Analysis of overall survival in a large multiethnic cohort reveals absolute neutrophil count of 1,100 as a novel prognostic cutoff in African Americans

Ioannis Mantzaris, Yiting Yu, Pavlos Msaouel, Anthony P. Lam, Murali Janakiram, Ellen W. Friedman, Ulrich G. Steidl, Amit K. Verma

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Although absolute neutrophil counts (ANC) below 1.5x103/uL are used to define neutropenia as a marker of increased susceptibility to infections, their relationship with survival has not been examined. Since low counts trigger extensive investigations, determining prognostic cutoffs especially for different ethnicities and races is critical.A multiethnic cohort of 27,760 subjects, 65 years old and above, was utilized to evaluate the association of neutropenia with overall survival in different ethnicities and races.The mean ANC was 4.6±1.51x103/uL in non-Hispanic whites, 3.6±1.57x103/uL in non-Hispanic blacks and 4.3±1.54x103/uL in Hispanics (p<0.001). An ANC below 1.5x103/uL was associated with significantly shorter overall survival among whites (HR 1.74; 95% CI 1.18 - 2.58; p<0.001), but not in blacks (HR 0.89; 95% CI 0.86 - 1.17; p=0.40) or Hispanics (HR 1.04; 95% CI 0.76 - 1.46; p=0.82), after adjustment for age, sex, comorbidities, anemia and thrombocytopenia. Using Cox regression multivariable models, an ANC below 1.1x103/uL in blacks was found to be associated with increased mortality (HR 1.86; 95%CI 1.21 - 2.87; p<0.01). We found no association between neutropenia and mortality at any ANC cutoff in elderly Hispanics. In conclusion, neutropenia was found to be an independent prognostic variable in the elderly, when determined in race-specific manner. Most importantly, a cutoff of 1.1x103 neutrophils/uL may be a more prognostically relevant marker in elderly blacks and could serve as a novel threshold for further evaluation and intervention in this population.

Original languageEnglish (US)
Pages (from-to)67948-67955
Number of pages8
JournalOncotarget
Volume7
Issue number42
DOIs
StatePublished - Oct 18 2016

Fingerprint

Survival Analysis
African Americans
Neutrophils
Neutropenia
Hispanic Americans
Mortality
Thrombocytopenia
Comorbidity
Anemia
Infection
Population

Keywords

  • African American
  • ethnicity
  • neutropenia
  • race
  • survival

ASJC Scopus subject areas

  • Oncology

Cite this

Analysis of overall survival in a large multiethnic cohort reveals absolute neutrophil count of 1,100 as a novel prognostic cutoff in African Americans. / Mantzaris, Ioannis; Yu, Yiting; Msaouel, Pavlos; Lam, Anthony P.; Janakiram, Murali; Friedman, Ellen W.; Steidl, Ulrich G.; Verma, Amit K.

In: Oncotarget, Vol. 7, No. 42, 18.10.2016, p. 67948-67955.

Research output: Contribution to journalArticle

@article{3e1b521c3a95460eb59f7c36669469c9,
title = "Analysis of overall survival in a large multiethnic cohort reveals absolute neutrophil count of 1,100 as a novel prognostic cutoff in African Americans",
abstract = "Although absolute neutrophil counts (ANC) below 1.5x103/uL are used to define neutropenia as a marker of increased susceptibility to infections, their relationship with survival has not been examined. Since low counts trigger extensive investigations, determining prognostic cutoffs especially for different ethnicities and races is critical.A multiethnic cohort of 27,760 subjects, 65 years old and above, was utilized to evaluate the association of neutropenia with overall survival in different ethnicities and races.The mean ANC was 4.6±1.51x103/uL in non-Hispanic whites, 3.6±1.57x103/uL in non-Hispanic blacks and 4.3±1.54x103/uL in Hispanics (p<0.001). An ANC below 1.5x103/uL was associated with significantly shorter overall survival among whites (HR 1.74; 95{\%} CI 1.18 - 2.58; p<0.001), but not in blacks (HR 0.89; 95{\%} CI 0.86 - 1.17; p=0.40) or Hispanics (HR 1.04; 95{\%} CI 0.76 - 1.46; p=0.82), after adjustment for age, sex, comorbidities, anemia and thrombocytopenia. Using Cox regression multivariable models, an ANC below 1.1x103/uL in blacks was found to be associated with increased mortality (HR 1.86; 95{\%}CI 1.21 - 2.87; p<0.01). We found no association between neutropenia and mortality at any ANC cutoff in elderly Hispanics. In conclusion, neutropenia was found to be an independent prognostic variable in the elderly, when determined in race-specific manner. Most importantly, a cutoff of 1.1x103 neutrophils/uL may be a more prognostically relevant marker in elderly blacks and could serve as a novel threshold for further evaluation and intervention in this population.",
keywords = "African American, ethnicity, neutropenia, race, survival",
author = "Ioannis Mantzaris and Yiting Yu and Pavlos Msaouel and Lam, {Anthony P.} and Murali Janakiram and Friedman, {Ellen W.} and Steidl, {Ulrich G.} and Verma, {Amit K.}",
year = "2016",
month = "10",
day = "18",
doi = "10.18632/oncotarget.8996",
language = "English (US)",
volume = "7",
pages = "67948--67955",
journal = "Oncotarget",
issn = "1949-2553",
publisher = "Impact Journals",
number = "42",

}

TY - JOUR

T1 - Analysis of overall survival in a large multiethnic cohort reveals absolute neutrophil count of 1,100 as a novel prognostic cutoff in African Americans

AU - Mantzaris, Ioannis

AU - Yu, Yiting

AU - Msaouel, Pavlos

AU - Lam, Anthony P.

AU - Janakiram, Murali

AU - Friedman, Ellen W.

AU - Steidl, Ulrich G.

AU - Verma, Amit K.

PY - 2016/10/18

Y1 - 2016/10/18

N2 - Although absolute neutrophil counts (ANC) below 1.5x103/uL are used to define neutropenia as a marker of increased susceptibility to infections, their relationship with survival has not been examined. Since low counts trigger extensive investigations, determining prognostic cutoffs especially for different ethnicities and races is critical.A multiethnic cohort of 27,760 subjects, 65 years old and above, was utilized to evaluate the association of neutropenia with overall survival in different ethnicities and races.The mean ANC was 4.6±1.51x103/uL in non-Hispanic whites, 3.6±1.57x103/uL in non-Hispanic blacks and 4.3±1.54x103/uL in Hispanics (p<0.001). An ANC below 1.5x103/uL was associated with significantly shorter overall survival among whites (HR 1.74; 95% CI 1.18 - 2.58; p<0.001), but not in blacks (HR 0.89; 95% CI 0.86 - 1.17; p=0.40) or Hispanics (HR 1.04; 95% CI 0.76 - 1.46; p=0.82), after adjustment for age, sex, comorbidities, anemia and thrombocytopenia. Using Cox regression multivariable models, an ANC below 1.1x103/uL in blacks was found to be associated with increased mortality (HR 1.86; 95%CI 1.21 - 2.87; p<0.01). We found no association between neutropenia and mortality at any ANC cutoff in elderly Hispanics. In conclusion, neutropenia was found to be an independent prognostic variable in the elderly, when determined in race-specific manner. Most importantly, a cutoff of 1.1x103 neutrophils/uL may be a more prognostically relevant marker in elderly blacks and could serve as a novel threshold for further evaluation and intervention in this population.

AB - Although absolute neutrophil counts (ANC) below 1.5x103/uL are used to define neutropenia as a marker of increased susceptibility to infections, their relationship with survival has not been examined. Since low counts trigger extensive investigations, determining prognostic cutoffs especially for different ethnicities and races is critical.A multiethnic cohort of 27,760 subjects, 65 years old and above, was utilized to evaluate the association of neutropenia with overall survival in different ethnicities and races.The mean ANC was 4.6±1.51x103/uL in non-Hispanic whites, 3.6±1.57x103/uL in non-Hispanic blacks and 4.3±1.54x103/uL in Hispanics (p<0.001). An ANC below 1.5x103/uL was associated with significantly shorter overall survival among whites (HR 1.74; 95% CI 1.18 - 2.58; p<0.001), but not in blacks (HR 0.89; 95% CI 0.86 - 1.17; p=0.40) or Hispanics (HR 1.04; 95% CI 0.76 - 1.46; p=0.82), after adjustment for age, sex, comorbidities, anemia and thrombocytopenia. Using Cox regression multivariable models, an ANC below 1.1x103/uL in blacks was found to be associated with increased mortality (HR 1.86; 95%CI 1.21 - 2.87; p<0.01). We found no association between neutropenia and mortality at any ANC cutoff in elderly Hispanics. In conclusion, neutropenia was found to be an independent prognostic variable in the elderly, when determined in race-specific manner. Most importantly, a cutoff of 1.1x103 neutrophils/uL may be a more prognostically relevant marker in elderly blacks and could serve as a novel threshold for further evaluation and intervention in this population.

KW - African American

KW - ethnicity

KW - neutropenia

KW - race

KW - survival

UR - http://www.scopus.com/inward/record.url?scp=85041845135&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041845135&partnerID=8YFLogxK

U2 - 10.18632/oncotarget.8996

DO - 10.18632/oncotarget.8996

M3 - Article

C2 - 27144332

AN - SCOPUS:85041845135

VL - 7

SP - 67948

EP - 67955

JO - Oncotarget

JF - Oncotarget

SN - 1949-2553

IS - 42

ER -