Quartile Of White Blood Cell Count Research Articles

Depressive symptoms and antidepressant use in relation to white blood cell count among postmenopausal women from the Women’s Health Initiative

Inflammation can play a role in the pathophysiology of depression, and specific types of antidepressants may have inflammatory or anti-inflammatory properties. Furthermore, depression and antidepressant use has been linked to white blood cell (WBC) count, a routinely measured inflammatory marker. We examined the cross-sectional and longitudinal relationships of depressive symptoms and/or antidepressant use with WBC count among postmenopausal women. Analyses of cross-sectional data at enrollment were performed on 125,307 participants, 50–79 years of age, from the Women’s Health Initiative Clinical Trials and Observational Studies who met eligibility criteria, and a subset of those with 3-year follow-up data were examined for longitudinal relationships. Depressive symptoms were defined using the Burnam Algorithm whereas antidepressant use was defined using therapeutic class codes. WBC count (Kcell/ml) was obtained through laboratory evaluations of fasting blood samples. Multivariable regression modeling was performed taking sociodemographic, lifestyle and health characteristics into consideration. At enrollment, nearly 85% were non-users of antidepressants with no depressive symptoms, 5% were antidepressant users with no depressive symptoms, 9% were non-users of antidepressants with depressive symptoms, and 2% were users of antidepressants with depressive symptoms. In fully-adjusted models, cross-sectional relationships were observed whereby women in the 2nd (OR = 1.06, 95% CI: 1.01, 1.13), 3rd (OR = 1.06, 95% CI: 1.00, 1.12) or 4th (OR = 1.10, 95% CI: 1.05, 1.17) quartiles of WBC count were more likely to exhibit depressive symptoms, and women in the 4th quartile were more likely to be users of antidepressants (OR = 1.07, 95% CI: 1.00, 1.15), compared to women in the 1st quartile. Compared to women who exhibited no depressive symptoms at either visit, those with consistent depressive symptoms at enrollment and at 3-year follow-up had faster decline in WBC count (β = −0.73, 95% CI: −1.33, −0.14) over time. No significant bidirectional relationships were observed between changes in depressive symptoms score and WBC count over time. In conclusion, depressive symptoms and/or antidepressant use were cross-sectionally related to higher WBC counts among postmenopausal women. Further evaluation of observed relationships is needed in the context of prospective cohort studies involving older adult men and women, with repeated measures of depression, antidepressant use, and WBC count.

Effect of routine inflammatory markers on clinical outcomes in acute basilar artery occlusion after endovascular thrombectomy: Results from ATTENTION registry.

To investigate the relationship between clinical routine inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), white blood cell count (WBC), neutrophils, lymphocytes, and platelets with clinical outcomes in acute basilar artery occlusion (BAO) patients receiving endovascular treatment (EVT). We recruited 2134 acute BAO patients from 48 stroke centers across 22 Chinese provinces in the ATTENTION registry from 2017 to 2021. Blood samples were drawn at admission. An unfavorable functional outcome was defined using a modified Rankin Scale (mRS) of 4-6 at 90 days. Safety outcomes included mortality within 90 days and symptomatic intracerebral hemorrhage within 3 days. A total of 1044 patients were included in the final study. After adjusting for confounding factors, the upper quartiles of WBC and NLR were related to 90-day unfavorable functional outcome (mRS = 4-6) compared with those in the lowest quartile (WBC: quartile 4, odds ratio (OR) = 1.85, 95% confidence interval (CI) = 1.22-2.80; NLR: quartile 4, OR = 2.02, 95% CI = 1.34-3.06). The higher quartiles of WBC and NLR were also related to the increased risk of mortality at 90 days. Restricted cubic spline regression analysis showed an incremental trend between NLR and 90-day unfavorable functional outcome (Pnonlinearity = 0.055). In subgroup analysis, a significant interaction was found between NLR and bridging therapy for predicting unfavorable functional outcome (P = 0.006). Higher WBC and NLR on admission are significantly related to unfavorable functional outcome and mortality at 90 days in acute BAO patients receiving EVT. Significant interaction was found between increased NLR and bridging therapy on these outcome measures.

Cardiorespiratory fitness, white blood cell count, and mortality in men and women

BackgroundWe examined the associations of cardiorespiratory fitness (CRF) and white blood cell count (WBC) with mortality outcomes. MethodsA total of 52,056 apparently healthy adults completed a comprehensive health examination, including a maximal treadmill test and blood chemistry analyses. CRF was categorized as high, moderate, or low by age and sex; WBC was categorized as sex-specific quartiles. ResultsDuring 17.8 ± 9.5 years (mean ± SD) of follow-up, a total of 4088 deaths occurred. When regressed jointly, significantly decreased all-cause mortality across CRF categories was observed within each quartile of WBC in men. Within WBC Quartile 1, all-cause mortality hazard ratios (HRs) with a 95% confidence interval (95%CI) were 1.0 (referent), 1.29 (95%CI: 1.06‒1.57), and 2.03 (95%CI: 1.42‒2.92) for high, moderate, and low CRF categories, respectively (p for trend < 0.001). Similar trends were observed in the remaining 3 quartiles. With the exception of cardiovascular disease (CVD) mortality within Quartile 1 (p for trend = 0.743), there were also similar trends across CRF categories within WBC quartiles in men for both CVD and cancer mortality (p for trend < 0.01 for all). For women, there were no significant trends across CRF categories for mortality outcomes within Quartiles 1–3. However, we observed significantly decreased all-cause mortality across CRF categories within WBC Quartile 4 (HR = 1.05 (95%CI: 0.76‒1.44), HR = 1.63 (95%CI:1.20‒2.21), and HR = 1.87 (95%CI:1.29‒2.69) for high, moderate, and low CRF, respectively (p for trend = 0.002)). Similar trends in women were observed for CVD and cancer mortality within WBC Quartile 4 only. ConclusionThere are strong joint associations between CRF, WBC, and all-cause, CVD, and cancer mortality in men; these associations are less consistent in women.

White Blood Cell Count as a Predictor of Incident Type 2 Diabetes Mellitus Among Non-Obese Adults: A Longitudinal 10-Year Analysis of the Korean Genome and Epidemiology Study.

PurposeLimited evidence is available on whether the white blood cell (WBC) count is a predictor of type 2 diabetes mellitus (T2DM) in non-obese individuals. This study aimed to determine whether WBC count could be used as an indicator for the prediction of incident T2DM among non-obese individuals using a large, community-based Korean cohort that was observed over 10 years.Patients and methodsA total of 4211 non-obese adults without diabetes aged 40–69 years were selected from the Korean Genome and Epidemiology Study. The participants were divided into four groups according to WBC count quartiles. We prospectively assessed the hazard ratios (HRs) with 95% confidence intervals (CIs) for incident T2DM, based on the American Diabetes Association criteria, using multivariate Cox proportional hazards regression models over 10 years after the baseline survey.ResultsDuring the follow-up period, 592 (14.1%) participants had newly developed T2DM. The higher quartile of WBC count groups showed significantly higher cumulative T2DM incidence over 10 years after the baseline survey (log-rank test, P < 0.001). Compared with the HRs for individuals in the referent lowest quartile, the HR (95% CI) for incident T2DM in individuals in the highest quartile was 1.55 (1.10–2.18) after adjusting for confounding variables.ConclusionA higher WBC count predicts future incident T2DM among community-dwelling non-obese Korean adults. This study suggests that WBC count could facilitate the prediction of non-obese individuals susceptible to T2DM.

White blood cell count and clustered components of metabolic syndrome: A study in western Iran.

Background:White blood cell count (WBC) is one of the objective parameters of systemic inflammation. The aim of present study was to evaluate the relationship between WBC count and metabolic syndrome.Methods:In this study on Lor population in Borujerd province (West of Iran), from 2011 to 2013, 800 persons were enrolled. MetS was defined based on ATP III criteria. Differences among the quartiles of WBC were examined by one-way analysis of variance.Results:Only 14.7% did not have any of the five components and 43% of all subjects had metabolic syndrome. The means of WBC count in MetS group were significantly higher than the control group (p<0.0001). In subjects without any MetS components, the means of WBC was 5.321 /µL, and it was 5.664, 5.714, 5.961, 6.302, and 6.572 /µL in subjects with 1, 2, 3, 4, and 5 components, respectively. These differences show a significant increasing trend (p<0.0001).Conclusion:WBC count was associated with clustered components of metabolic syndrome. It seems that WBC counts could be considered as a predictive factor for metabolic syndrome in preventive medicine.

Leukocytosis Is Associated with End Organ Damage in Chronic Myelomonocytic Leukemia (CMML) and Can be Mitigated with Cytoreductive Therapy

Introduction: CMML is a myeloid neoplasm hallmarked by cytopenias and a peripheral monocytosis. Although uniformly fatal, many patients (pts) are diagnosed incidentally and are monitored without treatment. Therapy is implemented when symptomatic cytopenias, splenomegaly, or bone marrow progression occur. Higher white blood cell count (WBC) and absolute monocyte count (AMC) are associated with inferior OS, however, they are currently not an indication for treatment. Case reports have demonstrated a putative link between CMML monocytes and end organ damage (EOD), which has not been systematically explored. We hypothesize that CMML cases with higher WBC and/or AMC will be at increased risk for EOD and that cytoreductive therapy could mitigate this risk.Methods: CMML pts with at least 2 measures of creatinine and liver function tests were retrospectively identified from the Moffitt Cancer Center CMML database. EOD was defined as the interval development of chronic kidney disease (CKD), acute kidney insufficiency (AKI) by Kdigo criteria, liver dysfunction, pleural effusion, or cardio-vascular events (CVE). CKD was defined by a GFR<60 for greater than 3 months. Those pts with preexisting EOD, to include CKD or history of AKI, transformation to Acute Myeloid Leukemia, or allogeneic transplant were excluded from this study. Categorical variables were compared with the Fisher's exact test and quantitative variables compared utilizing the Mann-Whitney test. The Kaplan-Meier method and log-rank test were used to estimate overall survival (OS).Results: Between 1/1/2000 and 1/1/2018, 313 CMML cases were identified that met the above criteria for study entry. The median age of pts in this cohort was 70 (31-95 range) with a male predominance (66%). 168 pts were classified as WHO CMML-0 (54%), 78 as CMML-1 (25%), and 67 as CMML-2 (21%). The majority of cases were intermediate risk by the Global MDACC score (30% INT-1, 28% INT-2). The most common somatic mutations included TET2(64%), ASXL1(44%), and SRSF2(45%). AKI was the most common type of EOD that occurred in 37% of cases, with new CKD in 8.6% of pts. Pleural effusions, defined by radiographic evidence by X-ray or CT-scan occurred in 29% of cases. Liver dysfunction, defined as transaminitis or hyperbilirubinemia 1.5x the upper limit of normal, occurred in 14% of cases, and CVE were recorded in 4.5% of cases. Development of new CKD (9.2% v 1.2%, p=0.012) and liver dysfunction (13.2% v 3.5%, p=0.012) were significantly more common in myeloproliferative-CMML (MPN) defined by FAB criteria. Because the FAB criteria relies solely on WBC, we explored the impact of WBC and AMC on EOD. To account for variability of longitudinal measures, we isolated the patient-specific peak WBC and AMC along with the corresponding markers of EOD for each peak, respectively. Using these variables WBC (Spearman r-value 0.25, p<0.0001), and to a greater extent AMC (Spearman r-value 0.30, p<0.0001), linearly correlated with creatinine and were associated with AKI (median AMC 11.7 vs. 5.5, p< 0.0001; median WBC 54.7 vs. 35.6, p <0.0001) and CKD (median AMC 19.7 vs. 6.5, p = 0.0002; median WBC 73.1 vs. 40.7, p = 0.002). This association remained significant when combining all EOD events (median AMC 11.4 vs 4.5, p <0.0001; median WBC 54.4 vs. 29, p < 0.0001). To identify a WBC and AMC within MPN-CMML that could be targeted for therapeutic intervention, we divided our cohort into WBC and AMC quartiles. Importantly, only the first quartile, defined by an upper boundary of 33.95 cells/dL for peak-WBC and 5.4 cells/dL for peak-AMC was statistically associated with a lower creatinine (p<0.004), AKI (p<0.0008), CKD (p<0.0003), or combined EOD events (p<0.002). MPN-CMML pts with new AKI had an inferior OS (17.1m v 30.7m, HR=1.51, p=0.0007) as did patients with a baseline WBC >33.95 (19.8m v 29.6m, p = 0.004). Patients with a baseline WBC at diagnosis >33.95 cells/dL treated with hydroxyurea had improved overall survival (22.6m vs. 12.4m, HR 0.35, p= 0.0006). This survival advantage did not hold in CMML patients with baseline WBC lower than 33.95 cells/dL suggesting that treatment may only mitigate poor outcomes in high WBC CMML patients (Figure 1).Conclusions: MPN-CMML is associated with EOD that includes AKI/CKD, pleural effusions, LFT abnormalities, and CVE. Those cases with a WBC >33.95cells/dL are at particularly high risk for EOD and cytoreductive therapy should be routinely considered to mitigate this risk. [Display omitted] DisclosuresSweet:Celgene: Honoraria, Speakers Bureau; Phizer: Consultancy; BMS: Honoraria; Agios: Consultancy; Astellas: Consultancy; Jazz: Speakers Bureau; Jazz: Speakers Bureau; Novartis: Consultancy, Honoraria, Speakers Bureau; Novartis: Consultancy, Honoraria, Speakers Bureau; BMS: Honoraria; Phizer: Consultancy; Agios: Consultancy; Astellas: Consultancy; Celgene: Honoraria, Speakers Bureau. Sallman:Celgene: Research Funding, Speakers Bureau. List:Celgene: Research Funding. Komrokji:Novartis: Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau; Celgene: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Novartis: Honoraria, Speakers Bureau.

White Blood Cell Count Associates with Peripheral Arterial Disease in a Chinese Community-based Population

In ammatory processes play an important role in the development of atherosclerotic disease. However, the relationship between white blood cell (WBC) count and the risk of peripheral arterial disease (PAD) is not well established especially in Chinese population. A total of 9113 Chinese subjects without acute in ammation from an atherosclerosis cohort were included in our analysis. Ankle brachial index (ABI) was measured using Omron BP-203RPEIII machine. PAD was de ned as ABI<0.9. Multivariate regression model was used to evaluate association of WBC count and PAD status. Mean (SD) WBC was 6.07±1.59×10 9 /L. Mean (SD) ABI was 1.10±0.09 and the prevalence of PAD was 2.4%. WBC count was signi cantly associated with PAD (OR=1.25, 95%CI: 1.16-1.34, P<0.001) with every 1×10 9 /L increase of WBC count. This relationship remained significant (OR=1.19, 95%CI: 1.10-1.28, P<0.001) after adjustment for sex, age, body mass index, current smoking and drinking status, hypertension, diabetes mellitus, dyslipidemia, history of stroke and coronary heart disease, antihypertensive agents, lipid- lowering agents, and hypoglycemic agents. Consistently, PAD ratio was also dose-dependent related to the quartiles of WBC count in multivariate regression model (OR=1.66, 95%CI: 1.05-2.64, P=0.032; OR=2.51, 95%CI: 1.61-3.92, P<0.001, for Q3 or Q4 vs Q1 group respectively). Elevated WBC count independently associates with high PAD prevalence in a Chinese community-based population, which supports the hypothesis that systemic in ammation acts a pivotal part in the etiology of atherosclerotic cardiovascular disease.

Marijuana Use Impacts Midlife Cardiovascular Events in HIV-Infected Men.

Marijuana use is prevalent among persons infected with human immunodeficiency virus (HIV), but its long-term effects on HIV disease progression and comorbidities are unknown. In this prospective study of 558 HIV-infected men enrolled in the Multicenter AIDS Cohort Study between 1990 and 2010, there were 182 HIV seroconverters and 376 with viral suppression on combination antiretroviral therapy (ART). Associations between heavy marijuana use and HIV disease markers or white blood cell (WBC) count were examined using mixed-effects and linear regression models. Effects of marijuana use on cardiovascular (CV) events and other endpoints were estimated using Kaplan-Meier and logistic regression analyses. The median baseline age of participants was 41, 66% were white, 79% had education >12 years, and 20% reported heavy marijuana use at ≥50% of biannual visits during follow-up. Long-term heavy marijuana use showed no significant associations with viral load, CD4 counts, AIDS, cancer, or mortality in both cohorts but was independently associated with increased CV events between ages 40-60 after adjusting for age, tobacco smoking, viral load, and traditional risk factors (odds ratio [OR], 2.5; 95% confidence interval [CI] 1.3, 5.1). Marijuana and tobacco use were each independently associated with higher WBC counts in adjusted models (P < .01); the highest quartile of WBC counts (≥6500 cells/µL) was associated with increased CV events (OR 4.3; 95% CI, 1.5, 12.9). Heavy marijuana use is a risk factor for CV disease in HIV-infected men ages 40-60, independent of tobacco smoking and traditional risk factors.

Relationship between high white blood cell count and insulin resistance (HOMA-IR) in Korean children and adolescents: Korean National Health and Nutrition Examination Survey 2008–2010

Background and aimsIncreasing evidence has indicated that insulin resistance is associated with inflammation. However, few studies have investigated the association between white blood cell (WBC) count and insulin resistance, as measured by a homeostasis model assessment of insulin resistance (HOMA-IR) in a general pediatric population. This study aimed to examine the association between WBC count and insulin resistance as measured by HOMA-IR in a nationally representative sample of children and adolescents. Methods and resultsIn total, 2761 participants (1479 boys and 1282 girls) aged 10–18 years were selected from the 2008–2010 Korean National Health and Nutrition Examination Survey. Insulin resistance was defined as a HOMA-IR value greater than the 90th percentile. The odds ratios and 95% confidence intervals for insulin resistance were determined using multiple logistic regression analysis. The mean values of most cardiometabolic variables tended to increase proportionally with WBC count quartiles. The prevalence of insulin resistance significantly increased in accordance with WBC count quartiles in both boys and girls. Compared to individuals in the lowest WBC count quartile, the odds ratio for insulin resistance for individuals in the highest quartile was 2.84 in boys and 3.20 in girls, after adjusting for age, systolic blood pressure, body mass index, and waist circumference. ConclusionA higher WBC count was positively associated with an increased risk of insulin resistance in Korean children and adolescents. This study suggests that WBC count could facilitate the identification of children and adolescents with insulin resistance.

The Association Between Hyperuricemia and Hematological Indicators in a Chinese Adult Population.

The aim of this study was to explore the relationship between hyperuricemia and hematological indicators.Five hundred twenty-two male and 255 female subjects (18–90 years old) were recruited in the study. The level of serum uric acid (SUA), total white blood cell (WBC) count, red blood cell (RBC) count, hemoglobin, hematocrit, and platelet count was measured, computed, and analyzed. Pearson correlation coefficients, Student t-tests, multivariate linear regression models, and multivariate logistic regression models were performed to analyze the results.For men, WBC count (r = 0.13, P < 0.01), RBC count (r = 0.15, P < 0.001), and hemoglobin (r = 0.11, P < 0.05) were significantly correlated with SUA. For women, WBC count (r = 0.24, P < 0.001), RBC count (r = 0.31, P < 0.001), hemoglobin (r = 0.31, P < 0.001), and hematocrit (r = 0.29, P < 0.001) were significantly correlated with SUA. For men, WBC (P < 0.01) and RBC (P < 0.05) counts were significantly higher in patients with hyperuricemia than in normal subjects. For men, after adjustment for confounding factors, those in the fourth quartiles of WBC counts had 1.66-fold increased odds of hyperuricemia as compared with those in the reference group. For women, after adjustment, those in the second to fourth quartiles of WBC count, RBC count, hemoglobin, and hematocrit had increased the odds of hyperuricemia as compared with those in the reference groups.Our study showed significant relations between the level of SUA and WBC count, RBC count, hemoglobin, and hematocrit, which could be important biological markers of hyperuricemia.

Serum white blood cell count and pulmonary function test are negatively associated

Introduction:A variety of inflammatory disorders influence the serum white blood cell (WBC) count. Elevated systemic inflammatory insult may contribute to impaired lung function, such as obstructive or restrictive lung disease. The aim of our study is to investigate the correlation between WBC count and pulmonary function.Material and Methods:Eligible participants aged ≥ 18 years (n = 16 312) were enrolled from the United States National Health and Nutrition Examination Survey III, 1988–1994. Pertinent information including pulmonary function test, demographics, WBC count, glucose, C-reactive protein and a personal health questionnaire were obtained for subjects without known pulmonary diseases. White blood cell counts were classified into quartiles over the normal range. Multiple hierarchical regression models and trends testing were used to assess the correlation between WBC counts and pulmonary function tests.Results:In the unadjusted mode of quartile-based analysis, the beta coefficients interpreted as the differences in FEV1% predicted upon comparing subjects in the upper three quartiles of WBC count to those in the lowest quartile were − 0.007, − 0.022 and − 0.041 (P < 0.001). After adjusting for multiple pertinent covariates, inverse association between quartiles of WBC count and FEV1% predicted remained essentially unchanged. The negative trends between FEV1% predicted and WBC count quartiles in the stratified comparison with extended-model approach were statistically significant (P for trends < 0.001) in quartile-based multiple linear regression.Conclusions:Elevated WBC count is independently associated with declined pulmonary function. It may be a simple, accessible and inexpensive indicator of changes in pulmonary function.

Serum white blood cell count and pulmonary function test are negatively associated.

A variety of inflammatory disorders influence the serum white blood cell (WBC) count. Elevated systemic inflammatory insult may contribute to impaired lung function, such as obstructive or restrictive lung disease. The aim of our study is to investigate the correlation between WBC count and pulmonary function. Eligible participants aged ≥18 years (n=16 312) were enrolled from the United States National Health and Nutrition Examination Survey III, 1988-1994. Pertinent information including pulmonary function test, demographics, WBC count, glucose, C-reactive protein and a personal health questionnaire were obtained for subjects without known pulmonary diseases. White blood cell counts were classified into quartiles over the normal range. Multiple hierarchical regression models and trends testing were used to assess the correlation between WBC counts and pulmonary function tests. In the unadjusted mode of quartile-based analysis, the beta coefficients interpreted as the differences in FEV1% predicted upon comparing subjects in the upper three quartiles of WBC count to those in the lowest quartile were -0.007, -0.022 and -0.041 (P<0.001). After adjusting for multiple pertinent covariates, inverse association between quartiles of WBC count and FEV1% predicted remained essentially unchanged. The negative trends between FEV1% predicted and WBC count quartiles in the stratified comparison with extended-model approach were statistically significant (P for trends<0.001) in quartile-based multiple linear regression. Elevated WBC count is independently associated with declined pulmonary function. It may be a simple, accessible and inexpensive indicator of changes in pulmonary function.

White Blood Cell Counts as Risk Markers of Developing Metabolic Syndrome and Its Components in the Predimed Study

BackgroundThe Metabolic Syndrome (MetS) is a cluster of metabolic abnormalities that includes hyperglucemia, hypertension, dyslipidemia and central obesity, conferring an increased risk of cardiovascular disease. The white blood cell (WBC) count has been proposed as a marker for predicting cardiovascular risk. However, few prospective studies have evaluated the relationship between WBC subtypes and risk of MetS.MethodsParticipants were recruited from seven PREDIMED study centers. Both a baseline cross-sectional (n = 4,377) and a prospective assessment (n = 1,637) were performed. Participants with MetS at baseline were excluded from the longitudinal analysis. The median follow-up was 3.9 years. Anthropometric measurements, blood pressure, fasting glucose, lipid profile and WBC counts were assessed at baseline and yearly during the follow-up. Participants were categorized by baseline WBC and its subtype count quartiles. Adjusted logistic regression models were fitted to assess the risk of MetS and its components.ResultsOf the 4,377 participants, 62.6% had MetS at baseline. Compared to the participants in the lowest baseline sex-adjusted quartile of WBC counts, those in the upper quartile showed an increased risk of having MetS (OR, 2.47; 95%CI, 2.03–2.99; P-trend<0.001). This association was also observed for all WBC subtypes, except for basophils. Compared to participants in the lowest quartile, those in the top quartile of leukocyte, neutrophil and lymphocyte count had an increased risk of MetS incidence. Leukocyte and neutrophil count were found to be strongly associated with the MetS components hypertriglyceridemia and low HDL-cholesterol. Likewise, lymphocyte counts were found to be associated with the incidence of the MetS components low HDL-cholesterol and high fasting glucose. An increase in the total WBC during the follow-up was also associated with an increased risk of MetS.ConclusionsTotal WBC counts, and some subtypes, were positively associated with MetS as well as hypertriglyceridemia, low HDL-cholesterol and high fasting glucose, all components of MetS.Trial registrationControlled-Trials.comISRCTN35739639.

Abstract 146: White Blood Cell Count and Risk of Stroke in Men and Women: the European Prospective Investigation into Cancer-Norfolk Prospective Population Study

Background and Objectives: An elevated white blood cell (WBC) count has been reported to be associated with all-cause mortality and risk of cardiovascular diseases. While the relationship between leukocyte count and coronary heart disease has been well documented, evidence on the association with risk of stroke has been less consistent. The aim of this study was to investigate the relationship between WBC count and incidence of stroke in a large cohort of disease-free men and women, and to assess how far any associations might be explained by traditional risk factors for stroke. Methods: We examined the prospective association between full blood WBC count and incident stroke in 7,392 men and 9,049 women from the general population participating in the European Prospective Investigation into Cancer-Norfolk Study. Participants were aged 39-79 years, without known heart attack, stroke, and cancer at the baseline examination in 1993-1997 and were followed up for incident stroke till March 2008. Results: During the median follow-up of 12 years, 542 incident stroke cases were observed. The age- and sex- adjusted risk of incident stroke increased with the increase of WBC count. Compared to the lowest quartile of WBC count, the age- and sex- adjusted hazard ratios (HRs) and 95% CIs for stroke were 1.11 (0.86-1.45), 1.40 (1.10-1.79), and 1.65 (1.29-2.09) in the second, third, and fourth quartile, respectively. Adjusting for smoking attenuated the results, while further adjustment for socioeconomic and lifestyle risk factors changed the association very little. The association was further attenuated after adjustment for biological risk factors such as systolic blood pressure and a history of diabetes at baseline, but people with the highest quartile of WBC count still had a higher risk of stroke than those in the lowest quartile (HR 1.32, 95% CI 1.02-1.71). Every 2*10 9 /L increase in WBC count was associated with a hazard ratio of 1.14 (95% CI 1.02-1.26) for stroke in the fully-adjusted model which included age, sex, smoking status, BMI, social class, educational level, alcohol intake, physical activity, systolic blood pressure, a history of diabetes at baseline, and total serum cholesterol. Conclusions: A positive association between WBC count and stroke was observed in these middle-aged and older men and women. Adjustment for smoking attenuated the association while multivariate adjustment for other risk factors did not further change the results.

White blood cell count and psychomotor cognitive performance in the elderly

White blood cell (WBC) count is associated with many inflammatory diseases such as cardiovascular disease, diabetes and hypertension. Research on the relationship of WBC count and cognition in the elderly is relatively sparse. This study examined the association between WBC count and cognitive performance in older adults. Data from the National Health and Nutrition Examination Survey (1999-2002) containing 1670 older adults were analysed. Every subject completed a household interview, examination of digit symbol substitution test (DSST) scores, WBC count measurement and a questionnaire regarding personal health. WBC count was restricted to the normal range and divided into quartiles, using a multiple hierarchical regression model to estimate the relationship between WBC counts and DSST scores. Quartile-based analysis with an extended-model approach was used for further covariates adjustment. Trends test examining the associations across increasing quartiles of WBC counts and DSST scores were also conducted. In the multiple hierarchical regression model, the β coefficient, representing the change of DSST scores for each 1000 cells uL(-1) increase in WBC count, was -0·097 (R(2) = 0·343, P < 0·001). After additional competent covariates adjustment, the negative correlation remained (all P < 0·001). In quartile-based multiple linear regression, the negative trends between DSST scores and WBC count quartiles in the stratified comparison with extended-model approach were all statistically significant (P for trends <0·001). Higher WBC counts, even within the normal range, were associated with poor psychomotor cognitive performance in the elderly.

Longitudinal Study on White Blood Cell Count and the Incidence of Metabolic Syndrome

Many studies have revealed that white blood cell count (WBC) is related to insulin resistance which is a central mechanism of metabolic syndrome (MetS). However, few cohort studies have examined the role of WBC in the development of MetS. We hypothesized that WBC is associated with the future development of MetS, and investigated the longitudinal incidence of MetS in healthy workers. WBC was measured in 5,073 workers (mean age 42.5 years) without MetS at baseline. The incidence of MetS was monitored over 7 years of follow-up, in relation to quartiles of WBC. During the follow-up, 925 participants were diagnosed as MetS. Incidence of MetS was increased in participants with higher WBC: the rates of incidence of MetS were 22.6, 32.9, 42.9, and 57.5 per 1,000 person-years of follow-up in the 1st, 2nd, 3rd, and 4th quartiles of WBC, respectively. After adjustments for confounding factors, the adjusted hazards ratio (95% confidence interval) for MetS was 1.00 (reference), 1.22 (0.98 to 1.51), 1.52 (1.24 to 1.87), and 1.66 (1.35 to 2.04) through the quartiles of WBC, respectively, (p <0.001). This relationship was consistent among current smokers and never smokers, and among male and female genders, respectively. WBC is useful in predicting the future development of MetS which leads to atherosclerotic diseases.

Elevated Peripheral Blood Monocyte Fraction in Nonalcoholic Fatty Liver Disease

An elevated white blood cell (WBC) count is associated with nonalcoholic fatty liver disease (NAFLD); however, a leukocyte subtype that is involved in the pathogenesis of NAFLD is not known. This study was conducted to investigate the association between NAFLD and WBC subtype fractions (%) among healthy elderly Koreans. A total of 794 subjects who underwent a health check-up were investigated. After excluding excessive alcohol intake and other liver diseases, NAFLD was diagnosed based on sonographic findings: hyperechogenecity of liver tissue, difference of echogenicity between liver and kidney, and visibility of vascular structures. The prevalence of NAFLD among entire cohort was 39.0% (310/794). The presence of NAFLD was significantly associated with higher blood WBC counts (5,485 ± 1073 vs. 5,230 ± 995 per mm(3), p = 0.001) and monocyte fraction (6.08 ± 2.40% vs. 5.12 ± 1.31%, p < 0.001). The multiple logistic regression analysis, after controlling confounders, including age, gender, body mass index, systolic and diastolic blood pressure, fasting blood glucose, alanine aminotransferase, triglyceride, and high-density lipoprotein cholesterol, showed that the prevalence risk of NAFLD was increased significantly according to the monocyte fraction quartiles: odds ratios (ORs) and 95% confidence intervals (CIs) for NAFLD were 1.00, 2.75 (1.63-4.62), 2.84 (1.67-4.84) and 5.17 (3.03-8.83), respectively. There were no significant associations between NAFLD and the total WBC count quartiles in this model. These results indicate that the elevated peripheral blood monocyte fraction is associated with NAFLD. The monocyte fraction might be a useful marker for NAFLD.

Sex Differences in the Relationship Between Leukocyte Count and Chronic Kidney Disease: The 2007 Korean National Health and Nutrition Examination Survey

Chronic kidney disease (CKD) has emerged as an independent predictor for cardiovascular disease (CVD), which is now regarded as an inflammatory disease. This study aimed to determine the association of CKD with white blood cell (WBC) count as a marker of systemic inflammation. We examined the association of WBC count with CKD in 2825 Korean adults (1155 men, 1670 women) in the 2007 Korean National Health and Nutrition Examination Survey (KNHANES). CKD was defined as either proteinuria or a glomerular filtration rate (GFR) <60 mL/min/1.73 m(2). The odds ratios (ORs) for CKD were calculated using multivariate logistic regression analysis after adjusting for confounding variables across gender-specific WBC count quartiles. The proportion of CKD increased with increasing WBC quartiles, from 9.7% in the lowest quartile to 20.7% in the highest quartile for women. In multivariate logistic regression analysis, the corresponding odds ratios (95% confidence intervals [CIs]) for a CKD across WBC count quartiles among women were 1.00, 1.45 (0.91-2.31), 1.65 (1.03-2.63), and 2.11 (1.33-3.35), after adjusting for age, body mass index (BMI), systolic blood pressure, fasting plasma glucose, smoking status, current drinking high-density lipoprotein cholesterol (HDL-C), and triglyceride. In contrast, compared with women, men appeared to have no significant results of a relationship between WBC quartiles and CKD. Our study shows a significant association between WBC count and the risk for CKD in women. Accordingly, potential health benefits of early detection of a higher level of WBC count may be useful for CKD risk assessment in women.

Metabolic syndrome and its association with white blood cell count in children and adolescents in Korea: The 2005 Korean National Health and Nutrition Examination Survey

Background and aims To estimate the prevalence of metabolic syndrome (MS) and determine its association with white blood cell (WBC) count as a marker of low-grade systemic inflammation in children and adolescents in Korea. Methods and results We investigated the prevalence of MS and its association with WBC count in 928 children and adolescents. MS was defined as having 3 or more conditions based on the modified criteria of the National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATP III). The odds ratios (ORs) for MS were also calculated using multivariate logistic regression analysis across WBC count quartiles (Q1, <5200; Q2, 5200–6100; Q3, 6200–7200; and Q4, ≥7300 cells/μL for boys; Q1, <5200; Q2, 5200–6000; Q3, 6100–7000; and Q4, ≥7100 cells/μL for girls). The prevalence of MS in children and adolescents in Korea was 6.7% (8.5% in boys, 4.5% in girls, P < 0.001). MS was more prevalent in overweight and obese children and adolescents in both boys and girls. The mean WBC counts continuously increased with each additional component of MS in both boys and girls. The ORs (95% CIs) for MS in each WBC quartile were 1.00, 1.56 (0.43–5.67), 4.47 (1.42–14.07), and 5.25 (1.71–16.07) in boys and 1.00, 1.05 (0.15–7.61), 2.89 (0.55–15.17), and 7.47 (1.61–36.67) in girls after adjusting for age, household income, and residential area. Conclusion In summary, this study shows that a substantial number of children and adolescents in Korea have MS, and elevated WBC count may be a surrogate marker for MS.

The Prevalence of Metabolic Syndrome and Diabetes Increases through the Quartiles of White Blood Cell Count in Japanese Men and Women

Low-grade systemic inflammation is proposed as a component of metabolic syndrome (MS) and is reported as a predictor of diabetes. We studied the association between white blood cell count (WBC) and MS and diabetes in Japanese men and women. Cross-sectional associations between WBC and metabolic syndrome (MS) defined by revised NCEP criteria for Japanese, Japanese MS (JMS) defined by the Examination Committee for Criteria of Metabolic Syndrome, and diabetes were examined using medical check-up data from 1,880 men and 1,079 women. The prevalence of MS, JMS, and diabetes was 6.4%, 5.5%, and 4.3%,13.2%, 11.5%, and 5.5%, 15.1%, 13.8%, and 5.1%, and 24.3%, 21.3%, and 8.5%, respectively through the quartiles of WBC in men (p<0.0001, <0.0001, and <0.01, respectively in comparison between the lowest quartile of WBC and the highest quartile of WBC) and 2.2%, 0.4%, and 0.4%, 4.5%, 0.7%, and 1.1%, 9.3%, 1.9%, and 1.5%, and 12.3%, 4.8%, and 3.3%, respectively through the quartiles of WBC in women (p<0.0001, <0.01, and <0.05, respectively in comparison between the lowest quartile of WBC and the highest quartile of WBC). The prevalence of MS, JMS, and diabetes increases through the quartiles of WBC in Japanese men and women. Thus, WBC may be useful as a marker of cardiovascular disease risk.