Markers Of Systemic Inflammatory Response Research Articles

The Usefulness of Extended Inflammation Parameters and Systemic Inflammatory Response Markers in the Diagnostics of Autoimmune Hepatitis.

(1) Introduction: Autoimmune hepatitis (AIH) is a chronic disease. A persistent autoimmune reaction in the liver is significantly related to the systemic inflammatory response. Extended Inflammation Parameters (EIP) can be used to assess the activation of immune cells such as activated neutrophils (NEUT-RI and NEUT-GI) and activated lymphocytes (RE-LYMP and AS-LYMP) in the phase of active inflammation. The role of the systemic inflammatory response markers should also be emphasised, especially: NLR, PLR, and RLR, which have recently been widely studied as markers in autoimmune skin diseases or liver diseases. (2) Materials and Methods: The study included 30 patients with AIH and 30 healthy volunteers. The parameters of the EIP group (RE-LYMP, AS-LYMP, NEUT-RI, NEUT-GI), calculated haematological indices Red Blood Cell Distribution Width-to-Platelet Ratio (RPR), Mean Platelet Volume-to-Platelet Ratio (MPR), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Red Blood Cell Distribution Width-to-Lymphocyte Ratio (RLR), and selected blood morphological and biochemical indices were analysed. The aim of the study was to assess the usefulness of the EIP and systemic inflammatory response markers in the diagnostics of AIH. (3) Results: Compared to the controls, the patients with AIH showed significantly higher EIP values: NEUT-RI (48.05 vs. 43.30), NEUT-GI (152.65 vs. 147.40), RE-LYMP (0.07 vs. 0.03), and the inflammatory response markers: MPR (0.05 vs. 0.04), RPR (0.07 vs. 0.05), and NLR (2.81 vs. 1.42. Among the examined markers, EIP has significant diagnostic potential: NEUT-RI (AUC = 0.86), NEUT-GI (AUC = 0.80), and RE-LYMP (AUC = 0.78), and so do calculated haematological indices, i.e., MPR (AUC = 0.75), PLR (AUC = 1.00), and RLR (AUC = 1.00) Moreover, the importance of NEUT-GI (AUC = 0.89), MPR (AUC = 0.93), PLR (AUC = 0.86), RPR (AUC = 0.91), and FIB-4 (AUC = 0.83) in the detection of liver fibrosis in the course of AIH has also been proven. (4) Conclusions: EIP and systemic inflammatory response markers may turn out to be useful in detecting AIH and in looking for features of already developed liver cirrhosis in its course.

Prognostic Value of Serum Procalcitonin Based Model in Moderate to Severe Traumatic Brain Injury Patients.

ObjectiveProcalcitonin (PCT) is an acknowledged marker of systemic inflammatory response. Previous studies have not reached agreement on the association between serum PCT and outcome of traumatic brain injury (TBI) patients. We designed this study to confirm the prognostic value of PCT in isolated TBI and those with extracranial injury, respectively.MethodsPatients hospitalized in our hospital for moderate-to-severe TBI between March 2015 and December 2019 were included. Logistic regression analysis was performed to validate the association between PCT and in-hospital mortality in these patients. AUC (area under the receiver operating characteristics curve) of PCT and constructed model were calculated and compared.ResultsAmong the included 211 patients, 81 patients suffered a poor outcome, with a mortality rate of 38.4%. Non-survivors had a higher level of serum PCT (2.73 vs 0.72, p<0.001) and lower GCS (5 vs 7, p<0.001) on admission than survivors. AUC of single PCT for predicting mortality in isolated TBI and those with extracranial injury were 0.767 and 0.553, respectively. Multivariate logistic regression showed that GCS (OR=0.744, p=0.008), glucose (OR=1.236, p<0.001), cholesterol (OR=0.526, p=0.002), and PCT (OR=1.107, p=0.022) were independently associated with mortality of isolated TBI. The AUC of the prognostic model composed of GCS, glucose, cholesterol, and PCT was 0.868 in isolated TBI.ConclusionPCT is an efficient marker of outcome in isolated moderate-to-severe TBI but not those with extracranial injury. A prognostic model incorporating PCT is useful for clinicians to make early risk stratification for isolated TBI.

Diagnosis of infectious complications in patients with acute pancreatitis

BACKGROUND: Up to 30% of patients with acute pancreatitis suffer from the severe form of the disease, of which 30% of cases are lethal, significantly rising to 80% at the development of infectious complications.&#x0D; AIM: To improve treatment results of patients with acute pancreatitis due to early diagnostics of infectious complications.&#x0D; MATERIALS AND METHODS: Expression of CD64 antigen on neutrophil membrane (DC64 index of neutrophils) was studied using a flow cytometer Cytomics FC500 (Beckman Coulter, USA) using 3-color combination of direct monoclonal antibodies Beckman Coulter: СD14FITC/CD64PE/CD45PC5. Material was whole blood.&#x0D; RESULTS: A direct correlation of moderate strength with the development of sepsis was found for both the procalcitonin value and C-reactive protein concentration at this period of illness. However, no relations of endogenous intoxication markers with the development of infectious complications were found (correlation coefficients less than 0.4). Thus, it should be noted that the difference in the indices of the studied parameters of the CD64 antigen expression in the groups began to increase exactly during the 23rd week of the disease.&#x0D; CONCLUSION: Based on the literature data, we formulated a working hypothesis, which states that the degree of CD64 receptor expression on peripheral blood neutrophils is an early marker of infectious complications of acute pancreatitis. The value of average fluorescence intensity index of molecules CD64 equal to 10 conventional units was accepted as a threshold value with regard to the development of IE, and the value of 15 conventional unitsas a threshold value with regard to sepsis. The study was conducted in a prospective group of 28 patients. In accordance with the provision of the working hypothesis, the patients were divided into 3 groups depending on the level of average fluorescence intensity index of molecules CD64. Expression of the CD64 receptor on peripheral blood granulocytes as an early laboratory marker of infectious complications of the disease was studied for the first time. We determined sensitivity and specificity, optimal terms of the given research, detected regularities of CD64 expression changes in the course of acute pancreatitis, correlations with other clinical and laboratory indexes, including prospective markers of infection (procalcitonin, C-reactive protein), with the integral scales of severity estimation of patients with acute destructive pancreatitis. Determination of the level of the receptor CD64 expression on the peripheral blood neutrophils showed that this marker reflects the dynamics of the disease course and gives the possibility of the early diagnostics of the infectious complications of acute pancreatitis. The use of this method provides additional information about the development of the surgical infection. It is important that the changes of CD64 antigen expression in dynamics outrun other markers of systemic inflammatory response and sepsis. CD64 antigen expression data on peripheral blood neutrophils is an additional factor in determining differentiated surgical tactics in phase I of the diseases development with regard to acute fluid collections in patients with acute pancreatitis.

A clinical case of Streptococcus equi subsp. ruminatorum infection in a 9-year-old child

Streptococcus equi subsp. ruminatorum is a zoonotic disease that can cause serious morbidity in immunocompromised people. The first case of infection in human was described in 2007. We describe a case of infection in a 9-year-old child with a history of liver transplantation, who was hospitalized for differential diagnosis of high fever on continuous immunosuppressive therapy with Tacrolimus. The examination revealed an increase in the level of systemic inflammatory response markers, cholestasis and cytolysis syndrome markers, which indicated cholangitis. Acute graft rejection was excluded. Streptococcus. equi subsp. ruminatorum was identified in the patient’s blood cultures, which made it possible to diagnose a generalized zoonotic infection (the child was often in contact with horses) with a possible focus in the bile ducts, which required antibiotic therapy in combination with short-term, within 1 day, withdrawal and then a lower dose of immunosuppressive therapy (temporary adjustment of tacrolimus dosage). During the treatment, clinical and laboratory signs of the infectious process improved, and the functional state of the liver graft normalized. Therapy was stopped after negative blood cultures were obtained. This case confirms that S. equi subsp. ruminatorum can cause human disease. We emphasize the utility of molecular biological tests and MALDI-TOF mass spectrometry to be performed in patients with infections caused by group C streptococci.

Prognostic value of systemic inflammatory response markers in cervical cancer

We investigated the association between preoperative ratios of inflammatory markers and the prognosis in patients with invasive cervical cancer (CC). In this single-centre study, we retrospectively enrolled 163 CC patients who underwent radical hysterectomy between February 2008 and October 2018. Among the evaluated ratios, a high neutrophil-to-lymphocyte ratio (N/L) was significantly associated with deep stromal invasion and tumour size larger than 2 cm, whereas a high M/L was significantly related to advanced-stage CC (IB3–IIIC2), lymphatic metastasis (total) and pelvic lymph node metastasis (p= .002, p= .046 and p= .046, respectively). The neutrophil count plus monocyte-to-lymphocyte ratio (NM/L) and platelet-to-lymphocyte ratio (P/L) were significantly higher in patients with deep stromal invasion, advanced stage and tumour size larger than 2 cm (p=.01, p=.044 and p=.007; p=.004, p=.005 and p=.003, respectively). In the multivariate analysis, high NM/L (>168) was associated with a statistically significant hazard ratio of 3.04 (95% CI: (1.38–6.72); p=.006) for recurrence and 9.05 (95% CI: (2.10–38.99); p=.003) for death. Both stage and NM/L are independent prognostic factors that are significantly associated with recurrence and overall survival in CC. Impact Statement What is already known on this subject? Previous studies suggested that there is a relationship between inflammation and the formation, development and progression of cancer. However, the relationship between cervical cancer (CC) and inflammatory blood parameters is incompletely understood. What do the results of this study add? This study investigated the relationship between systemic blood inflammatory ratios and clinicopathological patient characteristics and disease outcomes in CC. What are the implications of these findings for clinical practice and/or further research? According to this study, systemic blood inflammatory ratios may help predict the prognosis and survival of patients with CC.

P-207 Correlation between extramural vascular invasion (EMVI) and systemic inflammatory response markers in rectal cancer

Colorectal cancer (CRC) is the leading cause of cancer-related death worldwide. Rectal cancer constitutes around one-third of all CRCs. The current standard of care of patients with locally advanced rectal cancer is neoadjuvant radio/chemo-radiotherapy; however, treatment differs substantially across countries. Novel markers are required to optimize the treatment. Extramural vascular invasion (EMVI) is a well-established magnetic resonance imaging (MRI)-based negative prognostic marker. Systemic inflammatory response markers such as lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR) or platelet-to-lymphocyte ratio (PLR) are novel blood-based prognostic markers in many cancers, including CRC.

Relationship between systemic inflammatory response markers and immune treatment related toxicity (IrAEs) in hepatocellular carcinoma (HCC).

e16204 Background: A well-recognized class effect of immune check point inhibitors (ICI) is IrAEs ranging from low grade toxicities to life-threatening end organ damage requiring permanent discontinuation of ICI. Treatment related deaths are reported in ̃5% of patients (pts) treated with ICI. There are, however, no reliable markers to predict the onset &amp; severity of IrAEs. We tested the association between neutrophil-lymphocyte ratio (NLR) &amp; platelet-lymphocyte ratio (PLR) at baseline with development of clinically significant IrAE (graded ≥2) in HCC pts treated with ICI. Methods: Data was extracted from a large international database from a consortium of 11 tertiary-care referral centers located in the USA, Europe &amp; Asia. NLR=Absolute neutrophil count/ Absolute lymphocyte count (ALC) &amp; PLR=Platelet count/ALC. A cutoff of 5 for was used NLR &amp; 300 for PLR based on literature. We also tested the association between antibiotic &amp; steroid exposure to IrAEs. Results: Clinical data was collected from 361 pts treated between 2016–2020 across the USA (66%), Asia (12%) &amp; Europe (22%) in this multinational database. Most pts received Nivolumab monotherapy (n=318, 74%). 167 (46%) pts developed at least one IrAE, highest grade 1 in 80 (48%), grade ≥2 in 87(52%) pts. Baseline characteristics did not differ significantly between the groups (Table). In a univariable regression model to predict grade ≥2 IrAEs, a PLR &gt;300 was associated with a lower incidence of clinically significant IrAEs (OR = 0.40; p=0.044). NLR &gt;5 was associated with a trend toward lower incidence of clinically significant IrAEs (OR = 0.58; p=0.097). Multivariate analyses confirmed PLR as independent predictive marker of grade ≥2 IrAEs (OR = 0.24; p=0.007). Antibiotics use was not associated with IrAE incidence (OR = 1.02; p=0.954). Steroid use was associated with a &gt;2-fold higher incidence of grade ≥2 IrAEs (OR = 2.74; p&lt;0.001), though it may be noted that 37% of pts received steroids for treatment of IrAEs. Conclusions: Lower NLR &amp; PLR may predict the appearance of IrAEs in HCC treated with ICI, although this conclusion warrants prospective validation. This finding is in keeping with several studies that showed improved survival in pts who develop of IrAEs &amp; have a lower NLR &amp; PLR.[Table: see text]

The role of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in determining the prognosis of patients with testicular cancer

Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as systemic inflammatory response markers, have been shown to play a role in prognostic factors for patients with malignancies in recent years. However, their application as the prognostic factors of testicular cancer remains unknown. This study aims to evaluate the prognostic role of testicular malignancies using preoperative hematological parameters, NLR and PLR, and their pre-diagnostic role in the staging of testicular cancer. Methods: This was a cross-sectional retrospective study of thirty-nine patients who underwent radical orchiectomy due to testicular cancer at the Department of Urology Haji Adam Malik General Hospital between January 2014 and December 2018. For each patient, clinical features including age, sex, clinical stage, chemotherapy, radiology report, pre-treatment neutrophil count, lymphocyte count, platelet count, NLR, PLR, and postoperative histopathological report were collected. Then we analyzed the association between NLR, PLR and the testicular cancer metastasis incidence. Result: The mean age of the patients was 27.56 ± 17.47 years. Seventeen patients had seminoma (42.5%), 16 others were yolk sac type of cancer (40.0%), and the rest six patients were teratoma (3 patients), lymphoma (2 patients), and embryonal carcinoma (1 patient). More than half (66.48%) of the patients received chemotherapy after radical orchiectomy, with 48.70% in clinical stage III. PLR was associated with testicular cancer metastases (p=0.024), while NLR was not (p=0.729). Conclusion: High pre-treatment PLR levels are associated with the occurrence of metastasis in testicular cancer patients. Hematological parameters will become critical in the preoperative evaluation of such testicular cancer cases. The potential prognostic significance of NLR and PLR in testicular cancer should be tested with further studies.

Prognostic Value of Systemic Inflammatory Response Markers in Patients Undergoing Neoadjuvant Chemotherapy and Gastrectomy for Advanced Gastric Cancer in the Eastern European Population.

Simple SummaryThis study aimed to verify the prognostic value of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in GC patients undergoing neoadjuvant chemotherapy (NAC) and gastrectomy. Elevated NLR and PLR prior to NAC were associated with significantly higher risk of death (mOS: 36 vs. 87 months; HR = 2.21; p = 0.0255 and mOS: 30 vs. 87 months; HR = 2.89; p = 0.0034, respectively). Additionally, a significantly higher risk of death was observed in patients with elevated NLR after NAC (mOS: 35 vs. 87 months; HR = 1.94; p = 0.0368). Selected systemic inflammatory response markers (NLR, PLR) are significant prognostic factors in patients with advanced GC treated with NAC and gastrectomy, as shown in the Eastern European population.The prognostic value of the systemic inflammatory response markers, namely neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) has not yet been clarified in patients undergoing neoadjuvant chemotherapy (NAC) and gastrectomy for advanced gastric cancer (GC) in the Eastern European population. This study aimed to verify the prognostic value of NLR, PLR, and LMR in GC patients undergoing multimodal treatment. One hundred six GC patients undergoing NAC and gastrectomy between 2012 and 2020 were included. Analysed blood samples were obtained prior to NAC (pre-NAC group) and before surgical treatment (post-NAC group). To evaluate the prognostic value of the NLR, LMR, and PLR, univariable and multivariable overall survival (OS) analyses were performed. In the pre-NAC group, elevated NLR and PLR were associated with significantly higher risk of death (mOS: 36 vs. 87 months; HR = 2.21; p = 0.0255 and mOS: 30 vs. 87 months; HR = 2.89; p = 0.0034, respectively). Additionally, a significantly higher risk of death was observed in patients with elevated NLR in the post-NAC group (mOS: 35 vs. 87 months; HR = 1.94; p = 0.0368). Selected systemic inflammatory response markers (NLR, PLR) are significant prognostic factors in patients with advanced GC treated with NAC and gastrectomy, as shown in the Eastern European population.

Effect of C‐Reactive Protein-to-Albumin Ratio on Prognosis in Gastric Cancer Patients

Purpose: The ratio of c-reactive protein-to-albumin (CRP/Alb) is a biochemical marker of systemic inflammatory response and has been associated with poor survival in cancer. The purpose of this study was to investigate the effect of CRP/Alb ratios on prognosis in gastric cancers.Methods: This study included a retrospective review of a total of 147 patients with locally advanced gastric cancer. Mean platelet volume (MPV) was analyzed statistically to find a prognostic relationship between monocyte/lymphocyte ratio, platelet distribution volume (PDW), MPV/platelet, c-reactive protein/albumin ratio (CAR), and gastric cancer. Patients were staged according to the American Joint Cancer Committee (AJCC) Staging Guidelines.Results: The CRP/Alb ratio was independently associated with overall survival (OS) in patients with gastric cancer (GC). The CAR was above 0.25 in 52.7% (77) of the patients and below 0.25 in 47.3% (69) of the patients. Patients under 0.25 had statistically longer survival rates.Conclusion: A high preoperative CAR value could predict poor prognosis in locally advanced gastric patients. The same predictive value was not observed in other hematological parameters. This simple and cost-effective ratio can be used as a clinically accessible biomarker to assist clinicians in determining future treatment plans.

CLINICAL AND LABORATORY CHARACTERISTICS OF A NEW CORONAVIRUS INFECTION (COVID-19) IN CHILDREN COGNITIVE ACTIVITY

Clinical and laboratory observation was carried out for 91 children aged from 1 month to 14 years who were treated in an infectious hospital with a diagnosis of a new coronavirus infection. The diagnosis of SARS-CoV-2 was confirmed by PCR in all cases. Examination of patients included general clinical and biochemical tests, markers of systemic inflammatory response, coagulation parameters, chest X-ray, chest CT scan (if it was necessary). It was found that at present time, coronavirus infection in children has all clinical signs of acute respiratory viral infections, and most children suffer from COVID-19 in moderate forms (79,1 %). Among hospitalized patients, children aged 1 to 3 years were the largest group (34,1 %), the number of children under one year old was 29,7 %. Among the clinical symptoms, the most common were moderate temperature (100 % of children), signs of inflammation of the upper respiratory tract: hyperemia of the oropharynx (87,9 %), rhinorrhea and nasal congestion (61,5 %), cough (65,9 %). Diarrhea was recorded in 14,3 % of patients, vomiting in 15,3 % of children. Pneumonia was the most common complication of coronavirus disease among hospitalized children. It was registered in 25,3 % of clinical cases. Among children under one year old, pneumonia was registered less frequently than in older children - 14,8 % and 29,7 % of observations in the groups. Clinical and radiological signs of acute bronchitis were detected in 22 children (24,2 %), symptoms of acute bronchial obstruction were diagnosed in 18,2 % of cases, and signs of laryngitis were recorded in 14,3 %. We did not find significant changes in laboratory parameters. The average duration of hospital treatment for children was 6,80 ± 4,18 days.

Correlation between Lymphocyte-to-Monocyte Ratio (LMR), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR) and Tumor-Infiltrating Lymphocytes (TILs) in Left-Sided Colorectal Cancer Patients.

Simple SummaryColorectal cancer (CRC) is one of the most common cancers worldwide. Novel markers have been investigated in order to better predict the course of disease and adjust the treatment. Markers associated with cancer-related inflammation (CRI), both in the bloodstream and the tumor tissue, have been in the spotlight for years. In this study, we investigate whether blood-based markers: lymphocyte-to-monocyte ratio, neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio, correlate with tissue-based markers, such as tumor-infiltrating lymphocytes. We retrospectively analyzed 87 patients with locally advanced left-sided CRC treated with radical surgery. Fifty patients were found suitable for the study. We compared the results of their blood tests from the time of the surgical intervention and the density of lymphocytes in the resected tumors. We found no correlation between local and peripheral markers of CRI. Further prospective studies are needed to confirm the results.Colorectal cancer (CRC) is one of the leading causes of cancer-related mortality worldwide. Novel markers are required in order to select high-risk patients and better adjust the treatment. Both peripheral and local markers of cancer-related inflammation (CRI) such as lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR) or platelet-to-lymphocyte ratio (PLR) and tumor-infiltrating lymphocytes (TILs) have been thoroughly investigated in recent years and deemed to be highly prognostic. We hypothesized that there is an association between local and peripheral CRI indices and that blood-based biomarkers may serve as a surrogate of TILs. We retrospectively analyzed 87 patients with locally advanced left-sided CRC treated with radical-intent surgery in the Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, Poland, between January 2014 and December 2015. Fifty patients were found eligible for the study. The patients were divided in terms of pre-treatment values of systemic inflammatory response (SIR) markers into LMR/NLR/PLR-high and low groups. We evaluated the resected specimens by immunohistochemistry in order to assess the densities of CD3+ and CD8+ lymphocytes in the center of the tumor and in the invasive margin. We found that the level of CD3+ lymphocytes in the center of the tumor was statistically significantly higher in patients with low pre-treatment NLR (p = 0.044); however, no correlation between any of the SIR markers and CD3+ or CD8+ TILs was observed. Five-year overall survival (OS) was longer in patients with high LMR (p < 0.001), low NLR (p = 0.001) and low PLR (p = 0.095). No correlation between the density of TILs and OS was demonstrated. In conclusion, based on our study, peripheral blood-based markers and CD3+ and CD8+ TILs are not interrelated.

Alterations in neutrophil to lymphocyte ratio: An inexpensive, reproducible prognostic marker in patients with complicated liver cirrhosis

Introduction: Liver cirrhosis is generally known as an endstage process where healthy normal liver tissue is replaced by connective tissue. Neutrophil to lymphocyte ratio (NLR) is an inexpensive, readily available and reproducible test and has emerged as a marker of systemic inflammatory response. Aim: Our study aimed to evaluate the prognostic utility of increased NLR (&gt;3) for patients with liver cirrhosis admitted to hospital due to infection, variceal bleeding or any other cause. Patients and methods: A total of one hundred twenty cirrhotic patients, who were admitted to the hospital for reasons other than bleeding or sepsis, due to an underlying infection or because of variceal bleeding, were included in the study. Demographic data and laboratory findings were obtained from the patients’ medical record registry and NLR was calculated as the ratio of neutrophils to lymphocytes in the complete blood count on the day of admission. Results: A statistically significant correlation between NLR and patients’ outcome as well as MELD score was reported in the present study. Conclusions: Herein we show the value of NLR ratio in the prognosis of cirrhotic patients after hospital admission

Reproducibility of lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with locally advanced rectal cancer.

166 Background: Rectal cancer constitutes over one-third of all colorectal cancers (CRC) and is one of the leading cause of cancer-related death in developed countries. Treatment modalities applied in locally advanced tumors differ substantially among research centers. In order to identify high-risk patients and better adjust the therapy new markers are needed. Systemic inflammatory response (SIR) markers such as LMR, NLR and PLR have been proved highly prognostic in many malignancies, including CRC; however, they lack proper validation. In our study we assessed the reproducibility of LMR, NLR and PLR. Methods: Sixty patients with locally advanced rectal cancer treated in Maria-Sklodowska Curie National Institute of Oncology in Warsaw, Poland between 08.2017 and 12.2020 were prospectively enrolled in the study. Three consecutive blood morphology tests of each patient within a median period of 21 days were obtained before start of the treatment. Results: LMR, NLR and PLR calculated at two time-points were correlated with the coefficient of 0.776, 0.696 and 0.751 (p &lt; 0.005 in all measurements), respectively. Patients were divided into LMR, NLR, PLR-high and low groups. If LMR at the first test was out of the range of 2.2-3.0 (+/- 0.4 from the cut-off) the risk of misclassification in the second measurement defined as an affiliation to a different (high or low) group than initially was 5.0% (95% CI 1.0-13.9%). In case of NLR, when outside of the range of 2.5-3.5 (+/- 0.5) it was 8.3% (95% CI 2.8-18.4%) and PLR outside of the range of 125-175 (+/- 25) 10.0% (95% CI 3.8-20.5%). Mean percentage change between the third and the first measurement of lymphocytes, monocytes, neutrophils and platelets count ranged from -5.59% to 4.76% and the standard error from 2.0 to 3.9. Conclusions: In conclusion SIR markers are reproducible, easily obtained biomarkers with potential application in clinical practice.

Inflammatory continuum in the pathogenesis of atrial fibrillation after coronary bypass surgery

Atrial fibrillation (AF) after coronary bypass surgery is recorded in 20- 60% of patients and increase the early and long-term postoperative mortality. The aim of the review is to analyze the studies on causal relationships between damaging factors and the development of myocardial inflammation at each stage of surgical treatment in patients with multivessel coronary artery disease. In the review, myocardial inflammation is considered from the point of view of a continuum — a chronic process that originates from the coronary endothelium damage and continuously proceeds within the AF pathogenesis after coronary bypass surgery. For the first time, the concept of inflammatory continuum for postoperative AF is introduced. The review discusses the main and latest laboratory and instrumental markers of local and systemic inflammatory response, which are informative in terms of severity and promising for improving approaches to the diagnosis and prevention of postoperative AF. The review was prepared using available materials from Russian and foreign library databases (PubMed, Medline, Web of Science and Cochrane Library). The search depth was &gt;25 years since 1996. Based on the analysis of available studies, we concluded that inflammation is not just evidence of AF, but plays a causal role in its pathogenesis at each stage of surgical myocardial revascularization.

Evaluation of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Chronic Plaque Psoriasis.

Psoriasis is a common inflammatory dermatological condition and affects 2-3% population worldwide. Psoriasis area and severity index (PASI) and body surface area (BSA) are two commonly used scales used to measure disease severity in psoriasis patients. However, these scales are plagued by weaknesses as inter-observer variation and insufficient evaluation of micro-vascular inflammation. Thus, it is necessary to have an objective and simple measure of the severity of inflammation. The ratio of neutrophils-to-lymphocytes (NLR) and platelets-to-lymphocytes (PLR) are simple and inexpensive markers of systemic inflammatory response that can be measured as part of a complete blood count and are already used in the setting of inflammatory diseases. The utility of the NLR and PLR in psoriasis however, remains relatively unexplored. The present study was undertaken to assess if NLR, PLR and C-reactive protein were altered in chronic plaque psoriasis patients as compared to controls and also to determine correlation of NLR and PLR values with disease severity as measured by PASI. This case control study consisted of equal numbers (45 each) chronic plaque psoriasis patients and control subjects. The subjects were evaluated by way of history taking, clinical and blood examination. Thereafter, the results were tabulated and examined statistically. Our study results indicate that psoriasis patients tended to have a higher neutrophil count, lymphocyte count, NLR and C-reactive protein in comparison the control subjects (P < 0.05). We concluded that such easily available and low cost indices of systemic inflammation are raised in psoriasis patients and are positively correlated with the severity of involvement. They can thus not only be used to monitor the effect of systemic drugs in psoriasis.

Pretreatment anemia status and elevated PLR affect the prognosis of locally advanced cervical squamous cell carcinoma patients treated with concurrent chemoradiotherapy

Objective: To assess the prognostic value of platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) in locally advanced cervical squamous cell carcinoma (LACSC) treated with concurrent chemoradiotherapy (CCRT) regimens. Methods: The contribution of systemic immune inflammatory response markers (NLR, PLR, LMR, SII), inflammatory cells (lymphocytes, neutrophils, monocytes, platelets), and hematocrit in predicting the outcomes of concurrent chemoradiotherapy treatment in LACSC patients was examined using the Kaplan-Meier univariate survival analysis method. Variables that were significant for the univariate analysis were included in the multivariate regression analysis to confirm the independent prognostic factors affecting concurrent chemoradiotherapy in LACSC patients. Results: Univariate analysis showed that age (p = 0.024), PLR (p = 0.007), NLR (p = 0.089), LMR (p = 0.021), SII (p = 0.087), and Hb (p = 0.004) were all prognostic factors affecting OS (over survival). Multivariate regression analysis revealed that PLR (p = 0.066) and Hb (p = 0.045) before concurrent chemoradiotherapy were independent risk factors of OS in the studied population. Moreover, these two factors were significantly correlated (correlation coefficient Rs = –0.426, p = 0.000). Conclusions: The results suggested that elevated PLR and anaemia are likely to have poorer prognoses in LACSC patients who initially received radical CCRT. Moreover, pre-treatment anemia status may exacerbate the prognostic effects of PLR.

Патогенетические аспекты нарушений метаболома кишечника и эндотоксемии у лиц высокого кардио-метаболического риска

Aim. To study the relationship between the functional activity of the intestinal microbiota and endotoxemia with impaired gastrointestinal motility and excessive bacterial growth in patients with metabolic syndrome (MS). Materials and methods. 64 patients with MS were examined. Comprehensive examination included collection of complaints, anamnesis of the disease, questionnaires on actual nutrition, clinical examination, anthropometric study, assessment of indicators of carbohydrate and lipid metabolism, a marker of systemic inflammatory response of the body (CRP) in the blood. Determination of the blood endotoxin level, quantitative and qualitative composition of the parietal microbiota of the small intestine was carried out on an Agilent gas chromatograph with mass selective and flame ionization detectors (Agilent Technologies, USA). A chromatographic study of metabolites of microorganisms (SCFA) in coprofiltrate was carried out. The motor function of the gastrointestinal tract (GIT) was studied using peripheral electrogastroenterocolography using a Gastroscan-GEM device. The control group consisted of 30 apparently healthy individuals aged from 18 to 62 years. Statistical processing of the obtained results was carried out using the Statistica 6.1 software. Results. In 82.9% of the examined patients with MS, clinical signs of intestinal lesions were noted. The electrical activity of the MC departments in the postprandial period was low in 70% of patients. It was found that with MS with a decrease in the daily consumption of dietary fiber in the composition of the diet, the BMI value increases, the energy value of the diet and the use of simple carbohydrates increase. During the analysis of the main biochemical blood constants, it was possible to establish that MS is accompanied by a violation of carbohydrate and lipid metabolism. The CRP level was statistically significantly different from the CG in MS regardless of the degree of excess body weight, while a direct correlation of moderate strength was established between the BMI values and the CRP level. During the chromatographic study of metabolites of microorganisms in feces, it was possible to establish statistically significant differences in the profile and concentration of short-chain fatty acids (SCFA) of persons with MS, both in comparison with CG and in comparison with groups with different BMI values. According to the results of the study of the blood endotoxin level in patients with MS, its significant increase was revealed, more than 6 times, in comparison with the CG. The electrical activity of the colon on an empty stomach was unchanged, but decreased after a food load. Discoordination of motility is observed between the small intestine (SI) and the large intestine, aggravated after food stimulation. A significant decrease in the rhythm of contractions is observed at the frequencies of the jejunum, ileum, and colon both on an empty stomach and in the postprandial period, which indicates a weakening of propulsive bowel contractions in patients with MS. In patients with MS, excessive bacterial growth in MC is observed mainly due to opportunistic microbiota strains. Correlation analysis showed a moderate negative relationship between endotoxin levels and MC electrical activity, between endotoxin levels and the colon-to-ileum ratio. Conclusion. The study of the level of endotoxin, intestinal microbiota metabolites (SCFA), indicators of bacterial overgrowth, motor-evacuation functions of the gastrointestinal tract made it possible to identify important pathogenetic patterns concerning the contributing role of the latter in the development of endotoxemia and intestinal metabolic disorders in patients with MS.

P-OGC79 Post-operative NUn score as a prognostic tool for anastomotic leak after Oesophagectomy

Abstract Background Anastomotic leak (AL) after esophagectomy is still quite high with incidence reported between 5 and 20%. Early detection of AL will enable patient rescue and the remedial measures may decrease the associated significant morbidity and improve quality of life. Oesophagectomy is also associated with other infective complications such as respiratory infections and collections in the abdomen or chest. Noble and Underwood (NUn) published the NUn score combining blood-borne markers of systemic inflammatory response to define risk of anastomotic leak and major complications following oesophageal resection. This study aims to validate the ability of NUn score to identify AL specifically. Methods A total of 113 patients who underwent esophagectomy for oesophageal cancer over 11 years from 2011 to early 2021 in our centre were selected for this study from a prospectively maintained database. Patients with leaks (n = 11) were identified by reviewing their case records, electronic records, endoscopy and radiological results. Patients with missing values were excluded. Postoperative 7-day (POD) biochemical data that included white cell count (WCC), C-reactive protein (CRP) and Albumin were used to calculate NUn score. Sensitivity and Specificity of NUn score with a cut-off value of &amp;gt; 10 was calculated using the ROC curve analysis using SPSS. Results A total of 99 patients were included, among which 10 patients had anastomotic leaks (AL). Overall mean of NUn of patients with AL was 10.25 vs 9.95 without AL. NUn scores for day 1 to 7 are shown in the table in figure 1. NUn with the highest AUC was Day 7 (0.664 [CI 0.499 – 0.829]; p = 0.09), with 70% sensitivity and 57.3% specificity. The trends in WCC, CRP and albumin levels over 7 days were also not helpful in differentiating patients with AL. Conclusions In this study, the trends in rising WCC, CRP and decreasing albumin were not helpful in diagnosing anastomotic leaks specifically. The NUn score had a sensitivity of 70% on day 7. Procalcitonin, blood urea nitrogen or interleukin levels may help, and further studies are being planned. This study shows that current biochemical parameters can complement but not replace careful and regular medical examination and early radiological or endoscopic evaluation if an AL is suspected.

Relationship between serum 25-hydroxyvitamin D concentration and acute inflammatory markers in hospitalized patients with SARS-CoV-2 infection

INTRODUCTION: There is experimental and clinical evidence that the serum concentration of 25-hydroxyvita­min D [25(OH)D)] may decrease in acute systemic inflammatory responses; in this context, low values may not necessarily indicate a pre-existing deficiency. This may also apply to low 25(OH)D levels found in the context of the systemic inflammatory response caused by SARS-CoV-2 infection. To conduct a systematic review of the relationship between serum 25(OH)D and the concentrations of C-re­active protein (CRP), interleukin 6 (IL-6) and tumour necrosis factor a (TNF-a) in acutely hospitalized patients with SARS-CoV-2 infection. MATERIAL AND METHODS: We searched PubMed, EMBASE, Google Scholar and the Cochrane Database of Systematic Reviews for studies published between January 2020 and February 2021. In each study, the au­thors compared levels of inflammatory markers between patients reported as having low levels of 25(OH) D and those above the study cut-off. RESULTS: 18 studies were included (n = 3482, mean age 63.5 ± 9.3 years, 56.9% men). The cut-off for the definition of low 25(OH)D varied across studies. In all studies, mean values for inflammatory markers were higher in the low 25(OH)D groups. These differences were statistically significant (p &lt; 0.05) in 6/15 studies with CRP, 4/8 with IL-6 and 0/1 with TNF-a. CONCLUSIONS: Markers of acute systemic inflammatory response were elevated in patients with SARS-CoV-2 infection and low concentrations of 25(OH)D. Therefore, the vitamin D status in those patients should be interpreted with caution, and studies should be designed to assess whether hypovitaminosis D could be an epiphenomenon.