The Prognostic Value of Inflammatory Indices and the HALP Score in Aortic Dissection

Aortic dissection (AD) and aortic aneurysm (AA) are acute aortic syndromes associated with high mortality, requiring rapid recognition and accurate differentiation from each other and from healthy individuals. While imaging remains the diagnostic gold standard, hematological indices and inflammatory biomarkers may provide fast and accessible adjunctive tools in emergency settings. This retrospective comparative study, conducted at 2 tertiary centers, included 576 participants after exclusions: 213 patients with AD, 178 with AA, and 185 healthy controls. Demographic, clinical, and laboratory data were collected at admission. Hematological indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, platelet-to-neutrophil ratio, derived NLR (dNLR), systemic immune-inflammation index, fibrinogen-to-C-reactive protein ratio, and fibrinogen-to-d-dimer ratio, together with conventional inflammatory markers such as C-reactive protein, fibrinogen, and d-dimer, were analyzed. Receiver operating characteristic curve analysis and multivariable logistic regression were used to assess diagnostic performance. Compared with controls, patients with AD and AA exhibited significantly higher inflammatory indices (all P < .001). Neutrophil-to-lymphocyte ratio showed the highest diagnostic accuracy in distinguishing AD from controls (area under the curve [AUC] = 0.933, sensitivity 90.1%, specificity 89.7%), whereas platelet-to-neutrophil ratio and systemic immune-inflammation index also demonstrated considerable discriminative ability. For AA versus controls, NLR (AUC = 0.846) and platelet-to-neutrophil ratio (AUC = 0.838) were the most predictive parameters. For AD versus AA, fibrinogen-to-d-dimer ratio exhibited the best performance (AUC = 0.898, sensitivity 77.0%, specificity 83.7%). Multivariable logistic regression models combining clinical factors such as hypertension, sex, diabetes, and coronary artery disease with hematological indices achieved excellent discrimination (AUCs = 0.938 for AD vs controls, 0.870 for AA vs controls, and 0.944 for AD vs AA). Simple hematological ratios, particularly NLR and the novel fibrinogen-to-d-dimer ratio index, provide strong diagnostic and discriminative value in acute aortic syndromes. Integrating these biomarkers with clinical risk factors may enhance early triage and differential diagnosis, especially when advanced imaging modalities are delayed or unavailable.

This retrospective cohort study was designed to evaluate the association between eight systemic inflammation indicators at baseline and the metabolically unhealthy (MU) phenotype after two years of follow-up. Participants were defined as metabolically healthy (MH) if they met 0-2 of the criteria and metabolically unhealthy (MU) if they met ≥ 3 of the criteria. A many of 4175 subjects aged 20-80 years with a metabolically healthy (MH) phenotype at baseline were enrolled in the study. We compared the clinical characteristics between women and men enrolled at baseline according to the metabolic phenotype at follow-up. The associations between baseline inflammation indicators and MU status at follow-up were evaluated using logistic regression analysis. 922 (22.08%) developed new-onset MU symptoms during follow-up. Logistic regression analysis found that most inflammation indicators were significantly associated with MU phenotype at follow-up, aside from the LMR and SII. After adjusting for potential confounders, only the correlations between CRP level, neutrophil count, and MU phenotype reached significance. In comparison to the control group with a CRP of <0.50 mg/L, the odds ratios (ORs) and 95% confidence intervals (CIs) were 1.61 (1.25-2.09), 1.49 (1.15-1.94), and 1.68 (1.30-2.18) for individuals with CRP levels of 0.50-0.90 mg/L, 0.91-1.72 mg/L, and above 1.72 mg/L, respectively. In the population with a neutrophil count <5.00 ×109 cells/L, the neutrophil count correlated positively and significantly with the MU phenotype. In comparison to the control group with a neutrophil count of <2.75 × 109 cells/L, the ORs and 95% CIs were 1.65 (1.30-2.09) in the population with neutrophil count >4.17 × 109 cells/L. CRP and neutrophil counts positively correlated with the risk of MU phenotype in Chinese subjects. These composite inflammatory markers (NLR, PLR, LMR, and SII) provide limited advantages for predicting MU risks compared to CRP.

Objective: Asthma is a heterogeneous disease characterized by chronic airway inflammation. Mean Platelet Volume (MPV) is one of the markers of platelet activation. The disease activity has been shown to have an important role as a marker for the efficacy of anti-inflammatory therapy and inflammation. The aim of this study was to investigate the relationship between disease activity and mean platelet volume and to determine the mean platelet volume (MPV) and CRP values during asthma exacerbations and stable periods. Methods: In this study, data from 50 patients with asthma exacerbations, 50 stable asthmatic patients and 40 healthy subjects were evaluated retrospectively. Results: Even though the MPV values of patients with an asthma exacerbation was lower (9.2 ± 0.9 fL) than those of stable asthmatic patients (9.6 ± 1.3 fL), we did not find statistical differences between the groups in terms of MPV results (P = 0.374). Leukocyte, neutrophil counts and percentages and CRP levels were significantly higher in patients with an exacerbation than in stable asthmatic and control groups (p = 0.000). There was no difference in , neutrophil counts and percentages and CRP levels between stable asthmatic patients and healthy controls (p> 0.05). Conclusion: In conclusion, there was no statistically significant relationship between the MPV values and disease activity in asthmatic patients. We believe that prospective studies involving a larger number of patients are needed to determine the place of MPV in asthmatic patients, since the number of patients and controls in our study was low.

<b>Background:</b> The novel coronavirus SARS-CoV-2 (COVID-19) rapidly escalated from its origin in an animal market in Wuhan, China in December 2019 to a global pandemic, and the lungs are the most frequently affected organ. The aim of this study was to investigate the relationship between pulmonary function test parameters and laboratory parameters in COVID-19. <b>Materials and Methods:</b> A total of 60 patients who were admitted to the chest diseases department and intensive care unit of our hospital and were diagnosed with COVID-19 by real-time PCR analysis of nasopharyngeal swabs were evaluated. Pulmonary function tests and laboratory parameters at admission and on day 7 of treatment were analyzed. <b>Results:</b> On day 7 of treatment, white blood cell count, CRP, and fibrinogen level were significantly lower than at admission (p=0.002, 0.001, and 0.001, respectively), while forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) values were significantly higher compared to admitting values (p=0.001 for both). Correlation analysis of the changes in respiratory function values and laboratory parameters during follow-up (day 1 to day 7 of treatment) revealed that CRP level was positively correlated with FEV1 (r=0.616, p=0.01) and FVC values (r=0.51, p=0.01). Fibrinogen level was also positively correlated with FEV1 (r=0.345, p=0.01) and FVC (r=0.357, p=0.01). <b>Discussion:</b> Fibrinogen and CRP levels are easily accessible parameters that may help identify improvement or deterioration in pulmonary function in COVID-19 patients during follow-up and discharge while reducing the risk of transmission.

Objective: Favipiravir is a novel, orally bioavailable, purine nucleoside analogue drug. Recent studies showed that it was related to faster viral clearance time and a significant improvement rate in chest imaging in patients with COVID-19. While the mechanism of action of Favipiravir is well characterized, there is insufficient data about its effects on haematological inflammatory parameters during COVID 19 infection.&#x0D; Material and Methods: This observational study included 92 patients with COVID-19 (50 of them were female) with mild to moderate disease who taken Favipiravir in the Pandemic Center at Giresun University School of Medicine from April 2020 to October 2020. Patients with severe COVID-19 infection were excluded from the study.&#x0D; Results: After the five days of Favipiravir administration, compared to before the treatment, it was observed that the neutrophil counts of the patients (before the treatment mean 5.97 109/L (5.1 - 6.84) and after treatment 4.82 109/L (4.29 - 5.35) p=0,039) and Neutrophil/lymphocyte ratio (NLR) markedly decreased (before the treatment mean 6.88 (5.33 - 8.42) and after treatment 4.67 (3.23 - 6.10) p=0,002), while the lymphocyte count increased and these alternations were statistically significant. Platelet count and MCV levels were slightly increased after the treatment also statistically significant (p&lt;0.001, p=0.001). Although there was a significant decrease in CRP levels, no significant change was observed in other inflammatory markers (Ferritin, Sedimentation, Fibrinogen, D-Dimer, and Troponin). The overall mortality rate was 4%, with no deaths in ICU. &#x0D; Conclusion: In our study; in addition to previous knowledge from recent studies; increasing in the platelet count and decreasing in CRP and MPV levels are remarkable findings. These data may guide in the follow-up of Favipiravir treatment and in determining the prognosis.

Objective: To determine the clinical value of rhBNP in the treatment of patients with Stanford type B aortic dissection. Methods: From June 2018 to October 2021, 162 patients with Stanford type B aortic dissection were selected from the Cardiology Department of Henan Provincial Chest Hospital and randomly divided into two groups: control group (81 patients) and observation group (81 patients). The patients in the control group were treated with conventional therapy. On the basis of the control group, the patients in the observation group were treated with rhBNP. The cardiac function, renal function, pulmonary function, and inflammatory indices before and after treatment for 72 hours, as well as the incidence of adverse reactions between the two groups were compared. Results: After treatment, the cardiac function (LVEF and NT-pro BNP), renal function (urine output for 24 hours, Scr, and Cys-C), pulmonary function (PaO2, SPO2, and PaO2/FiO2), and inflammatory (IL-6, hsCRP, and MCP-1) indices of the observation group improved significantly compared to those of the control group (p &lt; 0.05). Conclusion: rhBNP can improve cardiac function, renal function, and pulmonary function, as well as alleviate inflammation in patients with Stanford type B aortic dissection. Hence, in the treatment of patients with Stanford type B aortic dissection, rhBNP provides multi-organ protection.

Background Esophageal cancer surgery is known for its high invasiveness, which results in significant postoperative complications. With the advancement of minimally invasive surgery (MIS) and Enhanced Recovery After Surgery (ERAS) protocols, there has been a reduction in recovery time and postoperative complications. Despite these improvements, patients undergoing esophagectomy still face considerable challenges in recovery, and methods to reduce inflammation, promote faster recovery, and improve long-term outcomes are essential. Investigating new perioperative strategies, including the use of preoperative steroids, rehabilitation programs, and adjunctive agents like cystine and theanine, holds promise for further enhancing recovery. Methods This study focuses on the effects of minimally invasive thoracoscopic esophagectomy, preoperative steroid administration, and early rehabilitation on recovery following esophageal cancer surgery. A randomized controlled trial evaluated the perioperative use of cystine and theanine in reducing the inflammatory response and improving recovery. The impact on postoperative complications, 6-minute walk test (6MWT) performance, and quality of recovery (QoR-40) scores were analyzed. Patients were also monitored for inflammatory markers, lymphocyte count, and other relevant clinical parameters throughout the perioperative period to assess the effectiveness of these interventions. Results Minimally invasive surgery in the prone position resulted in less blood loss, shorter ICU stays, and reduced postoperative pneumonia rates compared to traditional lateral position surgery. Preoperative steroid administration significantly suppressed postoperative tachycardia, accelerated fluid balance recovery, and reduced inflammatory cytokines. In the cystine-theanine trial, participants in the treatment group showed improved 6MWT results and better QoR-40 scores by postoperative day 13. Additionally, inflammatory markers like neutrophil count and CRP levels were significantly lower in the cystine-theanine group, supporting the role of these agents in reducing postoperative inflammation and promoting recovery. Conclusion The combination of minimally invasive surgery, preoperative steroids, and early rehabilitation significantly improves recovery in esophageal cancer surgery. Perioperative administration of cystine and theanine is a promising adjunctive therapy, effectively reducing postoperative inflammation, enhancing recovery outcomes, and improving quality of life. These findings support the broader implementation of these strategies to further optimize postoperative care and accelerate recovery in patients undergoing esophagectomy.

To test the hypothesis that preterm infants who develop new type of bronchopulmonary dysplasia BPD have higher cord blood sE-selectin levels and neutrophil counts in the tracheal aspirate at birth than those who do not. The relationship between cord blood sE-selectin levels and neutrophil counts in the tracheal aspirate at birth and the development of BPD was examined in 30 preterm infants. Levels of sE-selectin and neutrophil counts were measured by specific immunoassay and by cytospin analysis. Median cord blood levels of sE-selectin and neutrophil counts in the tracheal aspirate at birth were higher in preterm infants who developed BPD than in those who did not (P<0.01 for each). These differences persisted significantly after adjusting for the effects of gestational age and the presence of histologic chorioamnionitis and patent ductus arteriosus PDA (P<0.01 for each). Fetal pulmonary inflammation, as measured by increased cord blood levels of sE-selectin and neutrophil counts in the tracheal aspirate at birth, may be a risk factor for the development of new BPD in preterm infants. These results support the hypothesis that the lung injury responsible for new BPD in preterm infants can begin in the prenatal period and could be associated with a fetal pulmonary inflammation.

BackgroundThe coronavirus pandemic, an infection (coronavirus disease 2019—COVID‐19), caused by severe acute respiratory disease coronavirus 2 (SARS‐CoV‐2), continues to have a strong influence worldwide. Although smoking is a major known risk factor for respiratory infectious disease, the effects of smoking on COVID‐19 are unclear. In this study, we aimed to evaluate the relationship between smoking and important hematologic (lymphocyte count, neutrophil count, platelet count, neutrophil‐lymphocyte ratio [NLR], platelet‐lymphocyte ratio [PLR]), inflammatory, and biochemical biomarkers in the prognosis of hospitalized patients with COVID‐19.MethodsIn a COVID‐19 pandemic hospital between June and August 2020, 200 adult patients aged over 18 years were hospitalized with COVID‐19 inflammatory and hematologic biomarkers at their first admission and smoking data were selected for this study.ResultsThe rate of smokers was much higher among men (91.5%) than in women (8.5%) (p = 0.001). Neutrophil counts were evaluated and was significantly higher in current smokers (p < 0.001) and ex‐smokers (p = 0.001), and NLR (p = 0.008) and ferritin (p = 0.004) levels were higher than in never smokers. The saturation of patients had a negative significant linear correlation of NLR, PLR, and pack years of smoking. Compared with never smokers, current smokers had higher neutrophil counts (OR = 0.828 [0.750–0.915]; p = 0.041), NLR values (OR = 0.948 [0.910–0.987]; p = 0.009), and CRP levels (OR = 0.994 [0.990–0.999]; p = 0.019).ConclusionSerum neutrophil, NLR, and ferritin levels, which are widely used in determining the prognosis of COVID‐19, were found higher in current smokers/ex‐smokers. These results support the view that a poor prognosis of COVID‐19 is associated with smoking.

Thoracic aortic disease (TAD) encompasses a spectrum of life-threatening conditions, including thoracic aortic aneurysm (TAA), acute type A aortic dissection (ATAAD), and bicuspid aortic valve (BAV)-associated aortopathy. While genetic mutations are well-documented contributors, emerging evidence highlights epigenetic mechanisms as critical regulators of TAD pathogenesis. This comprehensive review explores the role of epigenetic modifications-DNA methylation, histone modifications, and microRNA (miRNA) regulation-in vascular remodeling, extracellular matrix degradation, and endothelial dysfunction. Aberrant DNA methylation patterns have been implicated in TAA and ATAAD, influencing genes responsible for vascular integrity and inflammation. Histone modifications modulate smooth muscle cell phenotype switching, impacting aneurysm progression. Additionally, dysregulated miRNA expression contributes to endothelial barrier disruption and extracellular matrix remodeling, presenting novel avenues for biomarker discovery. The reversibility of epigenetic modifications offers a promising therapeutic target, with pharmacological agents such as histone deacetylase inhibitors and miRNA-based therapies showing potential in preclinical models. This review underscores the translational potential of epigenetic biomarkers for early disease detection, risk stratification, and precision medicine approaches. Further research is needed to integrate these findings into clinical practice, paving the way for innovative diagnostic and therapeutic strategies in TAD management.

Atherogenic index as a predictor of atherosclerosis in subjects with familial Mediterranean fever

Several epidemiologic studies have shown the association between total leukocyte count and the risk of developing myocardial infarction. The purpose of this study was to assess the association between the total leukocyte and neutrophil counts and risk factors of ischemic heart disease in 1,384 Japanese factory workers. Total leukocyte and neutrophil counts were significantly higher in current smokers than in non-smokers. Among current smokers, the total leukocyte and neutrophil counts were positively associated with the number of cigarettes smoked daily and the duration of cigarette smoking and alcohol consumption. Being independent of smoking habit, the total leukocyte and neutrophil counts were also related to several characteristics recorded at the physical examinations. The total leukocyte and neutrophil counts were positively associated with serum total cholesterol, serum triglyceride and hematocrit levels, and inversely associated with the serum HDL-cholesterol level. No significant associations of the total leukocyte or neutrophil counts were found with the red blood cell count and hemoglobin level. These results suggest that the total leukocyte and neutrophil counts may represent the metabolic condition with a high coronary risk among apparently healthy people.

Neutrophil to lymphocyte ratio is predictive of severe complications and mortality in patients with dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid: A retrospective longitudinal observational study

Introduction: Although the C-arm allows real-time image capture and intensification to allow accurate placement of implants and fixation devices with minimal incisions, these advantages have the disadvantage of the amount of radiation exposure to operating room personnel, especially surgical operators. The exposure mainly was low dose (&lt;1 Sv). However, the effects of low-dose exposure may be accurate and should be considered seriously. Methods: This research was an observational prospective cohort study. A total of 30 residents who met the inclusion criteria had blood samples taken before and after femoral nailing surgery. Then, the blood sample underwent a complete blood count, IL-6, and CRP levels examination. During surgery, C-arm radiation will be measured using a personal dosimeter. The statistical tests used were descriptive statistics, proportion comparison analysis with the dependent t-test, and simple linear regression tests. Results: Univariate analysis using paired t-test proved changes in lymphocyte count, IL-6, and CRP levels of orthopedic residents before and after femoral nailing surgery with c-arm guiding with a statistically significant difference, based on p-values respectively: p=0.001; p=0.001; p=0.002. Simple linear regression test proved that radiation dosage of c-arm during operation is associated with a change in lymphocyte count, IL-6 and CRP levels before and after femoral nailing surgery with R squared values respectively: 0.474 (p=0.001), 0.694 (p=0.001) and 0.701 (p=0.001). Conclusion: Radiation dosage of c-arm during femoral nailing surgery is related to changes in lymphocyte count, interleukin-6, and c-reactive protein levels among orthopedics and traumatology residents.

Introduction: Percutaneous endoscopic gastrostomy (PEG) is a widely used procedure for patients with impaired oral intake due to various underlying conditions but with intact gastrointestinal tracts. Although generally considered safe and straightforward, PEG placement has been associated with a relatively high rate of early mortality. The mechanisms underlying this increased early mortality remain incompletely understood, but systemic inflammation is suspected to play a key role. Elevated inflammation markers, such as CRP and indices like the Systemic Immune-Inflammation Index (SII), have been linked to poor outcomes in PEG patients. However, it is still unclear whether PEG placement itself influences these inflammatory markers or whether high inflammation is primarily related to the underlying disease necessitating PEG. Clarifying the relationship between inflammation, PEG application, and early mortality is essential for better patient selection and management. Therefore, this study aimed to evaluate the association between pre-PEG inflammation status, as measured by SII, and early mortality following PEG placement.Methods: This prospective observational study included 96 patients aged 18 years and older who underwent PEG placement within 30 days prior to admission to the Palliative Care Clinic at Etlik City Hospital, Department of Internal Medicine, between February and June 2024. The study population consisted of patients with various underlying conditions necessitating PEG for enteral nutrition. The inclusion and exclusion criteria were clearly defined to establish a homogeneous cohort. Sample size was determined based on previous literature and power calculations to detect significant associations between inflammatory markers and mortality. Baseline laboratory values—including CRP, albumin, neutrophil, lymphocyte, and platelet counts—were collected from patient records prior to PEG placement. The Systemic Immune-Inflammation Index (SII) was calculated using the formula: platelet count × neutrophil count / lymphocyte count. The timing of laboratory assessments was standardized to within 48 hours before PEG. Patients’ treatments, including anti-inflammatory or immunosuppressive therapies, were documented as potential confounders affecting inflammatory markers. Patients were followed for 30 days post-PEG placement to assess early mortality. Statistical analyses were performed to evaluate the relationship between pre-PEG SII and mortality outcomes, adjusting for potential confounding factors including underlying diseases and treatments.Results: Of the 96 patients included in the study, 58 (60.4%) were female and 38 (39.6%) were male. CRP values ranged from 1 to 189.2 mg/L, with a mean of 58.18 ± 45.46 mg/L. Patients who died within 30 days post-PEG had significantly higher CRP levels compared to survivors (p = 0.031). Neutrophil counts ranged from 1,440 to 24,420/µL, with a mean of 6,913.24 ± 4,344.73/µL; deceased patients exhibited significantly elevated neutrophil counts (p = 0.001). Lymphocyte counts ranged between 120 and 3,400/µL, averaging 1,346.38 ± 729.30/µL; patients who died had significantly lower lymphocyte counts (p = 0.013). The SII values ranged from 107.70 to 12,920, with a mean of 1,766.32 ± 1,868.75; higher SII values were significantly associated with mortality (p = 0.001).Conclusion: Percutaneous endoscopic gastrostomy is a safe and effective method for providing enteral nutrition when applied under appropriate clinical conditions. Elevated pre-PEG inflammatory markers, specifically SII and CRP, are significantly associated with early mortality and can serve as useful predictors. Assessment of these parameters prior to PEG placement may assist clinicians in better selecting patients who are most likely to benefit from the procedure.