Neutrophilic Granulocyte Percentage Research Articles

Epidemiological and pathological characterization of acute respiratory infections.

This research comprehensively investigates the epidemiological features and pathogen profile of acute respiratory infections (ARI) in Shihezi City, Xinjiang. A pivotal aspect of this study is the construction of a Bayes discriminant function for principal pathogen infections. This innovative methodology aims to furnish a robust scientific basis for the prevention and clinical management of ARI, potentially guiding more effective strategies in both public health and clinical settings. We compiled and examined data from January 2020 to June 2023, pertaining to patients admitted with acute respiratory infections at the First Affiliated Hospital of Shihezi University. This investigation focused on discerning patterns in epidemiology and pathogen etiology. Among 2110 cases of acute respiratory infections (ARI), 1736 underwent pathogenetic testing. Of these, 595 cases tested positive for at least one pathogen, marking a positivity rate of 34.27%. Viral detections, at a rate of 27.47%, were notably higher than bacterial detections, which stood at 6.51%. The most prevalent viruses identified were Human respiratory syncytial virus (hRSV), Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and Human adenovirus (HAdV), while the dominant bacterial pathogens included Klebsiella pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. Co-infections were observed in 76 cases, accounting for 12.77% of positive diagnoses, predominantly involving hRSV in conjunction with other pathogens. In cases of acute bronchiolitis, hRSV was the most frequent pathogen, contributing to 23.10% of such cases. Similarly, in severe pneumonia cases, SARS-CoV-2 was predominant, accounting for 25.4% of these infections. The group with bacterial positivity exhibited elevated levels of C-reactive protein (CRP, 19.17 mg/L) and neutrophilic granulocyte percentage (NE%, 54.7%). The Bayes discriminant function demonstrated an initial validation accuracy of 74.9% and a cross-validation accuracy of 63.7%. The study underscores that hRSV, SARS-CoV-2, and HAdV are the primary pathogens in acute respiratory infections in the Shihezi region. Pathogen susceptibility exhibits variation across different age groups, with a higher pathogen detection rate in children compared to adults. The Bayes discriminant function shows significant promise in the classification and diagnosis of major pathogenic infections.

Characteristics and risk factors for invasive fungal infection in hospitalized patients with acute-on-chronic hepatitis B liver failure: a retrospective cohort study from 2010 to 2023.

The global burden of invasive fungal infections (IFIs) is emerging in immunologic deficiency status from various disease. Patients with acute-on-chronic hepatitis B liver failure (ACHBLF) are prone to IFI and their conditions are commonly exacerbated by IFI. However, little is known about the characteristics and risk factors for IFI in hospitalized ACHBLF patients. A total of 243 hospitalized ACHBLF patients were retrospectively enrolled from January 2010 to July 2023. We performed restricted cubic spline analysis to determine the non-linear associations between independent variables and IFI. The risk factors for IFI were identified using logistic regression and the extreme gradient boosting (XGBoost) algorithm. The effect values of the risk factors were determined by the SHapley Additive exPlanations (SHAP) method. There were 24 ACHBLF patients (9.84%) who developed IFI on average 17.5 (13.50, 23.00) days after admission. The serum creatinine level showed a non-linear association with the possibility of IFI. Multiple logistic regression revealed that length of hospitalization (OR = 1.05, 95% CI: 1.02-1.08, P = 0.002) and neutrophilic granulocyte percentage (OR = 1.04, 95% CI: 1.00-1.09, P = 0.042) were independent risk factors for IFI. The XGBoost algorithm showed that the use of antibiotics (SHAP value = 0.446), length of hospitalization (SHAP value = 0.406) and log (qHBV DNA) (SHAP value = 0.206) were the top three independent risk factors for IFI. Furthermore, interaction analysis revealed no multiplicative effects between the use of antibiotics and the use of glucocorticoids (P = 0.990). IFI is a rare complication that leads to high mortality in hospitalized ACHBLF patients, and a high neutrophilic granulocyte percentage and length of hospitalization are independent risk factors for the occurrence of IFI.

Predictors of a Favorable Response to Transforaminal Epidural Steroid Injections for Lumbar Radiculopathy in the Elderly

BACKGROUND: The efficacy and its associated predictors of transforaminal epidural steroid injection (TFESI) in elderly patients with lumbar radiculopathy are unknown. OBJECTIVE: The purpose of this retrospective study was to identify the efficacy of TFESI in elderly patients with lumbar radiculopathy and its associated predictors of long-term outcomes. STUDY DESIGN: Retrospective study. SETTING: Interventional pain clinics in West China Hospital of Sichuan University. METHODS: In total, 294 elderly patients who were diagnosed with lumbar radiculopathy and underwent transforaminal epidural steroid injections from January 2019 through January 2022 were retrospectively analyzed. Demographic, clinical, magnetic resonance imaging, and TFESI-related information was collected to assess the predictive factors of long-term outcomes of the TFESI. Pain scores were assessed using the Numeric Rating Scale. Treatment success was defined as a >= 50% reduction in pain scores at 6 months. RESULTS: Multivariate logistic regression analysis revealed that the duration of symptoms, immediate postoperative response, and neutrophilic granulocyte percentage were independently associated with a favorable response to TFESI. In addition, the level of pain at the initial visit and the number of TFESI performed were also associated with a good response in the multivariate regression analysis, even though the association was not statistically significant. LIMITATIONS: Approximately 6% of the patients were lost to follow-up; therefore, selection bias may have slightly influenced our findings. In addition, our patients were not compared with a control population, and consequently, a placebo effect could not be assessed. CONCLUSION: This study revealed that a short duration of symptoms, good immediate postoperative response and high neutrophilic granulocyte percentage were long-term predictors of a good response to TFESI in elderly patients with lumbar radiculopathy. KEY WORDS: Elderly, radiculopathy, epidural injection, predictors, neutrophil

An interpretable machine learning approach for predicting 30-day readmission after stroke

BackgroundStroke is the second leading cause of death worldwide and has a significantly high recurrence rate. We aimed to identify risk factors for stroke recurrence and develop an interpretable machine learning model to predict 30-day readmissions after stroke. MethodsStroke patients deposited in electronic health records (EHRs) in Xuzhou Medical University Hospital between February 1, 2021, and November 30, 2021, were included in the study, and deceased patients were excluded. We extracted 74 features from EHRs, and the top 20 features (chi-2 value) were used to build machine learning models. 80% of the patients were used for pre-training. Subsequently, a 20% holdout dataset was used for verification. The Shapley Additive exPlanations (SHAP) method was used to explore the interpretability of the model. ResultsThe cohort included 6,558 patients, of whom the mean (SD) age was 65 (11) years, 3,926 were males (59.86 %), and 132 (2.01 %) were readmitted within 30 days. The area under the receiver operating characteristic curve (AUROC) for the optimized model was 0.80 (95 % CI 0.68–0.80). We used the SHAP method to identify the top 10 risk factors (i.e., severe carotid artery stenosis, weak, homocysteine, glycosylated hemoglobin, sex, lymphocyte percentage, neutrophilic granulocyte percentage, urine glucose, fresh cerebral infarction, and red blood cell count). The AUROC of a model with the 10 features was 0.80 (95 % CI 0.69–0.80) and was not significantly different from that of the model with 20 risk factors. ConclusionsOur methods not only showed good performance in predicting 30-day readmissions after stroke but also revealed risk factors that provided valuable insights for treatments.

Neutrophilic granulocyte percentage is associated with anxiety in Chinese hospitalized heart failure patients

BackgroundIn patients with heart failure, anxiety disorder is common and associated with adverse prognosis. This study intended to find more confounding factors of Chinese heart failure patients.MethodsWe enrolled 284 hospitalized heart failure patients, whose New York Heart Association (NYHA) classed as II-IV and left ventricular ejection fraction (LVEF) ≤ 45%. All the patients were scaled in Hamilton Rating Scale for Anxiety (14-items) (HAM-A14). Ordinal logistic regression analysis was performed to examine the association of correlated factors with anxiety disorder.ResultsThere were 184 patients had anxiety accounting for 64.8% of all 284 hospitalized heart failure patients. The neutrophilic granulocyte percentage, urea nitrogen, total bilirubin and brain natriuretic peptide were positively associated with HAM-A14 score, meanwhile, the hemoglobin, red blood cells counts, albumin and LVEF were negatively associated with HAM-A14 score (All P < 0.05). After the adjustments of sex, hemoglobin, urea nitrogen, total bilirubin, albumin and brain natriuretic peptide, the neutrophilic granulocyte percentage was significantly associated with anxiety (OR = 43.265, P = 0.012). The neutrophilic granulocyte percentage was 0.616 ± 0.111, 0.640 ± 0.102, 0.681 ± 0.106 and 0.683 ± 0.113 in heart failure patients with no anxiety, possible anxiety, confirmed anxiety and obvious anxiety, respectively.ConclusionsNeutrophilic granulocyte percentage as well as the traditional risk factors such as sex, urea nitrogen and brain natriuretic peptide is associated with anxiety in hospitalized heart failure patients.

Immunological risk factors for sepsis-associated delirium and mortality in ICU patients.

BackgroundA major challenge in intervention of critical patients, especially sepsis-associated delirium (SAD) intervention, is the lack of predictive risk factors. As sepsis and SAD are heavily entangled with inflammatory and immunological processes, to identify the risk factors of SAD and mortality in the intensive care unit (ICU) and determine the underlying molecular mechanisms, the peripheral immune profiles of patients in the ICU were characterized.MethodsThis study contains a cohort of 52 critical patients who were admitted to the ICU of the First Affiliated Hospital of Jinan University. Comorbidity, including sepsis and SAD, of this cohort was diagnosed and recorded. Furthermore, peripheral blood samples were collected on days 1, 3, and 5 of admission for peripheral immune profiling with blood routine examination, flow cytometry, ELISA, RNA-seq, and qPCR.ResultsThe patients with SAD had higher mortality during ICU admission and within 28 days of discharge. Compared with survivors, nonsurvivors had higher neutrophilic granulocyte percentage, higher CRP concentration, lower monocyte count, lower monocyte percentage, lower C3 complement level, higher CD14loCD16+ monocytes percentage, and higher levels of IL-6 and TNFα. The CD14hiCD16- monocyte percentage manifested favorable prediction values for the occurrence of SAD. Differentially expressed genes between the nonsurvival and survival groups were mainly associated with immune response and metabolism process. The longitudinal expression pattern of SLC2A1 and STIMATE were different between nonsurvivors and survivors, which were validated by qPCR.ConclusionsNonsurvival critical patients have a distinct immune profile when compared with survival patients. CD14hiCD16- monocyte prevalence and expression levels of SLC2A1 and STIMATE may be predictors of SAD and 28-day mortality in ICU patients.

Prediction model for postoperative severe acute lung injury in patients undergoing acute type A aortic dissection surgery.

This study aimed to establish a risk assessment model to predict postoperative severe acute lung injury (ALI) risk in patients with acute type A aortic dissection (ATAAD). Consecutive patients with ATAAD admitted to our hospital were included in this retrospective assessment and placed in the postoperative severe ALI and nonsevere ALI groups based on the presence or absence of ALI within 72 h postoperatively (oxygen index [OI] ≤ 100 mmHg). Patients were then randomly divided into training and validation groups in a ratio of 8:2. Univariate and multivariate stepwise forward logistic regression analyses were used to statistically assess data and establish the prediction model. The prediction model's effectiveness was evaluated via 10-fold cross-validation of the validation group to facilitate the construction of a nomogram. After the screening, 479 patients were included in the study: 132 (27.6%) in the postoperative severe ALI group and 347 (72.4%) in the postoperative nonsevere ALI group. Based on multivariate logistics regression analyses, the following variables were included in the model: coronary heart disease, cardiopulmonary bypass (CPB) ≥ 257.5 min, left atrium diameter ≥ 35.5 mm, hemoglobin ≤ 139.5 g/L, preCPB OI ≤ 100 mmHg, intensive care unit OI ≤ 100 mmHg, left ventricular posterior wall thickness ≥ 10.5 mm, and neutrophilic granulocyte percentage ≥ 0.824. The area under the receiver operating characteristic (ROC) curve of the modeling group was 0.805 and differences between observed and predicted values were not deemed statistically significant via the Hosmer-Lemeshow test (χ2 = 6.037, df = 8, p = .643). For the validation group, the area under the ROC curve was 0.778, and observed and predicted value differences were insignificant when assessed using the Hosmer-Lemeshow test (χ2 = 3.3782, df = 7; p = .848). The average 10-fold cross-validation score was 0.756. This study established a prediction model and developed a nomogram to determine the risk of postoperative severe ALI after ATAAD. Variables used in the model were easy to obtain clinically and the effectiveness of the model was good.

Association between Neutrophilic Granulocyte Percentage and Diabetes Mellitus in Cushing's Syndrome Patients: A Cross-Sectional Study.

Background Glucose metabolism is frequently impaired in patients with Cushing's syndrome (CS) due to chronic exposure to excess glucocorticoids. Inflammation plays an essential role in the pathophysiology of diabetes mellitus (DM). The present study aimed to investigate the potential associations of inflammatory blood cell parameters, including white blood cell (WBC) count, neutrophil count, neutrophilic granulocyte percentage (NEUT%), lymphocyte count (LYM), and lymphocyte proportion (LYM%), with diabetes mellitus in Cushing's syndrome patients. Materials and Methods The cross-sectional study was conducted in Zhongshan Hospital of Fudan University, China. A total of 150 patients with Cushing's syndrome were retrospectively screened from 2017 to 2019. The demographic data, clinical data, and blood samples (lipids, adrenal, glucose, and inflammatory blood cell parameters) were recorded. Statistical analyses were carried out by using the SPSS software package, version 13.0. Results In this study, the prevalence of diabetes mellitus was 38.7% in patients with Cushing's syndrome. Patients with DM had higher WBC, neutrophil, NEUT% levels than patients without DM (p < 0.05). As the NEUT% increased, a stepwise increase in glucose and glycated hemoglobin (HbA1c) level was observed. In addition, in the multivariate logistic regression, NEUT% was a significant independent risk factor for DM, regardless of gender, age, body mass index (BMI), and triglyceride and 12 midnight cortisol (12 MN cortisol) level (OR = 2.542, 95% CI 1.337–4.835, p < 0.001). Conclusions In conclusion, elevated NEUT% level was linked to diabetes in patients with Cushing's syndrome. The neutrophilic granulocyte percentage may be referred to as a new predictor for diabetes in Cushing's syndrome patients.

Systematic Safety Evaluation of Cold Plasma-Activated Liquid in Rabbits

Plasma-activated liquid (PAL) can effectively and selectively kill various types of cancer cells both in superficial and deeper tumors. As a promising novel approach to oncotherapy, the safety of PAL is essential in the clinic but has not been thoroughly assessed. In myeloma and blood tumors, the pathogenesis is in the bone marrow cavity. We have therefore evaluated the safety of PAL in New Zealand rabbits by intra-bone marrow injection, and provide a basis of further clinical research and application of PALs. In this study, both a plasma jet and plasma surface were used to treat saline solution, phosphate-buffered solution, and cell culture medium, to produce PAL. Then, oscillograms and optical emission spectra were evaluated to characterize the plasma discharge. Acute toxicity tests and safety evaluation studies were conducted by intra-bone marrow injection of PAL into New Zealand rabbits, while control rabbits received saline only. Body weight, vital organ coefficient, organ appearance, organ histopathology, blood cell and hemoglobin parameters, and blood biochemical indicators were tested on the 30th day after injection. We found that there was no mortality or loss of mobility throughout the experimental period. Acute toxicity tests showed that there were no PAL-related side effects in rabbits receiving the maximum dose of 700 μL PAL. PAL treatments did not affect body weight, organ coefficient, organ appearance, organ histopathology, or blood biochemical indicators. However, the percentage of lymphocytes decreased while the percentage of neutrophil granulocytes increased compared with the control group. In summary, our results indicate that PAL can be safely injected into bone marrow of New Zealand rabbits without significant toxicity.

Prevalence of Cardiovascular Events and Their Risk Factors in Patients With Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Overlap Syndrome.

Rationale: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) have been identified as independent risk factors for cardiovascular diseases. However, the impact of COPD and OSA overlap syndrome (OS) on cardiovascular outcomes remains to be elucidated.Objective: To determine the prevalence of cardiovascular events and their risk factors in OS patients.Methods: Seventy-four patients who had OS between January 2015 and July 2020 were retrospectively enrolled, and 222 COPD-only patients and 222 OSA-only patients were pair-matched for age and sex from the same period and served as the OS-free control group. The prevalence rates of coronary heart disease (CHD), arrhythmia, heart failure, and pulmonary arterial hypertension (PAH) were compared among the three groups, and multivariable logistic regression models were used to screen the risk factors for specific cardiovascular events.Results: OS patients had higher prevalence rates of heart failure (10.8 vs. 0.5 and 1.4%, respectively) and PAH (31.1 vs. 4.5 and 17.1%, respectively) than those with OSA alone or COPD alone (all P < 0.01). The CHD prevalence was also significantly higher in the OS group than in the COPD-alone group (25.7 vs. 11.7%, P < 0.01). There was no significant difference in the prevalence of arrhythmia among the three groups (20.3, 22.5, and 13.1%, respectively, P > 0.05). In OS patients, risk factors for CHD included hypertension, diabetes, body mass index, lactate dehydrogenase level, and tidal volume; risk factors for heart failure included diabetes, partial pressure of oxygen, partial pressure of carbon dioxide, maximum ventilatory volume, and neutrophilic granulocyte percentage; and risk factors for PAH included minimum nocturnal oxygen saturation, partial pressure of carbon dioxide, and brain natriuretic peptide and lactate dehydrogenase levels.Conclusions: OS patients have a higher prevalence of cardiovascular events, which is associated with hypoxemia, hypercapnia, and impaired lung function in these patients.

Population-Based Study of the Clinical Characteristics and Risk Factors of Ischemic Colitis.

Ischemic colitis (IC) is a common ischemic disorder of the colon caused by insufficient blood supply to the colonic mucosa. This study aimed to identify the clinical characteristics, comorbidities, and risk factors in patients with IC. We performed a retrospective population-based study using electron video-colonoscopy imaging and pathological biopsies from 168 patients diagnosed with IC. A retrospective controlled study was used to analyze differences between a young to middle-aged patient group (78 cases) and an elderly patient group (90 cases) on the basis of clinical characteristics and risk factors. The primary symptoms in the 168 patients with IC were abdominal pain, diarrhea, and hematochezia. White blood cells (WBC), neutrophilic granulocyte percentage (NEUT%), C-reactive protein (CRP), and D-dimer were significantly elevated in elderly patients. The sigmoid colon and descending colon were the most common lesion locations (57.1% and 33.9%, respectively). Hypertension, cerebral infarction, and coronary heart disease were the most common comorbidities in elderly patients, while smoking history was the most common risk factor in young to middle-aged patients. The sigmoid colon and descending colon are the most affected locations in IC. Hypertension, diabetes mellitus, and cerebral infarction are the most common risk factors and comorbidities.

MO639THE ASSOCICATION BETWEEN SERUM INTERLEUKIN 1 BETA AND HEPARAN SULFATE IN DIABETIC NEPHROPATHY PATIENTS

Abstract Background and Aims The global diabetes mellitus (DM) prevalence in 2019 is estimated to be 9.3%. Approximately 20% to 40% of patients with DM develop diabetic nephropathy (DN). DN is the leading cause of end stage renal disease (ESRD). Inflammation is considered to be an important mechanism in the development of DM and persists for a long time before the occurrence of DN. Many studies demonstrated that decrease of endothelium glycocalyx (EG) was negatively correlated with proteinuria. Whether EG damage induced by inflammasome in DM patients leads to the occurrence of micro albuminuria (MA) and accelerating the progress of DKD is rarely studied. Method: This prospective, observational cohort study screened 300 diagnosed diabetic patients from departments of nephrology and endocrinology of our hospital. The exclusion criteria were: type 1 diabetes; acute infections; usage antibiotics within 3 months; kidney disease before; heart failure; malignancy. Finally 70 patients were invited to this study and were divided into type 2 DM (T2DM) group and type 2 diabetic nephropathy (T2DN) group. T2DM group were defined as patients with normal MA and without diabetic retinopathy (n=35). T2DN group were defined as patients with increased MA and diabetic retinopathy (n=35). Laboratory data were measured via routine laboratory methods. Heparan sulfate (HS) and interleukin 1 beta (IL-1β) were noted as EG biomarker and inflammasome biomarker respectively. Serum samples of patients were collected, and serum IL-1β and HS were measured by ELISA. SPSS 18.0 was used for all statistical analyses. Results: T2DN patients had higher serum IL-1β (27.85 vs. 21.35 pg/ml), higher HS (2.17 vs. 1.47 ng/ml), higher urea nitrogen (6.30 vs. 5.33 umol/L), higher CRP (2.03 vs. 0.81 mg/L), higher hemoglobin (128 vs. 141 g/L), higher neutrophil (4.1 vs. 3.4 × 109/L) and higher neutrophilic granulocyte percentage (63% vs. 56%) compared with T2DM patients (all P&amp;lt;0.05). Logistic regression analyses demonstrated serum HS was independently associated with T2DN. Furthermore in T2DN patients, serum IL-1β was positively correlated with HS (r = 0.6, P&amp;lt;0.01) and was and independent associated factor. The relationship of HS and IL-1β was not significant in T2DM patients. Conclusion T2DN patients had higher serum IL-1β and HS than T2DM patients in our study. In T2DN patients IL-1β was an independent associated factor of HS. The results suggested that the inflammasome may damage the EG in diabetic patients, which induced the occurrence of MA and accelerating the progress of DN.

Evaluation of different point-of-care tests to characterize the vaginal discharge of sows after parturition and parameters\u2019 correlation with subsequent reproductive performance

The lochia is the physiological uterine discharge post-partum, whereas abnormal fluids are often indicators of puerperal disorders in sows, which negatively influence the further reproductive performance. The aim of the study was to characterize the vaginal discharge in sows employing simple and feasible tests and to correlate the evaluated parameters with the subsequent reproductive performance of these sows. The birth process of 48 clinically healthy free farrowing sows was monitored and several parameters characterizing the vaginal discharge such as total amount, colour, amount of cells (somatic cell count) and cell characteristics (cytology) were collected daily from first to fifth day after parturition. Finally, the reproductive performance of the following gestation was evaluated and compared to the characteristics of the lochia. The amount of vaginal discharge was significantly increased on the second (p < 0.01), third (p = 0.019) and fourth (p = 0.011) day post-partum compared to day one. Furthermore, a decrease in the percentage of neutrophilic granulocytes from day one to three (p = 0.038), four (p = 0.038) and five (p = 0.048) post-partum was observed. The percentage of neutrophilic granulocytes in the yellowish vaginal discharge was increased compared to whitish (p = 0.02) or clear (p = 0.027) vaginal discharge. In addition, obstetrics (p = 0.003) and an increased farrowing duration (p = 0.017) significantly increased the amount of vaginal discharge. Sows with a high amount of vaginal discharge had a significant higher body temperature than sows with no (p = 0.014) or low amount (p < 0.01) of vaginal discharge. No correlation was detected between the evaluated parameters of the lochia and the subsequent reproductive performance. It is hypothesised that the amount of vaginal discharge alone is not a predictor for the performance of sows during their next gestation. However, it might serve as indicator for acute endometritis. In summary, the different parameters of the vaginal discharge determined by means of point-of-care tests might be useful to strengthen a presumptive diagnose of endometritis in sows during the first five days after parturition.

HAEMATOLOGICAL PARAMETERS AND C-REACTIVE PROTEIN IN PREDICTION OF DISEASE SEVERITY AND MORTALITY IN PATIENTS WITH SEPSIS

Sepsis is a life-threatening condition characterized by a systemic inflammatory response of the body caused by a severe infection. The aim of this study was to examine the importance of hematological parameters and c-reactive protein (CRP) in the diagnosis of sepsis, assessment of disease severity, and prediction of final outcome of these patients. The prospective study included 106 hospitalized patients with a clinical diagnosis of sepsis. Haematological parameters and CRP correlated with sepsis stage, and using ROC (Receiver operating characteristic) analysis were evaluated in the prediction of the final outcome of these patients. Among haematological parameters, patients with sepsis had a significantly higher proportion of total unsegmented neutrophil granulocytes, a lower percentage of lymphocytes, as well as a lower total platelet count (p&lt;0.05 for all measurements). An excellent positive correlation was found between serum CRP concentration and disease stage (r=0.77). The best predictive value for the presence of sepsis was shown by CRP at the cut- off value of 165 mg/L (AUC 0.98), followed by the percentage of unsegmented neutrophil granulocytes for the cut-off value of 15.5 (AUC 0.67), and the percentage of lymphocytes less than 9.9 (AUC 0.66), platelets lower than 118x109/L (AUC 0.63). At the CRP cut-off value of 294.7 mg/L (AUC 0.84; 95% CI 0.74-0.93), death could be predicted in 80.95% of patients with sepsis, with the sensitivity of 43.75% and the specificity of 89.71% (p&lt;0.0001). By monitoring changes in haematological parameters and CRP concentration in combination with other clinical and laboratory indicators, disease severity and final outcome in patients with sepsis can be predicted. Key words: CRP, lymphocytes, platelets, SIRS, sepsis

Factors affecting the length of hospital stay after laparoscopic appendectomy: A single center study.

AimThis study aimed to explore factors may affect the length of hospital stay after laparoscopic appendectomy.MethodsThe data of 636 patients undergoing laparoscopic appendectomy between July 2016 and July 2019 in Beijing Tsinghua Changgung Hospital were retrospectively analyzed. The patients were divided into group A (hospital stay ≤3 days, 348 patients) and group B (hospital stay >3 days, 288 patients) according to their hospital stay.Sex, age, disease onset time(time from onset to admission), nausea, vomiting, diarrhea, peritonitis, comorbidities, and history of appendicitis; preoperative body temperature (T), white blood cell (WBC) count, percentage of neutrophilic granulocytes, and preoperative C-reactive protein (CRP) level; time from diagnosis to surgery. appendix diameter, appendicolith, and ascites in ultrasound or CT; surgical time(the surgery start time was the time of skin incision, and the end time was the time the anesthesia intubation was removed), intraoperative blood loss (the volume of blood infiltrating into a gauze was calculated by weighing the gauze infiltrated with water and calculating the volume of water), intraoperative adhesions or effusions, and stump closure methods, convert to open appendectomy, appendix pathology(perforated or gangrenous appendicitis were defined as complicated appendicitis and simple or suppurative appendicitis were defined as uncomplicated appendicitis) and antibiotic treatment schemes were analyzed.ResultsSignificant differences were detected between group A and group B in age (37.10 ± 13.52y vs 42.94 ± 15.57y, P<0.01), disease onset time (21.36 ± 16.56 h vs 32.52 ± 27.99 h, P <0.01), time from diagnosis to surgery (8.63 ± 7.29 h vs 10.70 ± 8.47 h, P<0.01); surgical time(64.09 ± 17.24 min vs 86.19 ± 39.96 min, P < 0.01); peritonitis(52.9% vs 74%, P < 0.01), comorbidities (12.4% vs 20.5%, P < 0.01), appendicolith (27.6% vs 41.7%, P < 0.01), ascites before the surgery(13.8% vs 22.9%, P < 0.01), intraoperative adhesions or effusions(56% vs 80.2%, P < 0.01); preoperative temperature (37.11 ± 0.64°C vs 37.54 ± 0.90°C, P < 0.01); preoperative WBC count (13.06 ± 3.39 × 109/L vs 14.21 ± 4.54 × 109/L, P = 0.04);preoperative CRP level(18.99 ± 31.72 mg/L vs 32.46 ± 46.68 mg/L, P < 0.01); appendix diameter(10.22 ± 2.59 mm vs 11.26 ± 3.23 mm, P < 0.01); intraoperative blood loss (9.36 ± 7.29 mL vs 13.74 ± 13.49 mL, P < 0.01); using Hem-o-lok for stump closure(30.7% vs 38.5%, P = 0.04); complicated appendicitis (9.5% vs 45.8%, P < 0.01); and using ertapenem for antibiotic treatment after the surgery(4.3% vs 21.5%, P < 0.01). Multivariate analysis demonstrated that age (OR = 1.021; 95%CI = 1.007–1.036), peritonitis (OR = 1.603; 95% CI = 1.062–2.419), preoperative WBC count (OR = 1.084; 95% CI = 1.025–1.046), preoperative CRP level (OR = 1.010; 95% CI = 1.005–1.015), time from diagnosis to surgery (OR = 1.043; 95% CI = 1.015–1.072), appendicolith (OR = 1.852; 95% CI = 1.222–2.807), complicated appendicitis (OR = 3.536; 95% CI = 2.132–5.863), surgical time (OR = 1.025; 95% CI = 1.016–1.034), use of Hem-o-lok for stump closure (OR = 1.894; 95% CI = 1.257–2.852), and use of ertapenem for antibiotic treatment (OR = 3.076; 95% CI = 1.483–6.378) were the risk factors for a prolonged hospital stay.ConclusionsThe patient with appendicitis was older and had peritonitis, higher preoperative WBC count or CRP level, longer time from diagnosis to surgery, appendicolith, and complicated appendicitis, predicting a prolonged hospital stay. Shorter surgical time and the use of silk ligation for stump closure and cephalosporins + metronidazole for antibiotic treatment might be better choices to obtain a shorter hospital stay.

Diagnostic value of heart-type fatty acid-binding protein combined with echocardiography in sepsis with cardiac insufficiency

To observe the value of heart-type fatty acid-binding protein (H-FABP) and echocardiographic indexes in the diagnosis of cardiac insufficiency in sepsis. A prospective observational study was conducted. Eighty patients with sepsis admitted to the department of critical care medicine of the First Affiliated Hospital of Medical College of Shihezi University from October 2016 to January 2018 were enrolled. General clinical data such as gender, age, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA) score, hospitalization time and 28-day mortality were recorded. Echocardiographic indexes at 1, 3, 7, 10 days after diagnosis, and white blood cell (WBC), neutrophilic granulocyte percentage (N%), N-terminal pro-brain natriuretic peptide (NT-proBNP), serum H-FABP level were recorded. Sepsis patients were divided into normal cardiac function group (n = 30) and cardiac insufficiency group (n = 50) according to cardiac function, the differences of echocardiographic indexes and cardiac markers between the two groups at different time points were compared. Logistic regression was used to screen out cardiac ultrasound indexes and cardiac markers that affect the occurrence of cardiac dysfunction in sepsis patients, and then receiver operating characteristic (ROC) curve analysis was performed. Comparing the general data of the two groups, only the SOFA score of the cardiac insufficiency group was significantly higher than that of the normal cardiac function group (6.12±4.09 vs. 4.57±2.45, P < 0.05). N% and H-FABP in cardiac insufficiency group were higher than those in normal cardiac function group at the same time (N%: F = 6.973, P = 0.010; H-FABP: F = 17.303, P = 0.000). Without considering the time factor, there were significant differences in left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), stroke volume (SV), cardiac output (CO), left ventricular fractional shortening (LVFS), E-point of septal separation (EPSS), isovolumic relaxation time (IVRT), E peak deceleration time (EDT), A peak duration (Ad), left ventricular systolic pulmonary vein velocity (S), blood flow velocity of pulmonary vein in early left ventricular diastolic period (D), tricuspid orifice early diastolic blood flow velocity (E'), tricuspid orifice late diastolic blood flow velocity (A'), systolic velocities of the right ventricular free wall tricuspid annulus (Sm), and pulmonary valve annulus blood flow velocity (PVBV) between the two groups. ROC curve analysis of cardiac ultrasound indicators and cardiac markers screened by Logistic regression showed that the area under ROC curve (AUC) and the positive and negative predictive values were: LVEDV was 0.636, 77.30%, 56.03%; SV was 0.779, 88.82%, 71.19%; LVEF was 0.753, 92.12%, 55.21%; CO was 0.754, 88.82%, 77.19%; LVFS was 0.728, 81.25%, 66.99%; EPSS was 0.663, 96.99%, 51.56%; IVRT was 0.775, 86.97%, 73.55%; A' was 0.908, 96.58%, 89.60%; Sm was 0.738, 93.37%, 56.77%; H-FABP was 0.673, 80.26%, 57.25%, respectively. H-FABP was tested in parallel with LVEDV, SV, LVEF, CO, LVFS, EPSS, IVRT, A', Sm, and the positive predictive values were higher than the single diagnostic test (85.45%, 93.91%, 96.72%, 94.74%, 89.43%, 98.00%, 92.00%, 99.42%, 93.60%, respectively), the negative predictive values were lower than the single diagnostic test (50.89%, 57.93%, 49.15%, 58.18%, 57.05%, 45.74%, 57.92%, 64.13%, 47.78%, respectively). Cardiac ultrasound indicators LVEDV, SV, LVEF, CO, LVFS, EPSS, IVRT, A', and Sm combined with H-FABP are of certain value in the diagnosis of sepsis-associated heart dysfunction.

Hematological parameters in children with severe acute respiratory syndrome coronavirus 2 infection

Introduction. Recently, there has been a need to use more readily available parameters to assess the severe acute respiratory syndrome coronavirus 2 infection in children. Material and Methods. A single-center retrospective study included 30 children with severe acute respiratory syndrome coronavirus 2 infection who were admitted to the Isolation Department of the Institute for Child and Youth Health Care of Vojvodina from April to September 2020. A complete blood count with differential was performed. Additionally, systemic inflammatory index, neutrophil-lymphocyte ratio and plateletlymphocyte ratio were calculated. For comparison, age- and sex-matched 30 children negative for severe acute respiratory syndrome coronavirus 2 were included in the study. Results. In the period from April to September 2020, 30 laboratory-confirmed cases of coronavirus-19, aged 0 - 17 years, were admitted to the Institute for Child and Youth Health Care of Vojvodina. The age was not a risk factor for the development of coronavirus-19 (p = 0.707; OR: 1.018; 95% CI: 0.927 - 1.119). The comparison of hematological parameters of severe acute respiratory syndrome coronavirus 2 status showed that hemoglobin concentration (p &lt; 0.01) and hematocrit (p &lt; 0.01) were lower, and the percentage of neutrophil granulocytes (p &lt; 0.05) was higher among severe acute respiratory syndrome coronavirus 2 positive children. Furthermore, it was found that some severe acute respiratory syndrome coronavirus 2 positive children had a higher (p &lt; 0.01), while others had a lower (p &lt; 0.01) percentage of lymphocytes. The systemic inflammatory index, the ratio of neutrophils to lymphocytes, and the ratio of platelets to lymphocytes, were not found to be statistically significantly different (p &gt; 0.05). Conclusion. Low hemoglobin and hematocrit levels, a high percentage of neutrophil granulocytes, and a non-physiological percentage of lymphocytes (both, low and high) may have a diagnostic significance in children with severe acute respiratory syndrome coronavirus 2 infection.

Correlational analysis between neutrophil granulocyte levels and osteonecrosis of the femoral head

BackgroundThe correlation between peripheral blood neutrophil level and osteonecrosis of the femoral head (ONFH) has not been extensively studied. Thus, we aimed to investigate the correlation between neutrophil level in the peripheral blood (neutrophil granulocyte) and ONFH.MethodsA total of 984 cases of ONFH and femoral neck fractures (non-ONFH) diagnosed at the Department of Orthopedics at our institution between January 1, 2011 and December 31, 2016 were retrospectively reviewed. The ONFH and non-ONFH groups comprised 488 and 496 cases, respectively. Basic information and peripheral blood cell levels of the two groups were compared.ResultsThe patients’ mean age was 59.89 ± 17.06 years (range: 38–82 years). There were 457 male and 527 female patients, with a male-to-female ratio of 1:1.15. We found that neutrophil granulocyte levels and percentage of neutrophil granulocytes were significantly different between the ONFH and non-ONFH groups. Multimodal regression analysis showed that the percentage of neutrophil granulocytes was an independent protective factor against ONFH.ConclusionsThe factors influencing ONFH are neutrophil granulocyte levels and percentage of neutrophil granulocytes. Percentage of neutrophil granulocytes has a significant correlation with aseptic femoral head necrosis, providing a new perspective and direction for further study of femoral head necrosis.

Pituitary Stalk Thickening in a Large Cohort: Toward More Accurate Predictors of Pituitary Dysfunction and Etiology

Objective: To summarize the characteristics of patients with pituitary stalk thickening, analyze the association between pituitary stalk width and hypopituitarism, and develop a diagnostic model to differentiate neoplastic and inflammatory origins. Methods: A total of 325 patients with pituitary stalk thickening in a tertiary teaching hospital between January 2012 and February 2018 were enrolled. Basic characteristics and hormonal status were evaluated. Indicators to predict etiology in patients with histologic diagnoses were analyzed. Results: Of the 325 patients, 62.5% were female. Deficiency in gonadotropin was most common, followed by corticotropin, growth hormone, and thyrotropin. The increase in pituitary stalk width was associated with a risk of central diabetes insipidus (odds ratio [OR], 3.57; P<.001) and with a combination of central diabetes insipidus and anterior pituitary deficiency (OR, 2.28; P = .029). The cut-off pituitary stalk width of 4.75 mm had a sensitivity of 69.2% and a specificity of 71.4% for the presence of central diabetes insipidus together with anterior pituitary deficiency. Six indicators (central diabetes insipidus, pattern of pituitary stalk thickening, pituitary stalk width, neutrophilic granulocyte percentage, serum sodium level, and gender) were used to develop a model having an accuracy of 95.7% to differentiate neoplastic from inflammatory causes. Conclusion: Pituitary stalk width could indicate the presence of anterior pituitary dysfunction, especially in central diabetes insipidus patients. With the use of a diagnostic model, the neoplastic and inflammatory causes of pituitary stalk thickening could be preliminarily differentiated. Abbreviations: APD = anterior pituitary dysfunction; AUC = area under the curve; CDI = central diabetes insipidus; GH = growth hormone; MRI = magnetic resonance imaging; OR = odd ratio; PHBS = posterior hypophyseal bright spots; PST = pituitary stalk thickening; PSW = pituitary stalk width.

The Value of COX-2, NF-κB, and Blood Routine Indexes in the Prognosis of Malignant Peritoneal Mesothelioma

Background/Aims: To investigate differences in blood routine indexes and the expression of cyclooxygenase-2 (COX-2) and nuclear factor-kappa B (NF-κB) in malignant peritoneal mesothelioma (MPeM) and their relationship with clinical prognosis. Methods: We investigated changes in blood routine indexes between the MPeM patients and healthy subjects and detected the expression of COX-2 and NF-κB in peritoneal tissues by a streptavidin-peroxidase immunohistochemistry method. Potential prognostic factors were analyzed including age, gender, white blood cell count (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute platelet count (APC), absolute monocyte count (AMC), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), COX-2, and NF-κB. Cox regression model analysis established independent factors for the survival prognosis of the patients. Results: Compared with the control group, AMC, MXD%, ANC, neutrophilic granulocyte percentage (NEUT%), APC, NLR, MLR, and PLR were markedly increased (p < 0.05) in the MPeM group. The positivity rates for COX-2 and NF-κB expression were 59.4 and 44.9%, respectively. Single factor analyses indicated that PLR, NLR, MLR, COX-2, and NF-κB were factors that affected the overall survival of MPeM patients, but multivariate analyses identified MLR and COX-2 as independent prognostic factors. Conclusions: High blood levels of MLR and COX-2 are adverse prognostic factors for patients with MPeM.