CRITICAL CARE - ADULTS / ORIGINAL ARTICLE
Trends in complete blood count and derived inflammatory indices in ICU patients undergoing percutaneous tracheostomy: a retrospective exploratory study in Italy
1
Department of Anesthesia and Intensive Care, AOU “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
2
Department of Anesthesia and Intensive Care, ASL “Napoli 2 Nord”, “Santa Maria delle Grazie” Hospital, Pozzuoli (Neaples), Italy
3
Department of Anaesthesia and Intensive Care, Universitary Hospital “Agostino Gemelli”, Rome, Italy
These authors had equal contribution to this work
Submission date: 2025-05-05
Final revision date: 2025-12-03
Acceptance date: 2026-01-27
Publication date: 2026-02-21
Corresponding author
Antonio Romanelli
Department of Anesthesia and Intensive Care, AOU “San Giovanni di Dio e Ruggi d’Aragona,” Largo Città d’Ippocrate, Salerno, 84100, Italy
Department of Anesthesia and Intensive Care, AOU “San Giovanni di Dio e Ruggi d’Aragona,” Largo Città d’Ippocrate, Salerno, 84100, Italy
Anaesthesiol Intensive Ther 2026;58(1):30-41
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Inflammatory responses induced by percutaneous dilatational tracheostomy (PDT) are underexplored in critical patients. We examined trends in laboratory values in patients after undergoing PDT and their association with mortality.
Material and methods:
An analysis of critical patients who underwent PDT was performed. Laboratory values were collected before PDT and at 24, 48, 72, and 96 hours after. Pre-PDT values were divided into tertiles: Low, Medium, and High. Differences between survivors and non-survivors were assessed using appropriate tests. The Aligned Rank Transform (ART) test was used to analyze the tertile–time interaction by outcome. Post-hoc analyses were conducted as necessary. Tertile-outcome associations were evaluated with univariate and multivariate logistic regression, reporting odds ratios (OR) and 95% confidence intervals (95% CI). Survival differences for significant associations were analyzed with the log-rank test. A P-value < 0.05 was considered significant.
Results:
114 patients who underwent PDT were included. ART demonstrated significant interactions with monocytes and the Aggregate Index of Systemic Inflammation (AISI) relating to outcomes. Monocytes in the Low tertile significantly increased over time (P < 0.001). In multivariate analysis, patients in the Medium (OR: 0.323, 95% CI: 0.101–0.937, P = 0.044) and High (OR: 0.287, 95% CI: 0.087–0.847, P = 0.029) tertiles had a lower probability of death compared with the Low tertile. AISI trends in the Low, Medium, and High tertiles were significant (all P < 0.05). The Low tertile consistently increased over time (all pairwise P < 0.05). Multivariate regression indicated that high AISI was associated with outcomes (OR: 0.270, 95% CI: 0.074–0.861, P = 0.034). Log-rank tests for survival were not significant for monocytes or AISI.
Conclusions:
Monocyte and AISI trends after PDT may correlate with short-term mortality. Routine hematologic indices can be useful for early risk assessment. Further studies are needed to confirm these findings.
Inflammatory responses induced by percutaneous dilatational tracheostomy (PDT) are underexplored in critical patients. We examined trends in laboratory values in patients after undergoing PDT and their association with mortality.
Material and methods:
An analysis of critical patients who underwent PDT was performed. Laboratory values were collected before PDT and at 24, 48, 72, and 96 hours after. Pre-PDT values were divided into tertiles: Low, Medium, and High. Differences between survivors and non-survivors were assessed using appropriate tests. The Aligned Rank Transform (ART) test was used to analyze the tertile–time interaction by outcome. Post-hoc analyses were conducted as necessary. Tertile-outcome associations were evaluated with univariate and multivariate logistic regression, reporting odds ratios (OR) and 95% confidence intervals (95% CI). Survival differences for significant associations were analyzed with the log-rank test. A P-value < 0.05 was considered significant.
Results:
114 patients who underwent PDT were included. ART demonstrated significant interactions with monocytes and the Aggregate Index of Systemic Inflammation (AISI) relating to outcomes. Monocytes in the Low tertile significantly increased over time (P < 0.001). In multivariate analysis, patients in the Medium (OR: 0.323, 95% CI: 0.101–0.937, P = 0.044) and High (OR: 0.287, 95% CI: 0.087–0.847, P = 0.029) tertiles had a lower probability of death compared with the Low tertile. AISI trends in the Low, Medium, and High tertiles were significant (all P < 0.05). The Low tertile consistently increased over time (all pairwise P < 0.05). Multivariate regression indicated that high AISI was associated with outcomes (OR: 0.270, 95% CI: 0.074–0.861, P = 0.034). Log-rank tests for survival were not significant for monocytes or AISI.
Conclusions:
Monocyte and AISI trends after PDT may correlate with short-term mortality. Routine hematologic indices can be useful for early risk assessment. Further studies are needed to confirm these findings.
REFERENCES (29)
1.
Chiu CT, Chung YH, Lu HI, Lin MC. Weaning of long-term mechanically-ventilated patients following video bronchoscopy-guided percutaneous dilatational tracheostomy. Chang Gung Med J 2005; 28: 829-836.
2.
Freeman BD, Isabella K, Lin N, Buchman TG. A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest 2000; 118: 1412-1418. DOI: 10.1378/chest.118.5.1412.
3.
Brass P, Hellmich M, Ladra A, Ladra J, Wrzosek A. Percutaneous techniques versus surgical techniques for tracheostomy. Cochrane Database Syst Rev 2016; 7: CD008045. DOI: 10.1002/14651858.CD008045.pub2.
4.
Romem A, Gilboa H. Percutaneous tracheostomy in the ICU: a review of the literature and recent updates. Curr Opin Pulm Med 2023; 29: 47-53. DOI: 10.1097/MCP.0000000000000928.
5.
Merola R, Iacovazzo C, Troise S, Marra A, Formichella A, Servillo G, Vargas M. Timing of tracheostomy in ICU patients: a systematic review and meta-analysis of randomized controlled trials. Life (Basel) 2024; 14: 1165. DOI: 10.3390/life14091165.
6.
Han R, Gao X, Gao Y, Zhang J, Ma X, Wang H, Ji Z. Effect of tracheotomy timing on patients receiving mechanical ventilation: a meta-analysis of randomized controlled trials. PLoS One 2024; 19: e0307267. DOI: 10.1371/journal.pone.0307267.
7.
Premraj L, Camarda C, White N, Godoy DA, Cuthbertson BH, Rocco PRM, et al. Tracheostomy timing and outcome in critically ill patients with stroke: a meta-analysis and meta-regression. Crit Care 2023; 27: 132. DOI: 10.1186/s13054-023-04417-6.
8.
Meng X, Shao Y, Zhu W. Effect of open surgical and percutaneous dilatational tracheostomy on postoperative wound complications in patients: a meta-analysis. Int Wound J 2024; 21: e14368. DOI: 10.1111/iwj.14368.
9.
Yang L, Gao C, Li F, Yang L, Chen J, Guo S, et al. Monocyte-to-lymphocyte ratio is associated with 28-day mortality in patients with acute respiratory distress syndrome: a retrospective study. J Intensive Care 2021; 9: 49. DOI: 10.1186/s40560-021-00564-6.
10.
Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol 2020; 84: 106504. DOI: 10.1016/j.intimp.2020.106504.
11.
Wang X, Tian W, Zhao Y, Yang Y, Deng L. Systemic immune inflammation index and system inflammation response index on the third postoperative day predict poor prognosis of aneurysmal subarachnoid hemorrhage patients. Medicine (Baltimore) 2024; 103: e37818. doi: 10.1097/MD.0000000000037818.
12.
Wang S, Zhang G. Association between systemic immune-inflammation index and adverse outcomes in patients with acute coronary syndrome: a meta-analysis. Angiology 2025; 76: 946-954. DOI: 10.1177/00033197241263399.
13.
Sun YY, Wang MQ, Wang Y, Sun X, Qu Y, Zhu HJ, et al. Platelet-to-lymphocyte ratio at 24h after thrombolysis is a prognostic marker in acute ischemic stroke patients. Front Immunol 2022; 13: 1000626. DOI: 10.3389/fimmu.2022.1000626.
14.
Hosseninia S, Ghobadi H, Garjani K, Hosseini SAH, Aslani MR. Aggregate index of systemic inflammation (AISI) in admission as a reliable predictor of mortality in COPD patients with COVID-19. BMC Pulm Med 2023; 23: 107. DOI: 10.1186/s12890-023-02397-5.
15.
Romanelli A, Palmese S, De Vita S, Calicchio A, Gammaldi R. Stratifying mortality risk in intensive care: a comprehensive analysis using cluster analysis and classification and regression tree algorithms. Intensive Care Res 2024; 4: 116-128. DOI: https://doi.org/10.1007/s44231....
16.
Stiel L, Gaudet A, Thietart S, Vallet H, Bastard P, Voiriot G, et al. Innate immune response in acute critical illness: a narrative review. Ann Intensive Care 2024; 14: 137. DOI: 10.1186/s13613-024-01355-6.
17.
Vogeler M, Schenz J, Muller E, Weigand M, Fischer D. The immune system of the critically ill patient. Anasthesiol Intensivmed Notfallmed Schmerzther 2024; 59: 96-112. DOI: 10.1055/a-2070-3516 [Article in German].
18.
Venet F, Cour M, Rimmelé T, Viel S, Yonis H, Coudereau R, et al. Longitudinal assessment of IFN-I activity and immune profile in critically ill COVID-19 patients with acute respiratory distress syndrome. Crit Care 2021; 25: 140. DOI: 10.1186/s13054-021-03558-w.
19.
Greathouse KC, Hall MW. Critical illness-induced immune suppression: current state of the science. Am J Crit Care 2016; 25: 85-92. DOI: 10.4037/ajcc2016432.
20.
Monaghan SF, Banerjee D, Chung CS, Lomas-Neira J, Cygan KJ, Rhine CL, et al. Changes in the process of alternative RNA splicing results in soluble B and T lymphocyte attenuator with biological and clinical implications in critical illness. Mol Med 2018; 24: 32. DOI: 10.1186/s10020-018-0036-3.
21.
Adib-Conquy M, Adrie C, Fitting C, Gattolliat O, Beyaert R, Cavaillon JM. Up-regulation of MyD88s and SIGIRR, molecules inhibiting Toll-like receptor signaling, in monocytes from septic patients. Crit Care Med 2006; 34: 2377-2385. DOI: 10.1097/01.CCM.0000233875.93866.88.
22.
Albaiceta GM, Pedreira PR, Garcia-Prieto E, Taboada F. Therapeutic implications of immunoparalysis in critically ill patients. Inflamm Allergy Drug Targets 2007; 6: 191-196. DOI: 10.2174/187152807783334337.
23.
Sinistro A, Almerighi C, Ciaprini C, Natoli S, Sussarello E, Di Fino S, et al. Downregulation of CD40 ligand response in monocytes from sepsis patients. Clin Vaccine Immunol 2008; 15: 1851-1858. DOI: 10.1128/CVI.00184-08.
24.
Ziegler-Heitbrock L, Ancuta P, Crowe S, Dalod M, Grau V, Hart DN, et al. Nomenclature of monocytes and dendritic cells in blood. Blood 2010; 116: e74-e80. DOI: 10.1182/blood-2010-02-258558.
25.
Hortova-Kohoutkova M, Laznickova P, Bendickova K, De Zuani M, Andrejcinova I, Tomaskova V, et al. Differences in monocyte subsets are associated with short-term survival in patients with septic shock. J Cell Mol Med 2020; 24: 12504-12512. DOI: 10.1111/jcmm.15791.
26.
Zinellu A, Paliogiannis P, Mangoni AA. Aggregate index of systemic inflammation (AISI), disease severity, and mortality in COVID-19: a systematic review and meta-analysis. J Clin Med 2023; 12: 4584. DOI: 10.3390/jcm12144584.
27.
Tarle M, Raguz M, Luksic I. A comparative study of the aggregate index of systemic inflammation (AISI) and C-reactive protein (CRP) in predicting odontogenic abscesses severity: a novel approach to assessing immunoinflammatory response. Diagnostics (Basel) 2024; 14: 2163. DOI: 10.3390/diagnostics14192163.
28.
Thoppil J, Mehta P, Bartels B, Sharma D, Farrar JD. Impact of norepinephrine on immunity and oxidative metabolism in sepsis. Front Immunol 2023; 14: 1271098. DOI: 10.3389/fimmu.2023.1271098.
29.
Cimino C, Allos BM, Phillips EJ. A review of β-lactam-associated neutropenia and implications for cross-reactivity. Ann Pharmacother 2021; 55: 1037-1049. DOI: 10.1177/1060028020975646.
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