scholarly journals Preoperative White Blood Cell Count and Risk of 30-Day Readmission after Cardiac Surgery

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Jeremiah R. Brown ◽  
R. Clive Landis ◽  
Kristine Chaisson ◽  
Cathy S. Ross ◽  
Lawrence J. Dacey ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Cell ◽  
White Blood Cell ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Gastrointestinal Complications ◽  
Disease States ◽  
Inflammatory State ◽  
Independent Association ◽  
Wbc Count

Approximately 1 in 5 patients undergoing cardiac surgery are readmitted within 30 days of discharge. Among the primary causes of readmission are infection and disease states susceptible to the inflammatory cascade, such as diabetes, chronic obstructive pulmonary disease, and gastrointestinal complications. Currently, it is not known if a patient’s baseline inflammatory state measured by crude white blood cell (WBC) counts could predict 30-day readmission. We collected data from 2,176 consecutive patients who underwent cardiac surgery at seven hospitals. Patient readmission data was abstracted from each hospital. The independent association with preoperative WBC count was determined using logistic regression. There were 259 patients readmitted within 30 days, with a median time of readmission of 9 days (IQR 4–16). Patients with elevated WBC count at baseline (10,000–12,000 and >12,000 mm3) had higher 30-day readmission than those with lower levels of WBC count prior to surgery (15% and 18% compared to 10%–12%,P=0.037). Adjusted odds ratios were 1.42 (0.86, 2.34) for WBC counts 10,000–12,000 and 1.81 (1.03, 3.17) for WBC count > 12,000. We conclude that WBC count measured prior to cardiac surgery as a measure of the patient’s inflammatory state could aid clinicians and continuity of care management teams in identifying patients at heightened risk of 30-day readmission after discharge from cardiac surgery.

scholarly journals Gastrointestinal Complications after Cardiac Surgery: Incidence, Predictors, and Impact on Outcomes

2020 ◽  
Author(s):  
Nicholas Hess ◽  
Laura Seese ◽  
Yeahwa Hong ◽  
Derek Afflu ◽  
Yisi Wang ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Gastrointestinal Complications ◽  
Risk Factor Modification ◽  
Sternal Wound Infections ◽  
Long Term Impact ◽  
Surgery Incidence ◽  
Late Survival

Background: The purpose of this study was to investigate the incidence, predictors, and long-term impact of gastrointestinal (GI) complications following adult cardiac surgery. Methods: Index Society of Thoracic Surgeons (STS) adult cardiac operations performed between January 2010 and February 2018 at a single institution were included. Patients were stratified by the occurrence of postoperative GI complications. Outcomes included early and late survival as well as other associated major postoperative complications. A sub-analysis of propensity score matched patients was also performed. Results: 10,285 patients were included, and the overall rate of GI complications was 2.4% (n=246). Predictors of GI complications included dialysis dependency, intra-aortic balloon pump, congestive heart failure, chronic obstructive pulmonary disease, and longer aortic cross-clamp times. Thirty-day (2.6% vs 24.8%), one- (6.3% vs 41.9%), and three-year (11.1% vs 48.4%) mortality were substantially higher in patients who experienced GI complications (all P<0.001). GI complication was associated with a three-fold increased hazard for mortality (HR 3.1, 95% CI 2.6-3.7) after risk adjustment, and there was an association between the occurrence of GI complications and increased rates of renal failure (39.4% vs 2.5%), new dialysis dependency (31.3% vs 1.5%), multisystem organ failure (21.5% vs 1.0%), and deep sternal wound infections (2.6% vs 0.2%)(all P<0.001). These results persisted in propensity-matched analysis. Conclusions: GI complications are infrequent but have a profound impact on early and late survival, and often occur in association with other major complications. Risk factor modification, heightened awareness, and early detection and management of GI complications appears warranted.

General outcomes and risk factors for minor and major amputations in Brazil

Vascular ◽  
2017 ◽  
Vol 26 (3) ◽  
pp. 291-300 ◽  
Author(s):  
Jose O Leite ◽  
Leandro O Costa ◽  
Walter M Fonseca ◽  
Debora U Souza ◽  
Barbara C Goncalves ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Cell ◽  
Hospital Mortality ◽  
White Blood Cell ◽  
Postoperative Infection ◽  
Major Amputation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Minor Amputation ◽  
The Impact

Objectives Major and minor amputations are associated with significant rates of mortality. However, little is known about the impact of unplanned redo-amputation during the same hospitalization on outcomes. The objectives of this study were to identify the risk factors associated with in-hospital mortality after both major and minor amputations as well as the results of unplanned redo-amputation on outcome. Methods Retrospective study of 342 consecutive patients who were treated with lower extremity amputation in Brazil between January 2013 and October 2014. Results The in-hospital mortality rate was higher in major compared to minor amputation (25.6% vs. 4.1%; p < 0.0001). Whereas chronic kidney disease, chronic obstructive pulmonary disease, and planned staged amputation predicted in-hospital mortality after major amputation, age, and congestive heart failure predicted mortality after minor amputation. The white blood cell count predicted in-hospital mortality following both major and minor amputation. However, postoperative infection predicted in-hospital mortality only following major amputation. Conclusions In-hospital mortality was high after major amputations. Unplanned redo-amputation was not a predictor of in-hospital mortality after major or minor amputation. Planned staged amputation was associated with reduced survival after major but not minor amputation. Postoperative infection predicted mortality after major amputation. Systemic diseases and postoperative white blood cell were associated with in-hospital mortality. This study suggests a possible link between a pro-inflammatory state and increased in-hospital mortality following amputation.

Neutrophil and Monocyte Counts in Heparin-Induced Thrombocytopenia

2019 ◽  
Vol 119 (06) ◽  
pp. 941-951 ◽  
Author(s):  
Madeleine Hui ◽  
Jo-Ann I. Sheppard ◽  
Na Li ◽  
Theodore E. Warkentin
Keyword(s):  
Cardiac Surgery ◽  
Blood Cell ◽  
White Blood Cell ◽  
Monocyte Count ◽  
Heparin Induced Thrombocytopenia ◽  
Post Surgery ◽  
Leukocyte Counts ◽  
Wbc Count ◽  
Diagnosis Of Infection ◽  
Post Cardiac Surgery

Background Heparin-induced thrombocytopenia (HIT) antibodies activate platelets, monocytes and neutrophils. Despite these findings, it is unknown whether white blood cell (WBC) counts, including neutrophils and monocytes, are altered during HIT. Materials and Methods We evaluated changes in total WBC counts (including WBC subsets), in 50 post-cardiac surgery patients with serologically confirmed HIT (30 patients with HIT-associated thrombosis). Daily leukocyte counts were compared with those measured one day prior to HIT onset; WBC increases were classified as mild (20.0–49.9%), moderate (50.0–99.9%) or major (≥ 100% increase). We also compared changes in WBC counts in HIT patients with and without HIT-associated thrombosis, and non-HIT patients with thrombosis. Results Most (34/50 [68.0%]) patients with HIT developed WBC count increases (mild, 35.3%; moderate, 44.1%; major, 20.6%). The peak WBC count occurred on day 4 (median) of HIT, which corresponded to day 10 (median) post-surgery. Absolute neutrophil counts increased in most patients (38/50 [76.0%]); whereas absolute monocyte counts rose in some patients, the overall tendency was for the monocyte count to decrease during HIT. Unexpectedly, we found that the increase in total WBC counts, as well as in neutrophils, was seen mainly in patients who developed HIT-associated or non-HIT-associated thrombosis; in contrast, no difference in monocyte levels was seen in patients with or without thrombosis. Conclusion Leukocytosis and neutrophilia are commonly observed in patients with HIT, particularly in patients with HIT-associated thrombosis, as well as non-HIT patients with thrombosis. Thus, leukocytosis/neutrophilia should not infer automatically a diagnosis of infection or inflammation, when evaluating thrombocytopenia in heparin-exposed patients.

Association Between White Blood Cell Counts and Brachial-Ankle Pulse Wave Velocity in Chinese Hypertensive Adults: A Cross-Sectional Study

Angiology ◽  
2021 ◽  
pp. 000331972110211
Author(s):  
Buyun Jia ◽  
Chongfei Jiang ◽  
Yun Song ◽  
Chenfangyuan Duan ◽  
Lishun Liu ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Blood Cell ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
White Blood Cell ◽  
Pulse Wave ◽  
Final Analysis ◽  
Cross Sectional ◽  
Cell Counts ◽  
Wbc Count

Increased arterial stiffness is highly prevalent in patients with hypertension and is associated with cardiovascular (CV) risk. Increased white blood cell (WBC) counts may also be an independent risk factor for arterial stiffness and CV events. The aim of the study was to investigate the relationship between differential WBC counts and brachial-ankle pulse wave velocity (baPWV) in hypertensive adults. A total of 14 390 participants were included in the final analysis. A multivariate linear regression model was applied for the correlation analysis of WBC count and baPWV. Higher WBC counts were associated with a greater baPWV: adjusted β = 10 (95% CI, 8-13, P < .001). The same significant association was also found when WBC count was assessed as categories or quartiles. In addition, the effect of differential WBC subtypes, including neutrophil count and lymphocyte count on baPWV, showed the similar results. These findings showed that baPWV has positive associations with differential WBC counts in hypertensive adults.

scholarly journals The Ability of Metabolomics to Discriminate Non-Small-Cell Lung Cancer Subtypes Depends on the Stage of the Disease and the Type of Material Studied

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3314
Author(s):  
Tomasz Kowalczyk ◽  
Joanna Kisluk ◽  
Karolina Pietrowska ◽  
Joanna Godzien ◽  
Miroslaw Kozlowski ◽  
...  
Keyword(s):  
Metabolic Pathways ◽  
Early Stage ◽  
Chronic Obstructive ◽  
Liquid Chromatography Mass Spectrometry ◽  
Obstructive Pulmonary Disease ◽  
Cell Lung Carcinoma ◽  
Cancer Subtypes ◽  
Inflammatory State ◽  
Nsclc Patients

Identification of the NSCLC subtype at an early stage is still quite sophisticated. Metabolomics analysis of tissue and plasma of NSCLC patients may indicate new, and yet unknown, metabolic pathways active in the NSCLC. Our research characterized the metabolomics profile of tissue and plasma of patients with early and advanced NSCLC stage. Samples were subjected to thorough metabolomics analyses using liquid chromatography-mass spectrometry (LC-MS) technique. Tissue and/or plasma samples from 137 NSCLC patients were analyzed. Based on the early stage tissue analysis, more than 200 metabolites differentiating adenocarcinoma (ADC) and squamous cell lung carcinoma (SCC) subtypes as well as normal tissue, were identified. Most of the identified metabolites were amino acids, fatty acids, carnitines, lysoglycerophospholipids, sphingomyelins, plasmalogens and glycerophospholipids. Moreover, metabolites related to N-acyl ethanolamine (NAE) biosynthesis, namely glycerophospho (N-acyl) ethanolamines (GP-NAE), which discriminated early-stage SCC from ADC, have also been identified. On the other hand, the analysis of plasma of chronic obstructive pulmonary disease (COPD) and NSCLC patients allowed exclusion of the metabolites related to the inflammatory state in lungs and the identification of compounds (lysoglycerophospholipids, glycerophospholipids and sphingomyelins) truly characteristic to cancer. Our results, among already known, showed novel, thus far not described, metabolites discriminating NSCLC subtypes, especially in the early stage of cancer. Moreover, the presented results also indicated the activity of new metabolic pathways in NSCLC. Further investigations on the role of NAE biosynthesis pathways in the early stage of NSCLC may reveal new prognostic and diagnostic targets.

scholarly journals Predictive values of Alvarado score, serum C-reactive protein, and white blood cell count in the diagnosis of acute appendicitis: a prospective study

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Ademola Olusegun Talabi ◽  
Tewogbade Adeoye Adedeji ◽  
Oludayo Adedapo Sowande ◽  
Olusanya Adejuyigbe
Keyword(s):  
Acute Appendicitis ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
C Reactive Protein ◽  
Blood Cell Count ◽  
Alvarado Score ◽  
Reactive Protein ◽  
Wbc Count

Abstract Background The diagnosis of acute appendicitis in children is quite challenging as the rate of negative appendectomy varies between 15 and 57%. Increased utilization of imaging diagnostic facilities in advanced countries seems to have reduced the incidence of operating on normal appendix to a single digit. In low- and middle-income countries, the incidence remains unacceptably high (double digits). Inflammatory markers and scoring systems may be a suitable adjunct to increase diagnostic yield in most third world countries. Thus, the aim of this study was to evaluate the diagnostic value of Alvarado score, white blood cell count, and serum C-reactive protein in children with acute appendicitis. Results The ages of patients ranged between 4 and 15 years with a mean of 11.2 ± 2.8 years. The male to female ratio was 1.4 to 1.0. Nineteen percent of patients had negative appendiceal findings on histological examination. The sensitivity and specificity of Alvarado score, C-reactive protein estimation, total white blood cell count in diagnosing acute appendicitis were 86.4% and 63.2%, 98.8% and 36.8%, and 51.9% and 89.5% respectively. Alvarado score has the highest area under ROC curve analysis 0.824, 95% CI of 0.724 to 0.924 compared with CRP, 0.769. 95% CI of = 0.647 to 0.891 and WBC count, 0.765, 95% CI of 0.643 to 0.887. Both CRP and WBC count showed higher discriminatory values between complicated and uncomplicated appendicitis, p < 0.001. Conclusion Alvarado score outperformed other tests in setting the diagnosis of acute appendicitis. However, none of the tests can be relied on wholly for operative decision. Clinical judgement remains the bedrock for diagnosis and operative management.

scholarly journals Red Blood Cell Distribution Width Predicts Pulmonary Hypertension Secondary to Chronic Obstructive Pulmonary Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Jie Yang ◽  
Chuanmei Liu ◽  
Lingling Li ◽  
Xiongwen Tu ◽  
Zhiwei Lu
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Hypertension ◽  
Blood Cell ◽  
Tracking System ◽  
Chronic Obstructive ◽  
Cell Distribution ◽  
Obstructive Pulmonary Disease ◽  
Distribution Width ◽  
Copd Patients ◽  
Red Blood Cell Distribution

Purpose. This study aims at investigating the predictive value of red blood cell distribution width (RDW) in pulmonary hypertension (PH) secondary to chronic obstructive pulmonary disease (COPD). Methods. 213 eligible in-hospital COPD patients were reviewed between May 2016 and May 2018, including 39 cases with PH and 174 without PH. Clinical data including demographic characteristics, comorbidities, and results of ultrasound scans, imaging examinations, and laboratory tests were recorded. Results. Increased RDW level was observed in COPD patients with PH compared with COPD patients without PH, with 15.10 ± 1.72% versus 13.70 ± 1.03%, respectively (p<0.001). RDW shared positive relationships with brain natriuretic peptide (BNP) (p=0.001, r = 0.513), pulmonary artery (PA) systolic pressure (p=0.014, r = 0.390), and PA-to-ascending aorta (A) ratio (PA : A) (p=0.001, r = 0.502). Multivariate analysis indicated that RDW, BNP, and PA : A > 1 were the independent risk factors of PH secondary to COPD (p<0.05). The AUC of the RDW in patients with PH was 0.749 ± 0.054 (p<0.001). The optimal cutoff value of RDW for predicting PH was 14.65, with a sensitivity and a specificity value of 69.2% and 82.8%, respectively. Conclusion. RDW is significantly increased in COPD patients with PH and thus may be a useful biomarker for PH secondary to COPD.

scholarly journals Decrease in white blood cell counts after thiopentone barbiturate therapy for refractory intracranial hypertension: A common complication

2013 ◽  
Vol 04 (S 01) ◽  
pp. S31-S34 ◽  
Author(s):  
Shin Yi Ng ◽  
Ki Jinn Chin ◽  
Tong Kiat Kwek
Keyword(s):  
Statistical Analysis ◽  
Blood Cell ◽  
Intracranial Hypertension ◽  
White Blood Cell ◽  
Retrospective Review ◽  
T Test ◽  
Barbiturate Coma ◽  
Barbiturate Therapy ◽  
The Mean ◽  
Wbc Count

ABSTRACT Background: Leucopenia has been reported after induction of thiopentone barbiturate therapy for refractory intracranial hypertension. However, the incidence and characterisitics are not well described. Aims: We performed a retrospective review to describe the incidence and characteristics of leucopenia after induction of thiopentone barbiturate therapy. Setting and Design: Our centre is a national referral centre for neurotrauma and surgery in a tertiary medical institution.Materials and Methods: We performed a retrospective review of all patients who received thiopentone barbiturate therapy for refractory intracranial hypertension during an 18 month period from January 2004 to June 2005 in our neurosurgical intensive care unit. Statistical Analysis Used: Statistical analysis was performed using SPSS version 15.0. All data are reported as mean ± standard deviation or median (interquartile range). The Chi square test was used to analyze categorical data and student t test done for comparison of means. For paired data, the paired t?test was used.-test was used. Results: Thirty eight (80.9%) out of 47 patients developed a decrease in white blood cell (WBC) count after induction of thiopentone barbiturate coma. The mean decrease in WBC from baseline to the nadir was 6.4 × 10 9 /L (P <lt; 0.001) and occurred 57 (3-147) h after induction. The mean nadir WBC was 8.6 < 3.6 × 10 9 /L. Three (6.4%) patients were leucopenic, with a WBC count of 2.8, 3.1, and 3.6 < 10 9 /L. None of them were neutropenic. We did not find an association between decrease in WBC count and clinical diagnosis of infection. We did not find any association between possible risk factors such as admission GCS, maximum ICP prior to induction of barbiturate coma, APACHE II score, total duration and dose of thiopentone given, and decrease in WBC count. Conclusions: Decrease in WBC count is common, while development of leucopenia is rare after thiopentone barbiturate coma. Regular monitoring of WBC counts is recommended.

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