Mechanical ventilation (MV) is a supportive and life-saving therapy, however, it can cause ventilator-induced lung injury as a common complication. Thus, recruitment manoeuvres (RM) are applied to open the collapsed alveoli to ensure sufficient alveolar surface area for gas exchange. In the light of the fact that positive pressure ventilation is currently the standard treat- ment for improving pulmonary function, extrathoracic negative pressure is considered as an alter- native form of respiratory support. The aim of this study was to estimate the proinflammatory and oxidative response during MV and lung injury as well as the response after RM. All studied parameters were assessed at the following time points: T1-spontaneous breathing, T2- MV, T3- lung injury, T4 –RM. During MV (T2) elastase, MPO, ALP release, nitrite and superoxide generation significantly increased, whereas in later measurements a decrease in these values was noted. The MDA plasma concentration significantly (p<0.05) increased at T2, reaching a level of 13.30±0.87 nmol/ml; at other time points the values obtained were similar to the baseline value of 9.94±0.94 nmol/ml, whereas a gradual decrease in SOD activity at time T2-T4 points in comparison with the baseline value was found. During the study both neutrophil activity and oxi- dative stress indicate exacerbated response after MV and lung injury by bronchoalveolar lavage; however, extrathoracic negative pressure system as the MR ameliorates damaging changes which could further lead to serious lung injury.
I n t r o d u c t i o n: A high neutrophil-to-lymphocyte ratio (NLR) has been reported to be a strong biomarker of inflammation.
A i m: We sought to evaluate the impact of NLR on long-term all-cause and cardio-vascular (CV) mortality in hemodialysis (HD) patients.
Ma t e r i a l a n d Me t h o d s: A total of 84 chronic kidney disease (CKD) stage 5 patients with 54 of them on HD, with a median age of 61.5 (51.3–74.8) years were enrolled. The association between NLR and clinical biomarkers was investigated. Multivariable Cox regression analysis was used to find significant predictors of all-cause and CV mortality at follow-up.
R e s u l t s: The median NLR (interquartile range) was 3.0 (2.1–4.1). Patients with NLR ≥3.9 (the highest tertile) had higher five-year all-cause mortality then remaining patients (53.6% vs. 30.4%; p = 0.039). On the contrary, only a trend towards increased CV mortality was observed (25.0% vs. 42.9%; p = 0.10). NLR ≥3.9 was a significant predictor of all-cause mortality at five years [hazard ratio (95%CI): 2.23 (1.10– 4.50); p = 0.025] in Cox regression model adjusted for age, gender, and diabetes status. Similarly, while using NLR as continuous variable a significant association between NLR and all-cause mortality was confirmed even after adjustment for covariates [hazard ratio per 1 unit increase (95%CI): 1.26 (1.06–1.51); p = 0.009] with the area under the receiver operating characteristic (ROC) curve of 0.64. Correlations between NLR and WBC, concentration of fibrinogen, albumin were observed.
C o n c l u s i o n s: Asymptomatic inflammation measured by NLR showed an association with long-term all-cause mortality in stage 5 CKD patients, even while white blood cell count was in the normal range.
Background: In early phase of acute pancreatitis (AP), systemic inflammatory response syndrome may lead to organ failure. The severe form of AP is associated with high mortality that may be prevented by timely diagnosis and treatment of the predicted severe cases. Serum interleukin 6 (IL-6) and urokinase-type plasminogen activator receptor (uPAR) have been proposed as accurate early markers of severe AP. The aim of the study was to assess whether widely available blood count indexes: neutrophil to lymphocyte (NLR), lymphocyte to monocyte (LMR) and platelet to lymphocyte ratios correlate with IL-6 and uPAR and may be utilized to predict organ complications at the early phase of AP.
Methods: The study included 95 adult patients with AP treated at the Surgical Ward Complex of Health Care Centers in Wadowice, Poland. Organ failure was diagnosed according to modified Marshall scoring system, as recommended by 2012 Atlanta classification. Blood samples for laboratory tests were collected on days 1, 2 and 3 following the onset of AP symptoms.
Results: Patients with organ failure presented significantly lower LMR on day 1 and signifi cantly higher NLR on days 2 and 3. Strong positive correlations between NLR and IL-6 and moderate correlations between NLR and uPAR were observed throughout the study. Day 2 and 3 NLR values significantly predicted organ failure at the early phase of AP.
Conclusions: Taking into account the wide availability of NLR, it may be considered as a surrogate of more expensive tests to help the early assessment of organ failure complicating AP.