Evaluation of simple cost-effective immuno-haematological markers to predict outcome in hospitalized COVID-19 patients during second wave

Background:COVID-19 pandemic has strained the health infrastructure globally, hence the importance of cost-effective biomarkers. We aimed to identify simple haematological prognostic markers in hospitalized COVID-19 patients to differentiate between milder and severe cases, thus predicting outcome.Methods:A retrospective study of COVID-19 patients admitted at MallaReddy institute of medical sciences was conducted from April to June 2021. Total leukocyte count (TLC), neutrophil-to-lymphocyte ratio (NLR), derived NLR ratio (dNLR) and platelet-to-lymphocyte ratio (PLR) were calculated and correlated with outcome. These parameters were compared with other inflammatory markers using ROC(receiver operator curve)analysis.Results:303 patients of 397 fulfilled the inclusion criteria (male-198, female-105). There was a significant higher mean of NLR in patients with death (14.46�84) compared to patients recovered (8.43�33), similarly the dNLR was higher in death (8.06�34) compared to recovered (4.97�49). A significant positive strength of association between the NLR and dNLR with the ESR, CRP, CORADS score and CT severity score in the patients. The ROC analysis showed the NLR (AUC=0.777) and dNLR (0.799) a better marker to predict the outcome.Conclusions:In COVID-19, immuno-haematological markers like NLR, dNLR, PLR found to be a simple and cost-effective tool to prognosticate the clinical outcome among hospitalized patients and were in concordance with the other inflammatory markers. Hence, these markers serve as better indicators in risk stratification and better management.

The correlation between the prognosis of renal transplant recipients infected with BK virus and peripheral blood related indexes / 中华泌尿外科杂志

Objective:To investigate the correlation between the prognosis of patients infected with BK virus after renal transplantation and their peripheral blood related indexes.Methods:131 patients from the Renal Transplantation Department of the Second Xiangya Hospital of Central South University who underwent renal transplantation and firstly infected with BK virus after the surgery during the period from August 2018 to August 2021 were retrospectively analyzed. 93 males (71.0%) and 38 females (29.0%). The average age was (37.5±11.3) years old. 109 cases underwent cadaveric kidney transplant (83.2%) and 22 cases underwent relatives kidney transplant (16.8%). The onset time of the first infection with BK virus after renal transplantation was (188.7±16.6) days, and the serum creatinine was (127.5±39.5) μmol/L. 25 patients (19.1%)infected with BK virus were positive in blood and urine at the same time, and 106 patients (80.9%)infected with BK virus were positive only in urine. Among 131 patients infected with BK virus, 70 patients were treated by lowering the blood concentration of tacrolimus to enhance immunity, 12 patients were treated by switching tacrolimus to cyclosporine, and 49 patients had incomplete follow-up data. The DNA load of BK virus in 25 patients [5.6(2.4, 12.3)×10 3copies/ml] positive in blood, white blood cell count(WBC)(5.8±2.0)×10 9/L, hemoglobin(Hb)(122.0±22.4)g/L, platelet count(PLT)(187.1±63.1)×10 9/L, neutrophil count(NEUT)(3.9±1.7)×10 9/L, lymphocyte count(LYM)(1.5±0.8)×10 9/L, monocyte count(MONO)(0.4±0.2)×10 9/L, neutrophil to lymphocyte ratio(NLR)2.2(1.7, 3.5), derived neutrophil to lymphocyte ratio(dNLR)1.7(1.3, 2.6), platelet to lymphocyte ratio(PLR)121.3(86.3, 227.3), monocyte to lymphocyte ratio(MLR)0.2(0.1, 0.4) and lymphocyte to monocyte ratio(LMR)4.7±2.6. The DNA load of BK virus in 106 patients [20.4(0.4, 2 570.0)×10 5copies/ml] positive in urine, WBC 6.6(4.8, 9.1)×10 9/L, Hb(129.0±24.5)g/L, PLT 188.0(147.3, 226.5)×10 9/L, NEUT 4.6(3.0, 6.6)×10 9/L, LYM(1.7±0.8)×10 9/L, MONO 0.4(0.3, 0.5)×10 9/L, NLR 2.8(1.9, 3.9), dNLR 2.1(1.5, 3.0), PLR 120.5(87.0, 163.2), MLR 0.2(0.1, 0.4), LMR 4.5(2.8, 6.7). 70 patients infected with BK virus treated by lowering the blood concentration of tacrolimus were divided into BK virus rise group and BK virus decline group according to the change of BK virus DNA load in blood and urine before and after treatment (the grouping principle of this study gives priority to the change of BK virus DNA load in blood, followed by the change of BK virus DNA load in urine). The WBC, Hb, PLT, NEUT, LYM, MONO, NLR, dNLR, PLR, MLR, LMR, tacrolimus blood concentration and change difference, blood creatinine and change difference were analysed between two groups. Results:The BK virus DNA load in 25 patients positive in blood was correlated with NLR and dNLR ( r=0.5062, P=0.0098; r=0.5738, P=0.0027), and there was no correlation between the BK virus DNA load in blood with the WBC ( r=-0.0185, P=0.9302), Hb ( r=0.0912, P=0.6646), PLT ( r=-0.3931, P=0.0519), NEUT ( r=0.2438, P=0.2401), LYM ( r=-0.3035, P=0.1402), MONO ( r=-0.3279, P=0.1096), PLR( r=0.1054, P=0.6161), MLR( r=0.0738, P=0.7257), LMR( r=-0.0738, P=0.7257). There was no correlation between the BK virus DNA load in 106 patients positive in urine and WBC( r=0.0222, P=0.8209), Hb( r=-0.0323, P=0.7423), PLT( r=0.0847, P=0.3881), NEUT( r=0.0417, P=0.6713), LYM( r=0.0010, P=0.9916), MONO( r=0.0224, P=0.8196, NLR( r=0.0170, P=0.8623), dNLR ( r=-0.0013, P=0.9892), PLR( r=0.0387, P=0.6934), MLR( r=-0.0070, P=0.9433)and LMR( r=0.0070, P=0.9433). As for 70 patients infected with BK virus, there were 37 patients in the BK virus rise group and 33 patients in the BK virus decline group. In the two groups, age [(38.4±12.0)years old and(39.0±9.0)years old], gender [male /female: (23/14) cases and(27/6)cases], blood type [A+ /B+ /AB+ : (22/13/20)cases and (26/6/1)cases], donation type [relatives donnation/cadaveric donation: (29/8)cases and (27/60)cases], blood creatinine(after treatment)[123.0(98.4, 140.5)μmol/L and 132.0(107.1, 162.4)μmol/L] and change difference before and after treatment [0(-15.7, 10.5)μmol/L and -2.0(-9.1, 15.0)μmol/L], tacrolimus blood concentration (after treatment)[(6.7±2.0)ng/ml and(6.5±1.5)ng /ml] and tacrolimus concentration change difference [-1.4(-3.8, 0.6)ng/ml and -1.2(-2.2, 1.3)ng/ml] had no significant difference( P<0.05). The MONO of the two groups was statistically different [0.3(0.2, 0.5)×10 9/L and 0.4(0.3, 0.6)×10 9/L, P=0.033], and there was no difference between the two groups in WBC[6.6(4.1, 8.8)×10 9/L and 6.8(5.4, 8.9)×10 9/L], Hb[(133.2±25.3)g/L and(131.6±20.6)g/L], PLT[185.0(151.0, 231.5)×10 9/L and 196.0(149.0, 234.0)×10 9/L], NEUT[4.3(2.4, 6.4)× 10 9/L and 4.2(3.1, 5.5)×10 9/L], LYM[1.7(1.1, 2.2)×10 9/L and 1.8(1.1, 2.3)×10 9/L], NLR[2.5(1.9, 3.8)and 2.4(1.9, 3.7)], dNLR [2.0(1.5, 2.8)and 1.9(1.4, 2.5)], PLR [114.9(85.1, 159.4)and 111.3(77.1, 159.6)], LMR(4.6±2.6 and 5.2±2.4), MLR[0.2(0.2, 0.4)and 0.2(0.2, 0.4)]( P<0.05). Conclusions:There is a positive correlation between the blood BK virus DNA load and NLR, dNLR in renal transplant recipients infected with BK virus. The rise of MONO correlates with good prognosis of BK virus.

A study on the association between preoperative NLR and d-NLR and clinical outcome of postoperative colorectal cancer patient / 预防医学

Objective Toexploretheprognosticvalueofpreoperativeneutrophil-to-lymphocyteratioandderived neutrophil-to-lymphocyteratioincolorectalcancer(CRC)individuals.Methods Theclinicalpathologicaldataand preoperative blood routine test results were collected from medical records,and 5 year follow up was performed in a total of 555 surgically resected CRC cases.Receiver operative curve (ROC)was used to calculate NLR and d -NLR cut-off value,and Kaplan-Meier curve and multiple COX regression were selected to evaluate the influence of preoperative NLR and d -NLR on clinical outcome of CRC cases and prognostic predictive nomogram was established to evaluate the predictivevalueofNLRandd-NLR.Results Usingoverallsurvival(OS)asanendpoint,theoptimalcut-offvaluesof NLR and d-NLR were 3.21 (Sensitivity=0.752,specificity=0.753,AUC=0.762)and 2.12 (sensitivity=0.721, specificity=0.683,AUC=0.720),respectively.Preoperative NLR and d-NLR were significantly associated with free-recurrent survival (RFS)and OS(P<0.01).NLR and d-NLR were independent factors for prediction of RFS (HRNLR=2.53,HRd-NLR=1.60)and OS (HRNLR=2.75,HRd-NLR=2.11)in II-III stage preoperative CRC patients.The C-indexes of RFS and OS predictive nomograms including NLR and d-NLR were 0.851 and 0.836,and C-indexes without NLRandd-NLRwere0.801and0.793,respectively.Conclusion ThisresultsindicatedthatRFSandOSofthe patients with preoperative high NLR and d-NLR were significantly shorter than those with relative low NLR and d-NLR, and they were independent prognostic predictive factors for RFS and OS,and nomograms including NLR and d-NLR could significantly improve the prognostic predictive efficacy in postoperative CRC individuals.