Predictors Of Infectious Complications Research Articles

Neutrophil to lymphocyte ratio in predicting complications and prognosisin patients with acute cholangitis

Introduction: Acute cholangitis belongs to urgent conditions in surgery, which are accompanied by high mortality and require clear diagnosis and immediate treatment. One of these biomarkers is the neutrophil-lymphocyte ratio (NLR), but the insufficient number of studies does not allow judging its value as a marker of infectious complications in hepatobiliary surgery.Aim of the study: to determine the predictive value of the neutrophil-leukocyte ratio as a predictor of infectious complications after hepatobiliary surgery.Methods: We evaluated 229 patients with acute cholangitis who underwent biliary drainage. The severity of acute cholangitis was graded according to the Tokyo 2018 guideline. Patients were dichotomized according to the acute cholangitis severity (mild/moderate vs. severe), and blood culture positivity. The baseline NLR, white blood cell (WBC) count, and C-reactive protein (CRP) levels were compared between groups.Results: Of the 229 acute cholangitis patients analyzed, 83 (36.3%) had mild, 111 (48.5%) had moderate, and 35 (15.2%) had severe acute cholangitis. Positive blood culture (n = 114) was more frequently observed in the severe acute cholangitis group than the mild/moderate cholangitis group (83% vs. 43%, p < 0.001). The NLR was significantly higher in patients with severe cholangitis, shock, and positive blood culture. Conclusion: The neutrophil-lymphocyte ratio is a reliable predictor in predicting the risk of developing infectious complications in acute cholangitis. The high predictive value of CRP and PCT, as well as high availability and low cost of performing a clinical blood test, make NLR a more promising test in clinical practice.

Neutrophil to lymphocyte ratio in predicting complications and prognosis in patients with acute cholangitis

Introduction: Acute cholangitis belongs to urgent conditions in surgery, which are accompanied by high mortality and require clear diagnosis and immediate treatment. One of these biomarkers is the neutrophil-lymphocyte ratio (NLR), but the insufficient number of studies does not allow judging its value as a marker of infectious complications in hepatobiliary surgery.Aim of the study: to determine the predictive value of the neutrophil-leukocyte ratio as a predictor of infectious complications after hepatobiliary surgery.Methods: We evaluated 229 patients with acute cholangitis who underwent biliary drainage. The severity of acute cholangitis was graded according to the Tokyo 2018 guideline. Patients were dichotomized according to the acute cholangitis severity (mild/moderate vs. severe), and blood culture positivity. The baseline NLR, white blood cell (WBC) count, and C-reactive protein (CRP) levels were compared between groups.Results: Of the 229 acute cholangitis patients analyzed, 83 (36.3%) had mild, 111 (48.5%) had moderate, and 35 (15.2%) had severe acute cholangitis. Positive blood culture (n = 114) was more frequently observed in the severe acute cholangitis group than the mild/moderate cholangitis group (83% vs. 43%, p < 0.001). The NLR was significantly higher in patients with severe cholangitis, shock, and positive blood culture. Conclusion: The neutrophil-lymphocyte ratio is a reliable predictor in predicting the risk of developing infectious complications in acute cholangitis. The high predictive value of CRP and PCT, as well as high availability and low cost of performing a clinical blood test, make NLR a more promising test in clinical practice.

Neutrophil to lymphocyte ratio in predicting postoperative complications and prognosis in patients with colorectal cancer.

<br><b>Introduction:</b> Biological markers of inflammation are among the main tools for predicting the risk of developing postoperative infectious complications at the preclinical stage. One of these biomarkers is the neutrophil-lymphocyte ratio (NLR), but the insufficient number of studies does not allow judging its value as a marker of infectious complications in colorectal surgery.</br><br><b>Aim:</b> Aim of the study to determine the predictive value of the neutrophil-leukocyte ratio as a predictor of infectious complications after colon surgery.</br><br><b>Methods:</b> From September 2018 to December 2021, 234 patients were enrolled in the study after colon surgery. The frequency of infectious complications, the differences in the levels of NLR in patients with and without infectious complications were determined.</br><br><b>Results:</b> One hundred and thirty-seven patients met the criteria of NLR-low, and 97 patients were categorized as NLR-high. The NLR status was significantly correlated with T-stage, perineural invasion, and increased likelihood of complications. Univariate analysis indicated that both low albumin and meeting the criteria for the NLR-high group correlated with an increased occurrence of complications. Multivariate analysis identified NLR-high and low albumin levels as independent predictors for complications.</br><br><b>Conclusion:</b> The neutrophil-lymphocyte ratio is a reliable predictor in predicting the risk of developing infectious complications in colorectal surgery. In addition, low values of this biomarker are a significant criterion for a safe discharge of patients from hospital. The prevalence and availability of this test makes it easily reproducible in clinical practice.</br&gt.

Infectious complications during the initial 225 cases of standard PCNL: A single center experience

Introduction: Percutaneous nephrolithotomy(PCNL) has emerged as the treatment of choice for medium to large urinary stones. Infection is a life threatening complication and is the most common cause of death following PCNL. This study aimed to examine different predictors of infective complications in PCNL. Methods: This retrospective study was done on patients who underwent PCNL between 2016 and 2020 at a tertiary level medical college hospital. Medical records were reviewed for study variables. Results: Two hundred and twenty five cases were included out of which 121 were male. A total of 151 complications were recorded among which 27(17.88%) were major complications. Infectious complications were seen in 67 (29.77%) patients among which 39 cases (17.33%) were febrile urinary tract infections. Urosepsis developed in four patients and one patient died due to urosepsis related complication. Female (p=0.003), Diabetes mellitus (p=0.002), positive urine culture (p=0.0001), stone location (p=0.01), degree of hydronephrosis (p=0.001), duration of surgery (p=0.001), number of access tracts (p=0.0001), and initial 100 cases (p=0.001) were associated with post PCNL infections. Conclusion: Female, Diabetes mellitus, preoperative urine culture positivity, stone location, degree of hydronephrosis, duration of the operation, number of access tracts and surgeon experience are risk factors for post PCNL infections. Surgeons should be extra vigilant during their initial period. Urinary tract infection should be treated and extra care should be taken when operating in female patients giving ample attention to preoperative investigations.

Association Between Serum Albumin and Hospital-Acquired Infections After Aneurysmal Subarachnoid Hemorrhage.

Low serum albumin levels have been identified as a predictor of infectious complications in critically ill patients. However, the association in patients with aneurysmal subarachnoid hemorrhage (aSAH) remains unclear. We aimed to evaluate the prognostic value of hypoalbuminemia using blood samples at admission in patients with aSAH. In a multicenter observational study of patients with aSAH, serum albumin counts were collected on admission. Hypoalbuminemia was defined as a total albumin level < 35g/L. Multivariable logistic regression analyses and propensity score matching were performed to obtain the adjusted odds ratios (ORs) with 95% confidence intervals (CI) for the primary outcome of hospital-acquired infections. A total of 5448 patients were included in the observational cohort study. The odds of hospital-acquired infections were significantly higher in patients with albumin levels 30-34.9g/L (OR 1.62, 95% CI 1.38-1.90), 25-29.9g/L (OR 1.97, 95% CI 1.54-2.51), and < 24.9g/L (OR 2.43, 95% CI 1.53-3.86) compared with patients with albumin level ≥ 35g/L. The odds of hospital-acquired infections with a change in albumin levels from admission to 48-72h later of lower than - 10g/L and - 10 to - 5g/L were 1.67 (95% CI 1.41-1.86) and 1.24 (95% CI 1.05-1.46), respectively, compared with a change in albumin levels of - 5 to 5g/L. In this large study of matched patients with aSAH, hypoalbuminemia at admission was associated with hospital-acquired infections. A decrease in serum albumin levels within 72h of admission was associated with higher hospital-acquired infections.

Modified Frailty Index-5 Score and Post-Operative Infectious Complications in Patients Undergoing Surgery for Intestinal-Cutaneous Fistula: A Nationwide Retrospective Cohort Analysis.

Background: Post-operative infectious complications after repair of intestinal-cutaneous fistulas (ICF) represent a substantial burden and these outcomes vary widely in the literature. We aimed to evaluate the use of the modified frailty index-5 (mFI-5) to account for physiologic reserve to predict infectious complications in patients with ICF undergoing operative repair. Methods: We used the American College of Surgeon National Surgical Quality Improvement Program (ACS-NSQIP) 2006-2017 dataset to include patients who underwent ICF repair. The main outcome measure was 30-day infectious complications (surgical site infection [SSI], sepsis, pneumonia, and urinary tract infection [UTI]). The risk of 30-day post-operative infectious complications was assessed based on mFI-5 score. We performed multivariable logistic regression analyses to evaluate the association between infectious complications and mFI-5. Results: We identified 4,197 patients who underwent an ICF repair. The median age (interquartile range [IQR]) was 57 (46, 67) years, and the majority of patients were female (2,260; 53.9%); white (3,348; 79.8%); and 1,586 (38.3%) were obese. After adjustment for relevant confounders such as baseline patient characteristics, and operative details, mFI-5 was independently associated with infectious complications (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.25-3.21), particularly SSI (OR, 2.16; 95% CI, 1.28-3.63) and pneumonia (OR, 5.31; 95% CI, 2.29-12.35), but not UTI or sepsis. Conclusions: We showed that the mFI-5 is a strong predictor of infectious complications after ICF repair. It can be utilized to account for physiologic reserve, therefore reducing the variability of outcomes reported for ICF repair.

NEUTROPHIL-TO-LYMPHOCYTE RATIO AS AN INFECTIOUS COMPLICATIONS BIOMARKER IN COLORECTAL SURGERY (own data, systematic review and meta-analysis)

BACKGROUND: biological markers of inflammation belong to the main tool for predicting the risk of infectious complications at the preclinical stage. One of such biomarkers is the neutrophil-to-lymphocyte ratio (NLR), but an insufficient number of studies does not allow us to estimate its value as a predictor of infectious complications in colorectal surgery. AIM : to determine the predictive value of NLR as a predictor of infectious complications after colorectal surgery. PATIENTS AND METHODS: from January 2018 to December 2019 192 patients after colorectal surgery were included in the study. The rate of infectious complications, NLR levels differences in patients with and without infectious complications were determined, the area under the curve (AUC), sensitivity, specificity, negative and positive prognostic value of NLR on the 3rd (POD) and the 6th (POD) postoperative days were assessed. A literature search and meta-analysis of the data in accordance with the preferred reporting items for systematic reviews and meta-analyses checklist (PRISMA) were conducted. The information was taken from the Medline electronic database and the E-library, scientific electronic library, among the English and Russian literature without publication date restrictions by the keywords: “neutrophil/lymphocyteratio”, “neutrophil-to-lymphocyte ratio”, “neutrophil lymphocyte ratio”, “neutrophil ratio”, “lymphocyte ratio”, “colorectal”, “colon”, “rectum”. The systematic review included all the studies related to assessing the prognostic value of NLR as a predictor of infectious complications in colorectal surgery. RESULTS: infectious complications were detected in 29 (15.1%) of 192 patients. On the 3rd and the 6th POD, the patients with infectious complications had higher median NLR values than the patients without complications (p=0.0017 for the 3rd POD; p=0.018 for the 6th POD). On the 3rd POD, the area under the curve at the NLR cut-off point 5.13 was 0.644, sensitivity – 69.7%, specificity – 60.7% (p=0.019). On the 6th POD, similar indicators at an NLR cut-off point of 3.94 were 0.75, 75.9% and 70.6%, respectively (p&lt;0,001). Four studies, which included 1,152 observations, were added in the meta-analysis. On the 3th POD, the summarized AUC was 0.671, sensitivity – 86.3%, specificity – 60.3% (p=0.014). The risk of infection with a biomarker above the threshold increased by more than 10 times (OR=10.2; 95% CI: 1.4-72). On the 4th POD, the above indicators were 0.711, 75.4%, 87.5%, respectively (p=0.002). Odds ratio was 51 (95% CI: 20-128). CONCLUSION : the neutrophil-to-lymphocyte ratio is a reliable indicator for predicting the risk of developing infectious complications in colorectal surgery. In addition, the low values of this biomarker are an important criterion for the safe discharge of patients from hospital. The prevalence and availability of this test makes it easily feasible in clinical practice.

Association between cholesterol levels and infections after ischemic stroke

Multiple studies have suggested an immunomodulatory role of cholesterol. We investigated whether cholesterol levels are associated with the risk of infectious complications (ICs) in acute ischemic stroke patients. A single-center prospective cohort was analyzed. Total (TOTc), low-density lipoprotein cholesterol and high-density lipoprotein cholesterol levels were measured within 24h from admission. The outcome of interest was the occurrence of any IC (pneumonia, urinary tract infection, sepsis, other infection) during hospitalization. Predictors of ICs were investigated with multivariable logistic regression. A total of 603 patients were included (median age 78years, 49.3% males), of whom 134 (22.2%) developed an IC. Subjects with ICs had lower TOTc compared with patients without ICs (median 157 vs. 173mg/dL; P<0.001). When TOTc was stratified in quartiles, we observed a linear decrease in the prevalence of ICs with higher TOTc levels (Q1, <144mg/dL, 32.7%; Q2, 145-168mg/dL, 24.7%; Q3, 169-197mg/dL, 17.8%; Q4, >197mg/dL, 13.3% P<0.001). The inverse relationship between TOTc and ICs remained significant after adjustment for confounders in logistic regression [odds ratio (OR) for 10mg/dL increase, 0.92; 95% confidence intervals (CI), 0.87-0.97; P=0.001]. This association was also confirmed for low-density lipoprotein cholesterol (OR, 0.93; 95% CI, 0.88-0.99; P=0.013) and high-density lipoprotein cholesterol (OR, 0.85; 95% CI, 0.73-0.98; P=0.026) and was not mediated by statin treatment. Higher cholesterol levels are independently associated with lower risk of ICs in ischemic stroke patients. Further studies are needed to confirm our findings and characterize the biological mechanisms underlying this association.

The Nasal Microbiome As a Predictor of Infectious Complications after Hematopoietic Cell Transplant Patients

<h3>Introduction</h3> Hematopoietic cell transplantation (HCT) is a potentially curative treatment for a range of malignant and nonmalignant disorders. A common complication of HCT is the mucosal barrier injury that enables commensal microbes to invade underlying tissues and the bloodstream causing infections during the transplant period. Additionally, antibiotic use has a dramatic impact on the respiratory and intestinal microbiome by reducing the density and diversity of commensal flora and thus increasing the risk of acquiring drug resistant pathogens. <h3>Objectives</h3> To distinguish patients at risk of developing infections using nasal microbiome data and to evaluate the relationship of the nasal microbiome and different types of infections in the HCT population at our institution. <h3>Methods</h3> We conducted a prospective observational study. A total of 50 HCT patients were enrolled and blood, nasal washes and clinical data were collected at the preconditioning period (from day -14 of HCT up to 24 hours following initiation of conditioning regimen), every week for 8 weeks and every other week until week 14 post-HCT. Microbiome abundance prior to the infection's onset was analyzed. <h3>Results</h3> Patients were on average 56 years of age (range: 20-73) and the majority were white (n=40, 80%), male (n=34, 68%) and had leukemia (68%). Overall, patients experiencing any kind of infections had a different nasal microbiome than those without. An abundance of Stenotrophomonas in their nasal microbiome was associated with urinary tract infections and respiratory viral infections (FDR-Adj P value=0.009 and 0.004, respectively). Bacterial pneumonia occurred after an increase in Capnocytophaga was seen in the nasal microbiome (FDR-Adj P value=0.009) whereas fungal pneumonia occured after an increase in Pseudomonas, Methylobacterium, Lachnoclostridium, and Lactobacillus (FDR-Adj P value=0.01). Clostridium difficile gut colonization was observed following an increase in Dolosigranulum and Muribaculaceae in the nasal microbiome (FDR-Adj P value<0.0001) whereas Vancomycin-resistant enterococci colonization occurred after an increase in Muribaculaceae, Oblitimonas, Ignatzschineria, Lactobacillus, and Sporosarcina (FDR-Adj P value<0.007) (Figure). <h3>Conclusion</h3> Our findings provide important information on specific operational taxonomic unit abundances in the nasal microbiome and infections. The nasal microbiome could be key to predict infections in HCT recipients and design future interventions to prevent and reduce the morbidity and mortality related to infections in these high risk patients.

PROCALCITONIN IN EARLY PREDICTION OF ACUTE SEVERE PANCREATITIS

The aim of the study was to analyze the prognostic potential of procalcitonin in acute pancreatitis complicated by ascites-peritonitis. Materials and methods: The study analyzed the results of a comprehensive examination and treatment of 18 patients with acute pancreatitis complicated by enzymatic ascites-peritonitis, including 13 patients who were treated in the surgical department of KP "Poltava Regional Clinical Hospital. MV Sklifosovsky POR ", and 5 patients of other emergency hospitals in Poltava, in the period from 2017 to 2019. In addition to standard screening methods, these patients were additionally tested for procalcitonin to predict an adverse course in the early period. Results: To assess the relationship between the presence of elevated procalcitonin levels at the time of hospitalization of 0.5 ng / ml and above and unsatisfactory treatment results, differences were assessed using an accurate Fisher test. When comparing differences in the development of infectious complications in the dynamics of the disease in patients of the study group depending on the presence of elevated concentrations of procalcitonin or its absence at the time of hospitalization, a significant difference was found (p <0.05). Conclusions: In our opinion, the use of procalcitonin as a predictor of infectious complications in the dynamics of the disease will determine the category of patients in whom reducing the risk of flora translocation through the use of early oral antibiotic prophylaxis and parenteral drugs tropic to pancreatic tissue may reduce the incidence of purulent complications. In another category of patients, antibacterial therapy is not advisable due to the low risk of purulent-septic complications.

Massive Transfusion is an Independent Predictor of Infectious Complications in Critically Ill Trauma Patients

Massive Transfusion is an Independent Predictor of Infectious Complications in Critically Ill Trauma Patients

Predictors of complications related to venoarterial extracorporeal membrane oxygenation in adults: A multicenter retrospective cohort study

IntroductionVenoarterial extracorporeal membrane oxygenation (VA-ECMO) is a complex technology associated with risks and complications. ObjectiveTo identify predictors of complications related to VA-ECMO in adults. MethodsA retrospective cohort study, including 63 adult patients undergoing VA-ECMO, performed at two institutions in Brazil, from the time both centers implemented VA-ECMO (1999 in Institution A and 2012 in Institution B) treatment through March of 2018. The association between independent variables (institution, demographic, indications for ECMO, and pre-ECMO clinical characteristics) and the outcomes (neurological, renal, vascular, hemorrhagic, infectious, and mechanical complications) was investigated by means of multiple logistic regressions. ResultsPredictors of neurological complications were refractory cardiogenic shock following cardiotomy (OR = 0.10; 95% CI 0.00–1.01; p = 0.049) and following heart or lung transplant (OR = 0.04; 95% CI 0.00–0.42; p = 0.018). The use of inotropes/vasopressors was a predictor of vascular complications (OR = 7.72; 95% CI 1.83–39.87; p = 0.008). The levels of CK-MB were a predictor of renal complications (OR = 0.87; 95% CI 0.72–0.97; p = 0.046). Predictors of infectious complications were total bilirubin (OR = 0.02; 95% CI 0.00–0.26; p = 0.038) and body weight odds (OR = 1.24; 95% CI 1.08–1.61; p = 0.028). Class III heart failure was a predictor of mechanical complications (OR = 0.07; 95% CI 0.00–0.66; p = 0.034). ConclusionIdentifying predictors of complications may contribute to the indications for VA-ECMO.

Immune function as predictor of infectious complications and clinical outcome in patients undergoing solid organ transplantation (the ImmuneMo:SOT study): a prospective non-interventional observational trial

BackgroundSolid organ transplantation (SOT) is a well-established and life-saving treatment for patients with end-stage organ failure. Organ rejection and infections are among the main complications to SOT and largely determines the clinical outcome. The correct level of immunosuppression is of major importance to prevent these complications. However, it is a consistent observation that in recipients on the same immunosuppressive regimens the clinical outcome varies, and no reliable marker exists to monitor immune function.MethodsIn a prospective, observational study, we plan to enroll 630 adult patients with a planned organ transplantation at Rigshospitalet, University of Copenhagen, Denmark. Prior to and on different time points up to two years after transplantation we will perform a complete immunological profile on the recipients. This profile will consist of classical descriptive immune phenotyping (flow cytometry and circulating biomarkers) and the functional assay TruCulture®. In TruCulture® whole blood is incubated ex vivo with stimulants imitating bacterial, viral and fungal infections, where after a panel of selected cytokines is quantified. Clinical data from electronic health records will be obtained from the PERSIMUNE (Centre of Excellence for Personalized Medicine of Infections Complications in Immune Deficiency at Rigshospitalet, Copenhagen) data repository, a warehouse of data generated as part of routine care including vital signs, biochemistry, microbiology, pathology as well as medication, demographics, diagnoses, hospital contacts, surgical procedures and mortality.DiscussionThis will be the first large scale study to determine several aspects of immune function and perform a complete immunological profiling in SOT recipients. It is expected that knowledge generated will provide information to generate prediction models identifying patients at increased risk of infection and/or rejection. If the study is successful, we will subsequently use the generated prediction models to propose personalized immunosuppressive regimens to be tested in future randomized controlled trials.Trial registrationThis study has been approved by the Regional ethical committee (H-17024315), the Danish Data Protection Agency (RH-2016-47, RH-2015-04, I-Suite 03605) and the Danish National board of Health (3–3013-1060/1). The trial is retrospectively registered at clinicaltrials.gov (NCT03847285) the 20th February 2019.

Serum procalcitonin as a predictor of infectious complications after pancreaticoduodenectomy: review of the literature and our experience.

Procalcitonin (PCT) is an early predictor of bacterial infection. We reviewed the literature and analyzed data on our own patients to assess the value of PCT as a predictor of infectious complications after pancreaticoduodenectomy (PD). The relevant literature published up until November 30, 2018, was reviewed, with no publication date restrictions. Letters to the editor and studies lacking necessary data were excluded. We also reviewed, retrospectively, the medical records of 77 patients who underwent PD between January, 2011 and April, 2016 at our hospital, to evaluate infectious complications and laboratory results on postoperative days (PODs) 1 and 3. Six studies were screened, and four cohort studies on patients undergoing PD were analyzed. One report examined preoperative PCT and C-reactive protein (CRP) levels, whereas the others examined only postoperative PCT and/or CRP levels. All reports demonstrated the usefulness of PCT as a predictor of postoperative infectious complications; however, no report concluded that PCT was a better predictor than CRP, except for the one report that examined preoperative PCT levels. Conversely, our experience demonstrated that the most significant factor predicting infectious complications was PCT on POD 3 (sensitivity, 0.87; specificity, 0.88). Thus, serum PCT could be a predictor of all complications, including infectious complications, after PD, but no advantage over CRP was identified.

Infectious complications in patients with acute leukemia according to the duration of neutropenia

Introduction. Patients with hematological malignancies undergoing chemotherapy (CT) have high incidence of infections which profile is affected by various factors including neutropenia.Objective was to evaluate incidence and type of infections in patients with de novo acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) according to neutropenia duration.Materials and methods. Prospective study (2013–2015) included 110 patients (66 AML, 44 ALL) that received 480 CT cycles throughout 6 month.Results. Neutropenia with median duration of 15 (2–55) days was in 288 (60 %) of CT cycles. Infections occurred in 242 (50 %) of CT cycles and predominated in neutropenic compared to non-neutropenic patients (80 % vs 6 %, p &lt;0.0001). Infections prevailed in patients with AML compared to ALL patients (93 % vs 18 %, p &lt;0.0001) as in patients with neutropenia (96 % vs 45 %, p &lt;0.0001) and without neutropenia (27 % vs 4 %, p = 0.02). Prolongation of neutropenia from 1–7 days to ≥22 days was associated with increase of infections rate from 52 to 96 % (p &lt;0.0001). Incidence of infections in AML patients was high (92–100 %) regardless of neutropenia duration, whereas in ALL patients it increased from 25–33 to 91 % if neutropenia lengthened from 2 weeks to ≥22 days. During neutropenia the probability of fever of unknown origin was 33.9 %, clinically documented infection – 31.3 %, bacteremia – 17.2 %. They predominated in the first 2 weeks of neutropenia. Probability of invasive aspergillosis (IA) increased after 28 days of neutropenia and reached 66 % on the 55th day. First case of IA in patients with ALL was on 28th day of neutropenia whilst in AML patients – 4 (44 %) of 9 occurred more early (6–16 days of neutropenia). Nine (6 %) of 110 patients died, 4 (4 %) of them due to infection.Conclusions. Neutropenia was a predictor of infectious complications in patients with AML and ALL. Correlation between duration of neutropenia and incidence of infections was in patients with ALL, whereas in AML patients the rate of infections was high regardless of neutropenia duration. In patients with neutropenia for 2 weeks the most common types of infection were fever of unknown origin, clinically documented infection and bacteremia whilst IA predominated if neutropenia duration was ≥28 days.

Comparison of C-Reactive Protein and White Blood Cell Count as Predictors of Infectious Complications after Colorectal Surgery: A Single-Center Experience

Comparison of C-Reactive Protein and White Blood Cell Count as Predictors of Infectious Complications after Colorectal Surgery: A Single-Center Experience

Re: Predictors of Infectious Complications After Targeted Prophylaxis for Prostate Needle Biopsy

Re: Predictors of Infectious Complications After Targeted Prophylaxis for Prostate Needle Biopsy

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Jan 2018This Month in Adult Urology Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.09.138AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : Development and validation of objective performance metrics for robot-assisted radical prostatectomy: a pilot study. J Urol2018; 199: 296. Link, Google Scholar 2 : Comparative analysis of partial gland ablation and radical prostatectomy to treat low and intermediate risk prostate cancer: oncologic and functional outcomes. J Urol2018; 199: 140. Link, Google Scholar 3 : Which patients with upper tract urothelial carcinoma can be safely treated with flexible ureteroscopy with holmium:YAG laser photoablation? Long-term results from a high volume institution. J Urol2018; 199: 66. Link, Google Scholar 4 : Surgical and patient reported outcomes of artificial urinary sphincter implantation: a multicenter, prospective, observational study. J Urol2018; 199: 245. Link, Google Scholar 5 : Predictors of infectious complications after targeted prophylaxis for prostate needle biopsy. J Urol2018; 199: 155. Link, Google Scholar 6 : A comprehensive analysis of cribriform morphology on magnetic resonance imaging/ultrasound fusion biopsy correlated with radical prostatectomy specimens. J Urol2018; 199: 106. Link, Google Scholar 7 : Outcomes of single stage phalloplasty by pedicled anterolateral thigh flap versus radial forearm free flap in gender confirming surgery. J Urol2018; 199: 206. Link, Google Scholar 8 : Retroperitoneal lymphadenectomy for high risk, nonmetastatic renal cell carcinoma: an analysis of the ASSURE (ECOG-ACRIN 2805) adjuvant trial. J Urol2018; 199: 53. Link, Google Scholar 9 : Long-term testosterone therapy improves urinary and sexual function, and quality of life in men with hypogonadism: results from a propensity matched subgroup of a controlled registry study. J Urol2018; 199: 257. Link, Google Scholar 10 : Five-year followup results of a prospective, multicenter study of patients with overactive bladder treated with sacral neuromodulation. J Urol2018; 199: 229. Link, Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 199Issue 1January 2018Page: 1-3 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

Analysis of selected pro- and anti-inflammatory cytokines in patients with multiple injuries in the early period after trauma.

IntroductionSevere trauma causes damage to the protective barriers of the organism, and thus activates immunological reaction. Among substances secreted during this process pro-inflammatory cytokines are of high importance.The aim of the studySevere trauma causing multiple injuries is more likely to lead to particularly intensive inflammatory reaction, which can sometimes lead to serious complications, even life-threatening. The aim of the study is to determine those parameters which may serve as predictors of infectious complications and to enable estimation of the patient’s immunological status before the decision to introduce elective procedures.Material and methodsThe study population included patients with multiple trauma treated in the Department of Trauma Surgery of the Medical University of Gdańsk. The severity of injuries was evaluated with commonly used numerical scales (Revised Trauma Score – RTS, Injury Severity Score – ISS, Glasgow Coma Scale – GCS). Blood samples were collected on the first, second, and fifth day after injury. Evaluated parameters: C-reactive protein (CRP), the level of cytokines: IL-8, IL-1β, IL-6, TNF, IL-12p70, and IL-10. Control population: individuals without injury.ResultsEvaluation of IL-6, IL-8, and CRP levels in patients with multiple trauma in the early period after injury (2-3 days) could be considered as a predictor of delayed infection (5-10 days). CRP level, being cheap and commonly accessible, can be used in clinical practice enabling identification of patients at higher risk of infectious complications and introduction of appropriate treatment and prevention. The analysis of the mentioned parameters may contribute to choosing an appropriate management strategy, including “timing” depending on the patient’s biological status.

The Granulocyte-to-Lymphocyte Ratio as a Marker of Surgical Stress and a Predictor of Postoperative Infectious Complications After Gastric Cancer Surgery: An Analysis of Patients Enrolled in a Prospective Randomized Trial.

The granulocyte-to-lymphocyte ratio (GLR) in the blood may be a useful marker of surgical stress (SS) following surgery for cancer. The aim of the present study was to compare the SS by measuring the GLR, and further study the value of the GLR in predicting postoperative infectious complications (ICs). Data from 201 gastric cancer patients at Fujian Medical University Union Hospital who were enrolled in our prospective randomized controlled trial were extracted for this study. Blood samples to perioperatively measure the GLR were routinely taken. Additional external validation was performed using the dataset (n=135) from Nanfang Hospital who were enrolled in the same trial. Patients undergoing either laparoscopic or open resection showed a similar preoperative GLR, as well as similar GLRs, on postoperative days (PODs) 1 and 3. The GLR on POD 5 was lower in the laparoscopic group compared with the open group (p=0.014), and the optimal predictive GLR thresholds of postoperative ICs in both the laparoscopic and open groups were the same on POD 5, i.e. 6.5 and 7.4, respectively. The GLR on POD 5 was identified as an independent factor for postoperative ICs in both the laparoscopic and open groups. Similar results were found in the validation dataset. The GLR status not only correlates with SS but may also be a reliable predictor of ICs for gastric cancer patients after gastrectomy. The ideal GLR thresholds on POD 5 for ICs following laparoscopic and open gastrectomy are 6.5 and 7.4, respectively.