Karahan Feryal, Ünal Selma, Topçu Dilara Bal, Öztaş Yeşim, Bozlu Gülçin
Department of Pediatric Hematology, Mersin University Faculty of Medicine, Mersin.
Department of Medical Biochemistry, Akyurt State Hospital, Ankara.
Turk J Pediatr. 2022;64(1):92-97. doi: 10.24953/turkjped.2021.1385.
Sickle cell disease (SCD) is an inflammatory disease that can result in both chronic and acute inflammation. Immature granulocytes (IG) are not-yet-mature white blood cells that can be easily detected in complete blood count (CBC) tests. In recent studies it has been suggested that IG may play a role in determining the prognosis of inflammatory diseases. The aim of our study was to investigate the role of IG percentage on predicting acute chest syndrome (ACS) and the severity of vaso-occlusive crisis (VOC) in patients with SCD.
The study cohort consisted of 49 SCD patients admitted to the emergency department for VOC. If symptoms did not regress despite appropriate treatment including hydration and analgesia, they were hospitalized. Patients whose symptoms regressed were discharged from the emergency department within 24 hours. Blood samples, including CBC and C-reactive protein (CRP), a marker of inflammation, were taken within the first hour of admission. Steady state laboratory parameters from the previous visit in the last three months were collected from patient files.
The mean age was 18±4 (range 8-25) years. Most were hospitalized (41/49; 83.7%) and 8 of 49 were discharged from the emergency department after their treatment for VOC. ACS developed in 13 of 49 (26.5%). White blood cell, neutrophil and nucleated red blood cell counts, percentage of IG (IG%) and CRP levels were significantly increased in patients with VOC. IG% of patients with ACS was significantly higher than patients without ACS. However, ROC analysis showed that IG% was not associated with the development of ACS or hospitalization for VOC.
Despite a small SCD cohort, the significant increase in the IG% in patients with VOC compared to their baseline values has suggested a role for IG% in predicting VOC. Although IG% was higher in ACS, its utility in predicting ACS was poor.
镰状细胞病（SCD）是一种炎症性疾病，可导致慢性和急性炎症。未成熟粒细胞（IG）是尚未成熟的白细胞，可在全血细胞计数（CBC）检测中轻松检测到。最近的研究表明，IG可能在确定炎症性疾病的预后中起作用。我们研究的目的是调查IG百分比在预测SCD患者急性胸部综合征（ACS）和血管闭塞性危机（VOC）严重程度方面的作用。
研究队列包括49名因VOC入住急诊科的SCD患者。如果经过包括补液和镇痛在内的适当治疗后症状仍未消退，则将他们住院治疗。症状消退的患者在24小时内从急诊科出院。在入院后第一小时内采集血样，包括CBC和炎症标志物C反应蛋白（CRP）。从患者病历中收集过去三个月前一次就诊时的稳态实验室参数。
平均年龄为18±4（范围8 - 25）岁。大多数患者住院（41/49；83.7%），49名患者中有8名在接受VOC治疗后从急诊科出院。49名患者中有13名（26.5%）发生了ACS。VOC患者的白细胞、中性粒细胞和有核红细胞计数、IG百分比（IG%）和CRP水平显著升高。发生ACS的患者的IG%显著高于未发生ACS的患者。然而，ROC分析表明，IG%与ACS的发生或VOC住院无关。
尽管SCD队列规模较小，但与基线值相比，VOC患者的IG%显著升高表明IG%在预测VOC方面发挥了作用。尽管ACS患者的IG%较高，但其在预测ACS方面的效用较差。
