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PubMedDate not supplied

Mechanisms and mediators of neutrophilic leukocytosis.

Homeostatic mechanisms controlling levels of circulating leukocytes have been an enigma in the field of hematology for decades. The short circulating half-life of PMNs relative to other leukocytic cell types, and their critical role as a front line of defense against infectious agents ascribes particular importance to this regulatory process. While strident advances have expanded our knowledge of how leukocytes develop and mature in the bone marrow, their regulation and mechanisms for transport into the circulation remain largely unexplained. The relatively recent availability of recombinant cytokines and other highly purified biologic mediators, as well as the development of monoclonal antibodies against specific leukocyte adhesion molecules have led to new insights and renewed interest in this dynamic process (Springer, 1990; Petrides and Dittmann, 1990). This article reviews recent advances in defining the cellular and molecular interactions involved in leukocyte recruitment by various mediators, and proposes conceptual models for regulation of circulating leukocyte levels.

Animals↗
PubMed2005

Relation of leukocytosis to C-reactive protein and interleukin-6 among patients undergoing percutaneous coronary intervention.

An elevated white blood cell (WBC) count and elevated C-reactive protein (CRP) have been associated with an increased risk of adverse cardiac events. The relation between these 2 parameters of heightened systemic inflammation was characterized in patients who underwent percutaneous coronary intervention (PCI). Femoral arterial blood samples from a prospective registry of 100 patients who underwent PCI were obtained immediately before the procedure. The concentrations of CRP and interleukin-6 were determined by an enzyme-linked immunosorbent assay. Patients were stratified according to tertiles of ascending WBC counts before PCI. Univariate analysis compared patients in the highest WBC count tertile with the lower tertiles for clinical, angiographic, and procedural characteristics, as well as pre-PCI cytokine concentrations. Multiple logistic regression analysis was performed to examine the association between the elevated WBC count and baseline elevations in either CRP or interleukin-6, accounting for the simultaneous effect of confounding characteristics. Approximately 75% of patients had stable or unstable angina pectoris versus a marker-positive acute coronary syndrome. Patients in the highest WBC count tertile were more likely to be smokers, have received unfractionated heparin, have a marker-positive acute coronary syndrome, and have a CRP >3.0 mg/L. Multivariate analysis showed that only elevated troponin-I before PCI was independently associated with the highest WBC count tertile (odds ratio 10.9, 95% confidence interval 3.7 to 32.4, p < 0.01). In patients with negative troponin I findings, CRP >3.0 mg/L was a powerful independent predictor of an elevated pre-PCI WBC count (odds ratio 3.78, 95% confidence interval 1.07 to 13.3, p = 0.04). In conclusion, in patients with troponin I negative coronary syndromes, a pre-PCI elevation in the WBC count reflected cytokine-mediated inflammation.

Acute Disease↗
PubMed2006

Leukocytosis and increased risk of atrial fibrillation after general thoracic surgery.

BACKGROUND: In older patients who are known to be at greater risk for atrial fibrillation, we aimed to determine whether patients who develop atrial fibrillation-flutter (AF) after major thoracic surgery have an exaggerated white blood cell (WBC) count in response to surgical stress compared with those who do not develop AF. METHODS: Using a prospective database, 272 patients 60 years or older who were in sinus rhythm before surgery and had elective lobectomy, pneumonectomy, or esophagectomy were studied. Patients did not receive perioperative medications to prevent AF. Clinical characteristics and preoperative 12-lead electrocardiogram were examined and WBC counts were recorded for patients prior to and for up to five days after surgery. RESULTS: Atrial fibrillation-flutter was observed in 74 of 272 (27%) patients a median of 3 days after surgery. The increase in WBC count from preoperative to postoperative day 1 and age were jointly significant predictors of AF by multiple logistic regression (area under the receiver operating characteristic curve = 0.69). Using this model, a twofold increase in WBC from presurgery to postoperative day 1 corresponded to a 3.3-fold increase in the odds of developing AF (95% confidence interval [CI] 2.0 to 8.3) and for each 10 year increase in age, a 1.8-fold increase in risk of AF (95% CI 1.1 to 2.8) was seen. CONCLUSIONS: Increments in WBC were greater in patients with AF and coincided with the peak onset of AF. These prospective data support an important role for stress-mediated autonomic mechanisms in the pathogenesis of AF after major thoracic surgery. We aim to examine further whether WBC elevations on postoperative day one can help further risk stratify patients younger than 60 years or those with the highest risk who could benefit from one or more AF prevention strategies.

Age Factors↗
PubMed2004

Paraneoplastic leukocytosis with mature neutrophilia in a cat with pulmonary squamous cell carcinoma.

A 13-year old cat had 3-day duration of vomiting, lethargy, and anorexia. A complete blood count revealed a severe neutrophilia (126.9 x 10(3) cells/microl). Thoracic radiographs demonstrated a large solitary lung mass. A bone marrow aspirate documented myeloid hyperplasia. A left intercostal thoracotomy was performed and left cranial and caudal lung lobectomies were performed in order to remove the mass in its entirety. Histological diagnosis was squamous cell carcinoma of the lung. Following surgery, the severe neutrophilia began to decrease. It was in the normal range approximately 6 weeks postoperatively. The presence of a primary lung tumor combined with a mature neutrophilia with resolution following surgical resection suggests a paraneoplastic syndrome.

Animals↗
PubMed2003

Leukocytosis and adverse hospital outcomes after acute myocardial infarction.

An elevated white blood cell (WBC) count at the time of hospital presentation is associated with increased mortality after acute myocardial infarction (AMI). The association between WBC count and the development of clinically significant complications of AMI and death during hospitalization for AMI is, however, less clear. The objectives of this observational study were to examine the association between baseline WBC count, the development of heart failure, cardiogenic shock, and death during hospitalization for AMI from a more generalizable community-wide perspective. The study sample consisted of adult residents of all ages from the Worcester, Massachusetts, metropolitan area (1990 census estimate 437,000) hospitalized with confirmed AMI at all greater Worcester medical centers. The study population consisted of 3,796 men and 2,734 women of all ages hospitalized with validated AMI, in 12 annual periods between 1986 and 1999, aggregated into quintiles based on WBC count obtained at the time of hospital admission. In multivariable-adjusted regression analyses controlling for potentially confounding demographic and clinical factors, patients in the uppermost quintiles of WBC count were at increased risk for heart failure (odds ratio [OR] 2.77, 95% confidence interval [CI] 2.33 to 3.31), cardiogenic shock (OR 2.82, 95% CI 2.05 to 3.87), and hospital death (OR 2.14, 95% CI 1.66 to 2.76). The results of our large observational study suggest that the peripheral total leukocyte count is strongly associated with the development of heart failure, cardiogenic shock, and death during hospitalization for AMI. These findings suggest that the WBC count should be considered an important prognostic factor associated with adverse hospital outcomes in patients with AMI.

Aged↗
PubMed2003

Clinical assessment of leukocytosis: distinguishing leukocytoses caused by inflammatory, glucocorticoid, physiologic, and leukemic disorders or conditions.

The four major types of leukocytoses are inflammatory, glucocorticoid-associated, catecholamine-associated, and neoplastic. These leukocytoses are distinguished by leukocyte concentrations, microscopic features of leukocytes, and associations with other laboratory data. All laboratory findings need to be interpreted within the context of the case information, including signalment, history, and physical examination findings. Newer assays are being used to differentiate the different forms of leukocyte neoplasia and to distinguish between hyperplastic and neoplastic proliferations.

Animals↗
PubMedDate not supplied

[Neutrophilic leukocytosis of systemic or bacterial origin: discriminative C-reactive protein?].

Neutrophilic leucocytosis is frequent in systemic diseases and often leads to confusion with infective diseases. A C-reactive protein (CRP) level of 100 mg/l or more has been claimed to indicate a bacterial infection in over 80% of the cases. The purpose of this study was to test the discriminative value of CRP in patients with neutrophilic leucocytosis of bacterial or systemic origin. Sixty patients presenting with an inflammatory syndrome with neutrophilia entered the study and were divided into 2 groups. Group I comprised 30 patients with Horton's disease (n = 9), systemic vasculitis (n = 6), deep cancer (n = 5), connective tissue disease (n = 4) or Still's disease (n = 4). Group II consisted on 30 patients with infective diseases: septicaemia (n = 13), bacterial pneumonia (n = 12), pyelonephritis (n = 4) or cholecystitis (n = 1). In both groups the number of neutrophils was higher than 12,000/cubic mm. Mean CRP values were lower in group I (75.3 +/- 70 mg/l) than in group II (153 +/- 61 mg/l) (P less than 0.01). With values above 100 mg/l the specificity and sensitivity of CRP for infection were 45% and 55% respectively; the positive predictive value of CRP was 66% and its negative predictive value 76%. Specificity rose to 65% with a CRP level higher than 150 mg/l, and 74% for a CRP level higher than 200 mg/l, but such values were also observed in 4 patients of group I.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Leukocytosis, hypoalbuminemia, and the risk for chronic kidney disease in US adults.

BACKGROUND: Atherosclerosis and chronic kidney disease (CKD) share several common antecedents. However, the association between inflammatory markers and incident CKD is unknown. METHODS: We determined risk for incident CKD, defined by treatment for kidney failure or death related to kidney disease, in 9,250 US adults aged 30 to 74 years who participated in the Second National Health and Nutrition Examination Survey (NHANES II), a nationally representative prospective cohort study with 17 years of follow-up. RESULTS: After adjusting for age, race, sex, blood pressure, smoking, and body mass index, there was a graded positive association with increasing total white blood cell (WBC) count and risk for CKD (P for trend < 0.001; relative hazard (RH) highest versus lowest quartile, 2.34; 95% confidence interval [CI], 1.30 to 4.19). This association remained statistically significant after adjusting further for the presence of diabetes and cardiovascular disease at baseline (RH, 2.01; 95% CI, 1.11 to 3.65). A similarly strong and graded association with incident CKD was observed for hypoalbuminemia after adjusting for age, race, sex, blood pressure, smoking, and body mass index (P for trend = 0.02; RH lowest versus highest quartile, 1.91; 95% CI, 0.89 to 4.07) and additionally adjusting for the presence of diabetes and cardiovascular disease at baseline (P for trend = 0.02; RH lowest versus highest, 2.05; 95% CI, 0.96 to 4.39). CONCLUSION: In a nationally representative sample of US adults, elevated WBC count and hypoalbuminemia were associated with future risk for CKD. These results support the hypothesis that systemic inflammation is an independent risk factor for CKD.

Adult↗