monocyte count. NLR, PLR, and MLR were calculated and compared between MOGAD, MS, and HC. Receiver operator curve (ROC) analysis was performed to assess the ability of NLR, PLR, and MLR to distinguish between MOGAD and MS, MOGAD and HC, respectively. A logistic regression analysis was performed to determine the impact of NLR/PLR/MLR on MOGAD/MS relapse within one year of onset. Compared to HC, NLR is significantly higher in MOGAD and MS (p<0.001, p=0.04, respectively). The PLR and MLR are elevated in MOGAD compared to HC (p<0.001, p<0.001, respectively), and MLR in MS are also statistically higher than in HC (p=0.023). It is worth noting that NLR and PLR were much higher in MOGAD compared to MS (p<0.001, p=0.001, respectively), but a significant difference regarding MLR has not been found between MOGAD and MS. Based on ROC curve analyses, we found that using NLR, PLR, and MLR to discriminate between MOGAD and MS yielded a ROC-plot area under the curve (AUC) value of 0.794, 0.727, and 0.681, respectively. Meanwhile, the AUC of NLR, PLR, and MLR to discriminate between MOGAD and HC were 0.926, 0.772, and 0.786. Furthermore, the logistics analysis revealed a significant positive association between PLR and MOGAD relapse. NLR helps differentiate MOGAD and MS in disease onset, and higher PLR was related to MOGAD relapse.

TALAPRO-2: Phase 3 study of talazoparib (TALA) + enzalutamide (ENZA) versus placebo (PBO) + ENZA as first-line (1L) treatment in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC).

LBA17 Background: TALAPRO-2 (NCT03395197) is the first phase 3 study to combine the poly(ADP-ribose) polymerase inhibitor TALA with the androgen receptor inhibitor ENZA. Pts unselected for genetic alterations in DNA damage repair pathways, directly or indirectly involved with homologous recombination repair (HRR), received either TALA + ENZA or PBO + ENZA as 1L treatment for mCRPC. Methods: Pts randomized 1:1 to TALA 0.5 mg or PBO (all pts received ENZA 160 mg daily) were stratified by prior abiraterone or docetaxel for castration-sensitive PC and HRR gene alteration status. Key eligibility criteria: mildly or asymptomatic mCRPC with disease progression at study entry, ECOG PS ≤1, ongoing androgen deprivation therapy, no prior life-prolonging therapy for CRPC. Primary endpoint: imaging-based progression-free survival (ibPFS) by BICR per RECIST 1.1 and PCWG3. Results: 402 pts were randomized to receive TALA + ENZA and 403 PBO + ENZA. Of these 805 pts, enrollment was informed by tumor tissue for 804 (99.9%), by tumor tissue and blood for 114 (14.2%), and by blood only for 1 (0.1%). Median ibPFS by BICR was significantly improved in the TALA + ENZA vs PBO + ENZA arm (not reached vs 21.9 months, respectively; HR, 0.63; 95% CI, 0.51–0.78; P&lt; 0.001). ibPFS was significantly improved in HRR-deficient (HR, 0.46; 95% CI, 0.30–0.70; P&lt; 0.001), HRR-non-deficient or unknown (HR, 0.70; 95% CI, 0.54–0.89; P= 0.004), and HRR-non-deficient pts by tumor tissue testing (HR, 0.66; 95% CI, 0.49–0.91; P= 0.009) in the TALA + ENZA vs PBO + ENZA arm. Overall survival data are immature; 30.6% (TALA) and 32.0% (PBO) pts had died; HR (0.89 [95% CI, 0.69–1.14; P= 0.35]) favored the TALA + ENZA arm. Objective response rates, PSA response ≥50%, and time to PSA progression and use of subsequent cytotoxic chemotherapy and antineoplastic therapy significantly favored the TALA + ENZA vs PBO + ENZA arm. In pts, 71.9% (TALA + ENZA) and 40.6% (PBO + ENZA) had grade 3-4 treatment-emergent adverse events (TEAEs). The most common grade ≥3 TEAEs were anemia, low neutrophil, and low platelet counts (TALA + ENZA), and hypertension, anemia, and fatigue (PBO + ENZA). TEAEs led to discontinuation of TALA in 19.1% of pts (vs PBO in 12.2%). Discontinuation rates of ENZA were 10.8% in the TALA + ENZA vs 11.0% in PBO + ENZA arm. Median time to definitive clinically meaningful deterioration in global health status/quality of life (GHS/QoL) was significantly longer with TALA + ENZA vs PBO + ENZA (30.8 vs 25.0 months, respectively; HR, 0.78; 95% CI, 0.62–0.99; P= 0.04). Conclusions: TALA + ENZA demonstrated statistically significant and clinically meaningful improvement in ibPFS over standard of care ENZA as 1L treatment in pts with mCRPC regardless of HRR status, while delaying time to worsening in GHS/QoL. There were no new safety signals; toxicity was generally manageable. Clinical trial information: NCT03395197 .

Melastoma malabathricum L. Suppresses Neutrophil Extracellular Trap Formation Induced by Synthetic Analog of Viral Double-Stranded RNA Associated with SARS-CoV-2 Infection.

Platelet hyper-reactivity and neutrophil extracellular trap (NET) formation contribute to the development of thromboembolic diseases for patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study investigated the pathophysiological effects of SARS-CoV-2 surface protein components and the viral double-stranded RNA (dsRNA) on platelet aggregation and NET formation. Traditional Chinese medicine (TCM) with anti-viral effects was also delineated. The treatment of human washed platelets with SARS-CoV-2 spike protein S1 or the ectodomain S1 + S2 regions neither caused platelet aggregation nor enhanced agonists-stimulated platelet aggregation. Moreover, NET formation can be induced by polyinosinic-polycytidylic acid (poly(I:C)), a synthetic analog of viral dsRNA, but not by the pseudovirus composed of SARS-CoV-2 spike, envelope, and membrane proteins. To search for TCM with anti-NET activity, the plant Melastoma malabathricum L. which has anticoagulant activity was partially purified by fractionation. One of the fractions inhibited poly(I:C)-induced NET formation in a dose-dependent manner. This study implicates that SARS-CoV-2 structural proteins alone are not sufficient to promote NET and platelet activation. Instead, dsRNA formed during viral replication stimulates NET formation. This study also sheds new insight into using the active components of Melastoma malabathricum L. with anti-NET activity in the battle of thromboembolic diseases associated with SARS-CoV-2 infection.

Association of Circulating Neutrophils with Relative Volume of Lipid-Rich Necrotic Core of Coronary Plaques in Stable Patients: A Substudy of SMARTool European Project

Coronary atherosclerosis is a chronic non-resolving inflammatory process wherein the interaction of innate immune cells and platelets plays a major role. Circulating neutrophils, in particular, adhere to the activated endothelium and migrate into the vascular wall, promoting monocyte recruitment and influencing plaque phenotype and stability at all stages of its evolution. We aimed to evaluate, by flow cytometry, if blood neutrophil number and phenotype-including their phenotypic relationships with platelets, monocytes and lymphocytes-have an association with lipid-rich necrotic core volume (LRNCV), a generic index of coronary plaque vulnerability, in a group of stable patients with chronic coronary syndrome (CCS). In 55 patients, (68.53 ± 1.07 years of age, mean ± SEM; 71% male), the total LRNCV in each subject was assessed by a quantitative analysis of all coronary plaques detected by computed tomography coronary angiography (CTCA) and was normalized to the total plaque volume. The expression of CD14, CD16, CD18, CD11b, HLA-DR, CD163, CCR2, CCR5, CX3CR1, CXCR4 and CD41a cell surface markers was quantified by flow cytometry. Adhesion molecules, cytokines and chemokines, as well as MMP9 plasma levels, were measured by ELISA. On a per-patient basis, LRNCV values were positively associated, by a multiple regression analysis, with the neutrophil count (n°/µL) (p = 0.02), neutrophil/lymphocyte ratio (p = 0.007), neutrophil/platelet ratio (p = 0.01), neutrophil RFI CD11b expression (p = 0.02) and neutrophil-platelet adhesion index (p = 0.01). Significantly positive multiple regression associations of LRNCV values with phenotypic ratios between neutrophil RFI CD11b expression and several lymphocyte and monocyte surface markers were also observed. In the bivariate correlation analysis, a significantly positive association was found between RFI values of neutrophil-CD41a+ complexes and neutrophil RFI CD11b expression (p < 0.0001). These preliminary findings suggest that a sustained increase in circulating neutrophils, together with the up-regulation of the integrin/activation membrane neutrophil marker CD11b may contribute, through the progressive intra-plaque accumulation of necrotic/apoptotic cells exceeding the efferocytosis/anti-inflammatory capacity of infiltrating macrophages and lymphocytes, to the relative enlargement of the lipid-rich necrotic core volume of coronary plaques in stable CAD patients, thus increasing their individual risk of acute complication.

Correlation between serum cystatin C and lipid level in patients with chronic heart failure.

Serum cystatin C (Cys C) and blood lipid levels are related to the occurrence and development of chronic heart failure (CHF). However, there are few reports on the correlation between blood lipid level and serum Cys C level in patients with CHF. The aim of this study is to explore the correlation between serum Cys C level and blood lipid level in patients with CHF, and to provide valuable reference for clinical diagnosis and treatment of CHF. A total of 336 CHF patients who were hospitalized in the Department of Cardiovascular Medicine of Shaanxi Provincial People's Hospital from October 2017 to July 2018 were included and they were divided into a Cys C normal group (n=180) and a Cys C abnormal group (n=156) according to serum Cys C level of the patients. The general data, laboratory indicators, and cardiac ultrasound results were compared between the 2 groups. Pearson correlation analysis was used to detect the correlation between serum Cys C level and blood lipid level and other factors, and the data related to Cys C were further analyzed by multivariate logistic regression. Compared with the Cys C normal group, patients in the Cys C abnormal group had lower left ventricular ejection fraction (LVEF) (P<0.001), older age (P=0.030), higher incidence rate of diabetes and smoking index (P=0.002 and P=0.003, respectively). The levels of serum creatinine (SCr), blood urea nitrogen (BUN), and total bilirubin (TBIL) were higher (all P<0.001), while the levels of high density lipoprotein (HDL), apolipoprotein (Apo) A, and albumin (ALB) were lower (P<0.001, P=0.001, and P=0.003, respectively) in the Cys C abnormal group. Pearson correlation analysis showed that serum Cys C level was negatively correlated with platelet count, HDL, Apo A, ALB, and LVEF. It was positively correlated with smoking index, mean platelet volume, neutrophil ratio, BUN, and TBIL (all P<0.05). The results of multivariate logistic regression analysis showed that the decreased HDL level was a risk factor for the abnormality of serum Cys C in patients with CHF (OR=0.119, P=0.003), while Apo A was not a risk factor for its abnormality (P=0.337). HDL might be the only blood lipid index associated with abnormal serum Cys C in patients with CHF.

Lack of the human choline transporter‐like protein SLC44A2 causes hearing impairment and a rare red blood phenotype

Blood phenotypes are defined by the presence or absence of specific blood group antigens at the red blood cell (RBC) surface, due to genetic polymorphisms among individuals. The recent development of genomic and proteomic approaches enabled the characterization of several enigmatic antigens. The choline transporter‐like protein CTL2 encoded by the SLC44A2 gene plays an important role in platelet aggregation and neutrophil activation. By investigating alloantibodies to a high‐prevalence antigen of unknown specificity, found in patients with a rare blood type, we showed that SLC44A2 is also expressed in RBCs and carries a new blood group system. Furthermore, we identified three siblings homozygous for a large deletion in SLC44A2, resulting in complete SLC44A2 deficiency. Interestingly, the first‐ever reported SLC44A2‐deficient individuals suffer from progressive hearing impairment, recurrent arterial aneurysms, and epilepsy. Furthermore, SLC44A2null individuals showed no significant platelet aggregation changes and do not suffer from any apparent hematological disorders. Overall, our findings confirm the function of SLC44A2 in hearing preservation and provide new insights into the possible role of this protein in maintaining cerebrovascular homeostasis.

Abacavir causes leukocyte/platelet crosstalk by activating neutrophil P2X7 receptors thus releasing soluble lectin-like oxidized low-density lipoprotein receptor-1.

Abacavir, an antiretroviral drug used in HIV therapy associated with myocardial infarction, promotes thrombosis through P2X7 receptors. The role of platelets as pro-thrombotic cells is acknowledged whereas that of neutrophils-due to their secretory capacity-is gaining recognition. This study analyses the role of neutrophils-specifically the secretome of abacavir-treated neutrophils (SNABC )-in platelet activation that precedes thrombosis. Effects of abacavir or SNABC on platelet activation and platelet-leukocyte interactions and expression of lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) were analysed by flow cytometry. The secretome was analysed by proteomics. The role of leukocytes in the actions of abacavir was evaluated in a mouse model of thrombosis. Abacavir induced platelet-leukocyte interactions, not directly via effects of abacavir on platelets, but via activation of neutrophils, which triggered interactions between platelet P-selectin and neutrophil P-selectin glycoprotein ligand-1 (PSGL-1). SNABC stimulated platelet activation and platelet-leukocyte interactions through a process that was dependent on LOX-1, neutrophil P2X7 and platelet P2Y1, P2Y12 and P2X1 receptors. Abacavir induced the expression of LOX-1 on neutrophils and of the soluble form of LOX-1 (sLOX-1) in SNABC . Neutrophils, LOX-1, P2X7, P2Y1, P2Y12 and P2X1 receptors were required for the pro-thrombotic actions of abacavir in vivo. Neutrophils are target cells in abacavir-induced thrombosis. Abacavir released sLOX-1 from neutrophils via activation of their P2X7 receptors, which in turn activated platelets. Hence, sLOX-1 could be the missing link in the cardiovascular risk associated with abacavir.

Optimization of Radium-223 Treatment of Castration-resistant Prostate Cancer Based on the Burden of Skeletal Metastasis and Clinical Parameters.

Radium-223 dichloride (Ra-223) is now frequently used to treat prostate cancer that has metastasized to bone, although patient selection continues to be suboptimal for determining who will benefit most from this novel treatment modality. Seventy-nine patients with metastatic castration-resistant prostate cancer (mCRPC) were treated with Ra-223 from 2012 to 2016. The burden of skeletal metastasis was determined for each using the Bone Scan Index (BSI) as a ratio of diseased to normal bone. Clinical, laboratory, and survival data were collected and examined for associations with BSI, and treatment tolerability was assessed. Chemotherapy-naïve patients were significantly more likely to complete the full course of treatment. Median follow-up was 31 months (range 0.7-38.8 months) and median overall survival was 15.4 months (range 9.5-20.6 months). Overall survival was significantly associated with findings on bone scans (P < .05). Patients with higher BSI tended toward poorer outcomes. Nearly half the patients with low baseline BSI survived 3 years or more following Ra-223 treatment. By contrast, only 20% of the patients with high baseline BSI lived for 1 year, and none lived for an additional 3. Baseline BSI was significantly associated with decreased hemoglobin, higher serum PSA and alkaline phosphatase levels, and treatment-associated reductions in platelet and absolute neutrophil counts. Our results suggest better outcomes to Ra-223 therapy for patients who are chemotherapy-naïve and who undergo treatment earlier in the course of their disease as reflected by low BSI and concordant laboratory parameters.

Labs Do Not Predict Postoperative Intra-abdominal Abscess in Pediatric Perforated Appendicitis

IntroductionWe aim to evaluate the utility of postoperative labs in predicting the development of an intra-abdominal abscess (IAA) in pediatric patients with perforated appendicitis. We hypothesize that postoperative labs are not predictive of IAA development. MethodsThis was a single-institution retrospective cohort study that included pediatric patients (n = 61) who underwent surgery for perforated appendicitis from January 1, 2019 to December 1, 2020. Patients were stratified into those who developed a postoperative IAA (n = 22) and those who did not (n = 39). Postoperative labs (white blood cell [WBC] count, absolute neutrophil count, platelet count, C-reactive protein) were examined. Mann–Whitney U tests and chi-square tests were used to assess for differences between groups. ResultsThere was extensive heterogeneity and overlap in postoperative lab values between patients who developed an IAA and those who did not. Almost all patients who developed an IAA had clinical signs that were indicative of abscess formation regardless of their postoperative WBC count or change in WBC count. While patients who developed an IAA had a higher postoperative median WBC count (10.8 versus 8.4, P = 0.003) and a smaller WBC count decrease (−4.9 versus −7.4, P = 0.01), no cutoff value for any of the examined lab values specifically predicted abscess formation. Postoperative median absolute neutrophil count (7.4 versus 4.0, P = 0.15), platelet count (360 versus 353, P = 0.98), and C-reactive protein (8.20 versus 5.32, P = 0.06) did not differ significantly. ConclusionsWe conclude that postoperative labs have limited clinical utility in evaluating IAA development in children with perforated appendicitis.

Platelet-Neutrophil Crosstalk in Thrombosis.

Platelets are essential for the formation of a haemostatic plug to prevent bleeding, while neutrophils are the guardians of our immune defences against invading pathogens. The interplay between platelets and innate immunity, and subsequent triggering of the activation of coagulation is part of the host system to prevent systemic spread of pathogen in the blood stream. Aberrant immunothrombosis and excessive inflammation can however, contribute to the thrombotic burden observed in many cardiovascular diseases. In this review, we highlight how platelets and neutrophils interact with each other and how their crosstalk is central to both arterial and venous thrombosis and in COVID-19. While targeting platelets and coagulation enables efficient antithrombotic treatments, they are often accompanied with a bleeding risk. We also discuss how novel approaches to reduce platelet-mediated recruitment of neutrophils could represent promising therapies to treat thrombosis without affecting haemostasis.

Neutrophil Count, Platelet Indices, CRP and Their Association with Disease Activity of Juvenile Idiopathic Arthritis (JIA): A Study from Bangladesh

Background: Chronic inflammation of the joints in JIA patients is associated with raised levels of serum inflammatory biomarkers, which vary according to disease activity. Neutrophil count, platelet count, mean platelet volume (MPV), platelet distribution width (PDW), ESR and CRP are the essential markers to evaluate the disease activity status of JIA patients. Objectives: To assess neutrophil count, platelet count, MPV, PDW, CRP and Juvenile Arthritis Disease Activity Score (JADAS) in JIA patients and determine their association at the initial visit and six months after treatment. Methods: This prospective observational study was conducted from March 2019 to December 2020 in the department of paediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Fifty newly diagnosed JIA cases fulfilling the ILAR classification criteria were included in the study. Disease activity was assessed by JADAS 27. JADAS 27 and inflammatory biomarkers were measured at the initial visit and six months of treatment and these were compared. Results: Mean neutrophil count, platelet count, and CRP significantly decreased at follow-up after six months of treatment. MPV and PDW were increased after six months compared to the initial visit, and the change was significant. Mean JADAS 27 also decreased significantly at follow-up. Neutrophil count, Platelet indices and CRP had a significant association with JADAS 27. Conclusion: In this study, neutrophil count, platelet indices, and CRP after six months of treatment were improved. A significant association of JADAS 27 was found with platelet indices, neutrophil count and CRP.

Association between platelet lymphocyte ratio and neutrophil lymphocyte ratio and clinical outcomes following carotid endarterectomy.

Approximately 30% of stroke cases result from carotid disease. Although several risk factors for complications after carotid endarterectomy have been identified, the existence of a biomarker that can estimate postoperative risk in these patients has not yet been proven. This study aimed to investigate correlations between the platelet-lymphocyte ratio (PLR) and the neutrophil-lymphocyte ratio (NLR) and postoperative clinical outcomes in patients undergoing carotid endarterectomy. A retrospective study was conducted, including 374 patients who underwent carotid endarterectomy between 2002 and 2019 due to moderate to high extracranial internal carotid artery stenosis. Their platelet-lymphocyte ratio and neutrophil-lymphocyte ratios were obtained from the same blood samples. There was a statistically significant correlation between the PLR and the occurrence of restenosis (p < 0.01) and acute myocardial infarction (AMI) after endarterectomy (p = 0.03). Additionally, there was a statistically significant correlation between the PLR and the combined outcomes stroke and/or AMI and/or death (p = 0.03) and stroke and/or AMI and/or death and/or restenosis (p < 0.01). However, there were no significant correlations between NLR and these outcomes (p = 0.05, p = 0.16). The platelet-lymphocyte ratio proved to be a useful test for predicting occurrence of strokes, acute myocardial infarctions, and deaths during the postoperative period after carotid endarterectomy. It was also associated with the risk of postoperative restenosis.

Comparison of RDW and PLR values with CRP and NLR values in patients with postoperative leakage and abscess after pancreatectomy

AIM: New studies show red cell distribution width (RDW) to be altered by inflammatory cell wall changes in acute pancreatitis, sepsis and critical illness. We aimed to evaluate the efficacy of RDW, platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) values in patients who underwent pancreatectomy. MATERIALS AND METHODS: Fifty patients who underwent pancreatectomy were retrospectively compared. The study group consisted of patients who were followed up with clinical or laboratory evidence of either leakage or infection, with proof of infection being culture positivity and associated fever, tachycardia, and elevated laboratory values. The control group, on the other hand, comprised of 25 patients with uneventful postoperative course. RDW, neutrophil, platelet (PLT), aspartate aminotransferase (AST), alanine transaminase (ALT), C reactive protein (CRP), PLR and NLR values of the patients were compared among and between groups at 4 different time points (1: admission, 2: postoperative first week prior to infection, 3: at the time of infection and 4: discharge). RESULTS: Statistically significant results were obtained for ALT, CRP, neutrophil, and PLR ratios (p=0.003, p=0.002, p=0.028, p=0.032, respectively). Significant differences were also observed in RDW 2, RDW 3 and RDW 4 (p=0.034, p=0.010, p=0.031, respectively). Regarding CRP levels, significant differences were found for CRP 1 and CRP 3 levels (p=0.001, p=0.025, respectively). A significant difference was detected only for the PLR 4 value (p=0.009). CONCLUSIONS: In patients who underwent pancreatic resection and were suspected of having infection that progressed to a septic state, the levels of RDW, CRP, PLT, and PLR were observed to be correlated with infection and increased at various intervals before the culture results and evidence of infection emerged. Due to their association with the emergence of infections, these parameters have been proven to be effective and affordable tools in clinical decision-making.

Mean platelet volume and neutrophil to lymphocyte ratio in lupus nephritis patients

Mean platelet volume and neutrophil to lymphocyte ratio in lupus nephritis patients

Evaluation of hematological parameters in coronavirus disease 2019: Comparison between intensive care unit and non-intensive care unit patients

Abstract Background: There are ongoing waves of coronavirus disease 2019 (COVID-19) infection with many variants of this disaster, the latest being BF.7 are prevalent now as of December 25, 2022. There are various changes observed in the clinical, hematological, and biochemical parameters in the patients getting infected by COVID-19. At present, the knowledge of the disease and its severity are important for patient management and prediction of patient outcomes. The study aimed to analyze and compare the differences in the routine hematological parameters of intensive care unit (ICU) and non-ICU COVID-19 groups since their admission. Materials and Methods: A retrospective study conducted at a tertiary care hospital in New Delhi for 9 months from March 1, 2020 to November 30, 2020. Routine hematological data confirmed of COVID-19 cases, who were admitted in ICU or non-ICU were retrieved from the Departments of Pathology and Critical Care Medicine and analyzed. The hematological parameters comprising platelet count (109/L), hemoglobin concentration (g/dL), leukocyte count (LEU, 109/L), neutrophil count (NEU, %), eosinophil count (EO, %), lymphocyte count (LYM, %), and monocyte count (MONO, %) and their derivatives such as neutrophil-lymphocyte ratio (NLR) were evaluated. Results: The study showed that there was a significant difference (P &lt; 0.05) in the value of hematological parameters between ICU and non-ICU patients with higher levels ofLEU, NEU, and NLR in the ICU group compared to the non-ICU group confirmed COVID-19 positive patients. It was also observed that there was significantly higherLEU, higher NEU count, higher NLR and lower EO, LYM, and MONO count in deceased COVID-19 patients compared with recovered COVID-19 patients (P &lt; 0.05). Conclusion: This study helps in understanding the role of hematological parameters especially increased LEU count, higher NEU count, higher NLR, and LYM in severely infected COVID-19 positive patients, admitted in ICU-care settings and deceased COVID-19 patients. It also helps us in deriving a hypothesis that among all hematological parameters, the reduced LYM count can be a very specific prognosticator of the infected patients. Therefore, these hematological parameters can act as a biomarker to recognize the severity of the disease and to monitor the clinical course of COVID-19.

Inflammatory Markers in Lung CancerA Comparative Cross-sectional Study

Introduction: Lung cancer is the most common cause of cancer mortality worldwide, principally because of its late diagnosis. Chronic inflammation plays a significant role in tumour growth and progression via increasing the levels of inflammatory markers in blood. Inflammatory markers are expected to be valuable prognostic biomarkers in cancer. Markers like Absolute Neutrophil Count (ANC), Absolute Lymphocyte Count (ALC), platelet count, Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) may aid in assessing prognosis of lung cancer. Aim: To study the inflammatory markers (ANC, ALC, Platelet count, NLR and PLR) in lung cancer and correlate these markers with cancer stage and histopathological type. Materials and Methods: A hospital-based cross-sectional study was conducted in lung cancer patients at Institute of Respiratory Diseases, SMS Medical College, Jaipur, Rajasthan, India. Sixty patients with lung cancer and sixty controls were included. The clinical characteristics, ANC, ALC, platelet count, NLR and PLR of cases and controls were assessed and compared. Also, the comparison of these inflammatory markers with Tumor, Nodes and Metastases (TNM) staging and histopathological type of lung cancer were documented and results were interpreted. The data analysis was done with the use of Statistical Package for Social Sciences (SPSS) software, IBM manufacturer, Chicago, USA, (Ver.) 26. Results: Mean age (years) of the case and control groups was 60.17 and 61.03, respectively. Distribution of gender in cases and controls was comparable. The major histology of lung cancer was Non-Small Cell Lung Cancer (NSCLC, 81.66%) out of which squamous cell carcinoma constituted 55.00% and adenocarcinoma 21.67%, followed by small cell carcinoma at 18.33%. Overall, 46.67% of the patients belonged to TNM staging IVA followed by IIIB (25.00%). The levels of ANC, platelet count, NLR and PLR were significantly elevated and ALC was decreased in cases as compared to control. There was no statistically significant association between the inflammatory markers ANC, ALC, platelet counts, NLR and PLR with the histopathological type of lung cancer. Mean ANC, platelet count, NLR and PLR were found to be significantly elevated in late stages of lung cancer, whereas, ALC had no such association with the stages of lung cancer. Conclusion: Inflammatory markers (ANC, platelet count, NLR, PLR, ALC) can serve as valuable prognostic biomarkers in lung cancer and can easily be used in resource-limited areas.

Role of Inflammatory Markers and Clinical Correlate in Children Infected with the Novel SARS-CoV-2: A Prospective Observational Study

Introduction: Inflammatory markers have been used as predictors of adverse outcomes in adults with Coronavirus Disease-2019 (COVID-19) infection. Children mostly have mild infections and raised inflammatory markers have been reported only with severe COVID-19 or Multisystem Inflammatory Disorder (MIS-C). Studies in children showing the role of inflammatory markers in disease prognosis are few, and findings are not conclusive. Aim: To find out correlation, if any, between the inflammatory markers {Interleukin-6 (IL-6), C-reactive Protein (CRP), procalcitonin, Pro-B-type natriuretic Peptide (Pro-BNP), ferritin, D-dimer} with clinical presentation, prognosis, and outcome in children with acute COVID-19. Materials and Methods: The prospective, observational study was conducted at a tertiary care COVID-19 Paediatric Intensive Care Unit {PICU (Vardhaman Medical College and Hospital, New Delhi)}, Northern India, between September 2020 and December 2020. All children aged less than 12 years, with a positive COVID19 report were enrolled and investigated. Data was collected for clinical presentation, severity, treatment and outcome. The following variables were recorded: Complete Blood Count (CBC), Kidney Function Test (KFT) and Liver function Test (LFT), Absolute Lymphocyte Count (ALC), Absolute Neutrophil Count (ANC), Neutrophil-lymphocyte Ratio (NLR), Platelet Count (PLT), C-reactive Protein (CRP), Procalcitonin (PCT), serum ferritin, Lactate Dehydrogenase (LDH), fibrinogen, and Erythrocyte Sedimentation Rate (ESR) and ProBNP. Coagulation parameters like Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), International Normalised Ration (INR), D-dimer were taken. Data was analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: A total of 35 children were admitted during the study period. Seventeen children met the criteria for severe disease. Seven children met the criteria for MIS-C. Children presenting with conjunctivitis (n=3) were more likely to have signs of peripheral inflammation hypotension (n=4), tachycardia (n=6), and raised IL-6 levels (pg/mL) as well as the need for inotropic support. IL-6 values were higher in children (Mean±SD= 182.47±149.83). Median IL-6 value 199.8 (96.17-275.24) was highest in children with CRP &lt;10 mg/dL (p-value&lt;0.01). Children with raised D-dimer (Mean±SD=1881.94±1265.66 mg/dL) had a longer duration of stay (p-value=0.031). Conclusion: The study didn’t find any correlation between inflammatory markers with clinical presentation and the outcome of COVID-19 infection in children.

Study on the Changes in Common Laboratory Parameters in Dengue Patients with Secondary Bacterial Infection

Secondary bacterial infection can adversely affect the clinical course of primary viral infection indengue fever. Time consuming microbiological culture confirmations and false negative culture resultsdelay the timely initiation of antibiotics. The objective of this study was to describe the variation in thecommon laboratory parameters during the illness, identify criteria that may predict secondary bacterialinfection before microbial culture confirmation, identify the common organisms causing secondarybacterial infections and their antibiotic sensitivity patterns. A retrospective case-control study was carriedout at the Dengue Management Unit of the National Institute of Infectious Diseases, Sri Lanka. Patientstreated with antibiotics upon suspicion or culture confirmation of secondary bacterial infections andpatients not treated with antibiotics were selected for the study. Total WBC count, absolute neutrophilcount, platelet count, HCT (Hematocrit), CRP (C Reactive Protein) and average body temperature wererecorded. Independent sample t-test was used to analyze the data. Study results showed that most positivemicrobial cultures were detected on the 6th and 7th days of illness. Staphylococcus, Streptococcus, andnon-speciated Gram-positive cocci were the commonly isolated organisms. Patients with confirmedsecondary bacterial infection had significantly higher neutrophil count (3.32±0.35x103/μL, p&lt;0.05) andlower platelet counts (49.33±7.66x103/μL, p&lt;0.05) on the 6th and 5th day of illness respectively. Theaverage body temperature was significantly higher in the study group than the control from the fever day3 onwards (p&lt;0.05). The study subjects were more likely to have significantly lower HCT values(38.62±1.12%, p&lt;0.05) than their controls on the third and fourth days of fever. Overall, the present studysuggests that bacterial co-infection increases the mortality rate in dengue patients. The variation inabsolute neutrophil count, platelet count, and body temperature pattern compared to the illness day can beused along for early prediction of secondary bacterial infection.&#x0D; Keywords: dengue, bacterial infection, antibiotics, platelet count, HCT