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Medicine Jul 2017Monocytosis is associated with chronic infections such as tuberculosis or endocarditis as well as rheumatic and myeloproliferative disorders. Monocytes are also involved... (Observational Study)
Observational Study
Monocytosis is associated with chronic infections such as tuberculosis or endocarditis as well as rheumatic and myeloproliferative disorders. Monocytes are also involved in the pathogenesis of atherosclerosis, coronary artery disease, and stroke. The value of monocytosis as a prognostic marker in different diagnostic groups in the emergency setting, however, has not been investigated so far.The aim of the article is to study monocytosis as an outcome factor in the emergency setting.In a Swiss register study, we analyzed monocyte counts in 4238 patients aged >18 years who were admitted to the emergency department of a regional tertiary care hospital. Monocytosis was defined as 0.8×10 cells/L. Diagnoses were grouped into infection, cardiovascular, neurological, metabolic, gastrointestinal, pulmonary, or other. Thirty-day mortality was defined as the primary endpointA total of 1217 patients with monocytosis were identified. Patients with monocytosis at admission suffered more frequently from respiratory symptoms (17.7% vs 8.9%, P <.001) and infection as the final diagnosis (20.8% vs 10.3%, P <.001) while neurological diagnoses were significantly lower in the monocytosis group (15.3% vs 30.9%, P <.001). Patients with monocytosis suffered from more comorbidities such as congestive heart failure, chronic obstructive pulmonary disease, tumor, diabetes, or renal failure but not dementia. When adjusted for age, gender, comorbidities, and main diagnosis, the 30-day mortality (P = .002) and length of stay (P = .001) were significantly higher in patients with monocytosis. The 30-day mortality in patients with monocytosis was most notably influenced by a cardiological diagnosis (odds ratio 3.91).An increased monocyte count predicts adverse outcome in patients admitted to the emergency department. Mechanistic studies will be necessary to specify the potentially detrimental role of monocytosis in critical illness.
Topics: Adult; Aged; Comorbidity; Emergency Service, Hospital; Female; Humans; Length of Stay; Leukocyte Count; Leukocytosis; Male; Middle Aged; Monocytes; Mortality; Patient Readmission; Prognosis; Prospective Studies; Quality Control; Registries; Surveys and Questionnaires; Switzerland
PubMed: 28700476
DOI: 10.1097/MD.0000000000007404 -
Aging Cell Aug 2016Aging leads to a proinflammatory state within the vasculature without disease, yet whether this inflammatory state occurs during atherogenesis remains unclear. Here, we...
Aging leads to a proinflammatory state within the vasculature without disease, yet whether this inflammatory state occurs during atherogenesis remains unclear. Here, we examined how aging impacts atherosclerosis using Ldlr(-/-) mice, an established murine model of atherosclerosis. We found that aged atherosclerotic Ldlr(-/-) mice exhibited enhanced atherogenesis within the aorta. Aging also led to increased LDL levels, elevated blood pressure on a low-fat diet, and insulin resistance after a high-fat diet (HFD). On a HFD, aging increased a monocytosis in the peripheral blood and enhanced macrophage accumulation within the aorta. When we conducted bone marrow transplant experiments, we found that stromal factors contributed to age-enhanced atherosclerosis. To delineate these stromal factors, we determined that the vasculature exhibited an age-enhanced inflammatory response consisting of elevated production of CCL-2, osteopontin, and IL-6 during atherogenesis. In addition, in vitro cultures showed that aging enhanced the production of osteopontin by vascular smooth muscle cells. Functionally, aged atherosclerotic aortas displayed higher monocyte chemotaxis than young aortas. Hence, our study has revealed that aging induces metabolic dysfunction and enhances vascular inflammation to promote a peripheral monocytosis and macrophage accumulation within the atherosclerotic aorta.
Topics: Aging; Animals; Aorta; Atherosclerosis; Blood Vessels; Cell Count; Chemotaxis; Culture Media, Conditioned; Diet, High-Fat; Down-Regulation; Hematopoiesis; Hemodynamics; Inflammation; Inflammation Mediators; Insulin Resistance; Interleukin-6; Leukocytosis; Macrophages; Male; Mice; Mice, Inbred C57BL; Monocytes; Oligonucleotide Array Sequence Analysis; Receptors, LDL; Stromal Cells; Up-Regulation
PubMed: 27135421
DOI: 10.1111/acel.12488 -
Journal of Clinical Immunology Oct 2023
Topics: Humans; Child; Lung Diseases, Interstitial; Leukocyte Disorders; Antigens, Neoplasm
PubMed: 37291413
DOI: 10.1007/s10875-023-01529-0 -
International Journal of Cardiology Sep 2016Deep venous thrombosis (DVT) is a manifestation of venous thromboembolism (VTE). It has been estimated that there are 900,000 cases of pulmonary emboli (PE) and DVT per...
INTRODUCTION
Deep venous thrombosis (DVT) is a manifestation of venous thromboembolism (VTE). It has been estimated that there are 900,000 cases of pulmonary emboli (PE) and DVT per year resulting in 60,000 to 300,000 deaths. About two-thirds of VTE cases are associated with prolonged hospitalizations, emphasizing the importance of major surgery or immobilization as risk factors.
METHODS
Retrospective study conducted in a Metropolitan Hospital. A total of 46 records were obtained from the hospital database following the established inclusion and exclusion criteria. For the control group a total of 42 records were selected. Patients included in this study were admitted with the diagnosis of deep venous thrombosis identified either by lower leg Doppler.
RESULTS
Monocytosis with DVT, p-value was <0.001, with an Odd Ratio (OR) 9.35 and Interval Confidence (IC) 95% (3.2-27.3). The p-value for eosinophilia with DVT was 0.092, for males with DVT the p-value was 0.35 and age related groups with DVT value was 0.720. Sensitivity of monocytosis was 67.3%, specificity 80%, positive predictive value (PPV) 79.49% and negative predictive value (NPV) 63.9%.
CONCLUSION
This study revealed the association between monocytosis and DVT, thus patients with monocytosis are more likely to develop DVT. This evidence is consistent with previous studies establishing that monocytes could have an important role with the coagulation cascade activation and the formation of DVT. The association of monocyte count and DVT can be used in the future as a significant tool in those patients with suspected DVT to increase diagnostic yield.
Topics: Adult; Aged; Humans; Middle Aged; Monocytes; Predictive Value of Tests; Puerto Rico; Retrospective Studies; Venous Thrombosis
PubMed: 27343421
DOI: 10.1016/j.ijcard.2016.06.020 -
Journal of Cancer 2018To measure hematologic parameters derived from the white blood cell (WBC) count and differential count (DC) as prognostic factors for survival in patients with stage IB...
To measure hematologic parameters derived from the white blood cell (WBC) count and differential count (DC) as prognostic factors for survival in patients with stage IB and IIA cervical cancer. We retrospectively examined demographic, clinicopathologic, and laboratory parameters in a cohort of 233 patients with International Federation of Gynecology and Obstetrics stage IB and IIA cervical cancer who underwent surgical resection. We further assessed the effects of the WBC count and DC-derived hematologic parameters on progression-free survival (PFS) and overall survival (OS) after controlling for other parameters. Patients were followed up for a median of 46.6 months (range, 9-142 months). The Kaplan-Meier estimates of PFS and OS at 5 years were 88.5% and 92.3%, respectively. In a multivariate analysis, we identified the absolute monocyte count (AMC) (hazard ratio [HR], 11.78; <0.001) and tumor size (HR, 5.41; = 0.003) as the strongest prognostic factors affecting PFS. We also identified AMC (HR, 23.29; <0.001), tumor size, (HR, 5.27; = 0.033), and lymph node involvement (HR, 3.90; = 0.027) as the strongest prognostic factors affecting OS. AMC remained prognostic with respect to PFS or OS in a Cox model that controlled for the neutrophil-lymphocyte ratio or lymphocyte-monocyte ratio, although neither ratio was a significant prognostic factor for survival. Monocytosis and an increased tumor size were found to be independent prognostic factors affecting both PFS and OS in patients with stage IB and IIA cervical cancer.
PubMed: 29290770
DOI: 10.7150/jca.22234 -
Leukemia Jun 2023
Topics: Humans; Proteogenomics; DNA-Binding Proteins; Leukocytosis; Hematopoiesis; Mutation; Dioxygenases
PubMed: 36966263
DOI: 10.1038/s41375-023-01887-z -
A case of refractory systemic lupus erythematosus with monocytosis exhibiting somatic KRAS mutation.Inflammation and Regeneration Apr 2022Systemic lupus erythematosus (SLE), an autoimmune disorder that damages various organ systems, is caused by a combination of genetic and environmental factors. Although...
BACKGROUND
Systemic lupus erythematosus (SLE), an autoimmune disorder that damages various organ systems, is caused by a combination of genetic and environmental factors. Although germline mutations of several genes are known to cause juvenile SLE, most of the susceptibility genetic variants of adult SLE are common variants of the population, somatic mutations that cause or exacerbate SLE have not been reported. We hereby report a refractory SLE case with monocytosis accompanying somatic KRAS mutation that have been shown to cause lupus-like symptoms.
CASE PRESENTATION
A 60-year-old female patient who had been diagnosed with SLE was admitted to our hospital. Although prednisolone and tacrolimus treatments had kept her thrombocytopenia and anti-DNA Ab level at bay for more than 4 years, a diagnosis of transverse myelitis was made when she became acutely ill with pleocytosis. Elevated cells (predominately monocytes), protein, IgG, and IL-6 levels were also found in the cerebrospinal fluid (CSF) of the patient. Standard pulse treatments of methylprednisolone, high-dose of prednisolone, and intravenous cyclophosphamide in combination with plasma exchange could not alleviate the refractory neural and autoimmune manifestation. Monocytosis of peripheral blood was also noted. Flow cytometric analysis revealed elevated ratio of CD14+CD16+ atypical monocytes, which excluded the possibility of chronic myelomonocytic leukemia. Lupus-like symptoms with monocytosis reminded us of Ras-associated autoimmune leukoproliferative disorder, and Sanger sequencing of KRAS and NRAS genes from the patients' peripheral blood mononuclear cells (PBMC), sorted CD3+ lymphocytes and CD14+ monocytes, and cerebrospinal fluid were performed. An activating KRAS somatic mutation was found in the patients' DNA at the time of encephalomyelitis diagnosis.
CONCLUSION
Somatic mutations of some genes including KRAS may cause the refractoriness of SLE.
PubMed: 35361277
DOI: 10.1186/s41232-022-00195-w -
International Journal of Laboratory... Apr 2020The 2016 revised 4th edition of the World Health Organization classification of hematopoietic neoplasms updated the diagnostic criteria for chronic myelomonocytic... (Review)
Review
The 2016 revised 4th edition of the World Health Organization classification of hematopoietic neoplasms updated the diagnostic criteria for chronic myelomonocytic leukemia (CMML). Persistent peripheral blood monocytosis of at least 1 × 10 /L and a percentage of monocytes ≥10% of the circulating white blood cell count (WBC) are both prerequisite criteria for this diagnosis. CMML represents the prototype of "overlapping" myeloid neoplasms with concurrent myeloproliferative and myelodysplastic features. However, clinical presentation is heterogeneous, with cases showing prevailing "dysplastic" features and others a predominant "proliferative" phenotype. Accounting for this diversity, two variants of CMML are recognized: "dysplastic" CMML defined by WBC < 13 × 10 /L and "proliferative" CMML with WBC ≥ 13 × 10 /L often showing features mimicking a myeloproliferative neoplasm. Although not an official WHO category, the "oligomonocytic" variant of CMML is defined by relative monocytosis with an absolute monocyte count of 0.5-0.9 × 10 /L. It can be considered a "pre-phase," as it frequently anticipates the development of an overt, classic CMML. In an attempt at improving disease prognostication, the blast count based grading system for CMML of the WHO 2008 Classification has been expanded in 2016 to include a new "CMML-0" category. Lastly, the large body of knowledge on the molecular events occurring in CMML has been used to assist diagnosis and assess prognosis. Despite the step forwards, diagnosis of CMML still remains one of exclusion as no clinical, pathologic or molecular findings are specific for this disease. The current review brings insight into the spectrum of CMML and provides practical advice to approach suspected cases of CMML.
Topics: Humans; Leukemia, Myelomonocytic, Chronic; Mutation; Prognosis
PubMed: 31841277
DOI: 10.1111/ijlh.13145 -
Bone Marrow Transplantation Jun 2024
PubMed: 38909123
DOI: 10.1038/s41409-024-02333-z -
International Journal of Hematology Jun 2017Chronic Myelomonocytic Leukemia is a chronic myeloid neoplasm occurring mostly in the elderly with overlapping features of myelodysplastic syndromes (MDS) and... (Review)
Review
Chronic Myelomonocytic Leukemia is a chronic myeloid neoplasm occurring mostly in the elderly with overlapping features of myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN) characterized by chronic monocytosis. Recent progresses in the molecular and cellular pathogenesis of CMML have stirred a renewed interest in this clinically heterogeneous disorder. Here, we review the recent progresses in the biology of CMML and how it affects its current and future clinical management.
Topics: Humans; Leukemia, Myelomonocytic, Chronic; Myelodysplastic Syndromes
PubMed: 28455647
DOI: 10.1007/s12185-017-2243-z