Neutrophile-to-Lymphocyte Ratio as a Predictor of Mortality and Response to Treatment in Invasive Aspergillosis among Heart Transplant Recipients—Exploratory Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Study Approval
2.3. Statistical Analysis
3. Results
3.1. Demographical and Clinical Analysis
3.2. Immunosuppressive Treatment
3.3. Infective Aspergillosis Diagnosis and Treatment
3.4. Laboratory Results, Clinical Symptoms and CT Scan Analysis
4. Discussion
Study Limitation
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Group 1 Survival (n = 10) | Group 2 Deceased (n = 5) | p-Value | |
---|---|---|---|
Gender (M/F) | 9 (90%)/1 (10%) | 4 (80%)/1 (20%) | 0.591 |
Age | 56 ± 5 | 54 ± 9.3 | 0.591 |
Initial diagnosis (DCM/ICM) | 6 (60%)/4 (40%) | 3 (60%)/2 (40%) | 1.000 |
Co-morbidities: | |||
1. Arterial hypertension | 4 (40%) | 2 (40%) | 0.895 |
2. Diabetes mellitus | 3 (30%) | 2 (40%) | 0.689 |
3. Kidney dysfunction | 5 (50%) | 2 (40%) | 0.867 |
4. Hipercholesterolemia | 4 (40%) | 2 (40%) | 0.919 |
5. Atrial fibrillation | 1 (10%) | 1 (20%) | 0.578 |
6. Stroke | 2 (20%) | 1 (20%) | 0.878 |
7. Chronic obstructive pulmonary disease | 2 (20%) | 1 (20%) | 0.578 |
Aspergillosis: | |||
Onset (days following HTX) | 79 ± 43 | 83 ± 75 | 0.896 |
Symptoms: | |||
Fever | 4 (40%) | 3 (60%) | 0.705 |
Cough | 8 (80%) | 4 (80%) | 0.121 |
No symptoms | 1 (10%) | 1 (20%) | 1.000 |
Fatigue | 7 (70%) | 4 (80%) | 0.264 |
Shortness of breath | 4 (40%) | 2 (40%) | 0.439 |
Laboratory: | |||
Serum galactomannan level | 5 ± 3.9 | 4.1 ± 3.8 | 0.678 |
CT scan: | |||
Segment involved | 3.5 [2–7] | 2 [2–7.25] | 0.960 |
Left lobe | 1.5 [1–4] | 2 [1.5–2.25] | 0.736 |
Right lobe | 2.5 [2–3] | 2 [0–4.5] | 0.904 |
Findings: | |||
Consolidations | 6 | 2 | 0.464 |
Nodules | 4 | 6 | |
Small | 1 | 1 | 0.7469 |
Large | 3 | 5 | 0.747 |
Parabronchial infiltrate | 1 | 1 | 0.591 |
Crescent sign | 3 | 4 | 0.067 |
Bronchoscopy: | 7 (70%) | 5 (100%) | |
BAL galactomannan | 5.2 ± 2.1 | 5.3 ± 2.3 | 0.934 |
Group 1 Survival (n = 10) | Group 2 Deceased (n = 5) | p-Value | |
---|---|---|---|
Hospitalization: | |||
1. Overall (days) | 21 (14–29) | 31 (6–77) | p = 0.056 |
2. ICU (days) | 2 (1–14) | 13 (9–25) | p = 0.008 * |
3. Mechanical ventilation (pts) | 3 (30%) | 5 (100%) | p = 0.044 * |
- hospitalization day when mechanical support was required | 10 (8–12) | 11 (9–18) | p = 0.786 |
- mechnical ventilation therapy (hrs) | 40 (24–240) | 308 (222–583) | p = 0.001 * |
4. Amin pressors requirements (pts) | 0 | 3 (60%) | |
Concomitant bacterial infection: | 1 (10%) | 4 (80%) | p = 0.034 * |
- onset of diagnosis regarding hospitalization (days) | 11 (9–12) | 11 (8–14) | p = 0.934 |
- pathogen | Escherichia coli-1 | Escherichia coli-2 | |
Proteus mirabilis-2 | |||
- therapy | Meropenemum | Meropenemum |
Group 1, No = 10 | Group 2, No = 5 | p-Value | |
---|---|---|---|
Before therapy | |||
1. WBC × 109/L | 7.77 ± 4.9 | 8.0 ± 5.1 | 0.919 |
2. Neutrophils × 109/L | 6.7 ± 3.9 | 7.2 ± 4.9 | 0.835 |
3. Lymphocytes × 109/L | 0.64 ± 0.3 | 0.3 ± 0.1 | 0.049 |
4. NLR | 3.6 [2.8–4.3] | 2.7 [2.5–11.7] | 0.178 |
5. RDW (%) | 17.2 ± 2 | 15.9 ± 0.3 | 0.141 |
6. Plt × 103/L | 249 ± 54 | 232 ± 142 | 0.807 |
7. PDW (fL) | 55.5 ± 5.1 | 63 ± 5.1 | 0.037 |
After 3 days of therapy | |||
1. WBC × 109/L | 7.4 ± 4 | 10.7 ± 6.5 | 0.462 |
2. Neutrophils × 109/L | 6.3 ± 3.9 | 10 ± 6.4 | 0.391 |
3. Lymphocytes × 109/L | 0.65 ± 0.4 | 0.3 ± 0.14 | 0.014 * |
4. NLR | 10.8 [4.3–17.0] | 20.2 [17.4–116.8] | 0.037 * |
5. RDW (%) | 17.4 ± 2.1 | 16.1 ± 0.7 | 0.244 |
6. Plt × 103/L | 248 ± 77 | 220 ± 100 | 0.807 |
7. PDW (fL) | 58.2 ± 11 | 64.7 ± 5.8 | 0.327 |
After 7 days of therapy | |||
1. WBC × 109/L | 6.1 ± 1.9 | 11.7 ± 7.8 | 0.111 |
2. Neutrophils × 109/L | 4.8 ± 1.5 | 11.05 ± 7.5 | 0.066 |
3. Lymphocytes × 109/L | 0.95 ± 0.6 | 0.36 ± 0.2 | 0.037 * |
4. NLR | 5.2 [3.2–8.1] | 32.2 [13.5–49.9] | 0.010 * |
5. RDW (%) | 17.2 ± 1.9 | 16.3 ± 0.7 | 0.387 |
6. Plt × 103/L | 243 ± 68 | 243 ± 140 | 0.807 |
7. PDW (fL) | 58 ± 12 | 63 ± 7 | 0.327 |
Patients | NLR on Admission | Median Difference on Admission/3rd Day | NLR 3rd Day | Median Difference on Admission/7th day | NLR 7th Day |
---|---|---|---|---|---|
1 | 31.6 | 126.2 | 157.8 | 14.3 | 45.9 |
2 | 6.1 | 14.2 | 20.3 | −1.2 | 4.9 |
3 | 8.1 | 4.6 | 12.7 | −2.6 | 5.5 |
4 | 21.1 | −4 | 17.1 | 9.3 | 30.4 |
5 | 12.8 | −9.6 | 3.2 | −10.1 | 2.7 |
6 | 38.8 | −26 | 12.8 | −26.7 | 12.1 |
7 | 30.8 | 72.4 | 103.2 | 31.3 | 62.1 |
8 | 5.4 | 6.5 | 11.9 | 26.8 | 32.2 |
9 | 4.2 | 0.1 | 4.3 | −0.8 | 3.4 |
10 | 6.6 | 0.5 | 7.1 | −3.3 | 3.3 |
11 | 11.8 | 8.4 | 20.2 | 3.7 | 15.5 |
12 | 4.8 | −1.8 | 3 | −2.4 | 2.4 |
13 | 6.7 | 2.2 | 8.9 | 1.5 | 8.2 |
14 | 18.9 | 0.5 | 19.4 | −12.1 | 6.8 |
15 | 49.3 | −30 | 19.3 | −41.7 | 7.6 |
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Urbanowicz, T.; Michalak, M.; Olasińska-Wiśniewska, A.; Perek, B.; Rodzki, M.; Wachowiak-Baszyńska, H.; Jemielity, M. Neutrophile-to-Lymphocyte Ratio as a Predictor of Mortality and Response to Treatment in Invasive Aspergillosis among Heart Transplant Recipients—Exploratory Study. Medicina 2021, 57, 1300. https://doi.org/10.3390/medicina57121300
Urbanowicz T, Michalak M, Olasińska-Wiśniewska A, Perek B, Rodzki M, Wachowiak-Baszyńska H, Jemielity M. Neutrophile-to-Lymphocyte Ratio as a Predictor of Mortality and Response to Treatment in Invasive Aspergillosis among Heart Transplant Recipients—Exploratory Study. Medicina. 2021; 57(12):1300. https://doi.org/10.3390/medicina57121300
Chicago/Turabian StyleUrbanowicz, Tomasz, Michał Michalak, Anna Olasińska-Wiśniewska, Bartłomiej Perek, Michał Rodzki, Hanna Wachowiak-Baszyńska, and Marek Jemielity. 2021. "Neutrophile-to-Lymphocyte Ratio as a Predictor of Mortality and Response to Treatment in Invasive Aspergillosis among Heart Transplant Recipients—Exploratory Study" Medicina 57, no. 12: 1300. https://doi.org/10.3390/medicina57121300