Lymphocyte subsets in 32 patients with multisystem inflammatory syndrome in children (MIS-C)

BACKGROUND: Lymphopenia is a hallmark of multisystem inflammatory syndrome in children (MIS-C). We aimed to characterize lymphocyte subsets’ shifts and their correlations with other severity markers of MIS-C. METHODS: In this prospective cross-sectional study, we performed peripheral lymphocyte phenotyping in 32 patients with MIS-C. We analyzed lymphocyte subsets at three time-points of the disease: the acute (A), convalescent (B), and recovery (C) phases. Based on age-normalized lymphocyte counts, we distinguished two groups of patients: “the mild” and “the severe”. In addition, we examined differences between these groups regarding other severity markers. RESULTS: In phase A, 84% of children had lymphopenia. Decreased absolute counts of CD3, CD4, and CD8 cells were observed in, respectively, 88%, 72%, and 84% of patients. The natural killer cells were decreased in 63% and CD19 in 59% of children. “The severe” group had significantly higher procalcitonin and troponin I levels and lower platelets and albumin. Moreover, “the severe” group had hypotension more frequently (73% vs. 20%, p=0.008). In phase B, all lymphocyte counts increased, and 32% of children had lymphocytosis. The increase of CD3, CD4, and CD8 counts correlated with some laboratory severity markers (hemoglobin, procalcitonin, D-dimer, lactate dehydrogenase, N-terminal prohormone of brain natriuretic peptide, albumin), but not with steroid use. In phase C, most children had normal lymphocyte counts. CONCLUSIONS: Substantial shifts in lymphocyte counts during MIS-C apply most to T lymphocytes and correlate with the disease severity markers, particularly hypotension prevalence. A proportion of children with MIS-C develops transient lymphocytosis during convalescence.

Download Full-text

Association of Inflammatory Markers with the Severity of COVID-19 in a Tertiary Care Hospital in Bagalkot, India - A Cross-Sectional Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/466 ◽

2021 ◽

Vol 8 (28) ◽

pp. 2520-2525

Author(s):

Sunil Baragi ◽

Pavani Mallikarjun Dyavannavar

Keyword(s):

Serum Ferritin ◽

Inflammatory Markers ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Prediction Of Mortality ◽

Severe Group ◽

D Dimer

BACKGROUND A novel coronavirus was identified as being responsible for a cluster of pneumonia cases worldwide. With an upward trajectory of (corona virus disease-19) COVID-19 cases and its numerous presentations, there is an urgent requirement of identifying initial signs of decline of quality and an adequate response in order to shift a patient to specialized intensive care units (ICU) for those who progress morbidly to severe or critical categories. It has been reported that various acute phase reactants like erythrocyte sedimentation rate (ESR), ferritin, C-reactive protein (CRP), lactate dehydrogenase (LDH) and D-dimer are raised much more in severe and critical patients than in the mild cases. These markers might have a role to predict mortality. The present study was done to assess the relationship of serum ferritin, and CRP levels at admission with in-hospital mortality among patients with COVID-19 infection and to determine cut-off values of the best prediction of mortality. METHODS A cross-sectional study of 109 reverse transcription polymerase chain reaction (RTPCR) confirmed COVID-19 patients admitted in our hospital was done. The outcome of cases was categorized into mild, moderate and severe grades. RESULTS Out of 109, 80(73.4 %) were males and 29 (26.6 %) were females. Majority patients of both genders were having severe disease with 30 males and females 10 (P - value = 0.066). Among 109 patients, mild cases (33), moderate case (36), severe case (40). Serum ferritin value severe group (n = 49) 422.45 ng/mL, moderate group (n = 33) 563.64 ng/mL, mild group (n = 27) 529.63 ng/mL. Mean ESR value in severe group 98.37, moderate group 100, mild group 100. Mean CRP in severe group 242.86 mg/L, moderate group 248.48 mg/L, mild group 307.41 mg/L. Mean d-dimer in severe group 971.43 ng/mL, moderate group 803.03 ng/mL, mild group 811.11 ng/mL. CONCLUSIONS Our study showed higher levels of markers like ferritin, D-dimer, CRP and ESR in severe patients as compared to mild and helped in forecasting the advancement of mild cases to severe. Also, the blood levels of CRP and ferritin and the duration to complete symptomatic relief all demonstrated a substantial statistical link thus aiding for monitoring of patients at home and in hospitals. KEYWORDS Covid-19, Inflammatory Markers

Download Full-text

SAT0330 NEW IMMUNOMODULATORY COMBINATION THERAPIES IN PATIENTS WITH SYSTEMIC SCLEROSIS: A RETROSPECTIVE CROSS-SECTIONAL STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.1855 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1110.1-1111

Author(s):

J. Qiao ◽

S. X. Zhang ◽

T. T. Zhang ◽

J. Zhang ◽

M. T. Qiu ◽

...

Keyword(s):

Systemic Sclerosis ◽

Side Effects ◽

Lymphocyte Subsets ◽

Cross Sectional Study ◽

Peripheral Lymphocyte ◽

High Morbidity ◽

Combination Therapies ◽

Sectional Study ◽

Cross Sectional ◽

Long Term Treatment

Background:Systemic sclerosis (scleroderma, SSc) is a rare complex connective tissue disease associated with high mortality and high morbidity1. Active SSc are typically treated with immunosuppressants, which may create a variety of severe side-effects, especially for long-term treatment2. As the pathogenesis of SSc is still a matter of debate, growing evidences have focused on the immune disorders3. However, the quantitative status of lymphocyte subsets in SSc patients are unclear and effects of immunomodulatory combination therapies (avoiding side-effects of conventional therapy) on the lymphocyte subsets are unknown.Objectives:To investigate the quantitative status of peripheral lymphocyte subpopulations and CD4+T subsets in SSc patients for the exploration of SSc pathogenesis and evaluate the effects of new immunomodulatory combination therapies on those cells.Methods:From July 2014 to December 2019, total 166 patients with SSc and 206 healthy controls (HCs) were enrolled in this study, in which, 79 follow-up patients received immunomodulatory drugs (IMiDs) such as low-dose interleukin-2, rapamycin, metformin, retinoic acid and coenzyme Q10. The absolute numbers of T, B, NK, CD4+T, CD8+T, Th1, Th2, Th17 and Tregs in peripheral blood of these subjects were detected by flow cytometry combined with standard absolute counting beads.Results:Patients with SSc had lower absolute counts of total T, NK, Th2, Th17 and Tregs as compared with those of HCs (P<0.05) (Figure 1). After immunomodulatory combination treatments, there were increases in a various of peripheral lymphocyte subsets such as T, B and CD8+T (P< 0.05). Moreover, the increased level of Tregs was much more dramatical than those of other lymphocyte subsets, resulting in the decrease ratios of Teffs/Tregs such as Th1/Tregs and Th2/Tregs and rebuilding immunologic equilibrium (Figure 2).Conclusion:This cross-sectional study clarified the abnormal status of lymphocyte subsets in SSc patients, suggesting lymphocyte subsets, especially Tregs, might be relevant and play a crucial role in the pathogenesis of SSc, thus providing a potential therapeutic target for SSc patients. Immunomodulatory combination therapies effectively increase the level of Tregs as well as other lymphocytes to some degree and maintain the immunologic equilibrium, which may help for SSc patients’ symptom remission.References:[1]Denton CP, Khanna D. Systemic sclerosis. Lancet 2017;390(10103):1685-99. doi: 10.1016/S0140-6736(17)30933-9 [published Online First: 2017/04/18][2]Winthrop KL, Weinblatt ME, Bathon J, et al. Unmet need in rheumatology: reports from the Targeted Therapies meeting 2019. Ann Rheum Dis 2020;79(1):88-93. doi: 10.1136/annrheumdis-2019-216151 [published Online First: 2019/10/31][3]Skaug B, Khanna D, Swindell WR, et al. Global skin gene expression analysis of early diffuse cutaneous systemic sclerosis shows a prominent innate and adaptive inflammatory profile. Ann Rheum Dis 2019 doi: 10.1136/annrheumdis-2019-215894 [published Online First: 2019/11/27]Acknowledgments :None.Disclosure of Interests:None declared

Download Full-text

Profile of D-dimer in Uncomplicated Pregnancy

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v7i4.1065 ◽

2019 ◽

pp. 283-287

Author(s):

Rahajuningsih Dharma ◽

Mercy T. Panjaitan ◽

Kanadi Sumapradja ◽

Rianto Setiabudy

Keyword(s):

Pregnant Women ◽

Clinical Pathology ◽

Cross Sectional Study ◽

Control Group ◽

Sectional Study ◽

Cross Sectional ◽

Uncomplicated Pregnancy ◽

D Dimer

Abstract Objective: To obtain the profile of D-dimer in uncomplicated pregnancy. Methods: A cross sectional study was done on 90 uncomplicated pregnant women consisted of 30 women in each trimester and 30 healthy, nonpregnant women as control group from July to August 2012. D-dimer level was measured by particle enhanced immunoturbidimetry method using Innovance D-dimer and Sysmex CA 1500 in the Department of Clinical Pathology, Dr. Cipto Mangunkusumo Hospital, Jakarta. Results: All women in the control group showed normal D-dimer level (<0.,5 mg/L FEU). The median and range of D-dimer level in the 1st trimester, 2nd trimester, and 3rd trimester were 0.42 mg/L FEU and 0.1-1.07 mg/L FEU, 0.97 mg/L FEU and 0.6-3.34 mg/L FEU, and 1.56 mg/L FEU and 0.69-3.75 mg/L FEU, respectively. Increased D-dimer level was found in 27% of pregnant women in 1st trimester, 87% in 2nd trimester, and 100% in 3rd trimester. Conclusion: Increased D-dimer level was found in 27% of pregnant women in 1st trimester, 87% in 2nd trimester, and 100% in 3rd trimester. The range of D-dimer level in the 1st trimester was 0.1-1.07 mg/L FEU, in the 2nd trimester was 0.6-3.34 mg/L FEU, and in the 3rd trimester was 0.69-3.75 mg/L FEU. Keywords: D-dimer, trimester, uncomplicated pregnancy Abstrak Tujuan : Untuk mendapatkan profil D-dimer pada kehamilan tanpa komplikasi. Metode : Penelitian potong lintang dilakukan pada 90 perempuan hamil tanpa komplikasi yang terdiri atas 30 perempuan pada tiap trimester dan 30 perempuan sehat yang tidak hamil, sebagai kelompok kontrol dari bulan Juli sampai Agustus 2012. Kadar D-dimer diukur dengan cara particle enhanced immunoturbidimetry menggunakan reagen InnovanceÒ D-dimer dan koagulometer SysmexÒ CA 1500 di Deparemen Patologi Klinik, Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo, Jakarta. Hasil: Seluruh perempuan dalam kelompok kontrol mempunyai kadar D-dimer dalam batas normal (<0.,5 mg/L FEU). Median (rentang) kadar D-dimer pada trimester pertama, kedua, dan ketiga berturut-turut 0.42 mg/L FEU (0.1-1.07 mg/L FEU), 0.97 mg/L FEU (0.6-3.34 mg/L FEU), dan 1.56 mg/L FEU (0.69-3.75 mg/L FEU). Peningkatan kadar D-dimer ditemukan pada 27% perempuan hamil trimester pertama, 87% trimester kedua, dan pada 100% trimester ketiga. Kesimpulan: Peningkatan kadar D-dimer ditemukan pada 27% perempuan hamil trimester pertama, 87% trimester kedua dan 100% pada trimester ketiga. Rentang kadar D-dimer level pada trimester pertama adalah 0.1-1.07 mg/L FEU, pada trimester kedua 0.6-3.34 mg/L FEU, dan pada trimester ketiga 0.69-3.75 mg/L FEU. Kata kunci: D-dimer, kehamilan tanpa komplikasi, trimester

Download Full-text