scholarly journals INFLAMMATORY RESPONSE IN SOLID ORGAN AND TISSUE RECIPIENT WITH COVID-19

JBMTCT ◽  
2020 ◽  
Vol 2 (1) ◽  
pp. 37-43
Author(s):  
Ana Teresa Sobreira Lima Verde ◽  
Ana Vitória Magalhães Chaves ◽  
Fernando Barroso Duarte ◽  
José Huygens Parente Garcia ◽  
Paula Frassinetti Castelo Branco Camurça Fernandes

Introduction: The COVID-19 infection is caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infection, which was first reported in Hubei, Wuhan province, China, in December 2019. There is a concern that immunocompromised patients are at greater risk of morbidity and mortality due to COVID-19 infection, although there is limited data on these patients. Here, we present an evolution of a series of cases of patients with COVID-19 in our service. Patients and methods: This is a retrospective cohort study conducted at the Hospital Universitário Walter Cantídio in Fortaleza-CE, Brazil. All patients hospitalized due to COVID-19 were screened for a history of organ or tissue transplantation, with a total number of 77 patients. Only patients confirmed for COVID-19 were included in the study. The inflammatory response and initial laboratory results, as well as the CALL score, were compared to a cohort of patients with COVID-19 not transplanted at the same time in our clinical ward or intensive care unit (ICU). The clinical course and clinical findings recorded during treatment were extracted from the electronic medical record. A bilateral P <0.05 (5%) was considered significant. Results: The total number of hospitalizations until July 24, 2020 for confirmed cases of COVID-19 was 77 patients. Of the total, 33 (42%) patients needed ICU. Most patients were male (61%). The median age was 62 [95% CI: 54-63] years, 31 (37%) had a previous diagnosis of hypertension, 24 (28%) of type 2 diabetes mellitus (DM-2). The total lethality of our service was 22%. The CALL score of patients admitted to the clinical ward and in the ICU was analyzed, with a higher average observed in the patients admitted in ICU, the average was 9.34 in the patients admitted in the clinical ward and 10.9 in the patients who required ICU. (p = 0.003) . The effect of neutrophil/lymphocyte ratio(NLR) at admission on the need of ICU care was analyzed by ROC curve and AUC and was found to be significant (AUC: 0.708, p = 0.002, 95% CI = 0.593 to 0.823). The number of transplant recipients in our service was 17 patients. The mean age was 56 years and the median was 55 years [95% CI: 45-65 years]. Of this subgroup, 6 patients (35%) required ICU, with no statistical difference when compared to non- transplanted patients (p = 0.443), and only 3 evolved to death (17%), also without statistical difference when compared to the subgroup of non-transplanted patients (p = 0.484). When compared to the sample of non-transplanted patients, lower values were found of the White Blood cells count, neutrophils and ferritin. However, despite lower values of fibrinogen, D-dimer, C-reactive protein (CRP) and lactate dehydrogenase (LDH), there was no statistical difference. Conclusion: It is a new disease, with few data, mainly in the studied population. Our sample was a reduced sample, however it was surprising to see a lower inflammatory tendency, although without statistical significance and with mortality similar to the general population. In addition, it is worth emphasizing the importance shown on the neutrophil / lymphocyte ratio of admission demonstrated by the ROC curve in patients who evolve in need of an ICU care.

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3256
Author(s):  
Adam Brewczyński ◽  
Beata Jabłońska ◽  
Agnieszka Maria Mazurek ◽  
Jolanta Mrochem-Kwarciak ◽  
Sławomir Mrowiec ◽  
...  

Several immune and hematological parameters are associated with survival in patients with oropharyngeal cancer (OPC). The aim of the study was to analyze selected immune and hematological parameters of patients with HPV-related (HPV+) and HPV-unrelated (HPV-) OPC, before and after radiotherapy/chemoradiotherapy (RT/CRT) and to assess the impact of these parameters on survival. One hundred twenty seven patients with HPV+ and HPV− OPC, treated with RT alone or concurrent chemoradiotherapy (CRT), were included. Patients were divided according to HPV status. Confirmation of HPV etiology was obtained from FFPE (Formalin-Fixed, Paraffin-Embedded) tissue samples and/or extracellular circulating HPV DNA was determined. The pre-treatment and post-treatment laboratory blood parameters were compared in both groups. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), and systemic immune inflammation (SII) index were calculated. The impact of these parameters on overall (OS) and disease-free (DFS) survival was analyzed. In HPV+ patients, a high pre-treatment white blood cells (WBC) count (>8.33 /mm3), NLR (>2.13), SII (>448.60) significantly correlated with reduced OS, whereas high NLR (>2.29), SII (>462.58) significantly correlated with reduced DFS. A higher pre-treatment NLR and SII were significant poor prognostic factors for both OS and DFS in the HPV+ group. These associations were not apparent in HPV− patients. There are different pre-treatment and post-treatment immune and hematological prognostic factors for OS and DFS in HPV+ and HPV− patients. The immune ratios could be considered valuable biomarkers for risk stratification and differentiation for HPV− and HPV+ OPC patients.


2021 ◽  
pp. 19-26
Author(s):  
Jeremiah Adeyemi Akinwumi ◽  
Fabian Victory Edem ◽  
Ganiyu Olatunbosun Arinola

The pandemicity of coronavirus disease 2019 (COVID-19) necessitated its novel biomarkers in prognosis and monitoring in low resource settings. Changes in total white blood cell counts have been associated with the progression of diseases. This study determined the prognostic value of some cellular inflammatory cells and their indices in relation to duration of hospital admission, gender, and age of COVID-19 patients. This longitudinal and case–control study determined blood cell components (total white blood cells (TWBC), neutrophil, lymphocyte, monocyte, and platelet) and inflammatory indices (neutrophil lymphocyte ratio [NLR], lymphocyte monocyte ratio [LMR], platelet lymphocyte ratio [PLR], derived NLR [DNLR], and systemic immune inflammatory index [SII]) in 95 symptomatic hospitalized COVID-19 patients and 45 COVID-19 free controls. These parameters were related to age, sex, and days of admission of the patients. Blood samples obtained were analyzed using hematological autoanalyzer (Sysmex XN-450) and indices calculated. Data were analyzed using the Statistical Package for the Social Sciences (SPSS Inc., USA) version 20.0. The mean platelet count (P = 0.016) and PLR (P = 0.000) were significantly lower while TWBC counts (P = 0.013) were significantly increased in COVID-19 patients compared with control. The mean TWBC count (P = 0.030) and SII (P = 0.029) were significantly increased while lymphocyte count (P = 0.015) and LMR (P = 0.026) were significantly decreased in COVID-19 patients at discharge compared with COVID-19 patients at admission. The mean neutrophil count (P = 0.048), PLR (P = 0.015), and SII (P = 0.022) were significantly lower while mean lymphocyte count (P = 0.026) was significantly higher in COVID-19 patients aged <40 years compared with patients aged ?40 years. This study concluded that inflammatory response is a phenomenon in COVID-19 patients especially in patients ?40 years of age and that this inflammation persist till discharge, though gender has no influence on cellular inflammatory indices of COVID-19 patients.


2021 ◽  
Vol 49 ◽  
Author(s):  
Társsila Mara Vieira Ferreira ◽  
Alexandre Tavares Camelo Oliveira ◽  
Victor Machado De Carvalho ◽  
Ana Débora Nunes Pinheiro ◽  
Thaíse Cristine Ferreira De Carvalho Sombra ◽  
...  

Background: Canine Leishmaniasis (CanL) is a multisystemic and chronic inflammatory disease characterized by nonspecific clinical manifestations. In CanL, inflammatory cells and chemical mediators released in response to the parasite play a role in disease development and progression. Alterations on hematological parameters have been documented in CanL. These changes can also be assessed in relation to systemic inflammation caused by this disease. The circulating leukocyte counting, such as neutrophils, as well as the albumin level, are considered direct indicators of an inflammatory host environment. Several studies point to the use of biomarkers on the assistance in diagnosis and prognosis of several canine pathologies. The present study investigated the Neutrophils to Lymphocyte Ratio (NLR), Albumin to Globulin Ratio (AGR), and Neutrophils to Albumin Ratio (NAR) on systemic inflammatory response induced by Canine Leishmaniasis (CanL).Materials, Methods & Results: For this purpose, adult dogs with confirmed diagnosis to CanL were divided into symptomatic (SD, n = 33) and asymptomatic (AD, n = 20) dogs for L. infantum and control dogs (CD, n = 20). Routine hematological and biochemical parameters were determined in blood samples using a veterinary automatic hematology and biochemical analyzers. Asymptomatic dogs (AD) had a higher number of white blood cells and neutrophils (16.48 ± 4.93; 13.41 ± 3.60, respectively) in relation to symptomatic dogs (SD) (13.54 ± 5.13; 10.42± 3.69, respectively) (P = 0.015 and P < 0.0001, respectively). Neutrophils to Lymphocyte Ratio (NLR) was higher in dogs with leishmaniasis (9.45 ± 3.76) than in healthy dogs (3.39 ± 1.19) (P < 0.0001). Serum total proteins (STP) and globulins increased in CanL, while albumin and AGR decreased in CanL, when compared to CD and references values to canine species. Neutrophils to Albumin Ratio (NAR) was higher in AD and SD (5.02 ± 1.14; 4.79 ± 1.07, respectively) when compared to CD (2.36 ± 0.55) (P < 0.0001). Discussion: As reported in scientific researches, dogs with Leishmaniasis present alterations in circulating cell counts. Based on these data, we decided to expand this information using the NLR as a parameter in an attempt to better clarify the changes in these cells in CanL. We observed that NLR was increased on CanL in relation to healthy dogs, which could be a consequence of relative neutrophilia rather than lymphopenia. Neutrophils to Lymphocyte Ratio (NLR) is a biomarker that conveys information about inflammatory conditions. An elevated NLR can reflect an upregulated innate immune response, since neutrophils are effector cells of innate immunity and are involved in several acute and chronic inflammatory processes. Albumin is an acute phase protein that is considered an immune-inflammatory biomarker, which can be found reduced systemically in progressive inflammatory response. Serum total proteins (STP) and globulins were increased in CanL. These data are already well documented in CanL, which serum globulins are mainly associated with the increase of acute phase proteins, cytokines, and increase of specific antibodies to Leishmaniainfantum. Our results showed neutrophilia with hypoalbuminemia in CanL. So, in an attempt to assess the relationship of these two available markers, we used NAR calculation in order to evaluate the changes induced by CanL. In this study NAR was higher in CanL when compared to control dogs. Thus, our data indicate that NLR and NAR could be used as biomarkers in veterinary medical clinics in order to assess inflammatory profile in CanL, mainly in asymptomatic dogs. These parameters obtained from routine blood tests might be useful as cost-effective, easily accessible and helpful markers in order to distinguish the inflammatory response intensity in CanL.


Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Yanan Hu ◽  
Yi Liu ◽  
Yongzhe Liu ◽  
Hui Chen ◽  
Wei Jiang ◽  
...  

Introduction: Systemic inflammatory response evoked by cardiac surgery involving a cardio-pulmonary bypass (CPB) in combination of surgical trauma, ischemia/reperfusion injury, hypothermia, and endotoxin release contributed to the postoperative morbidity and mortality. This study aimed to explore the potential of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) as novel markers to evaluate and predict the adverse clinical outcomes after longer CPB time in cardiac surgery. Methods: Patients who underwent cardiac surgery with or without CPB were allocated into two groups, CPB group (n=11) and N-CPB group (n=21). The time course of NLR, PLR, SII, and C-reactive protein (CPR) were analyzed at preoperative day 1 and postoperative day 1, 3, and 7. The baseline and postoperative parameters, the ICU and hospital stay were recorded. Results: There were no differences of baseline parameters between groups. The level of NLR, PLR, SII, and CPR at postoperative day 1 was higher than that in the preoperative day 1 in both groups (p < 0.01). The level of NLR, SII and CPR at postoperative day 3 was higher than that in the preoperative day 1 in both groups (p < 0.05). The NLR and SII at postoperative day 3 were higher in CPB group than that in N-CPB group (p < 0.05). The ICU and hospital stay was longer in CPB group than N-CPB group (p < 0.05). Conclusions: The longer duration of CPB time induced higher systemic inflammatory response characterized by higher level of NLR, PLR and SII. The SII predicted the poor outcome after longer CPB. The peak of systemic inflammatory response occurred on the third day after cardiac surgery.


2018 ◽  
Vol 129 (3) ◽  
pp. 583-592 ◽  
Author(s):  
Shi-hao Zheng ◽  
Jin-lan Huang ◽  
Ming Chen ◽  
Bing-long Wang ◽  
Qi-shui Ou ◽  
...  

OBJECTIVEGlioma is the most common form of brain tumor and has high lethality. The authors of this study aimed to elucidate the efficiency of preoperative inflammatory markers, including neutrophil/lymphocyte ratio (NLR), derived NLR (dNLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), and prognostic nutritional index (PNI), and their paired combinations as tools for the preoperative diagnosis of glioma, with particular interest in its most aggressive form, glioblastoma (GBM).METHODSThe medical records of patients newly diagnosed with glioma, acoustic neuroma, meningioma, or nonlesional epilepsy at 3 hospitals between January 2011 and February 2016 were collected and retrospectively analyzed. The values of NLR, dNLR, PLR, LMR, and PNI were compared among patients suffering from glioma, acoustic neuroma, meningioma, and nonlesional epilepsy and healthy controls by using nonparametric tests. Correlations between NLR, dNLR, PLR, LMR, PNI, and tumor grade were analyzed. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic significance of NLR, dNLR, PLR, LMR, PNI, and their paired combinations for glioma, particularly GBM.RESULTSA total of 750 patients with glioma (Grade I, 81 patients; Grade II, 208 patients; Grade III, 169 patients; Grade IV [GBM], 292 patients), 44 with acoustic neuroma, 271 with meningioma, 102 with nonlesional epilepsy, and 682 healthy controls were included in this study. Compared with healthy controls and patients with acoustic neuroma, meningioma, or nonlesional epilepsy, the patients with glioma had higher values of preoperative NLR and dNLR as well as lower values of LMR and PNI, whereas PLR was higher in glioma patients than in healthy controls and patients with nonlesional epilepsy. Subgroup analysis revealed a positive correlation between NLR, dNLR, PLR, and tumor grade but a negative correlation between LMR, PNI, and tumor grade in glioma. For glioma diagnosis, the area under the curve (AUC) obtained from the ROC curve was 0.722 (0.697–0.747) for NLR, 0.696 (0.670–0.722) for dNLR, 0.576 (0.549–0.604) for PLR, 0.760 (0.738–0.783) for LMR, and 0.672 (0.646–0.698) for PNI. The best diagnostic performance was obtained with the combination of NLR+LMR and dNLR+LMR, with AUCs of 0.777 and 0.778, respectively. Additionally, NLR (AUC 0.860, 95% CI 0.832–0.887), dNLR (0.840, 0.810–0.869), PLR (0.678, 0.641–0.715), LMR (0.837, 0.811–0.863), and PNI (0.740, 0.706–0.773) had significant predictive value for GBM compared with healthy controls and other disease groups. As compared with the Grade I–III glioma patients, the GBM patients had an AUC of 0.811 (95% CI 0.778–0.844) for NLR, 0.797 (0.763–0.832) for dNLR, 0.662 (0.622–0.702) for PLR, 0.743 (0.707–0.779) for LMR, and 0.661(0.622–0.701) for PNI. For the paired combinations, NLR+LMR demonstrated the highest accuracy.CONCLUSIONSThe NLR+LMR combination was revealed as a noninvasive biomarker with relatively high sensitivity and specificity for glioma diagnosis, the differential diagnosis of glioma from acoustic neuroma and meningioma, GBM diagnosis, and the differential diagnosis of GBM from low-grade glioma.


2021 ◽  
Vol 16 (1) ◽  
pp. 1365-1376
Author(s):  
Yiping Cheng ◽  
Wenhao Yu ◽  
Yuping Zhou ◽  
Tao Zhang ◽  
Haiyan Chi ◽  
...  

Abstract The role of inflammation has been identified in the pathogenesis of diabetic ketoacidosis (DKA). The neutrophil/lymphocyte ratio (NLR) and white blood cells (WBC) can be used to predict a systemic inflammatory response. Changes in NLR and WBC levels have never been explored in type 1 diabetes mellitus (T1DM) patients with DKA and an uninfected state. This retrospective study included a total of 644 participants. NLR and WBC were measured in the control group (n = 316) and in T1DM patients with mild-DKA (n = 92), severe-DKA (n = 52), and non-DKA (n = 184) in an uninfected state. Then, we assessed the independent predictors of DKA occurrence in T1DM patients in an uninfected state. The diagnostic performance of variables was determined by receiver operating characteristic curve analysis. Serum NLR of T1DM patients is significantly higher than that of normal controls, and if DKA occurs, NLR increases further and increases with the severity of DKA. In addition to diastolic blood pressure, blood urea nitrogen, glycated hemoglobin (HbA1c), and WBC, NLR was also independently associated with DKA in T1DM patients with an uninfected state (OR = 1.386, 95% CI: 1.127–1.705, p = 0.002). Furthermore, the diagnosis analysis showed that except for NLR and WBC, the area under the curve (AUC) of indicators with a statistical difference in patients with and without DKA were 0.747 for DKA diagnosis, and after the addition of NLR and WBC, the AUC was 0.806. The increased NLR level represents a low-cost and highly accessible predictor for DKA in T1DM patients with an uninfected state. The addition of inflammation indicators can play a statistically significant role in the prediction model of the DKA occurrence.


2020 ◽  
Vol 7 ◽  
Author(s):  
Xuanqi Liu ◽  
Haiyan Ge ◽  
Xiumin Feng ◽  
Jingqing Hang ◽  
Fengying Zhang ◽  
...  

Background: Chronic obstructive pulmonary disease (COPD) is characterized by pulmonary and systemic inflammatory processes, and exacerbation of COPD represents a critical moment in the progression of COPD. Several biomarkers of inflammation have been proposed to have a predictive function in acute exacerbation. However, their use is still limited in routine clinical practice. The purpose of our study is to explore the prognostic efficacy of novel inflammatory hemogram indexes in the exacerbation among stable COPD patients.Method: A total of 275 stable COPD patients from the Shanghai COPD Investigation Comorbidity Program were analyzed in our study. Blood examinations, especially ratio indexes like platelet–lymphocyte ratio (PLR), platelet × neutrophil/lymphocyte ratio [systemic immune-inflammation index (SII)], and monocyte × neutrophil/lymphocyte ratio [systemic inflammation response index (SIRI)], lung function test, CT scans, and questionnaires were performed at baseline and routine follow-ups. Clinical characteristics and information of exacerbations were collected every 6 months. The relationship between hemogram indexes and diverse degrees of exacerbation was assessed by logistic regression. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the ability of hemogram indexes to predict exacerbation of COPD. Furthermore, the discrimination and accuracy of combined indexes were measured by ROC and calibration curve.Result: There was a significant positive correlation between PLR levels and total exacerbation of COPD patients in a stable stage in a year. Also, the predictive ability of PLR exceeded any other ratio indexes, with an AUC of 0.66. SII and SIRI ranked second only to PLR, with an AUC of 0.64. When combining PLR with other indexes (sex, COPD year, and St. George's Respiratory Questionnaire scores), they were considered as the most suitable panel of index to predict total exacerbation. Based on the result of the ROC curve and calibration curve, the combination shows optimal discrimination and accuracy to predict exacerbation events in COPD patients.Conclusion: The hemogram indexes PLR, SII, and SIRI were associated with COPD exacerbation. Moreover, the prediction capacity of exacerbation was significantly elevated after combining inflammatory hemogram index PLR with other indexes, which will make it a promisingly simple and effective marker to predict exacerbation in patients with stable COPD.


2020 ◽  
Vol 5 (1) ◽  
pp. 85-93
Author(s):  
Rendy Singgih ◽  
Yohanes Firmansyah

Abstract Introduction:  Hypertension in pregnancy is a common complication that affects maternal and fetal morbidity and mortality. Comprehensive handling is needed to overcome the incidence of hypertension in pregnancy so that it does not get worse. The use of inflammatory markers is widely used as a predictor of the incidence of hypertension in pregnancy, especially preeclampsia. Neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) values are believed to predict the incidence of hypertension in pregnancy. Aim of study: The purpose of this study was to determine the ability of both the NLR and MPV values to predict the incidence of hypertension in pregnancy. Methods: This research is an analytic observational study using secondary data from medical records. The data were taken from the Cimacan Regional Hospital from January to December 2019. The variables were then tested statistically to see the difference in the mean. If there are significant results, the predictor's ability will be tested again with the ROC curve test. Results: The results of statistical tests between the normotensive pregnancy group and pregnancy with hypertension showed that the mean difference was significant in the NLR variable with P-value of 0.004 and MPV with a P-value of 0.005. Then the NLR and MPV values were tested again by the ROC Curve method. The AUC results on the NLR variable (AUC: 0.562 / p-value: 0.022) and MPV (AUC: 0.560 / p-value: 0.022). Conclusion: Although NLR and MPV had differences mean between the two groups, their ability to predict pregnancy with hypertension was very low.   Keywords: Pregnancy; Hypertension; Preeclampsia; NLR; MPV.


BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Gordon Cooper ◽  
Katrina Knight ◽  
Pamela Bain ◽  
Morag McLellan ◽  
Giuliana Torpiano ◽  
...  

Abstract Introduction The host systemic inflammatory response (SIR) is prognostic in a wide variety of solid tumours, with a greater degree of inflammation being associated with a worse clinical outcome. Neutrophil Lymphocyte Ratio (NLR) is an established way to measure SIR in vivo. We aimed to establish whether preoperative NLR correlates with infective complications in patients undergoing colorectal cancer (CRC) resection. Methods Data was extracted retrospectively for all CRC resections over a 2 year period (2016-2018) at a single district general hospital. NLR was measured for each patient from bloods at the time of pre-operative assessment. Post-operative complications were recorded using the Clavien-Dindo classification and subsequently classified as infective and non-infective. A Two-tailed Mann-Whitney U test was used to evaluate the data from an online resource. Results Of the 131 patients, 49 had complications of which 20 were infective. Of total complications 58% were male and 35% were aged 75 years or older. Current or ex-smokers constituted 43% and 41 of the total patients had a BMI &gt;30 kg/m2. Pre-assessment mean NLR was 2.3 in those without complications and 4.7 in those with any complication. A mean NLR of 5.4 was present in those with infective complications, p-value 0.026. Conclusion This study found that a raised NLR was present preoperatively in those who developed infective complications following CRC resection. This is a simple, readily available and cost-effective method of identifying patients at risk of complication. This ultimately may be useful in highlighting patients who would benefit from enhanced pre-operative optimisation. Further research to validate these findings in larger studies would seem warranted.


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