Clinical and laboratory parameter dynamics as markers of blood stream infections in pediatric oncology patients with fever and neutropenia. Hazan Guy,Ben-Shimol Shalom,Fruchtman Yariv,Abu-Quider Abed,Kapelushnik Joseph,Moser Asher,Falup-Pecurariu Oana,Greenberg David Journal of pediatric hematology/oncology BACKGROUND:Identifying markers associated with blood stream infection (BSI) in children with fever and neutropenia (FN) could lead to a substantial reduction in unnecessary treatment. STUDY OBJECTIVE:The aim of this study was to determine the association between clinical/laboratory parameters and BSI in pediatric oncology patients with FN. METHODS:This prospective study was conducted between 2007 and 2010 at the Pediatric oncology unit. Clinical and laboratory parameters were obtained from all hospitalized FN patients. Linear regression and trends were calculated to determine the association between clinical/laboratory parameters and BSI. RESULTS:Of the 195 FN episodes in 73 children, BSIs were identified in 38 (19%) episodes. Gram-positive bacteria, gram-negative bacteria, and fungi caused 47%, 43%, and 10% of all BSIs, respectively. Mean fever duration was longer in the BSI group (5 d) compared with the non-BSI group (2 d, P=0.01). Mean (±SD) monocyte count at admission was lower in the BSI group compared with the non-BSI group (0.06±0.1 vs. 0.14±0.33 cells/mm, respectively, P=0.05). Mean C-reactive protein (CRP) levels at hospitalization days 5 to 8 were higher in children with BSI (P<0.001). Increment trends of monocyte and platelet levels and decrement trend of CRP levels were noted in the BSI group but not in the non-BSI group (P<0.01 for all). CONCLUSIONS:Prolonged fever, lower monocyte count at admission, higher CRP levels between the fifth and the eighth hospitalization days, increment trends of monocyte and platelet levels, and CRP level decrement were associated with BSI. These factors may serve as markers for BSI in pediatric oncology patients with FN. 10.1097/MPH.0000000000000057

Increased platelet-monocyte aggregates and cardiovascular disease in end-stage renal failure patients. Ashman Neil,Macey Marion G,Fan Stanley L,Azam Urooj,Yaqoob Muhammad M Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association BACKGROUND:Atherosclerotic cardiovascular disease is a major cause of morbidity and mortality in patients with end-stage renal disease. This excess morbidity cannot be entirely explained by well-recognized conventional and novel risk factors alone, and occurs irrespective of dialysis modality. Recent evidence suggests that the activation of platelets and their interaction with circulating cells are important independent risk factors for atherosclerosis in non-uraemic patients. We therefore studied platelet activation and circulating platelet-leucocyte aggregates in stable patients without evidence of cardiovascular disease on continuous ambulatory peritoneal dialysis (CAPD) and haemodialysis and investigated an association with cardiovascular events. METHODS:Immunofluorescent flow cytometry was used to measure the percentage of P-selectin- (CD62P) positive platelets, the percentage of platelet-neutrophil and platelet-monocyte aggregates, and the expression of the P-selectin ligand, P-selectin glycoprotein ligand-1 (PSGL-1, CD162) on leucocytes in haemodialysis and CAPD patients and normal controls. The platelet count and the mean platelet component (MPC, a measure of platelet activation) were determined on the ADVIATM 120 Haematology System (Bayer, NY). RESULTS:Platelet activation as assessed by MPC or CD62P expression was significantly increased in haemodialysis but not CAPD patients compared with controls. Circulating platelet-monocyte aggregates were significantly increased in parallel with a significant reduction in PSGL-1 expression on monocytes in both patient groups compared with normal controls. The presence of higher platelet-monocyte aggregates in dialysis patients was associated with increased cardiovascular events. CONCLUSION:We describe increased platelet-monocyte aggregates with reduced leucocyte PSGL-1 expression in patients with end-stage renal disease irrespective of dialysis modality, associated with an increased risk of cardiovascular disease. These findings may suggest a novel mechanism by which accelerated atherosclerosis occurs in uraemic patients. 10.1093/ndt/gfg348