Admission C-reactive Protein Levels Research Articles

Characteristics of Acute Pelvic Inflammatory Disease in Surgically Treated Females Over Ten Years - A Single-Center Study

Background: Pelvic inflammatory disease (PID) is a public health problem that demands rapid diagnosis and treatment and may severely impair female reproductive health. Objective: To analyze anamnestic information, laboratory findings, and clinical and microbiological features of patients with severe acute PID that underwent a surgical procedure. Methods: This retrospective study enrolled 97 cases that were surgically treated in the Department of Obstetrics and Gynecology, University Hospital „ Sveti Duh“ between 2009 and 2019. Results: Most women were within the age group 35-44 (38.14%). Lower abdominal pain was the most common symptom (92.78%). Compared to intraoperatively confirmed PID, C-reactive protein (CRP) yielded the highest sensitivity (88.10%) while cervical motion tenderness possessed the highest specificity (53.85%). The tubo-ovarian abscess was detected in 35.05% of intraoperative specimens, mainly occurring in women between 45-54 years (P=0.017) and absent between 15-24 (P=0.012) and 25-34 years (P=0.049). The length of hospital stay was influenced by the number of symptoms (ρ=0.316, P=0.002), admission CRP levels (ρ=0.620, P<0.001), and admission body temperature (ρ=0.386, P<0.001). Out of 59.30% of positive cultures, one pathogen was isolated in 70.59%, mainly Escherichia coli (41.18%). Admission CRP levels impacted the efficacy of microbiologic isolation (P=0.001). The empirical treatment was mostly based on the clindamycin/gentamicin combination (51.72%). Conclusion: Severe clinical picture that requires surgical treatment can be expected in women >35 years. Longer hospital stay was associated with more symptoms, higher CRP, and temperature values on admission. It is important to have a low threshold for diagnosis and to consider both aerobic and anaerobic pathogens when selecting antibiotic treatment.

Post-discharge outcomes of hospitalized children diagnosed with acute SARS-CoV-2 or MIS-C.

Hospitalized children diagnosed with SARS-CoV-2-related conditions are at risk for new or persistent symptoms and functional impairments. Our objective was to analyze post-hospital symptoms, healthcare utilization, and outcomes of children previously hospitalized and diagnosed with acute SARS-CoV-2 infection or Multisystem Inflammatory Syndrome in Children (MIS-C). Prospective, multicenter electronic survey of parents of children <18 years of age surviving hospitalization from 12 U.S. centers between January 2020 and July 2021. The primary outcome was a parent report of child recovery status at the time of the survey (recovered vs. not recovered). Secondary outcomes included new or persistent symptoms, readmissions, and health-related quality of life. Multivariable backward stepwise logistic regression was performed for the association of patient, disease, laboratory, and treatment variables with recovered status. The children [n = 79; 30 (38.0%) female] with acute SARS-CoV-2 (75.7%) or MIS-C (24.3%) had a median age of 6.5 years (interquartile range 2.0-13.0) and 51 (64.6%) had a preexisting condition. Fifty children (63.3%) required critical care. One-third [23/79 (29.1%)] were not recovered at follow-up [43 (31, 54) months post-discharge]. Admission C-reactive protein levels were higher in children not recovered vs. recovered [5.7 (1.3, 25.1) vs. 1.3 (0.4, 6.3) mg/dl, p = 0.02]. At follow-up, 67% overall had new or persistent symptoms. The most common symptoms were fatigue (37%), weakness (25%), and headache (24%), all with frequencies higher in children not recovered. Forty percent had at least one return emergency visit and 24% had a hospital readmission. Recovered status was associated with better total HRQOL [87 (77, 95) vs. 77 (51, 83), p = 0.01]. In multivariable analysis, lower admission C-reactive protein [odds ratio 0.90 (95% confidence interval 0.82, 0.99)] and higher admission lymphocyte count [1.001 (1.0002, 1.002)] were associated with recovered status. Children considered recovered by their parents following hospitalization with SARS-CoV-2-related conditions had less symptom frequency and better HRQOL than those reported as not recovered. Increased inflammation and lower lymphocyte count on hospital admission may help to identify children needing longitudinal, multidisciplinary care. ClinicalTrials.gov (NCT04379089).

Diabetes Status, c-Reactive Protein, and Insulin Resistance in Community-Acquired Pneumonia-A Prospective Cohort Study.

C-reactive protein (CRP) is commonly used to guide community-acquired pneumonia (CAP) treatment. A positive association between admission glucose and CRP levels has been observed in patients with CAP. The associations between prediabetes, unknown diabetes, acute-on-chronic hyperglycaemia, and CRP levels, and between admission CRP levels and insulin resistance (IR) in CAP, remain unexplored. This study investigated the associations firstly between chronic, acute, and acute-on-chronic hyperglycaemia and CRP levels, and secondly between admission CRP levels and IR in CAP. In a prospective cohort study of adults with CAP, the associations between chronic, acute, and acute-on-chronic hyperglycaemia (admission glucose minus HbA1c-derived average glucose) and CRP levels until admission day 3 were modelled with repeated-measures linear mixed models. IR was estimated with the homeostasis model assessment of IR (HOMA-IR). The association between admission CRP levels and HOMA-IR was modelled with linear regression. In 540 patients, no association between chronic, acute, or acute-on-chronic hyperglycaemia and CRP levels was found. In 266 patients, every 50 mg/L increase in admission CRP was associated with a 7% (95% CI 1-14%) higher HOMA-IR. In conclusion, our findings imply that hyperglycaemia does not influence CRP levels in patients with CAP, although admission CRP levels were positively associated with IR.

Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stages IIIb-V chronic kidney disease?

Studies have shown elevated C-reactive protein (CRP) to predict mechanical ventilation (MV) in patients with coronavirus disease 2019 (COVID-19). Its utility is unknown in patients with chronic kidney disease (CKD), who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance. To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stages IIIb-V CKD and COVID-19. We conducted a retrospective cohort study on patients with COVID-19 and stages IIIb-V CKD. The primary outcome was the rate of invasive MV, the rate of noninvasive MV, and the rate of no MV. Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables. Cutoffs for variables were CRP: 100 mg/L, ferritin: 530 ng/mL, D-dimer: 0.5 mg/L, and lactate dehydrogenase (LDH): 590 U/L. 290 were screened, and 118 met the inclusion criteria. CRP, D-dimer, and ferritin were significantly different among the three groups. On univariate analysis for invasive MV (IMV), CRP had an odds ratio (OR)-5.44; ferritin, OR-2.8; LDH, OR-7.7; D-dimer, OR-3.9, (P < 0.05). The admission CRP level had an area under curve-receiver operator characteristic (AUROC): 0.747 for the IMV group (sensitivity-80.8%, specificity-50%) and 0.663 for the non-IMV (NIMV) group (area under the curve, sensitivity-69.2%, specificity-53%). Our results demonstrate a positive correlation between CRP, ferritin, and D-dimer levels and MV and NIMV rates in CKD patients. The AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stages IIIb-V CKD. This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.

Differentiating between bacterial and viral infections by estimated CRP velocity.

Differentiating between acute viral and bacterial infection is challenging due to the similarity in symptom presentation. Blood tests can assist in the diagnosis, but they reflect the immediate status and fail to consider the dynamics of an inflammatory response with time since symptom onset. We applied estimated C-reactive protein (CRP) velocity (eCRPv), as derived from the admission CRP level divided by time from symptom onset, in order to better distinguish between viral and bacterial infections. This cross-sectional study included patients admitted to the emergency department with a confirmed viral (n = 83) or bacterial (n = 181) infection. eCRPv was defined as the ratio between the absolute CRP level upon admission to time from symptom onset (in hours). Absolute CRP and eCRPv values were compared between the 3 groups. Bacterial patients presented with higher CRP levels (133 mg/L) upon admission compared to viral patients (23.31 mg/L) (P < 0.001). Their median value of eCRPv velocity was 4 times higher compared to the viral patients (1.1 mg/L/h compared 0.25 mg/L/h, P < 0.001). Moreover, in intermediate values of CRP (100-150 mg/L) upon admission, in which the differential diagnosis is controversial, high eCRPv is indicative of bacterial infection, eCRPv >4 mg/L/h represents only bacterial patients. During an acute febrile illness, the eCRPv value can be used for rapid differentiation between bacterial and viral infection, especially in patients with high CRP values. This capability can potentially expedite the provision of appropriate therapeutic management. Further research and validation may open new applications of the kinetics of inflammation for rapid diagnosis of an infectious vs. a viral source of fever.

245. Can Inflammatory Markers be used as an Early predictor for Mechanical ventilation in COVID-19 patients with Stages IIIb-V Chronic Kidney Disease?

Abstract Background The clinical use of inflammatory markers soared during the COVID-19 pandemic. Though studies have shown C-reactive protein (CRP) to predict mechanical ventilation (MV) in patients with COVID-19, its utility is unknown in patients with chronic kidney disease (CKD), who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance of inflammatory cytokines. Our aim was to assess the association of inflammatory markers like CRP, ferritin, LDH, D dimer, and MV rate in patients with stages IIIb-V CKD and COVID-19. Methods We conducted a cross-sectional study on inpatients in a community hospital from 12/1/19 to 1/1/22 with COVID-19 and stages IIIb-V CKD without a previous renal transplant. Primary endpoints were invasive MV (IMV) rates, noninvasive MV (NIMV) rates, and no MV. Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables. Cutoffs for variables were CRP 100 mg/L, ferritin 530ng/ml, D-dimer 0.5mg/L and LDH 590 U/L. Univariate analysis and Area under curve (AUC-ROC) between the covariates and outcomes were computed. Results 290 patients were screened, and 118 patients met inclusion criteria. CRP, D dimer, and ferritin were significantly different among the three groups. On univariate analysis for IMV, CRP had an OR 5.44; ferritin, OR 2.8; LDH, OR 7.7; D-dimer, OR 3.9, WBC count, OR 4.2 (p&amp;lt; 0.05). Admission CRP level was 0.747 for the IMV group (AUC-ROC, sensitivity 80.8%, specificity 50%) and 0.663 for the NIMV group (AUC-ROC, sensitivity 69.2%, specificity 53%) Conclusion Our results illustrate a positive correlation between CRP, ferritin, and D-dimer levels and MV and NIMV rates. The ROC demonstrates a good sensitivity for CRP levels in detecting MV thereby emphasizing the utility of these biomarkers as good predictive markers in COVID-19 patients with CKD. With increasing use of inflammatory markers to prognosticate disease severity in COVID, the applicability of these markers in different populations should be investigated. A similar pattern of elevated inflammatory markers predicting the rate of MV was found in patients with stages IIIb-V CKD. This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation due to CKD alone. Disclosures All Authors: No reported disclosures.

C-reactive protein as a non-linear predictor of prolonged length of intensive care unit stay after gastrointestinal cancer surgery.

The relationship between C-reactive protein (CRP) levels and prolonged intensive care unit (ICU) length of stay (LoS) has not been well defined. To explore the association between CRP levels at ICU admission and prolonged ICU LoS in gastrointestinal cancer (GC) patients after major surgery. A retrospective study was performed to quantify serum CRP levels and to establish their association with prolonged ICU LoS (≥ 72 h) in GC patients admitted to the ICU. Univariate and multivariate regression analyses were conducted, and restricted cubic spline curves with four knots (5%, 35%, 65%, 95%) were used to explore non-linearity assumptions. A total of 408 patients were enrolled. Among them, 83 (20.3%) patients had an ICU LoS longer than 72 h. CRP levels were independently associated with the risk of prolonged ICU LoS [odds ratio (OR) 1.47, 95% confidence interval (CI) 1.00-2.17]. Restricted cubic spline analysis revealed a non-linear relationship between CRP levels and OR for the prolonged ICU LoS (P = 0.035 for non-linearity). After the cut-off of 2.6 (log transformed mg/L), the OR for prolonged ICU LoS significantly increased with CRP levels. The adjusted regression coefficient was 0.70 (95%CI 0.31-1.57, P = 0.384) for CRP levels less than 2.6, whereas it was 2.43 (95%CI 1.39-4.24, P = 0.002) for CRP levels higher than 2.6. Among the GC patients, CRP levels at ICU admission were non-linearly associated with prolonged ICU LoS in survivors. An admission CRP level > 2.6 (log transformed mg/L) was associated with increased risk of prolonged ICU LoS.

Relationship between a Self-Reported History of Depression and Persistent Elevation in C-Reactive Protein after Myocardial Infarction.

Background: Elevated levels of C-reactive protein (CRP) are associated with both an increased risk of cardiovascular disease (CVD) and depression. We aimed to test the hypothesis that a self-report history of depression is associated with a smaller decrease in CRP levels from hospital admission to 3-month follow-up in patients with acute myocardial infarction (MI). Methods: We assessed 183 patients (median age 59 years; 84% men) with verified MI for a self-report history of lifetime depression and plasma CRP levels within 48 h of an acute coronary intervention and again for CRP levels at three months. CRP values were categorized according to their potential to predict CVD risk at hospital admission (acute inflammatory response: 0 to <5 mg/L, 5 to <10 mg/L, 10 to <20 mg/L, and ≥20 mg/L) and at 3 months (low-grade inflammation: 0 to <1 mg/L, 1 to <3 mg/L, and ≥3 mg/L). Additionally, in a subsample of 84 patients showing admission CRP levels below 20 mg/L, changes in continuous CRP values over time were also analyzed. Results: After adjustment for a range of potentially important covariates, depression history showed a significant association with a smaller decrease in both CRP risk categories (r = 0.261, p < 0.001) and log CRP levels (r = 0.340, p = 0.005) over time. Conclusions: Self-reported history of depression may be associated with persistently elevated systemic inflammation three months after MI. This finding warrants studies to test whether lowering of inflammation in patients with an acute MI and a history of depression may improve prognosis.

POS-905 PROSPECTIVE STUDY ON COVID-19 INFECTION IN KIDNEY TRANSPLANT RECIPIENTS IN SABAH: A PRELIMINARY RESULT

In December 2019, a new strain of coronavirus, later named as COVID-19, was identified in Wuhan, Hubei Province, China and has since become a worldwide pandemic. There is paucity of literature on the clinical progression and outcome of kidney transplant recipients diagnosed with COVID-19. We aim to determine the clinical features, management and outcomes of COVID-19 in kidney transplant recipients This is a prospective cohort study from 1 December 2020 - 31 December 2021. All kidney transplant recipients age more than 18 years old diagnosed with COVID-19 infection, by reverse transcriptase polymerase chain reaction or rapid test kit for COVID-19 antigen, will be admitted and followed up throughout admission with clinical, laboratory data and outcomes recorded. There were a total of 7 cases of COVID-19 infection in kidney transplant recipients up until 15 September 2021. Six were males and 1 female with mean age of 52.1 years old (SD 13.2) and admission median creatinine of 124 υmol/L (IQR 46). Two patients had new-onset-diabetes mellitus after transplant (28.6%) while 4 (57.1%) had hypertension. Majority (n=6, 86%) had oral prednisolone, mycophenolate mofetil and tacrolimus as baseline immunosuppressants. Only 2 patients (28.6%) were not vaccinated while the rest were fully vaccinated with BNT162b2 where the mean days to COVID-19 infection following vaccination was 85 days. Majority (n=6, 85%) presented with respiratory symptoms such as fever, cough and/or myalgia. On presentation, 3 patients (42.9%) were diagnosed with severe illness requiring oxygen support, 2 patients (28.6%) had moderate illness, 1 (14.3%) was of mild illness and 1 was asymptomatic. Four patients (57%) developed acute kidney injury where 1 patient required hemodialysis. Three patients (42.9%) required intensive care management. Throughout the hospitalisation, 1 patient deteriorated and was ventilated while 2 required high flow nasal cannula, and another 2 required face mask oxygen support. Only 2 patients required no oxygen support throughout admission. Antimetabolite immunosuppressant was withheld for all 7 patients and patients requiring oxygen therapy (n=5) received intravenous methylprednisolone ranging from 3-7 days. Two patients received intravenous tocilizumab while 1 received oral baricitinib for additional treatment of critical COVID-19 infection. Higher admission c-reactive protein level predicts more severe COVID-19 infection (p=0.019), while age, creatinine, albumin, ferritin and vaccination status were not statistically significant in predicting severity of COVID-19. As of now, 5 patients were discharged well, 1 died due to COVID-19 complications, and 1 patient is still under intensive care giving the mortality rate of 14.3% in Sabah. This case series showed that despite being fully vaccinated, 4 out of 5 patients still suffered from severe and critically ill COVID-19 infection with 1 death making the mortality rate of 20% amongst the vaccinated group. This may be due to suboptimal antibody response in kidney transplant recipients following vaccination. Safety measures with good hand hygiene, social distancing and face mask are still critical to prevent disease transmission for kidney transplant recipient. Our report revealed that kidney transplant recipient is at risks of severe COVID-19 infection with high mortality despite being vaccinated.

The impact of routine pulse oximetry use on outcomes in COVID-19-infected patients at increased risk of severe disease: A retrospective cohort analysis.

The phenomenon of silent hypoxaemia has been described in patients with COVID-19 pneumonia, which is characterised by low oxygen saturation levels of &lt;90% in those who appear clinically well and do not show signs of significant respiratory distress. To assess the impact on clinical outcomes for high-risk COVID-19 patients using a pulse oximeter to monitor oxygen saturation levels in a home setting. We performed a retrospective cohort analysis using data from a large South African insurance administrator. Patients were categorised as high risk, based on age and specific underlying clinical conditions, or from predictive models derived from medical scheme administrative claims data. The impact of pulse oximetry home monitoring on COVID-19 clinical outcomes was investigated by the use of Cox proportional hazard models. Between 2 March 2020 and 31 October 2020, of 38 660 patients analysed, 8 115 were in the intervention group. The 60-day mortality rate for the evaluated high-risk population was 1.35%. After adjusting for age and comorbidity differences, the intervention group was found to have an adjusted hazard ratio of 0.52 (p&lt;0.0001). No statistical significance was found between the intervened and control groups for admission to hospital, admission to intensive care unit (ICU) and use of mechanical ventilation. The intervention group had a lower median C-reactive protein (CRP) level on admission (p=0.03). After adjustment for admission CRP levels, elevated CRP was associated with an increased mortality (p&lt;0.0001), while the statistical significance in mortality between the intervention and the control group was lost. High-risk COVID-19 patients who used a pulse oximeter to monitor oxygen saturation levels had significantly lower mortality rates compared with other high-risk patients. The mortality benefit may be explained by earlier presentation to hospital, as suggested by lower initial CRP levels.

Clinical and prognostic implications of C-reactive protein levels in myocardial infarction with nonobstructive coronary arteries.

BackgroundMyocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous condition. Recent studies suggest that MINOCA patients may have a proinflammatory disposition. The role of inflammation in MINOCA may thus be distinct to myocardial infarction with significant coronary artery disease (MI‐CAD).HypothesisWe hypothesized that inflammation reflected by C‐reactive protein (CRP) levels might carry unique clinical information in MINOCA.MethodsThis retrospective registry‐based cohort study (SWEDEHEART) included 9916 patients with MINOCA and 97 970 MI‐CAD patients, used for comparisons. Multivariable‐adjusted regressions were applied to investigate the associations of CRP levels with clinical variables, all‐cause mortality and major cardiovascular events (MACE) during a median follow‐up of up to 5.3 years.ResultsMedian admission CRP levels in patients with MINOCA and MI‐CAD were 5.0 (interquartile range 2.0–9.0) mg/dl and 5.0 (interquartile range 2.1–10.0 mg/dl), respectively. CRP levels in MINOCA exhibited independent associations with various cardiovascular risk factors, comorbidities and estimates of myocardial damage. The association of CRP with peripheral artery disease tended to be stronger compared to MI‐CAD. The associations with female sex, renal dysfunction and myocardial damage were stronger in MI‐CAD. CRP independently predicted all‐cause mortality in MINOCA (hazard ratio 1.22 [95% confidence interval 1.17–1.26]), similar to MI‐CAD (p interaction = 0.904). CRP also predicted MACE (hazard ratio 1.08 [95% confidence interval 1.04–1.12]) but this association was weaker compared to MI‐CAD (p interaction<.001).ConclusionsWe found no evidence indicating the presence of a specific inflammatory pattern in acute MINOCA compared to MI‐CAD. However, CRP levels were independently, albeit moderately associated with adverse outcome.

Gender differences in acute stone admissions - should we have a lower threshold for treatment in female patients?

To examine the gender-related differences in the presentation, management and outcomes of patients admitted with acute renal colic at our institution. A retrospective analysis of 231 consecutive patients requiring inpatient admission for acute renal colic between October 2015 and March 2018. For each admission, data on demographics, admission blood results, stone characteristics, management and outcomes were collected. Differences between genders were compared using the chi-squared and Student's t-test. Gender distribution was 35% female: 65% male. There was no significant difference in age, American Society of Anesthesiologists Physical Status Classification grade or history of diabetes. Women had a higher admission C-reactive protein level (89.3 vs 32.9mg/L, P < 0.001) and neutrophil count (10.0 vs 8.8×109 /L, P = 0.04) than men. They also had more positive cultures (34.1% vs 6.0%, P < 0.001) and were more likely to require percutaneous nephrostomy insertion (9.8% vs 0.7%, P = 0.005). Women had more intensive therapy unit (ITU) admissions (12.2% vs 0.6%, P < 0.001) and longer lengths of stay (4.4 vs 1.8days, P < 0.001) than men. There was no mortality in our series. In the present study, women admitted with acute renal colic were more likely to have an associated infection than men and require rapid decompression. Although there was no difference in mortality, women experienced greater morbidity as evidenced by the higher rate of ITU admissions and longer length of stay. These differences are important to consider when assessing the suitability of conservative management for female patients.

Clinical usefulness of early serial measurements of C-reactive protein as outcome predictors in patients with subarachnoid hemorrhage

BackgroundThe purpose of this study was to evaluate the role of C-reactive protein (CRP) in predicting neurological outcomes of patients with subarachnoid hemorrhage (SAH).MethodsIn this retrospective, observational study of adult patients with SAH treated between January 2012 and June 2017. Initial CRP levels collected within 24 h from the onset of SAH, the follow-up CRP levels were measured. The primary outcome was neurological status at six-month follow-up assessed with the Glasgow Outcome Scale (GOS, 1 to 5).ResultsAmong 156 patients with SAH, 145 (92.9%) survived until discharge. Of these survivors, 109 (69.9%) manifested favorable neurological outcomes (GOS of 4 or 5). Initial CRP levels on admission and maximal CRP levels within four days were significantly higher in the group with poor neurological outcome compared with those manifesting favorable neurological outcomes (P = 0.022, P < 0.001, respectively). However, the clearance of CRPs did not differ significantly between the two groups (P = 0.785). Analysis of the receiver operating characteristic curve for prediction of poor neurological outcome showed that the performance of the maximal CRP was significantly better compared with the initial CRP or the clearance of CRP (P = 0.007, P < 0.001, respectively). In this study, the effect of CRP on neurological outcomes differed according to surgical clipping. The maximal CRP levels within four days facilitate the prediction of neurological outcomes of SAH patients without surgical clipping (C-statistic: 0.856, 95% confidence interval [CI]: 0.767–0.921). However, they were poorly associated with neurological prognoses in SAH patients who underwent surgical clipping (C-statistic: 0.562, 95% CI: 0.399–0.716). Multivariable logistic regression analysis revealed that age (adjusted odds ratio [OR]: 1.10, 95% CI: 1.052–1.158), initial Glasgow Coma Scale (adjusted OR: 0.74, 95% CI: 0.647–0.837), and maximal CRP without surgical clipping (adjusted OR: 1.27, 95% CI: 1.066–1.516) were significantly associated with poor neurological outcomes in SAH patients.ConclusionsEarly serial measurements of CRP may be used to predict neurological outcomes of SAH patients. Furthermore, maximal CRP levels within four days post-SAH are significantly correlated with poor neurological outcomes.

5947Predictive role of C-reactive protein levels in patients with ST-segment elevation acute myocardial infarction for heart failure related events

Abstract Background ST-segment elevation myocardial infarction (STEMI) is associated with an intense acute inflammatory response and an increased risk of death and heart failure (HF). C-reactive protein (CRP) is the inflammatory biomarker most commonly used for risk stratification in patients with cardiovascular diseases. CRP levels are known to rise and fall during STEMI in response to myocardial injury. In this study, we analyzed whether admission CRP or delayed CRP (measured at 72 hours after admission) held a greater predictive value for adverse HF events in patients with STEMI. Methods We analyzed data from the VCUART3 clinical trial enrolling 99 patients with STEMI within 12 hours of presentation at 3 sites in the United States of America treated with anakinra or placebo. CRP levels were measured with a high-sensitivity assay at time of admission and again at 72 hours later. A dedicated committee composed of individuals not involved in the conduct of the trial adjudicated HF events including a composite endpoint of death from any reason or incidence of HF defined as new-onset HF requiring hospital admission or a new prescription for a loop diuretic (D+HF) and a composite endpoint of death and HF hospitalization (D+HHF) at 1 year. We used a time-dependent Cox-regression analysis to determine the association of CRP at admission or at 72 hours with the outcomes of interest in univariate and multivariate analysis. Data are presented as median and interquartile range. (ClinicalTrials NCT01950299) Results CRP levels from admission and 72 hours were available in 90 and 87 subjects respectively and they increased from 4.6 [2.8–8.5] mg/L to 11.6 [4.6–24.5] mg/L (P&lt;0.001). Both admission CRP (CRP0) and CRP at 72 hours (CRP72) were associated with the risk of D+HF (P=0.011 and &lt;0.001, respectively) and of D+HHF (P=0.010 and P&lt;0.001, respectively); however at multivariate analysis, only CRP72 remained significantly associated with the risk of D+HF (P=0.001) and D+HHF (P=0.004) while CRP0 was not. CRP72 significantly correlated with NTproBNP levels at 72 hours (NTproBNP72, Spearman rho R=+0.37, P=0.001). NTproBNP72 predicted D+HF (P=0.030) but not independently of CRP72 (P=0.096 for NTproBNP72 and P=0.007 for CRP72 at multivariate analysis including the 2 variables). NTproBNP72 did not predict D-HHF. Conclusions Among contemporary patients with STEMI, the levels of CRP at 72 hours after admission was superior to admission CRP levels for predicting the incidence of HF events, and independent of NTproBNP levels. Our results indicate the importance of the inflammatory response during STEMI, supporting the concept of inhibiting the inflammatory response as a therapeutic strategy. Acknowledgement/Funding Funded by NHLBI 1R34HL121402; Drug supply from Swedish Orphan Biovitrum

Prognostic Role of Admission C-Reactive Protein Level as a Predictor of In-Hospital Mortality in Type-A Acute Aortic Dissection: A Meta-Analysis.

Acute aortic dissection (AD) is a lethal vascular disease, accounting for over 90% cases of acute aortic syndrome. Despite advances in understanding associated risk factors, the long-term prognosis for AD patients is still poor. Several prognostic biomarkers have been used for AD as per the IRAD, such as older age (>70 years), onset of chest pain and hypotension, but they are not effective in all patients. Instead, C-reactive protein (CRP) is a consistent inflammatory marker. CRP levels are abnormally increased in AD. However, the prognostic value of serum CRP level in AD remains unclear. To perform a systematic review and meta-analysis (registration no CRD42017056205) to evaluate whether CRP is a biomarker associated with in-hospital mortality in type-A AD. PubMed, Web of Science, CNKI, SciELO, and EMBASE were searched for papers published from January 2000 to October 2017 for studies on the prognostic role of CRP at admission in type-A AD patients. Outcome data were extracted and pooled hazard ratios (HRs) were calculated. 18 (N = 2875 patients) studies met the inclusion criteria. Elevated CRP level was associated with a significantly increased risk of in-hospital mortality in patients with type-A AD (HR = 1.15, 95% CI: 1.06-1.25, p = 0.001). The pooled sensitivity of CRP in type-A AD patients was 77% (95% CI 69%-84%, p < 0.001), and the specificity was 72% (95% CI 66%-78%, p < 0.001). Elevated CRP level is significantly associated with increased risks of in-hospital mortality in patients with type-A AD. CRP is a convenient prognostic factor in type-A AD patients.

Association between C-reactive protein levels at hospital admission and long-term mortality in patients with acute decompensated heart failure

The C-reactive protein (CRP) levels obtained at hospital admission are associated with the prognosis of several cardiovascular diseases, including acute coronary syndrome. Although the admission CRP level is associated with in-hospital mortality in patients with acute decompensated heart failure (ADHF), there are limited data on the association between the admission CRP level and long-term mortality in patients with ADHF. This study included consecutive ADHF patients admitted to our institution from 2007 to 2011. Eligible patients were divided into four groups based on quartiles of admission CRP levels. The association between the admission CRP level and long-term mortality was assessed by multivariable Cox proportional analysis, including other independent variables with p values < 0.1 in the univariable analyses. Overall, 527 eligible patients were examined. There were 142 deaths (27%) during a median follow-up period of 2.0years. In the multivariable analysis, the hazard ratio (HR) significantly increased with admission CRP levels in a dose-dependent manner for mortality (p for trend = 0.034). Multivariable analysis also showed a significant association between the admission CRP level, when treated as a natural logarithm-transformed continuous variable, and increased mortality (HR 1.16, p = 0.030). In patients with ADHF, the admission CRP level was associated with an increased risk of long-term mortality.

Can common serum biomarkers predict complicated appendicitis in children?

As appendicitis in children can be managed differently according to the severity of the disease, we investigated whether commonly used serum biomarkers on admission could distinguish between simple and complicated appendicitis. Admission white blood cell (WBC), neutrophil (NEU), and C-reactive protein (CRP) levels were analysed by ROC curve, and Kruskal-Wallis and contingency tests. Patients were divided according to age and histology [normal appendix (NA), simple appendicitis (SA), complicated appendicitis (CA)]. Of 1197 children (NA=186, SA=685, CA=326), 7% were <5years, 55% 5-12, 38% 13-17. CA patients had higher CRP and WBC levels than NA and SA (p<0.0001). NEU levels were lower in NA compared to SA or CA (p<0.0001), but were similar between SA and CA (p=0.6). CA patients had higher CRP and WBC levels than SA patients in 5-12- (p<0.0001) and 13-17-year groups (p=0.0075, p=0.005), but not in <5-year group (p=0.72, p=0.81). We found CRP >40mg/L in 58% CA and 37% SA (p<0.0001), and WBC >15×109/L in 58% CA and 43% SA (p<0.0001). Admission CRP and WBC levels may help the clinician predict complicated appendicitis in children older than 5years of age. Early distinction of appendicitis severity using these tests may guide caregivers in the preoperative decision-making process.

O10-3 - Relationship between Admission C-Reactive Protein Level and Long-Term Mortality in Patients with Acute Decompensated Heart Failure

O10-3 - Relationship between Admission C-Reactive Protein Level and Long-Term Mortality in Patients with Acute Decompensated Heart Failure

Factors determining clinical outcomes in intussusception in the developing world: Experience from Johannesburg, South Africa.

Rates of open reduction of intussusception were noted to be unacceptably high during an institutional internal audit. To determine the impact of revised protocols to better select patients for pneumatic reduction (PR), and document associated morbidity and mortality, and the factors that affect the above. Medical records of patients between 3 months and 3 years of age presenting to the Department of Paediatric Surgery at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, from 2007 to 2010 were reviewed. Determining factors, including duration of symptoms, admission C-reactive protein (CRP) level and weight, were analysed against clinical outcomes, notably PR, bowel resection, relook laparotomy and death. A total of 97 cases were suitable for inclusion. In 62 of these (63.9%), PR was attempted; this was successful in 32 cases (51.6%), giving an overall successful PR rate of 33.0%. In 7 of the 62 patients, a pneumoperitoneum was documented during the reduction attempt. Of the 65 patients who underwent surgery, 53 required intestinal resection and 12 had spontaneous or manual reduction. Ileostomy was necessary in 9 patients, and 7 required relook laparotomy. The overall mortality rate was 9.1%. Averages of 'determining factors' assessed against clinical outcome were as follows: mean weight (standard deviation (SD)) 7.4 (4.3) kg, mean duration of symptoms (DOS) 3.0 (SD 2.2) days, and admission CRP level 50.9 mg/L (range 1 - 249.3). Prolonged DOS and a raised CRP level predicted a poor outcome. Despite marked improvements in management and PR outcomes, intussusception remains associated with significant morbidity and mortality. Prolonged DOS and an elevated CRP predict worse outcomes. The use of these markers in association with clinical factors may assist management decisions, specifically with regard to operative or non-operative management. Awareness and education are key to prompt presentation and early diagnosis. Well-defined protocols introduced at all points of contact ensure early recognition and resuscitation as well as prompt referral for definitive management.

Admission CRP Level as an Indicator for the Need of Percutaneous Cholecystostomy in Acute Cholecystitis

Background: Percutaneous cholecystostomy (PC) and conservative treatment are alternatives to surgery in patients with moderate acute calculous cholecystitis. Failure or non-improvement after conservative treatment is an indication for PC. Aim: To investigate whether C-reactive protein (CRP) level on admission is associated with percutaneous cholecystostomy (PC) in patients with acute cholecystitis. Methods: A database of patients admitted due to acute calculous cholecystitis and treated conservatively was assembled. Diagnosis was established clinical presentation and appropriate findings in imaging studies. Patients who underwent PC at admission due to organ failure or patients operated on index admission were excluded. Overall, 161 patients were identified, of whom 106 were treated conservatively and 55 were treated with PC. Data regarding the clinical presentation, comorbidities, physical examination and various laboratory parameters were retrieved from medical files. Results: Patients who underwent PC were older and with higher American Society of Anesthesiologists score. The mean CRP level was higher for patients treated by PC than those treated conservatively (112.8 ± 10.6 mg/ml and 45 ± 5.3 mg/ml, respectively, p < 0.001). Mean WBC count did not differ between these two groups of patients (13.8 ± 1 K/mm3 and 12.2 ± 0.5 K/mm3, respectively, p = 0.15). Patients who underwent PC had higher frequency of acute (31% vs. 5.7%) and chronic renal failure (20% vs. 4.7%, for PC and conservative treatment, respectively). Conclusion: Increased CRP level and renal failure are associated with the need for PC. These markers prompt early PC.