Immature ganulocytes are a potential biomarker in the early diagnosis of lower extremity subacute arterial thrombosis
Abstract
Aims: Acute arterial embolism in peripheral arteries is generally diagnosed quickly. In contrast, subacute arterial thrombosis (SAT), which arises as an acute exacerbation of chronic peripheral artery disease (PAD), is often more challenging to diagnose rapidly, primarily due to the development of collateral circulation. This study aims to investigate the role of immature granulocytes (IG) in the early diagnosis of SAT in patients with chronic PAD.
Methods: This retrospective study was conducted at a single center between 2019 and 2021. A total of 99 patients with chronic lower extremity PAD were included in the study. Of these, 27 patients (27.2%) who developed exacerbations in the form of SAT were assigned to the SAT group. The remaining 72 patients (72.8%) with chronic PAD were included in the control group. Blood samples from patients in both groups were collected at their first admission before receiving any treatment. Complete blood count parameters were analyzed using an automatic hematological analyzer and compared between the two groups.
Results: Comparison between the control and SAT groups revealed significant differences in hemogram parameters. These parameters included white blood cell count (WBC, p<0.001), neutrophil count (NEUT#, p<0.001), lymphocyte count (LYMPH#, p=0.004), eosinophil count (EO#, p=0.035), neutrophil percentage (NEUT%, p<0.001), lymphocyte percentage (LYMPH%, p<0.001), monocyte percentage (MONO%, p=0.013), eosinophil percentage (EO%, p=0.008), immature granulocyte count (IG#, p<0.001), immature granulocyte percentage (IG%, p=0.002), neutrophil-to-lymphocyte ratio (NLR, p<0.001). These parameters were statistically significantly different in patients with SAT compared to patients with chronic atherosclerotic lower extremity peripheral artery.
Conclusion: Our study demonstrates that immature granulocytes show 81% sensitivity and %59 specificity for the early diagnosis of SAT. These findings suggest that immature granulocytes may serve as a reliable biomarker for the early detection of SAT.
Ethical Statement
In the study, the principles of the Declaration of Helsinki were adhered to. Before the start of the study, approval was obtained from our university Clinical Research Ethics Committee with the number 12.01.2022-KAEK-143-138.
Supporting Institution
Kastamonu University Faculty of Medicine
Thanks
Prof.Dr.Osman Güler
References
- Obara H, Matsubara K, Kitagawa Y. Acute limb ischemia. Ann Vasc Dis. 2018;11(4):443-448. doi:10.3400/avd.ra.18-00074
- Katzen BT. Clinical diagnosis and prognosis of acute limb ischemia. Rev Cardiovasc Med. 2002;3(Suppl 2):S2-S6.
- Schwartz SM, Heimark RL, Majesky MW. Developmental mechanisms underlying pathology of arteries. Physiol Rev. 1990;70(4):1177-1209. doi: 10.1152/physrev.1990.70.4.1177
- Smith DA, Lilie CJ. Acute Arterial Occlusion. [Updated 2023 Jan 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441851/
- Dosluoglu HH, Harris LM. Endovascular management of subacute lower extremity ischemia. Semin Vasc Surg. 2008;21(4):167-179. doi:10.1053/j.semvascsurg.2008.11.002. PMID: 19073306
- Olinic DM, Stanek A, Tătaru DA, Homorodean C, Olinic M. Acute limb ischemia: an update on diagnosis and management. J Clin Med. 2019; 8(8):1215. doi:10.3390/jcm8081215
- Ayres LS, Sgnaolin V, Munhoz TP. Immature Granulocytes Index as an early marker of sepsis. Int J Lab Hematol. 2019;41(3):392-396. doi:10. 1111/ijlh.12990
- Karakulak S, Narcı H, Ayrık C, Erdoğan S, Üçbilek E. The prognostic value of immature granulocyte in patients with acute pancreatitis. Am J Emerg Med. 2021;44:203-207. doi:10.1016/j.ajem.2020.03.028
- Lipiński M, Rydzewska G. Immature granulocytes predict severe acute pancreatitis independently of systemic inflammatory response syndrome. Prz Gastroenterol. 2017;12(2):140-144. doi:10.5114/pg.2017. 68116
- Park JH, Byeon HJ, Lee KH, et al. Delta Neutrophil Index (DNI) as a novel diagnostic and prognostic marker of infection: a systematic review and meta-analysis. Inflamm Res. 2017;66(10):863-870. doi:10.1007/s00011-017-1066-y
- Ünal Y. A new and early marker in the diagnosis of acute complicated appendicitis: immature granulocytes. Ulus Travma Acil Cerrahi Derg. 2018;24:434-439. doi:10.5505/tjtes.2018.91661
- Georgakopoulou VE, Makrodimitri S, Triantafyllou M, et al. Immature granulocytes: innovative biomarker for SARS‑CoV‑2 infection. Mol Med Rep. 2022;26(1):217. doi:10.3892/mmr.2022.12733
- Lipiński M, Rydzewska G. Immature granulocytes predict severe acute pancreatitis independently of systemic inflammatory response syndrome. Prz Gastroenterol. 2017;12(2):140-144. doi:10.5114/pg.2017. 68116
- Malengier-Devlies B, Metzemaekers M, Wouters C, Proost P, Matthys P. Neutrophil homeostasis and emergency granulopoiesis: the example of systemic juvenile idiopathic arthritis. Front Immunol. 2021;12:766620. doi:10.3389/fimmu.2021.766620
- Wang L, Luqmani R, Udalova IA. The role of neutrophils in rheumatic disease-associated vascular inflammation. Nat Rev Rheumatol. 2022; 18(3):158-170. doi:10.1038/s41584-021-00738-4
- Suszczyk D, Skiba W, Jakubowicz-Gil J, Kotarski J, Wertel I. The role of myeloid-derived suppressor cells (MDSCs) in the development and/or progression of endometriosis-state of the art. Cells. 2021;10(3):677. doi: 10.3390/cells10030677
- Korkut M, Bedel C, Sivil R, et al. Usefulness of immature granulocytes as a prognostic factor in ST-elevation myocardial infarction. Braz J Cardiovasc Surg. 2022;37(6):893-899. doi:10.21470/1678-9741-2021-0088
- Combadière B, Adam L, Guillou N, et al. LOX-1-expressing immature neutrophils identify critically-ill COVID-19 patients at risk of thrombotic complications. Front Immunol. 2021;12:752612. doi:10.3389/fimmu.2021.752612
- Karahan F, Ünal S, Topçu DB, Öztaş Y, Bozlu G. The role of immature granulocyte percentage in predicting acute chest syndrome and the severity of the vaso-occlusive crisis in sickle cell disease. Turk J Pediatr. 2022;64(1):92-97. doi:10.24953/turkjped.2021.1385
- Baril DT, Ghosh K, Rosen AB. Trends in the incidence, treatment, and outcomes of acute lower extremity ischemia in the United States Medicare population. J Vasc Surg. 2014;60(3):669-677. doi:10.1016/j.jvs. 2014.03.244
Olgunlaşmamış granülositler alt ekstremite subakut arteriyel trombozunun erken tanısında potansiyel bir biyobelirteçtir
Abstract
ÖZET
Amaç: Periferik arterlerdeki akut arteriyel emboli (AAE) genellikle hızlı bir şekilde tanı alır. Buna karşılık, kronik periferik arter hastalığının (PAH) akut alevlenmesi olarak ortaya çıkan subakut arteriyel tromboz (SAT), kollateral dolaşımın gelişmesi nedeniyle genellikle hızlı tanı konulması açısından daha zorludur. Bu çalışmanın amacı, kronik PAH'lı hastalarda SAT'nin erken tanısında immatür granülositlerin (IG) rolünü araştırmaktır.
Yöntem: Bu retrospektif çalışma, 2019-2021 yılları arasında tek merkezde gerçekleştirildi. Çalışmaya kronik alt ekstremite PAH’ı olan toplam 99 hasta dahil edildi. Bu hastalardan 27’si (%27,2), SAT şeklinde alevlenme geçiren hastalar olup SAT grubuna alındı. Kalan 72 hasta (%72,8) ise kronik PAH’lı ve stabil olan kontrol grubunu oluşturdu. Her iki gruptaki hastaların tedavi öncesi başvuru sırasında alınan kan örneklerinden tam kan sayımı (CBC) parametreleri otomatik hematolojik analizör ile incelenerek gruplar arasında karşılaştırıldı.
Bulgular: Kontrol ve SAT grubu karşılaştırıldığında hemogram parametrelerinde anlamlı farklılıklar saptandı. Bu parametreler; lökosit sayısı (WBC, p<0.001), nötrofil sayısı (NEUT#, p<0.001), lenfosit sayısı (LYMPH#, p=0.004), eozinofil sayısı (EO#, p=0.035), nötrofil yüzdesi (NEUT%, p<0.001), lenfosit yüzdesi (LYMPH%, p<0.001), monosit yüzdesi (MONO%, p=0.013), eozinofil yüzdesi (EO%, p=0.008), immatür granülosit sayısı (IG#, p<0.001), immatür granülosit yüzdesi (IG%, p=0.002), nötrofil/lenfosit oranı (NLR, p<0.001) ve sistemik immün-inflamasyon indeksi (SII, p<0.001) olarak belirlendi. Tüm bu parametrelerde SAT hastaları ile kronik aterosklerotik alt ekstremite PAH hastaları arasında istatistiksel olarak anlamlı farklılık saptandı.
Sonuç: Çalışmamız, immatür granülositlerin SAT’nin erken tanısında %81 duyarlılık ve %59 özgüllük gösterdiğini ortaya koymuştur. Bu bulgular, immatür granülositlerin SAT’nin erken saptanmasında güvenilir bir biyobelirteç olabileceğini düşündürmektedir.
Ethical Statement
Çalışmada Helsinki Bildirgesi’nin ilkelerine uyulmuştur. Çalışmanın başlamasından önce, üniversitemiz Klinik Araştırmalar Etik Kurulu'ndan 12.01.2022-KAEK-143-138 numarasıyla onay alınmıştır.
Supporting Institution
Kastaömonu Üniversitesi Tıp Fakültesi Kalp Damar Cerrahisi Bölümü
Thanks
Prof.Dr.Osman Güler
References
- Obara H, Matsubara K, Kitagawa Y. Acute limb ischemia. Ann Vasc Dis. 2018;11(4):443-448. doi:10.3400/avd.ra.18-00074
- Katzen BT. Clinical diagnosis and prognosis of acute limb ischemia. Rev Cardiovasc Med. 2002;3(Suppl 2):S2-S6.
- Schwartz SM, Heimark RL, Majesky MW. Developmental mechanisms underlying pathology of arteries. Physiol Rev. 1990;70(4):1177-1209. doi: 10.1152/physrev.1990.70.4.1177
- Smith DA, Lilie CJ. Acute Arterial Occlusion. [Updated 2023 Jan 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441851/
- Dosluoglu HH, Harris LM. Endovascular management of subacute lower extremity ischemia. Semin Vasc Surg. 2008;21(4):167-179. doi:10.1053/j.semvascsurg.2008.11.002. PMID: 19073306
- Olinic DM, Stanek A, Tătaru DA, Homorodean C, Olinic M. Acute limb ischemia: an update on diagnosis and management. J Clin Med. 2019; 8(8):1215. doi:10.3390/jcm8081215
- Ayres LS, Sgnaolin V, Munhoz TP. Immature Granulocytes Index as an early marker of sepsis. Int J Lab Hematol. 2019;41(3):392-396. doi:10. 1111/ijlh.12990
- Karakulak S, Narcı H, Ayrık C, Erdoğan S, Üçbilek E. The prognostic value of immature granulocyte in patients with acute pancreatitis. Am J Emerg Med. 2021;44:203-207. doi:10.1016/j.ajem.2020.03.028
- Lipiński M, Rydzewska G. Immature granulocytes predict severe acute pancreatitis independently of systemic inflammatory response syndrome. Prz Gastroenterol. 2017;12(2):140-144. doi:10.5114/pg.2017. 68116
- Park JH, Byeon HJ, Lee KH, et al. Delta Neutrophil Index (DNI) as a novel diagnostic and prognostic marker of infection: a systematic review and meta-analysis. Inflamm Res. 2017;66(10):863-870. doi:10.1007/s00011-017-1066-y
- Ünal Y. A new and early marker in the diagnosis of acute complicated appendicitis: immature granulocytes. Ulus Travma Acil Cerrahi Derg. 2018;24:434-439. doi:10.5505/tjtes.2018.91661
- Georgakopoulou VE, Makrodimitri S, Triantafyllou M, et al. Immature granulocytes: innovative biomarker for SARS‑CoV‑2 infection. Mol Med Rep. 2022;26(1):217. doi:10.3892/mmr.2022.12733
- Lipiński M, Rydzewska G. Immature granulocytes predict severe acute pancreatitis independently of systemic inflammatory response syndrome. Prz Gastroenterol. 2017;12(2):140-144. doi:10.5114/pg.2017. 68116
- Malengier-Devlies B, Metzemaekers M, Wouters C, Proost P, Matthys P. Neutrophil homeostasis and emergency granulopoiesis: the example of systemic juvenile idiopathic arthritis. Front Immunol. 2021;12:766620. doi:10.3389/fimmu.2021.766620
- Wang L, Luqmani R, Udalova IA. The role of neutrophils in rheumatic disease-associated vascular inflammation. Nat Rev Rheumatol. 2022; 18(3):158-170. doi:10.1038/s41584-021-00738-4
- Suszczyk D, Skiba W, Jakubowicz-Gil J, Kotarski J, Wertel I. The role of myeloid-derived suppressor cells (MDSCs) in the development and/or progression of endometriosis-state of the art. Cells. 2021;10(3):677. doi: 10.3390/cells10030677
- Korkut M, Bedel C, Sivil R, et al. Usefulness of immature granulocytes as a prognostic factor in ST-elevation myocardial infarction. Braz J Cardiovasc Surg. 2022;37(6):893-899. doi:10.21470/1678-9741-2021-0088
- Combadière B, Adam L, Guillou N, et al. LOX-1-expressing immature neutrophils identify critically-ill COVID-19 patients at risk of thrombotic complications. Front Immunol. 2021;12:752612. doi:10.3389/fimmu.2021.752612
- Karahan F, Ünal S, Topçu DB, Öztaş Y, Bozlu G. The role of immature granulocyte percentage in predicting acute chest syndrome and the severity of the vaso-occlusive crisis in sickle cell disease. Turk J Pediatr. 2022;64(1):92-97. doi:10.24953/turkjped.2021.1385
- Baril DT, Ghosh K, Rosen AB. Trends in the incidence, treatment, and outcomes of acute lower extremity ischemia in the United States Medicare population. J Vasc Surg. 2014;60(3):669-677. doi:10.1016/j.jvs. 2014.03.244
Details
| Primary Language | English |
|---|---|
| Subjects | Cardiovascular Surgery |
| Journal Section | Original Article |
| Authors | |
| Publication Date | May 30, 2025 |
| Submission Date | February 1, 2025 |
| Acceptance Date | May 17, 2025 |
| Published in Issue | Year 2025 Volume: 8 Issue: 3 |
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