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Hematological and leukocyte morphometric indices as low-cost diagnostic adjuncts in acute coronary syndromes
Mansi Mehrotra1, Dushyant Singh Gaur2, Kunal Gururani3
1Department of Hematopathology, Homi Bhabha Cancer Hospital, New Chandigarh, Punjab, India.
Insights
Routine blood tests and leukocyte analysis effectively identify Acute Coronary Syndromes (ACS) in patients. However, these low-cost methods show limited ability to differentiate between specific ACS subtypes like STEMI, unstable angina, and NSTEMI.
Area of Science:
- Hematology
- Clinical Diagnostics
- Cardiovascular Medicine
Background:
- Acute Coronary Syndromes (ACS) are a leading cause of death globally.
- Access to advanced diagnostics for ACS is often limited in resource-constrained areas.
- Routine hematological indices and leukocyte parameters offer potential low-cost diagnostic adjuncts.
Purpose of the Study:
- To assess the effectiveness of routine hematological indices and leukocyte Volume, Conductivity, and Scatter (VCS) parameters in identifying ACS.
- To evaluate the utility of these parameters in differentiating between ACS subtypes.
Main Methods:
- A cross-sectional study involving 291 adults (151 ACS patients, 140 controls).
- Analysis of routine hematological indices and leukocyte morphometric parameters (VCS).
- Multivariable logistic regression using L1-regularization to identify predictors of ACS.
Main Results:
- ACS patients exhibited higher leukocyte counts, lower hemoglobin, increased mean platelet volume (MPV), reduced neutrophil conductivity, and altered monocyte scatter compared to controls (p < 0.01).
- Elevated white blood cell (WBC) count, reduced hemoglobin, increased MPV, decreased neutrophil conductivity, and increased monocyte scatter independently predicted ACS.
- The combined hematological and VCS model showed excellent ACS identification performance (AUC 0.98 ± 0.02) but limited ability to differentiate ACS subtypes (AUC 0.63-0.65).
Conclusions:
- Routine hematological indices and leukocyte VCS parameters are valuable, low-cost tools for identifying Acute Coronary Syndromes.
- These parameters have a limited role in distinguishing between specific subtypes of ACS, such as STEMI, unstable angina, and NSTEMI.
Objective:
Acute Coronary Syndromes (ACS) remain a major cause of morbidity and mortality, particularly in resource-limited settings where access to advanced diagnostics may be constrained. This study aimed to evaluate the utility of routine hematological indices and leukocyte morphometric parameters-volume, conductivity, and scatter (VCS)-as low-cost adjuncts for identifying ACS and differentiating its subtypes.
Results Description:
This cross-sectional study included 291 adults (151 ACS patients and 140 healthy controls) evaluated between January 2022 and August 2023. Compared with controls, ACS patients had significantly higher total leukocyte counts, lower hemoglobin levels, increased mean platelet volume (MPV), reduced neutrophil conductivity (MN-C-NE), and increased monocyte scatter parameters (MN-LALS-MO, MN-AL2-MO) (all p < 0.01). On L1-regularized multivariable logistic regression, elevated WBC count, reduced hemoglobin, increased MPV, decreased neutrophil conductivity, and increased monocyte scatter indices independently predicted ACS. The combined model demonstrated excellent discriminatory performance (AUC 0.98 ± 0.02). However, discrimination between ACS subtypes was limited, with poor performance for differentiating STEMI from unstable angina and NSTEMI (AUC 0.63-0.65, p > 0.05). These findings suggest that hematological and VCS parameters are effective for identifying ACS but have limited utility in subtype differentiation.
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