Average C-reactive Protein Research Articles

EARLY MANIFESTATIONS OF HEART FAILURE AND ACTIVITY OF SYSTEMIC INFLAMMATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION DEPENDING ON RISK FACTORS

Acute myocardial infarction and heart failure (HF) resulting from this condition remain complex and not fully understood problems in cardiology. It is important to detect early manifestations of HF and optimize treatment to prevent pathological myocardial remodeling and the occurrence of adverse events. The increase in systemic inflammation activity (SIA) and the presence of comorbidities in patients contribute to the development of HF. The aim of the study- to investigate the impact of risk factors (RF) such as arterial hypertension (AH), diabetes mellitus (DM), history of COVID-19, and obesity on the occurrence of HF and SIA in patients with ST-elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention. Materials and Methods. The study involved 50 patients from the cardiology and reperfusion therapy department of St. Panteleimon Hospital in Lviv (66,00 (52,43-78,35) % men and 34,00 (21,65-47,57) % women), with an average age of 62,01±10,30 years. Blood levels of NT-proBNP (a biomarker of HF) and C-reactive protein (CRP) (a biomarker of SIA) were analyzed on the day of hospitalization for STEMI (the first day from the onset of clinical symptoms, stenting of the infarct-related coronary artery). Results were evaluated using descriptive statistical analysis methods (mean and standard deviation; median and percentile, fractions and their 95 % confidence intervals, calculated by the Wald and Fisher methods), unpaired Student's t-test, and Pearson correlation analysis. Results. The average NT-proBNP levels in the studied patients were 0,50 (0,30; 2,60) ng/ml, and CRP levels were 10,50 (6,00; 20,80) IU/ml (p<0,05, compared to normal parameters). NT-proBNP levels significantly (p<0,05) exceeded the upper reference limit in the presence of AH (0,50 (0,30; 3,30) ng/ml); DM (0,61 (0,30; 4,37) ng/ml); history of COVID-19 (0,61 (0,32; 3,36) ng/ml) (as well as without this RF – 0,49 (0,15; 1,37) ng/ml); obesity (0,31 (0,19; 380) ng/ml). The average NT-proBNP levels in patients with a history of COVID-19 were significantly (p<0,05) higher compared to those in patients without it. CRP levels in blood were significantly (p<0,05) higher than normal values in patients with AH (11,05 (5,60; 25,90) IU/ml); DM (15,20 (7,06; 25,20) IU/ml) (as well as without this RF – 9,50 (5,54; 18,20) IU/ml); history of COVID-19 (12,52 (8,20; 19,65) IU/ml) (as well as without it in history – 9,99 (5,60; 20,06) IU/ml); obesity (9,63 (6,52; 35,00) IU/ml) (as well as without this RF – 10,50 (5,81; 18,40) IU/ml). Average CRP levels in patients with DM and a history of COVID-19 were significantly (p<0,05) higher compared to those without these RFs. The correlation between NT-proBNP and CRP levels was direct – strong in the presence of DM (r=0,78; p=0,012) and history of COVID-19 (r=0,70; p=0,001), medium strength in patients with AH (r=0,55; p=0,0004). Conclusions. In patients with STEMI who underwent myocardial revascularization, early manifestations of HF and a significant increase in SIA occur within the first day of the disease, promoted by such risk factors as AH, DM, history of COVID-19, and obesity. In the presence of DM and history of COVID-19, CRP should be considered an early marker of HF occurrence alongside NT-proBNP, as indicated by a strong direct correlation between these indicators in this category of individuals.

Hemorrhagic versus non-hemorrhagic presentation of presumed reversible cerebral vasoconstriction syndrome (RCVS): Presentations and outcomes

Introduction Reversible cerebral vasoconstriction syndrome (RCVS) can present with hemorrhage, ischemia, or both. We aim to compare the differences in presentation and outcomes between patients with RCVS. Methods The hemorrhagic presentation group had 58 patients, and the non-hemorrhagic presentations had 30 patients. Subgroup analysis compared patients with evidence of one or more types of hemorrhage ( n = 53), no evidence of hemorrhage or infarction ( n = 23), evidence of infarction only ( n = 7), and combination of hemorrhage and infarction ( n = 5). Clinical and radiographic data were analyzed. Results Migraine ( p = 0.030) and intracranial tumors ( p = 0.004) were more frequent in non-hemorrhagic presentation. Seizures on admission ( p = 0.047) and higher than average C-reactive protein (CRP) ( p = 0.037) were seen at a higher rate in patients with hemorrhagic presentation. RCVS2 scores were not unexpectedly higher in patients with hemorrhage than non-hemorrhagic presentations ( p = 0.010). Outcomes between the hemorrhagic and non-hemorrhagic groups were comparable. Subgroup analysis found a higher subset of patients with opiate use ( p = 0.046) in the hemorrhage-only group. Patients with hemorrhage presented with a thunderclap headache ( p < 0.001) more often when compared to the other three groups. RCVS2 score was not unexpectedly higher in the hemorrhage-only group compared with the other groups ( p = 0.004). Conclusion A history of migraines was associated with ischemia, while intracranial tumor was significantly associated with evidence of either an infarct, or no changes on imaging. Exposure to opiates, and seizures or thunderclap headache on presentation were associated with hemorrhage. If our data are reproducible, the RCVS2 score may benefit from inclusion of other, small hemorrhages as criterion for diagnosis for RCVS.

Unnecessary repetitions of C-reactive protein and leukocyte count at the emergency department observation unit contribute to higher hospital admission rates.

The aim of the present study was to assess the effect of repeated laboratory measurement of C-reactive protein (CRP) and leukocyte count on the decision whether to admit or dicharge the patient with localized infections who received antibiotics at the Emergency Department (ED) observation unit. Adult patients with respiratory, urinary tract and abdominal infections, observed at the ED after antibiotic administration, in whom repeated measurements of CRP and leukocyte count were performed within 24 h, were included. They were initially grouped as planned discharge, planned admission and unclear attitude towards admission. Initial and repeated CRP and leukocyte count results, clinical dynamics (improvement, worsening, unchanged) and clinical decision about discharge or admission, were recorded. A total of 1,038 patients were eligible for inclusion. No significant differences in initial CRP and leukocyte count values were observed, nor any association of CRP and leukocyte count changes with clinical dynamics. Among 504 patients eligible for discharge at second laboratory sampling according to clinical dynamics, 54.4 % were further observed or admitted. Discharged patients had an average negative absolute (p<0.001) and relative CRP change (p=0.002). Clinical dynamics, first and second CRP results and absolute CRP change were independently associated with the decision to discharge or further observe/admit. Schematic repetitions of CRP and leukocyte count at the ED observation unit are common, regardless of patients' clinical condition. Clinical judgment remains the main guiding factor to admit or discharge the patient, but repeated CRP testing influences the final decision, contributing to higher admission rates.

The association between precarious employment and stress among working aged individuals in the United States

ObjectivePrecarious employment is a plausible stressor, which may adversely affect health. We investigated the association between multidimensional precarious employment and perceived and biological stress in the U.S. MethodsWe used data from waves 4 (2008–2009) and 5 (2016–2018) of the National Longitudinal Study of Adolescent to Adult Health. Eight indicators were mapped to five dimensions of precarious employment to create a continuous score (PES, range: 0–5): material rewards, working-time arrangements, stability, workers' rights, and interpersonal relationships. Perceived stress was constructed from the four-item Cohen's perceived stress score (PSS; range: 0–16; wave 4). We measured biological stress in waves 4 and 5 via C-reactive protein (CRP). Given variability in CRP collection between waves, we treated wave 4 and 5 as cross-sectional. We employed adjusted linear regression models to estimate whether the PES was associated with the PSS in wave 4 (n = 11,510) and CRP in waves 4 (n = 10,343) and 5 (n = 3452). ResultIndividuals were aged 28 and 37 years on average in wave 4 and 5, respectively. Half were female and most identified as non-Hispanic (NH)-White (∼73 %), followed by NH-Black (∼14 %), Hispanic (∼9 %) and NH-other (∼4 %). Average PES was inversely related to education. The PSS averaged 8.1 (Interquartile Range [IQR] = 7.0,9.0). Average CRP was 4.4 mg/L (IQR = 0.8,5.0) in wave 4 and 3.6 mg/L (IQR = 0.8,4.2) in wave 5. The PES was associated with perceived stress (β=0.06; 95 % CI = 0.01,0.10) and CRP in wave 5 (β=0.34; 95 % CI = 0.07,0.62). ConclusionsGiven the deleterious effects of stress on health, policies to reduce precarious employment warrant consideration.

Lateral Approach With and Without Posterior Stabilization for Lumbar Pyogenic Spondylodiscitis Treatment: A Retrospective Study With an Average Follow-up of 7 Years

Objective: The aim of this study was to present the results after an average of 7-year follow-up in patients diagnosed with pyogenic spondylodiscitis (PS) treated with lumbar discectomy and fusion through minimally invasive lateral lumbar interbody fusion (LLIF), with and without posterior stabilization.Methods: In this retrospective analysis, patients diagnosed with PS treated with minimally invasive LLIF were studied. Variables included C-reactive protein (CRP), blood cultures, and findings on magnetic resonance imaging, computed tomography, and x-ray examinations. The classification of PS according to Pola was recorded.Results: Twenty-one patients were male (70%) and 9 were female (30%), with an average age of 67.6 years (range, 33–85 years). The average follow-up was 83.2 months (range, 12–160 months). In 7 out of the 30 cases, treatment consisted exclusively of discectomy and anterior fusion through LLIF. Bone consolidation was observed in 27 out of 30 cases (90%), with an average postoperative CRP level of 5.77±5.00 mg/L at the end of follow-up.Conclusion: The treatment of lumbar PS through debridement and minimally invasive LLIF, with or without posterior stabilization, resulted in infection control over an average follow-up of 83 months.

Decoding the Correlation Between Inflammatory Response Marker Interleukin-6 (IL-6) and C-reactive Protein (CRP) With Disease Activity in Rheumatoid Arthritis.

Excessive interleukin-6 (IL-6) production in rheumatoid arthritis (RA) leads to joint destruction, inflammation, and systemic symptoms. IL-6 inhibitors alleviate symptoms. C-reactive protein (CRP), an inflammation biomarker, correlates with RA activity. In this study, we assessIL-6 and CRP levels in RA patients to understand their association with disease activity. This cross-sectional study was conducted at a tertiary care hospital in central Indiafor 15 months, from July 2022 to September 2023. The study involved 75 participants diagnosed with RA and receiving outpatient treatment. Exclusion criteria included anti-IL-6 drug treatment, bedridden individuals, proxy patients, and those without consent. Disease activity was assessed using the 28-joint disease activity score (DAS28), while IL-6 and CRP levels were measured following the standard procedures. The average CRP levels were found to be 51.67 ± 47.49 mg/L, while IL-6 levels averaged 65.16 ± 43.67 pg/ml. The results revealed a substantial positive correlation between IL-6 levels and DAS28 (r = 0.603, p value < 0.001), indicating a significant association. Additionally, a moderate correlation between CRP levels and DAS28 (r = 0.493, p value < 0.001) highlighted a significant relationship between these variables. The analysis showed that higher IL-6 levels were associated with increased disease activity and suggested IL-6 as a valuable indicator for assessing RA severity. Also, CRP levels had a moderate correlation with disease activity. Overall, IL-6 is a better marker for disease activity when compared to CRP levels in patients with RA.

Correlation of Psychological Factors, Obesity, Serum Cortisol, and C-Reactive Protein in Patients with Fibromyalgia Diagnosed with Obstructive Sleep Apnea and Other Comorbidities.

Fibromyalgia (FM) is a chronic pain disorder and is associated with disability, and high levels of pain and suffering. FM is known to co-occur with obesity and obstructive sleep apnea (OSA). Individuals with FM often experience symptoms of pain, depression and anxiety, sleep disturbances, and fatigue. These symptoms may be exacerbated by OSA and contribute to the symptoms' severity in FM. Obesity is a common comorbidity in OSA patients, and as FM and OSA are related in some patients, obesity also may contribute to FM symptom severity. For healthcare providers to effectively manage FM patients, a better understanding of the co-occurrence between these FM comorbidities and psychological factors is needed. This study was approved by IRB and conducted using a retrospective EPIC chart review. To identify FM, the following ICD-9 codes were used: (729.1) and ICD-10 (M79.7) codes. To identify patients with OSA, the following ICD-9 codes were used: (327.23) and ICD-10 (G47.33). Body Mass Index (BMI), the total number of medical diagnoses, and psychiatric conditions were documented for each patient. The prevalence of psychiatric conditions including depression and anxiety was compared between patients with and without obesity (BMI > 30), and patients with fewer than 25 medical diagnoses and those with 25 or more diagnoses. A chart review was conducted to identify patients with fibromyalgia with prior serum cortisol testing within the last ten years. Cortisol levels were compared and patients were divided into six groups: 1. FM without identified psychiatric conditions; 2. FM with psychiatric diagnosis of adjustment disorders and insomnia; 3. FM with psychiatric diagnosis of depressive disorders; 4. FM with psychiatric diagnosis of bipolar disorders; 5. FM with psychiatric diagnosis of mixed anxiety and depression; 6. FM with psychiatric diagnosis of anxiety disorders. Available C-reactive protein (CRP) values were gathered. The total FM and OSA population was N = 331. The mean age of the patient population was 63.49 years old, with 297 being female. The diagnoses mean was 31.79 ± 17.25 and the mean total psychiatric diagnoses was 2.80 ± 1.66. The mean BMI was 36.69 ± 8.86, with obesity present in 77.95% of the patients. A total of 66.99% of patients had comorbid anxiety and depression with 25 or more medical problems vs. 33.01% of patients who had fewer than 25 medical problems (odds ratio = 1.50). Patients with a BMI < 30 (N = 71) had rates of anxiety and depression at 64.79% and a mean total of 2.79 ± 1.66 psychiatric diagnoses, whereas patients with a BMI > 30 (N = 258) had rates of anxiety and depression at 61.63% (odds ratio = 1.28) and a mean total of 2.80 ± 1.66 psychiatric diagnoses. The most common other psychiatric conditions among FM/OSA patients included hypersomnia and substance use disorders. Cortisol data: Available cortisol results: FM n = 64, female: 59, male: 5, mean age: 63, average BMI: 38.8. The averages for serum cortisol alone for groups 1-6, respectively, are 9.06, 5.49, 13.00, 14.17, 12.25, and 16.03 μg/dL. These results indicate a relatively upward cortisol serum value by the addition of several psychiatric conditions, with the most notable being anxiety for patients with FM. CRP values were available for 53 patients with an average CRP of 4.14. Higher rates of anxiety and depression were present in FM patients with 25 or more diagnoses. The odds ratios indicate that a patient with 25 or more medical problems was 1.5 times more likely to have anxiety and depression than those with fewer diagnoses. Additionally, those with a BMI > 30 were 1.3 times more likely to have anxiety and depression than those with a normal BMI. addressing psychological factors in FM and OSA is important as high healthcare utilization is common in patients with FM and OSA.

Temporal relationship between inflammation and metabolic disorders and their impact on cancer risk.

Inflammation and metabolic disorders are closely associated with cancer. Whether inflammation leads to metabolic disorders or vice versa during cancer initiation remains unclear. In this study, we explored this temporal relationship and the co-exposure effect on cancer risk. This prospective study had two phases. Initially, we examined the temporal relationship between inflammation (high-sensitivity C-reactive protein (CRP)) and metabolic disorders (metabolic syndrome severity Z-score (MetS-Z)) using a 3.98-year survey and cross-lagged analysis. Subsequently, we assessed the connection of co-exposure to inflammation and metabolic disorders, and the risks of overall cancer, as well as specific obesity-related, non-obesity-related, digestive system, lung, and other cancers using an 11.04-year survey and Cox proportional hazard models. The cross-lagged analysis revealed that the path coefficient from baseline CRP to follow-up MetS-Z (β2 = 0.032; 95% confidence interval (CI) = 0.026, 0.046) was more significant than the path coefficient from baseline MetS-Z to follow-up CRP (β1 = 0.009; 95% CI = -0.001, 0.019). During the follow-up, 2304 cases of cancer occurred. Compared with the risk of cancer of patients with low average cumulative CRP and MetS-Z, patients with high value had a significantly increased risk (hazard ratio = 1.54, 95% CI = 1.30, 1.83). The mediation analysis showed that MetS-Z mediated the association between CRP levels and overall cancer (12.67%), digestive system cancer (10.16%), and obesity-related cancer risk (13.87%). Inflammation had a greater impact on metabolic disorders than vice versa. Co-exposure to inflammation and metabolic disorders significantly increased the risk of cancer, particularly digestive system and obesity-related cancers. Chinese Clinical Trial Registry: ChiCTR-TNRC-11001489.

The possible anti-inflammatory effect of extra virgin olive oil with colchicine in treatment of resistant cases of familial Mediterranean fever in a cohort of pediatric Egyptian patients

BackgroundPeople of Mediterranean descent are primarily affected by the autoinflammatory genetic condition known as familial Mediterranean fever (FMF). The disease is resistant to colchicine therapy in 10–20% of patients. Numerous recent animal studies showed promising results of extra virgin olive oil (EVOO) to control inflammation. The objective of this study was to assess the effectiveness of combining EVOO with colchicine in the treatment of colchicine-resistant familial Mediterranean fever (CRFMF) patients.ResultsBoth the frequency of episodes and inflammatory indicators significantly decreased after a three-month course of daily EVOO treatment with colchicine. The average erythrocyte sedimentation rate (ESR) of patients was 78.6 mm/h before the EVOO administration, and it dropped to 27.8 mm/h, after that. Additionally, after taking EVOO, the mean serum amyloid A (SAA) decreased from 123.82 mg/dl to 59.78 mg/L. Also, the average C-reactive protein (CRP) decreased from 34.22 to 7.84 mg/dl following its administration; the mean nucleotide-binding domain, leucine-rich-containing family, and pyrin domain-containing-3 (NLRP3) level decreased from 134.92 to 64.23 pg/ml. The mean caspase-1 level decreased from 7.8 to 4.98 ng/ml; and the mean levels of cytokines, interleukin 6 (IL-6), interleukin 1 beta (IL-1 β), and tumor necrosis factor-alpha (TNF-α) decreased from 9.8, 18.14, and 52.7 pg/ml, respectively, to 5.95, 12.51, and 29.39 pg/ml. Finally following the administration of EVOO, there was a notable overall improvement in the quality of life of (CRFMF) patients.ConclusionEVOO demonstrated a significant positive impact when paired with the tolerated dosage of colchicine in the management of CRFMF. Improvements were observed in both clinical and laboratory settings, including a reduction in the attack frequency and serum levels of inflammatory markers, such as NLRP3, caspase-1, ESR, CRP, IL-1β, IL-6, and TNF-α without any negative side effects.

Using oral molecular hydrogen supplements to combat microinflammation in humans: a pilot observational study.

Background: Persistent inflammation over time can cause gradual harm to the body. Molecular hydrogen has the potential to specifically counteract reactive oxygen species (ROS), reduce disease severity, and enhance overall health. Investigations of the anti-inflammatory and antioxidant properties of oral solid hydrogen capsules (OSHCs) are currently limited, prompting our examination of the beneficial effects of OSHCs. Subsequently, we conducted a clinical study to assess the impact of OSHCs supplementation on individuals with chronic inflammation. Materials and methods: Initially, we evaluated the oxidative reduction potential (ORP) properties of the OSHCs solution by comparing it to hydrogen-rich water (HRW) and calcium hydride (CaH2) treated water. In our outpatient department, stable patients with chronic illnesses who were treated with varying doses of OSHCs were randomized into low-, medium-, and high-dose groups for 4 weeks. Primary outcomes included changes in the serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) concentrations after four weeks of OSHCs consumption. Secondary outcomes included changes in the Brief Fatigue Inventory-Taiwan (BFI-T) fatigue scale, Control Status Scale for Diabetes (CSSD70) scores, and Disease Activity Score 28 (DAS28). Results: Compared to HRW and CaH2, OSHCs demonstrated a prolonged reduction in ORP for 60 minutes in vitro and enabled a regulated release of hydrogen over 24 hours. A total of 30 participants, with 10 in each dosage (low/medium/high) group, completed the study. The average ESR120 significantly decreased from the first week to the fourth week, with a noticeable dose effect (low-dose group, p = 0.494; high-dose group, p = 0.016). Overall, the average CRP concentration showed a distinct decreasing trend after four weeks of OSHCs administration (w0 vs. w4, p = 0.077). The average DAS28 score demonstrated a significant decrease following OSHCs treatment. Furthermore, there were improvements in the BFI-T and CSSD70 scores. Conclusion: OSHCs supplementation may exert anti-inflammatory and antioxidant effects on individuals with chronic inflammation. However, further clinical studies could be investigated to explore the potential therapeutic effects of OSHCs.

Microbiological Profile and Clinical Features of Septic Arthritis of the Shoulder: A 10-Year Cohort Single-Centre Study.

Introduction Septic arthritis (SA) constitutes a pressing orthopedic emergency characterized by acute, non-traumatic joint pain. Timely diagnosis and intervention are imperative to avert complications such as chondrolysis and systemic sepsis. The etiology is predominantly hematogenous, necessitating an integrated approach involving surgical and microbiological modalities. Shoulder aspiration and microbiological analysis play pivotal roles in guiding treatment, especially when positive findings prompt more aggressive therapeutic strategies. This study aims to elucidate the nuanced clinical and epidemiological characteristics of septic arthritis in both native and prosthetic joints within a singular institutional cohort over a decade. Methods This retrospective case series analysis spanned a 10-year period, focusing on non-prosthetic shoulder joints from January 2012 to July 2021. In this timeframe, only 183 aspirations were performed and sent to the microbiology department for analysis, including cultures, microscopy, and antibiotic sensitivity tests for positive cultures. The study delved into the microbiological profile of infections, encompassing gram stain, culture positivity rates, identification of microorganisms, and antibiotic susceptibility patterns. Additionally, the incidence of primary joint infections with resistant strains, particularly methicillin-resistant Staphylococcus aureus(MRSA), was scrutinized. Statistical analysis utilized the SPSS program version 20.0 (IBM Inc., Armonk, New York), with a significance level set at 5%. The project, registered with the trust's clinical audit department (Reg #5372), adhered to the Declaration of Helsinki and good clinical practice guidelines. Data collection involved extracting non-identifiable patient modifiers from the laboratory database bank into Excel spreadsheets. Results The study included 183 patients, with 108 (59%) females and 75 (41%) males. The average age was 76.2±16.5 years. Among them, 138 (75.4%) reported pain, and 15 (8.2%) had a body temperature over 37.8°C. Lab results showed a mean white blood cell count of 11.6±4.5 and an average C-reactive protein level of 121.7±102.1. Leucocytosis (>11,000 WBC) was seen in 82 (44.8%) cases. Elevated C-reactive protein (CRP; >10 mg/dl) was found in 136 (74.3%) patients. Synovial fluid analysis revealed no crystals in 91.3% of cases. Microbial resistance analysis showed 19 strains resistant to co-trimoxazole and 11 to erythromycin. Among co-trimoxazole-resistant strains, 73.7% were Staphylococcus aureus, a statistically significant association (p<0.001). Conclusion The evolving sensitivity patterns of microbes in septic arthritis underscore the necessity to reassess empirical antibiotic therapy. Subsequent joint damage resulting from infection can result in substantial disability.

ASSOCIATION OF RELIGIOUS ATTENDANCE, RELIGIOSITY/SPIRITUALITY, AND C-REACTIVE PROTEIN IN MIDDLE TO OLDER ADULTS IN THE U.S

Abstract Elevated levels of C-reactive Protein (CRP), a biomarker of systemic inflammation, are associated with a higher risk of cognitive decline and dementia. Religious attendance and religiosity/spirituality are associated with better cognitive health, yet the underlying physiological mechanisms are not well understood. We examined the association between religious service attendance, religiosity/spirituality, and CRP levels in a nationally representative sample of U.S. adults aged 50 years and older (n=6,652) from the Health and Retirement Study from 2006 to 2014. The mean age was 70.7(9.32) years, 84.4% were White, 58.4% were female, and mean CRP levels were 3.98 (8.50) ug/mL. Utilizing the generalized estimating equation (GEE), a significant negative association was found between religious service attendance and religiosity/spirituality with average CRP levels, even after controlling for age, sex, education, marital status, race/ethnicity, income, body mass index (BMI), and health conditions (diabetes, cancer, hypertension) [B: -0.39, 95% CI:-0.76,-0.03, p&amp;lt;0.034 and B: -0.04, 95% CI:-0.07,-0.01, p&amp;lt;0.01]. Age, income, and education were negatively associated with CRP levels, while being female, Black/African American, having diabetes, cancer, hypertension, and BMI were positively associated with CRP levels. Findings contribute to our understanding of a possible mechanism by which religious service attendance and religiosity/spirituality influence cognitive health through reduced systemic inflammation. Interventions are needed to sustain religious attendance supporting religiosity/spirituality for adults who find religion/spirituality important, with the potential to reduce the risk of cognitive decline and dementia.

Cardiac complications as a major predictor of in-hospital death in infective endocarditis using machine-learning algorithm analysis

Abstract Introduction Despite advances in diagnostic and therapeutic strategies, infective endocarditis (IE) remains associated with devastating outcomes with substantial mortality rate. In patients who develop cardiac complications, an early aggressive therapeutic strategy regarding surgical intervention may be warrant. The epidemiologic profile of IE has been changed, which highlights the need for studies with risk stratification of patients hospitalized with IE. Purpose The study aim is to investigate variables strongly associated with in-hospital death and define groups of patients at different risk profile based on values of explanatory variables. Methods A prospective cohort including 349 consecutive patients with IE admitted to a quaternary hospital. The diagnosis was based on the modified Duke criteria and modified European Society of Cardiology criteria from 2015. Data regarding predisposing conditions, laboratory, imaging results, treatment, and outcomes were described. The primary endpoint was in-hospital mortality due to any complication related to IE. Cardiac complications were defined as development or worsening heart failure, prosthesis rupture or perivalvular extension of infection. In-hospital death was analyzed through conditional inference trees and the composed nodes were discriminated in groups with different risks of death and by logistic regression model. Results The median age was 55 years, 59% of patients had native valve, 23.5% prosthetic valve and 35.5% intracardiac device-related IE. Rheumatic heart disease corresponded to 25%, 18% presented diabetes and 13.5% had chronic kidney disease as predisposing conditions. The main causative microorganism was Staphylococcus aureus (19%) and average C-reactive protein (CRP) at diagnosis was 72mg/L. During treatment, 123 (35%) had cardiac complications, 73 (21%) neurological complications, and 45 (13%) suffered embolic events. A total of 105 (47%) patients underwent cardiac surgery. The overall in-hospital mortality was 35.5%. On multivariable analysis, the independent predictors of death were increasing age, high CRP, neurologic and cardiac complications (Figure 1), with C statistic of the model 0.76 (CI 95% 0.70-0.82). According to the decision-tree analysis (Figure 2), patients with cardiac complications, CRP &amp;gt;71mg/L and age &amp;gt;43 years-old had 83.8% mortality rate, whereas those without cardiac or neurologic complications and CRP ≤51 had 7.1% in-hospital death. Among all predictors, cardiac complications showed the strongest association with the primary endpoint. Conclusions Cardiac and neurologic complications, elevated age and high CRP were independently associated with death. The machine-learning algorithm demonstrated that cardiac complications were the most important risk factor for in-hospital death. Early identification of patients who are at high risk of death can offer opportunity for more aggressive monitoring and approach to improve IE outcome.Logistic regression modelDecision-tree analysis

Factors Associated With Sinoatrial Reinnervation After Heart Transplantation.

Factors associated with sympathetic and parasympathetic sinoatrial reinnervation after heart transplantation (HTx) are inadequately studied. Fifty transplant recipients were examined at 7 to 12 wk (index visit), 6, 12, 24, and 36 mo after HTx. Supine rest heart rate variability in the low-frequency (LF) domain (sympathetic and parasympathetic sinoatrial reinnervation) and the high-frequency (HF) domain (parasympathetic sinoatrial reinnervation) were measured repeatedly and related to selected recipient, donor, and perisurgical characteristics. We primarily aimed to identify index visit factors that affect the sinoatrial reinnervation process. Secondarily, we examined overall associations between indices of reinnervation and repeatedly measured recipient characteristics to generate new hypotheses regarding the consequences of reinnervation. LF and HF variability increased time dependently. In multivariate modeling, a pretransplant diagnosis of nonischemic cardiomyopathy (P = 0.038) and higher index visit handgrip strength (P = 0.028) predicted improved LF variability. Recipient age, early episodes of rejection, and duration of extracorporeal circulation were not associated with indices of reinnervation. Study average handgrip strength was positively associated with LF and HF variability (respectively, P = 0.005 and P = 0.029), whereas study average C-reactive protein was negatively associated (respectively, P = 0.015 and P = 0.008). Indices of both sympathetic and parasympathetic sinoatrial reinnervation increased with time after HTx. A pretransplant diagnosis of nonischemic cardiomyopathy and higher index visit handgrip strength predicted higher indices of mainly sympathetic reinnervation, whereas age, rejection episodes, and duration of extracorporeal circulation had no association. HTx recipients with higher indices of reinnervation had higher average handgrip strength, suggesting a link between reinnervation and improved frailty. The more reinnervated participants had lower average C-reactive protein, suggesting an inhibitory effect of reinnervation on inflammation, possibly through enhanced function of the inflammatory reflex. These potential effects of reinnervation may affect long-term morbidity in HTx patients and should be scrutinized in future research.

E29 Juvenile Idiopathic Arthritis (JIA) in Algeria, from diagnosis to management

Abstract Introduction Juvenile idiopathic arthritis (JIA) is the most common chronic arthritis in children in the world. Objectives to describe a series of 120 children with juvenile idiopathic arthritis (JIA), diagnosed and recruited in the pediatric departments of 5 cities; Sétif and the cities surrounding: Bordj BouArreridj, M'sila, Béjaïa, Batna, between January 1st 2012 to December 31st, 2018 (seven years). The aim is to study the epidemiological, clinical, therapeutic, evolutionary, and the quality of life at presentation, 3rd, 6th and 12th month of follow-up of patients with JIA with evaluation of the incidence and prevalence rate. Materials and methods Our longitudinal, multicentre, and ambispective study (retrospective between 2012–2015, prospective between 2016–2018), allowed us to collect 120 newly diagnosed cases of JIA who fulfilled International League of Association for Rheumatology (ILAR) criteria. Patients were followed up for a duration of 12 months. Results 120 children were studied; females were predominant (54,2%). The average age at diagnosis was 7,46 ± 3,77 years with age at disease onset of ∼6,69 ± 3,65 years and a relatively diagnostic delay of 9,34 ± 13,05 months. Oligoarticular JIA was the most frequent (35,8%), persistent oligoarticular (32,5%) and extensive oligoarticular (3,3%).This is followed by polyarticular JIA (30,8%), Rheumatoid factor (RF) (25,8%) and with RF (5%), and systemic JIA (21,7%), 4.2% psoriatic arthritis (JPsA) and 2.5% enthesitis related arthritis (ERA) with 5% of uncategorized forms. Uveitis was present in 5.8% of cases. The initial inflammatory balance is disturbed with a erythrocyte sedimentation rate (ESR) of 56,32 ± 35,54 mm at the first h, and an average C-reactive protein (CRP) of 42,84 ± 53,76 mg/l, anaemia was seen in more than two thirds of the children (67,5%), thrombocytosis 35,8% and hyperleukocytosis in almost a quarter of children (22,5%). Antinuclear Antibodies (ANA) were present in a quarter of cases (25,8%), RF in 5%, and anti-cyclic citrullinated peptides (anti-CCP) in 3,3% of cases and Human Leucocyte Antigen B27 (HLA B27) was positive in 4.2% of children. An initial activity in non-systemic forms according to the Juvenile Arthritis Disease Activity Score (JADAS10) was moderate in more than a quarter of children, and a strong initial activity according to the American College of Rheumatology (ACR) in more than half of the systemic forms. A moderate initial average functional incapacity assessed by the Childhood Health Assessment Questionnaire (CHAQ) at 1,73 ± 0,52, a moderately altered initial average quality of life Juvenile Arthritis Quality of Life Questionnaire (JAQQ) at 4,07 ± 1,12 and a pain-physician Visual Analogue Scale (VAS) initial mean at 4,98 ± 1,74. The mean annual incidence rate in Sétif during the prospective study was 3,88/100 000 children under 16 and those of the Eastern region including Sétif and the surrounding wilayas (BBA, M'sila, Béjaïa, and Batna) is 2 per 100 000 children under 16. The rate of prevalence of JIA in Sétif is 11,25/100 000 children under 16, and in the East region of the study was 5,80/100 000 children under the age of 16. Medications used were non-steroidal anti-inflammatory drugs (NSAIDs) in (83.3%) followed by disease-modifying antirheumatic drugs (DMARDs) in 65%. Methotrexate in (63,3%), glucocorticoids in (49,2%), and aspirin used in 16,7%, intra-articular corticosteroid injections (IACs) in (15.8%), biotherapy in (19,1%). 27,5% had functional rehabilitation. Evolution at one year is marked by 44.5% disease inactivity with treatment and 31,1% remission. Conclusion JIA is the most common chronic rheumatic disease in children. Nevertheless, it is considered a rare but not exceptional pathology. It is one of the main causes of short-, medium- and long-term disability. Ethics Associate Professor of pediatrics, department of medicine University Setif-Algeria (pediatric center –Setif-Algeria)

Management of COVID-19 Pneumonia: Experience in a Peripheral Tertiary Level Hospital in Bangladesh

Background: Since the detection of the first case of the novel SARS-CoV-2 virus in Wuhan, China, on December 31, 2019, the world stepped into an era of the pandemic as declared by WHO on March 11, 2020. With no prior knowledge regarding this new pandemic, the evidence-based practice of medical management was at stake. Experience sharing from different corners of the world played an essential role in building knowledge to save the world. Methods: The researchers collected data for this retrospective study, from hospital records of the COVID-19 dedicated unit of Sylhet Women’s Medical College, Sylhet, Bangladesh, that was formed temporarily in July 2020, in response to the pandemic situation in the country. This article includes data on 3408 admitted COVID-19 patients with moderate to severe symptoms, managed in the isolation unit including its intensive care unit (ICU) up to November 2021. Results: The mean age of the patients was 57.21±12.58 years and male to female ratio was 1:1.8. Fever (44.4%), cough (38.9), and fatigability (33.3%) were the common symptoms. Diabetes mellitus (67.7%), systemic hypertension (63.7%), asthma (8.65%), chronic obstructive pulmonary disease (21.94%), and, ischemic heart disease (31.2%) were the top co-morbid conditions. Of the study subjects, 68.2% were RT-PCR positive for COVID-19, 67.3% had an abnormal baseline chest X-ray, and 91.1% had a ground glass shadow on a high-resolution CT scan of chest. Average C-reactive protein, D-dimer, and serum ferritin values were 71.68±60.38, 1.16±2.11, and 839±748.57 respectively. Hypoxemia, which was a common problem among them, was managed with oxygen therapy with an appropriate delivery device, with or without supplementation by dexamethasone (78.3%), or methylprednisolone (18.8%). Eighteen (18) patients refused to receive any antiviral therapy, 61 received oral Favipiravir and the rest of them received injectable Remdesevir. Standard care was augmented with Baricitinib in 60 patients. Thirty-six (36) patients in the ICU, with poor response to standard care, were treated with Tocilizumab. Death rates were 9.46% in the non-ICU block, but they were 6-10 times higher in the ICU. Conclusion: Every medical professional learned from the initial two years of the COVID-19 pandemic. Lessons learnt from experience helped building up the knowledge pool necessary for generating effective protocols for COVID-19 pneumonia management.

Does chronic oral contraceptive use detrimentally affect C-reactive protein or iron status for endurance-trained women?

Chronic use of the oral contraceptive pill (OCP) is reported to increase C-reactive protein (CRP) levels and increase the risk of cardiovascular disease in premenopausal females. A secondary analysis of data from two research studies in eumenorrheic (n = 8) and OCP (n = 8) female athletes. Basal CRP and iron parameters were included in the analysis. Sample collection occurred following a standardized exercise and nutritional control for 24 h. Eumenorrheic females were tested in the early-follicular and mid-luteal phases, and the OCP users were tested in quasi-follicular and quasi-luteal phases (both active pill periods). A main effect for group (p < 0.01) indicated that average CRP concentration was higher in OCP users compared with eumenorrheic females, regardless of the day of measurement within the cycle. Results demonstrate a degree of iron parameters moderation throughout the menstrual cycle that is influenced by basal CRP levels; however, no linear relationship with CRP, serum iron, and ferritin was observed. Basal CRP values were consistently higher in the OCP group despite participants being in a rested state. These results may indicate a potential risk of cardiovascular disease in prolonged users of the OCP when compared to eumenorrheic female athletes.

Assessing serum C-reactive protein as a predictor of COVID-19 outcomes: a retrospective cross-sectional study.

The current study aims to conclude the possibility of C-reactive protein (CRP) level serving as a biomarker for early prediction of COVID-19 infections. In this retrospective cross-sectional study, 88 people participated who were infected with COVID-19, aged from 25 to 79 years old. Compare the CRP test range of all samples from patients who visited the hospital between January and April 2022. All participants were confirmed to have COVID-19 through nasopharyngeal swab analysis and real-time polymerase chain reaction real-time polymerase chain reaction testing. Results showed that the majority of infected individuals had elevated CRP levels. A P-value of less than 0.05 indicated a significant difference in CRP levels between alive and dead patients. No significant difference in CRP levels was found between male and female patients. The average CRP level of deceased patients was 137.79mg/l, while the average CRP level of survivors was 14.37mg/l. The median interquartile range of deceased patients was also found to be significantly higher compared to survivors. In conclusion, serum CRP levels potentially predict the severity and development of sickness in patients with COVID-19 infections.

#4858 THE CHANGES OF THE C REACTIVE PROTEIN LEVEL DURING THE CRRT PROCEDURE

Abstract Background and Aims Continuous renal replacement therapy (CRRT) is recommended for critically ill patients (pts). Various infections and sepsis often occur in these pts. In addition to being frequently used as inflammation parameter, C reactive protein (CRP) is considered an important regulator of inflammatory processes and may have an active role in atherosclerosis. Changes in its level can have indirect effects on these processes. The aim of this study was to monitor change of CRP level during the CRRT procedure and to evaluate the potential correlation between this change and other monitored parameters. Method The study was done as the observational, retrospectively prospective study on 154 pts, on whom 343 CRRT procedures (proc) were performed. All pts were treated at the Clinics of the University Clinical Centre of Vojvodina, by the Dialysis Department, during 2021. and 2022. Procedures that lasted longer than 5 hours were included. CRRT modalities were CVVHD and CVVHDF, with the use of different filters (EMiC2, Kit8/CiCa1000, oXiris, ST150), according to the device (MultiFiltrate, PrismaFlex) and anticoagulation used. Demographic, clinical and CRRT proc data were collected from the medical documentation. Blood for laboratory testing was sampled at the beginning and the end of the proc. An increase or decrease of CRP level by more than 5% compared to the initial value was considered significant. The collected data were statistically processed. Results From 154 pts, 86.83% were men, 13.17% women, with average (avg.) age of 56.52 years. From 343 proc, 41.69% were CVVHD, 58.31% CVVHDF, with avg. duration of 1033 min. Average ultrafiltration (UF) was 2670mL, with avg. UF/hour of 161.54mL/h. Average initial CRP level was 176.25mg/l, with avg. level of 174.6mg/l at the end of the proc. In 44.9% proc an increase and in 43.44% proc a decrease in the CRP level was verified. The CRP level did not change significantly during 11.66% proc (40/343). Patients' age (p = 868) and gender (p = 752) did not affect the change in CRP level during CRRT proc. Procedures in which CRP level decreased lasted longer (1084min) than those with CRP level increase (1023min), but the difference is not statistically significant (p = 199). Prescribed CRRT dose (p = 485), nor total UF (p = 164) did not affect change in CRP level during proc. Hourly UF was significantly lower for CRRT proc during which CRP level decreased (148.18mL/h) compared to those with the CRP level increase (172.23mL/h) (p = 000). CRRT modality had a significant impact on changes of CRP level during the proc. In a higher percentage of CVVHD proc (48.32%) a decrease in CRP level was seen compared to CVVHDF proc (36.36%) (p = 035). A significant difference was found in the changes of CRP levels in relation to the filters used (p = 011). The use of the EMiC2 filter most often resulted in a decrease in CRP level (56.25%), compared to the use of other filters. Septic condition was present in 85.91% of proc that ended with a decrease of CRP level and in 66.23% of proc with the CRP level increase (p = 000). In proc with the CRP level decrease, basal levels of PCT and fibrinogen were significantly higher than in those with the CRP level increase (p = 037, p = 000 retrospectively). Initial number of WBC did not differ between two groups (p = 424). Comorbidities such as diabetes (p = 489), malignancy (p = 5) or autoimmune disease (p = 25) did not affect change in CRP level during CRRT proc, nor did surgery precede the proc (p = 782). No association between the changes of CRP level during the CRRT proc and the subsequent pts mortality (p = 289) or recovery of renal function (p = 808) was found. Conclusion During the CRRT procedure, the level of CRP in significantly influenced by the average hourly ultrafiltration, the CRRT modality, the filter used, and the presence of septic condition, with high levels of PCT and fibrinogen.

Relationship of Inflammatory Parameters and Nutritional Status in Cancer Patients.

Chronic inflammation and cytokine storm can cause uncontrolled events in cancer. Pro-inflammatory molecules released by malignant cells send signals to the brain, liver, and neuroendocrine cells, interfering with appetite and promoting anorexia. Malnutrition in cancer patients is associated with increased treatment toxicity, reduced physical efficiency, and decreased survival. Therefore, early recognition of malnutrition could improve quality of life, treatment compliance, and survival. The aim of the study was to explore the relationship between inflammatory parameters with disease stage and nutritional status in patients with solid cancers. We screened 77 consecutive patients from 3 clinical Institutions in Sicily, Italy, with solid tumors who were either in follow-up after curative treatment or being treated for metastatic disease using the Mini Nutritional Assessment (MNA) questionnaire. Inflammatory parameters, including interleukin 6 (IL6), C-reactive protein (CRP), β2-microglobulin, ferritin, and transferrin were evaluated. A statistically significant difference was found in mean values of IL6, CRP, β2-microglobulin, ferritin, and transferrin between patients without evidence of disease and metastatic patients. Among the metastatic group, there was a significant difference in mean values of these inflammatory parameters between patients with malnutrition and those with normal nutritional status. The difference in average IL6, CRP, β2-microglobulin, and ferritin between patients at risk of malnutrition and those with normal nutritional status was also significant. However, the difference between patients at risk of malnutrition and those with malnutrition was not significant. IL6, CRP, transferrin, ferritin, and β2-microglobulin are functional inflammatory parameters that indicate risk of malnutrition and support the MNA screening test to identify patients with solid tumors who require nutritional support.