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Turkish Journal of Biochemistry

Türk Biyokimya Dergisi

IMPACT FACTOR 2018: 0.329

CiteScore 2018: 0.28

SCImago Journal Rank (SJR) 2018: 0.138
Source Normalized Impact per Paper (SNIP) 2018: 0.169

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Volume 43, Issue 3


Large unstained cells are correlated with inflammatory biomarkers in patients with invasive aspergillosis

Büyük boyanmamış hücreler invaziv aspergillozis hastalarında enflamatuvar biyobelirteçler ile koreledir

Isil CakirORCID iD: http://orcid.org/0000-0001-5728-4671 / Nuri Cakir / Mustafa Altay Atalay / Ayse Nedret Koc
Published Online: 2018-01-25 | DOI: https://doi.org/10.1515/tjb-2017-0042



The percentage of large unstained cells (%LUCs) reflects peroxidase-negative cells and activated lymphocytes. Unlike other infections, the value of %LUCs in the diagnosis of fungal infections is not clear. We aimed to evaluate %LUCs and its correlations with other inflammatory parameters of invasive aspergillosis (IA) patients.


Twenty patients and 20 healthy participants were included. Full blood count parameters including %LUCs values were recorded. Platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), eosinophil to lymphocyte ratio (ELR) were calculated.


There was a significant difference between the study groups for %LUCs [2.40 (2.22–3.25); 1.43 (1.25–2.10), respectively; p<0.001]. Furthermore, %LUCs were statistically significantly correlated with PLR, NLR and MLR (p=0.020, 0.040, 0.040; respectively) but not correlated with ELR (p>0.05).


The %LUCs values were significantly increased and correlated with markers of inflammation in patients. We suggest that the %LUCs is a useful predictor and may be an aid in the diagnosis and/or the management of IA and may help clinicians for follow up these patients in therapy process. Our study provides target pathways for further studies in the diagnosis of Aspergillus-infected patients using inflammatory parameters.



Büyük boyanmamış hücre yüzdesi (%LUCs), peroksidaz negatif hücreleri ve aktive lenfositleri ifade eder. Diğer enfeksiyonlardan farklı olarak, fungal enfeksiyonların teşhisinde %LUCs değeri açık değildir. İnvaziv aspergilloz (IA) hastalarında %LUCs ve bunun diğer enflamatuvar parametrelerle korelasyonunu değerlendirmeyi amaçladık.


Yirmi hasta ve yirmi sağlıklı katılımcı dahil edildi. %LUCs değerlerini de içeren tam kan sayımı parametreleri kaydedildi. Platelet/lenfosit oranı (PLR), nötrofil/lenfosit oranı (NLR), monosit/lenfosit oranı (MLR), eozinofil/lenfosit oranı (ELR) hesaplandı.


Çalışma grupları arasında %LUCs anlamlı farklı idi [2.40 (2.22–3.25); 1.43 (1.25–2.10), sırasıyla; p<0.001]. Ayrıca, %LUCs değeri PLR, NLR ve MLR ile anlamlı korele (sırasıyla p=0.020, 0.040, 0.040) fakat ELR ile korele değil idi (p>0.05).


Hastalarda %LUCs değerleri anlamlı yüksek ve enflamasyon belirteçleri ile korele idi. %LUCs değerinin faydalı bir belirteç olduğunu, IA tanısı ve/kontrolünde destek olabileceğini ve bu hastaların tedavi süreçlerinde takipleri için klinisyenlere yardım edebileceğini önermekteyiz. Çalışmamız, enflamasyon parametrelerini kullanarak Aspergillus- enfekte hastaların teşhisinde, ileri çalışmalar için hedef yolaklar sağlamaktadır.

Keywords: Invasive aspergillosis; Large unstained cells; Inflammation; Platelet to lymphocyte ratio; Neutrophil to lymphocyte ratio; Monocyte to lymphocyte ratio; Eosinophil to lymphocyte ratio

Anahtar Kelimeler: İnvaziv aspergilloz; Büyük boyanmamış hücreler; Enflamasyon; Platelet/lenfosit oranı; Nötrofil/lenfosit oranı; Monosit/lenfosit oranı; Eozinofil/lenfosit oranı


  • 1.

    Wyatt TT, Golovina EA, van Leeuwen R, Hallsworth JE, Wösten HA, Dijksterhuis J. A decrease in bulk water and mannitol and accumulation of trehalose and trehalose-based oligosaccharides define a two-stage maturation process towards extreme stress resistance in ascospores of Neosartorya fischeri (Aspergillus fischeri). Environ Microbiol 2015;17:383–94.Web of SciencePubMedCrossrefGoogle Scholar

  • 2.

    Perfect JR, Cox GM, Lee JY, Kauffman CA, de Repentigny L, Chapman SW, et al. The impact of culture isolation of Aspergillus species: a hospital-based survey of aspergillosis. Clin Infect Dis 2001;33:1824–33.PubMedCrossrefGoogle Scholar

  • 3.

    Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax 2015;70:270–7.CrossrefWeb of SciencePubMedGoogle Scholar

  • 4.

    Nucci M, Nouér SA, Cappone D, Anaissie E. Early diagnosis of invasive pulmonary aspergillosis in hematologic patients: an opportunity to improve the outcome. Haematologica 2013;98:1657–60.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 5.

    Vanker N, Ipp H. The use of the full blood count and differential parameters to assess immune activation levels in asymptomatic, untreated HIV infection. S Afr Med J 2013;104:45–8.Web of SciencePubMedCrossrefGoogle Scholar

  • 6.

    Park BK, Park JW, Han EC, Ryoo SB, Han SW, Kim TY, et al. Systemic inflammatory markers as prognostic factors in stage IIA colorectal cancer. J Surg Oncol 2016;114:216–21.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 7.

    Wu Y, Chen Y, Yang X, Chen L, Yang Y. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with disease activity in patients with systemic lupus erythematosus. Int Immunopharmacol 2016;36:94–9.Web of ScienceCrossrefPubMedGoogle Scholar

  • 8.

    Verweij PE, Brandt ME. Aspergillus, fusarium, and other opportunistic moniliaceous fungi. In: Murray PR, Baron EJ, Jorgensen JH, Landry ML, Pfaller MA, editors. Manual of clinical microbiology, 9th ed., vol. 2. Washington: ASM Press, 2007:1802–38.Google Scholar

  • 9.

    Ascioglu S, Rex JH, de Pauw B, Bennett JE, Bille J, Crokaert F, et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002;34:7–14.PubMedCrossrefGoogle Scholar

  • 10.

    De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46:1813–21.Web of ScienceGoogle Scholar

  • 11.

    Mandviwala T, Shinde R, Kalra A, Sobel JD, Akins RA. High-throughput identification and quantification of Candida species using high resolution derivative melt analysis of panfungal amplicons. J Mol Diagn 2010;12:91–101.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 12.

    Balajee SA, Sigler L, Brandt ME. DNA and the classical way: identification of medically important molds in the 21st century. Med Mycol 2007;45:475–90.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 13.

    Sanguinetti M, Porta R, Sali M, La Sorda M, Pecorini G, Fadda G, et al. Evaluation of VITEK 2 and RapID yeast plus systems for yeast species identification: experience at a large clinical microbiology laboratory. J Clin Microbiol 2007;45:1343–6.CrossrefWeb of ScienceGoogle Scholar

  • 14.

    Pagano L, Akova M, Dimopoulos G, Herbrecht R, Drgona L, Blijlevens N. Risk assessment and prognostic factors for mould-related diseases in immunocompromised patients. J Antimicrob Chemother 2011;66(Suppl 1):i5–14.CrossrefWeb of SciencePubMedGoogle Scholar

  • 15.

    Pagano L, Caira M, Candoni A, Offidani M, Fianchi L, Martino B, et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica 2006;91:1068–75.PubMedGoogle Scholar

  • 16.

    Del Bono V, Mikulska M, Viscoli C. Invasive aspergillosis: diagnosis, prophylaxis and treatment. Curr Opin Hematol 2008;16:586–93.Web of ScienceGoogle Scholar

  • 17.

    Hörmet Öz HT, Koç AN, Atalay MA, Eser B, Yildiz O, Kaynar L. The diagnostic value of the galactomannan and (1,3)_beta-d-glucan in diagnosis of invasive Aspergillosis. Nobel Medicus 2014;10:44–9.Google Scholar

  • 18.

    Roques M, Chretien ML, Favennec C, Lafon I, Ferrant E, Legouge C, et al. Evolution of procalcitonin, C-reactive protein and fibrinogen levels in neutropenic leukaemia patients with invasive pulmonary aspergillosis or mucormycosis. Mycoses 2016;59:383–90.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 19.

    Vanker N, Ipp H. Large unstained cells: a potentially valuable parameter in the assessment of immune activation levels in HIV infection. Acta Haematol 2014;131:208–12.CrossrefWeb of ScienceGoogle Scholar

  • 20.

    Shin D, Lee MS, Kim DY, Lee MG, Kim DS. Increased large unstained cells value in varicella patients: a valuable parameter to aid rapid diagnosis of varicella infection. Dermatol 2015;42:795–9.Web of ScienceCrossrefGoogle Scholar

  • 21.

    Yang W, Liu Y. Platelet-lymphocyte ratio is a predictor of venous thromboembolism in cancer patients. Thromb Res 2015;136:212–5.Web of SciencePubMedCrossrefGoogle Scholar

  • 22.

    Yayla C, Akboga MK, Canpolat U, Akyel U, Gayretli K, Doğan M, et al. Platelet to lymphocyte ratio can be a predictor of infarct-related artery patency in patients with ST-segment elevation myocardial infarction. Angiology 2015;66:831–6.Web of ScienceCrossrefPubMedGoogle Scholar

  • 23.

    Meng X, Wei G, Chang Q, Peng R, Shi G, Zheng P, et al. The platelet-to-lymphocyte ratio, superior to the neutrophil-to- lymphocyte ratio, correlates with hepatitis C virus infection. Int J Infect Dis 2016;45:72–7.CrossrefWeb of SciencePubMedGoogle Scholar

  • 24.

    Aydin E, Karadag MA, Cecen K, Cigsar G, Aydin S, Demir A, et al. Association of mean platelet volume and the monocyte/lymphocyte ratio with brucella-caused epididymo-orchitis. Southeast Asian J Trop Med Public Health 2016;47:450–6.PubMedGoogle Scholar

  • 25.

    Sun X, Liu X, Liu J, Chen S, Xu D, Li W, et al. Preoperative neutrophil-to-lymphocyte ratio plus platelet-to-lymphocyte ratio in predicting survival for patients with stage I-II gastric cancer. Chin J Cancer 2016;35:57.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 26.

    Brescia G, Pedruzzi B, Barion U, Marioni G. Are neutrophil-, eosinophil-, and basophil-to-lymphocyte ratios useful markers for pinpointing patients at higher risk of recurrent sinonasal polyps? Am J Otolaryngol 2016;37:339–45.CrossrefPubMedWeb of ScienceGoogle Scholar

About the article

Corresponding author: Dr. Isil Cakir, Department of Clinical Biochemistry, Training and Research Hospital, 38010 Kayseri, Turkey, Phone: +903523368884-1219, 1239

Received: 2017-02-07

Accepted: 2017-10-24

Published Online: 2018-01-25

Conflict of interest statement: No conflict of interest was declared by the authors.

Citation Information: Turkish Journal of Biochemistry, Volume 43, Issue 3, Pages 306–311, ISSN (Online) 1303-829X, DOI: https://doi.org/10.1515/tjb-2017-0042.

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