Average C-reactive Protein Research Articles

Abstract P224: Does Cognitive Function And C-reactive Protein Produce A Combined Effect On All-cause Mortality Risk? An Analysis Of Older Adults In The 1999-2002 NHANES

Introduction: There is limited evidence examining the combined effects of cognitive function and C-reactive protein (CRP) on mortality risk using a large nationally representative sample of U.S. adults. Hypothesis: We assessed the hypothesis that cognitive function and CRP produce a combined effect in predicting all-cause mortality risk. Objective: Examine the combined effects of cognitive function and CRP in predicting all-cause mortality in a large nationally representative sample of U.S. adults. Methods: The study sample (n=2,111) included older adults (≥ 60 years of age) who participated in the 1999-2002 National Health and Nutrition Examination Survey. A four-level variable was created based on CRP concentration and cognitive function (high cognitive function and low to average CRP; high cognitive function and high CRP; low cognitive function and low to average CRP; low cognitive function and high CRP). Results: Compared to a referent group with low to average CRP and high cognitive function, analysis revealed a statistically significant increase in risk of all-cause mortality in adults with high CRP and low cognitive function (Hazards Ratio [HR] 1.97; 95% Confidence Interval [CI], 1.52-2.55, p<0.0001) and in adults with low to average CRP and low cognitive function (HR 1.76; 95% CI, 1.44-2.15, p<0.0001). Similar relationships were not revealed in adults with high cognitive function, regardless of CRP concentration. Conclusions: In a large nationally representative sample of older U.S. adults, low cognitive function was associated with increased all-cause mortality risk independent of CRP concentration.

Factors affecting the mortality rate of patients with cancer hospitalized with COVID-19: a single center’s experience

The main objective is to define the mortality of patients with cancer admitted to our hospital, their clinical and demographic characteristics, investigate the risk of COVID-19 for patients with cancer, and determine factors that affect the mortality rates of patients with cancer dying of COVID-19. A total of 2401 patients were admitted to our hospital with the diagnosis of COVID-19 from March 11th, 2020, to May 31st, 2020. Ninety-two out of a total of 112 cancer patients were included in this study based on the planned inclusion/exclusion criteria. The clinical, demographic, and laboratory features and treatments provided were studied, and their effect on mortality rates was analyzed. In our study the median age of the patients was 67 years, and 55.4% were male. More than half (56.5%) of our patients had metastasis. The mortality rate was 6.2% in the overall population with COVID-19, whereas it was 23.9% in patients with cancer. The mortality rate in patients with metastasis was statistically significantly higher compared with those without metastasis (34.0% vs. 10.3% P = 0.008). The mortality rate in patients still smoking was statistically significantly higher than in non-smokers (37.5% vs. 12.5% P = 0.033). The mortality rates of patients with high average C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and D-dimer levels were statistically significantly higher than in those without, and the mortality rates of patients with lower average albumin and hemoglobin levels were statistically significantly higher than those without (P < 0.001, P = 0.006, P = 0.041, P < 0.001, P < 0.001, and P = 0.028, respectively). Having metastases concurrent with COVID-19 was a statistically significant factor predictive of prognosis. Also, high CRP, ferritin, LDH, and D-dimer, and low albumin and hemoglobin were related to increased mortality rates. The predictive and prognostic role of possible factors related to prognosis is still unknown and further large, multicenter prospective studies are needed to confirm these results.

Single-Stage Combined Anterior Corpectomy and Posterior Instrumented Fusion in Tuberculous Spondylitis With Varying Degrees of Neurological Deficit.

A combined anterior decompression and stabilization followed by posterior instrumented fusion promotes fusion of the affected segment of spine and prevents further progression of deformity. The objective of this study is to report on outcome of patients with tuberculous spondylitis, progressive neurologic deficit, and kyphotic deformity who underwent single-stage anterior corpectomy and fusion and posterior decompression with instrumented fusion. A total of 49 patients (29 males, 20 females) with varying grades of neurological deficit due to tuberculosis of the spine (thoracic, thoracolumbar, and lumbar) were included in this prospective study. The diagnosis of tubercular infection was established after clinical, hematological, radiological, and histological specimens taken at surgery. All were treated with combined anterior and posterior decompression, debridement, and stabilization with direct autologous bone grafting or wrapped bone graft in mesh or expandable cages. Neurological status and visual analog scale (VAS) pain score were recorded at each visit. X-rays, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and liver function were evaluated at 3, 6, and 12 months after surgery and then once a year thereafter. Results were analyzed in terms of neurological recovery (Frankel grade), bony union time, and correction of kyphotic deformity. The mean age was 37.8 years (range, 2-65 years). Mean preoperative VAS scores improved from 5.6 to 1.5. The average ESR and CRP returned to normal within 6 months in all patients. The mean time to fusion was 8.4 months for the whole group. The neurological deficit in 42 of 49 patients had excellent or good clinical outcome (P < .0001). A total of 10 of 17 patients improved from Frankel A and B to Frankel E (normal activity). Three patients each in the thoracic and thoracolumbar groups improved to Frankel D. Radiological measurements showed the mean kyphotic correction was 61%, 66%, and 67% in the thoracic, thoracolumbar, and lumbar/lumbosacral spine, respectively. Combined single-stage anterior decompression and stabilization followed by posterior instrumented fusion is safe and effective in the treatment of tuberculous spondylitis with neurological deficit in the thoracic and lumbar spine. This procedure helps to correct and maintain the deformity, abscess clearance, spinal-cord decompression, and pain relief as well as return to normal motor function. Bony fusion prevents further progression of deformity. 2.

Prediction of Cytokine Storm and Mortality in Patients with COVID-19 Admitted to ICU: Do Markers Tell the Story?

Introduction: COVID-19 has caused approximately one million deaths worldwide as of November 24, 2020. Markers of disease activity like ferritin, C-reactive protein (CRP), and D-dimers are frequently monitored to detect the best opportunity for intensive treatment. Methods: All patients of >18 years of age were included. The primary variables of interest, ferritin, CRP, and D-dimers, for each patient throughout hospitalization were recorded. Primary clinical outcomes of length of stay in ICU and survival were recorded. Demographics: age, gender, BMI, and nationality. Ferritin, CRP, and D-dimers were recorded daily if available for the whole ICU stay, and all other variables were recorded on admission day to ICU. Results: The sample includes 235 records. More than 95% of patients have all markers on the day of admission to ICU were ferritin (median 1,278; IQR 1,424), D-dimer 1.21 (3.4), and CRP 129.5 (121). Daily average levels of markers were different from their admission day level: ferritin 1,395 (1,331), D-dimer 3.11 (5.52), and CRP 107 (75.8). Multiple logistic regression analysis determined that average CRP during the stay was the only predictor of survival. Discussion: Data on markers utilization to detect the acute phase of inflammation help clinicians focus on the opportunity window for intensive treatment. Conclusion: Average CRP during the stay in ICU is higher than CRP on admission. Average CRP is the only factor that predicts survival.

Serum protein profiles and C-reactive protein in natural canine filariasis.

Background and Aim:Canine filariasis is caused by several species of filarial worms. The pathophysiological response to infection is mainly due to the filaria lifecycle. Laboratory detection methods to assess the pathological alterations characteristic of filariasis are needed urgently. Serum protein profiles and C-reactive protein (CRP) levels are used widely to diagnose several animal diseases. This study aimed to determine the serum protein profiles and CRP levels in dogs infected with Dirofilaria immitis or Brugia pahangi or both parasites.Materials and Methods:Blood samples were collected from 980 dogs presenting at animal hospitals and veterinary clinics in Bangkok and its vicinity. The presence of microfilaria in samples was determined using a buffy coat smear and staining with Wright–Giemsa. The sheathed and unsheathed microfilaria species were identified by acid phosphatase staining. Forty positive samples were tested. The serum protein profiles were identified by agarose gel electrophoresis. The CRP concentration was measured using a fluorescent immunoassay.Results:Albumin levels and albumin-to-globulin ratios were significantly lower, and total protein, β2 globulin, and γ globulin levels were significantly elevated in dogs infected with D. immitis and B. pahangi compared with reference values in normal dogs. The average CRP concentrations in dogs infected with D. immitis or B. pahangi were 69.9 and 12.9 mg/L, respectively.Conclusion:The total protein and γ globulin levels increased in canine filariasis compared with the normal reference range. The CRP concentration in dogs infected with D. immitis was extremely high, whereas that in dog infected with B. pahangi was normal.

Inflammatory and hemostatic abnormality in atrial fibrillation patients at tertiary care hospital, Mardan

Objective: To determine the levels of C-reactive protein (CRP) and D-dimers in patients presenting with atrial fibrillation. Study design: Descriptive Cross sectional/Observational. Place and duration of study: From Januarty 2019 to June 2020, the study was carried out in the cardiology and pathology departments of Mardan Medical Complex and Bacha Khan Medical College Mardan. Material and Methods: This study included a total of 100 patients with atrial fibrillation, with 50 people serving as the control group. The levels of CRP and D-dimers were determined in all cases. Results: 35% of the individuals in this study had increased CRP levels. The average CRP level was 2.99 +/- 0.652mg, which was substantially higher than in the control group. Similarly, 45% of patients had an increased D-dimer level. Among these individuals, 30% had D-dimer levels between 250 and 500mg, and 50% had levels between 500 and 1000 ng/ml, which were considerably higher than the control group. Conclusion: According to the findings of the study, atrial fibrillation is related with both inflammatory and coagulation abnormalities, as seen by higher CRP and D-dimer levels. Both these indicators are thromboembolic risk factors.

The role of C-reactive protein in predicting the severity of COVID-19 disease: A systematic review.

Since December 2019, coronavirus diseases-2019 (COVID-19) dispersed into 200 countries and affected more than 70 million people. The clear picture of the SARS-CoV-2 infection is still under investigation. In this review, we evaluated whether C-reactive protein biomarker is able to predict the clinical outcomes or correlated with the severity of COVID-19 disease. The databases MEDLINE, Hinari, Google Scholar, and Google search were used to find potential studies published from COVID-19 epidemic until May 2021. A format prepared in Microsoft Excel spreadsheet was used to extract the appropriate details from each original report. For further review, the extracted data were exported to STATA/MP version 16.0 software. Keywords including “COVID-19,” “SARS-CoV-2,” and “C-reactive protein,” among others were used to search relevant articles. Only studies which reported the average C-reactive protein value and COVID-19 disease stage outcomes were included. Twenty articles were included in the review. All studies found considerably higher level of C-reactive protein in patients with severe COVID-19 as compared to mildly infected patients. This review evidenced that it is still there for a given biomarker to early identify the state of progression in asymptomatic and/or mildly infected individuals into severe disease; the level of C-reactive protein may be used in predicting the likelihood of disease progression. Findings from this review showed level of C-reactive protein is a good biomarker to predict the severity of COVID-19 disease. Although COVID-19 researches are at the early stages, investigation of C-reactive protein levels throughout the disease course may have paramount importance for clinicians in early detection of severe manifestations and subsequently improve the prognosis. However, further large-scale studies are required to confirm these findings.

1554. Epidemiology of Adult Bacterial Hand Infections at Two Urban Hospitals

BackgroundHand infections represent a major source of morbidity, which can result in hand stiffness and amputation. Early appropriate empiric antibiotic regimen may reduce the associated morbidity, hence the importance to examine local epidemiology. The aim of this study was to define the current epidemiology of adult hand infections at two urban hospitals in New York City.MethodsWe performed a double center, retrospective study of adult patients hospitalized from March 2018 to May 2020. Patients with positive cultures associated with the hand infections were included. Retrospectively, 100 patients were reviewed. Data on baseline demographic, clinical, surgical, microbiology, and treatment parameters were collected.ResultsOf the 100 patients, 76% were male, with median age of 47.5 years (35, 58.25) and average C-reactive protein (CRP) of 50.66 mg/L (± 64.64) on admission (see Table 1). Previous hospitalization within 1 year (38%), previous surgical procedures (39%) and recent IV medication use (26%) were common. 130 bacterial isolates were identified (see Table 2). The most frequent organisms were Gram-positive, with Methicillin susceptible Staphylococcus aureus (MSSA, 25.38%), Streptococcus species (20.08%), and Methicillin resistant Staphylococcus aureus (MRSA, 15.38%) being the most common. Gram-negative organisms were infrequent, with Haemophilus parainfluenzae (3.85%), Enterobacter cloacae (3.85) and Pseudomonas aeruginosa (3.08%) being the most prevalent. Of the 100 patients, 27% had polymicrobial infections, associated with trauma (6%), illicit IV use (6%) and unknown (7%) etiologies.Table 1: Baseline demographics and co-morbid conditions Table 2: Types and numbers of organisms in relation to etiologies ConclusionWithin our population, the most common organisms associated with hand infections were Gram-positive, with Staphylococcus aureus and Streptococcus species being the most prevalent. Gram-negative pathogens were infrequently isolated. The results within this study can provide guidance to clinicians on assessing the appropriate empiric antibiotic regimen in patients with hand infections, and can serve as a basis for further studies identifying risk factors associated with isolation of organisms associated with hand infections.Disclosures All Authors: No reported disclosures

Evaluation of Low-Dose Ketamine on Inflammatory Biomarker Profile Following Off-Pump Coronary Artery Bypass Grafting

AbstractThe role of ketamine in attenuating the postoperative inflammatory response is a subject of recent clinical interest. Despite several studies elucidating the anti-inflammatory potential of ketamine in on-pump coronary artery bypass grafting and noncardiac surgeries, the literature on the role of ketamine in ameliorating systemic inflammatory response syndrome following off-pump coronary artery bypass grafting (OPCAB) is rather scarce. This prospective observational study was designed to compare the postoperative inflammatory milieu with and without the addition of low dose (0.5 mg/kg) of ketamine to the anesthetic regimen in the patients undergoing OPCAB, wherein 60 patients were allocated to group T, receiving ketamine (n = 30) and the group C, not receiving ketamine (n = 30). The estimated biomarkers included C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α), troponin T, and creatine kinase-MB (CK-MB) at the following time points: prior to induction (T0), immediate postoperative period (T1), 4 hours postoperatively (T2), 24 hours postoperatively (T3), and 48 hours postoperatively (T4). The major finding of the study was a significant reduction in the postoperative values of CRP and IL-6 at T1, T2, T3, and T4 (p &lt; 0.001) However, postoperative serum levels of TNF-α, CK-MB, and troponin T were comparable in the group T and group C. The average postoperative CRP and IL-6 levels positively correlated with the VISh (the highest postoperative vasopressor inotrope score) with the r values of 0.733 (p &lt; 0.001) and 0.704 (p &lt; 0.001), respectively. The index study substantiates the anti-inflammatory potential of ketamine in preventing immune function alterations attributable to anesthesia and cardiac surgery.

Investigation Of The Relationship Between Physical Activity, Inflammatory Proteins And Adiponectin In Older Adults

INTRODUCTION: Chronic low-grade inflammation (CLGI) is a hallmark of aging and significantly contributes to the development and progression of numerous chronic diseases including cardiovascular disease (CVD) and diabetes. CLGI is frequently defined as elevated serum levels of inflammatory proteins including C-reactive protein (CRP) and interleukin-6 (IL-6). Physical activity has been reported to have anti-inflammatory effects. PURPOSE: To explore the relationships among habitual physical activity, inflammation, and cardiometabolic risk factors in older adults. METHODS: In 82 subjects (23 male / 59 female) body composition was determined (bioelectrical impedance) and physical activity was measured objectively (7-day accelerometry) as well as subjectively (Community Health Activities Model for Seniors (CHAMPS)). Enzyme-Linked Immunosorbent Assays (ELISA) were used for the quantitative measurement of IL-6, CRP, and an anti-inflammatory, adipose tissue derived hormone, adiponectin. Blood lipids were also measured utilizing a point-of-care analyzer. Partial correlations (controlling for age and sex) were used to analyze associations. SUMMARY OF RESULTS: Mean values included: age (68.5 ± 6.3 yr); body fat percentage (31±11%); accelerometry (cts/min: 114.1±56.5, sedentary-to-moderate ratio: 12.8±6.1); CHAMPS (2,328±1658 kcal/wk); CRP (1.5±1.6 mg/dL); IL-6 (4.2±1.0 ng/mL); adiponectin (11.2±6.0 μg/mL); LDL (114±28 mg/dL); and HDL (62±17 mg/dL). CRP was significantly (p< 0.05) correlated with body fat percentage (r= 0.54), HDL/LDL (r= 0.42), IL-6 (r= 0.37), and adiponectin (r= -0.25). IL-6 was significantly correlated with body fat percentage (r= 0.24), activity counts/min (r= -0.27), and LDL/HDL (0.29). Adiponectin was significantly correlated with body fat percentage (r= -0.35), CHAMPS (r= 0.28), and HDL (r= 0.51). CONCLUSION: The average CRP value for this population of older adults is indicative of moderate risk for the development of CVD. The correlations reported here are supportive of previous research suggesting that body composition and physical activity level are important determinants of inflammatory profile and disease risk. This project was funded by an NIH grant 1R15AG055923-01

COVID-19 Pneumonia Hospitalizations Followed by Re-Presentation for Presumed Thrombotic Event

COVID-19 Pneumonia Hospitalizations Followed by Re-Presentation for Presumed Thrombotic Event

Evidence of a Relationship Between Plasma Leptin, Not Nesfatin-1, and Craving in Male Alcohol-Dependent Patients After Abstinence.

The goal of this study was to determine whether the plasma leptin, nesfatin-1, cortisol, brain-derived neurotrophic factor (BDNF), and inflammatory cytokines could be used as potential biomarkers for the degree of craving in the alcohol-dependent patients after 1 month of abstinence. A total of 83 patients with alcohol use disorder (AUD) and 61 healthy subjects were assessed. Patients with AUD were selected from Department of Material Dependence, Anhui Mental Health Center, and subjects in the control group were selected from healthy volunteers. The Alcohol Urge questionnaire Scale (AUQ) was used to evaluate the extent of craving for alcohol, and the Michigan Alcoholism Screening Test (MAST), the Fagerstrom Test for Nicotine Dependence (FTND), the Self-Rating Anxiety Scale (SAS), and the Self-Rating Depression Scale (SDS) were also assessed in patients with AUD. Enzyme-Linked Immunosorbent Assay (ELISA) was used for the measurement of plasma leptin, nesfatin-1, cortisol, BDNF, Interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) levels. Compare with healthy controls, the average leptin, leptin/BMI, IL-6, CRP, and TNF-α levels in patients with AUD were significantly increased, while the BDNF levels were significantly decreased. Moreover, the partial correlational analysis showed that the AUQ scores of the alcohol-dependent patients were positively correlated with the plasma leptin levels (r = 0.613, P < 0.001), rather than nesfatin-1 (r = 0.066, P = 0.569) after controlling for age as covariate. Furthermore, plasma nesfatin-1 levels were found to be correlated with the SDS scores (r = 0.366, P = 0.001) in the AUD group. In addition, plasma leptin levels were positively associated with the plasma IL-6 (r = 0.257, P = 0.033), CRP (r = 0.305, P = 0.011), and TNF-α (r = 0.311, P = 0.009) levels, and negatively associated with the BDNF levels (r = −0.245, P = 0.042) in patients with AUD. These results suggest that plasma leptin, but not nesfatin-1, might be a potential biomarker for the degree of craving in alcohol-dependent patients after 1 month of abstinence, the mechanism of which might be related to the dysfunction of the inflammatory cytokines and BDNF levels.

Spontaneous Incidence of Vertebral Body Infection Following Osteoporotic Vertebral Fracture: A Case Series Study and Review of Literature.

Retrospective case series. The aim of this study was to examine the spontaneous incidence rate and features of pyogenic vertebral osteomyelitis in osteoporotic vertebral fracture (OVF). Pyogenic vertebral osteomyelitis is a rare complication of OVF. We experienced some cases of vertebral body infection after OVF. In this retrospective, single-center study, clinical data were collected by chart review. We examined the number of cases of pyogenic vertebral osteomyelitis following OVF between April 2014 and August 2018. Further, we examined the mechanism of injury, age, sex, duration from the diagnosis of OVF to the diagnosis of vertebral body infection, C-reactive protein level at the time of diagnosis of OVF, medical history, primary infection site, and serious events. The spontaneous incidence rate of complications was 0.7% (4/554). In all cases (two males and two females), fall history was present and vertebral body infection was not suspected to be present at the point of injury. The average age was 81.8 (range, 75-89, SD, 5.7) years. The average duration from the diagnosis of OVF to the diagnosis of vertebral body infection was 55.0 (range, 16-132, SD, 52.4) days. The average C-reactive protein level at the time of diagnosis of OVF was 11.5 (range, 0.5-29.7, SD, 12.7) mg/L. Medical history included rheumatoid arthritis (n = 1), diabetes mellitus (n = 1), malignant tumor (stage IV) (n = 1), and brain infarction (n = 2). The primary sources of infection were pneumonia (n = 3), and urinary tract infection (n = 1), and all patients experienced bacillemia at/after the diagnosis of fracture. All patients died due to septic shock. The spontaneous incidence rate of vertebral body infection among OVF patients was 0.7%; however, the occurrence of this complication led to serious events. Clinicians should pay attention to the possibility of bacillemia in elderly or immunocompromised OVF patients. 4.

Effect of Obesity and Family History of Cardiovascular Diseases and Diabetes Mellitus on Levels of C-Reactive Protein in Young Male

AbstractObjective: Objective of the current study was to investigate the effect of obesity and positive family history of Cardiovascular Disease (CVD), Diabetes Mellitus (DM) on plasma C reactive protein (CRP) levels in apparently healthy young individuals.Methods: Young male Saudi students were interviewed for their personal medical and family history of Cardiovascular Disease (CVD) and Diabetes Mellitus (DM). Anthropometric parameters, height, weight, waist and hip circumference were measured. In-addition they answered perceived stress scale(PSS-14) questionnaire; Finally, Plasma C-reactive protein level was examined in all participants.Results: Results showed that the majority of our participants are overweight with mean BMI 27.113 ± 0.343 Kg/m2, but are non-stressed (24 ± 0.29). Around fifty-four per cent of participants have a positive family history of Cardiovascular Disease (CVD), Diabetes Mellitus (DM). Average Plasma CRP level was (0.267 ± 0.016 mg/dl) with 26.75% of the participants in the high-risk category. Moreover, participants that are overweight/obese and with a positive family history of Cardiovascular Disease (CVD), Diabetes Mellitus (DM) showed Significantly (P&lt;0.0001) higher levels of Plasma hs-CRP, compared to the normal weight and with negative family history. A significant correlation was also observed between hs-CRP and BMI and WC. However, stress scores were not significantly different among different groups.Conclusion: Obesity, particularly in association with a positive family history of Cardiovascular Disease (CVD), Diabetes Mellitus (DM) or one of the two diseases is a strong predictor of low-grade systemic inflammation indicated by high plasma hs-CRP level.

Effect of Biologic Material Reinforcement on Surgical Anastomosis After Gastrectomy-A Pilot Study.

Background: Acellular dermal matrix is a biologic material derived from the skin of human cadaveric donors. It has been used successfully in the past to reduce complications in breast surgery and hernia repair. This investigation was aimed at assessing the feasibility of using acellular dermal matrix to support the anastomosis after gastrectomy with the aim of reducing anastomotic site leakage complications.Methods: Patients were randomly assigned to standard anastomotic reconstruction (control arm) or anastomotic reconstruction with acellular dermal matrix reinforcement (intervention arm). Surgical outcomes related to anastomotic complications were collected. Because actual anastomotic leaks found on imaging studies are infrequent and thus require a very high number of patient recruitment to detect statistically significant difference between the two groups, in this pilot investigation other clinical and laboratory measures that have been shown to correlate to or predict anastomotic leaks were also collected. Each surgical outcome was compared.Results: A total of 94 patients (intervention arm: 50, control arm: 44), were included in the analysis. Two patients in the control arm (4.55%) and one patient in the intervention arm (2.00%) experienced anastomotic leakage (p = 0.598), a difference without statistical significance. However, average postoperative C-reactive protein (CRP) levels and NUn scores, both of which have been shown to reflect likelihood of progressing to anastomotic leakage, were significantly lower for the intervention arm. The control arm showed an average CRP level of 128.77 mg/dL (SD: 97.08) while the intervention arm showed 77.38 mg/dL (SD: 49.08, p = 0.049).Conclusions: Leakage rate reduction with acellular dermal matrix reinforcement of anastomotic site was not detected in this investigation. However, postoperative inflammation levels and numerical predictors of anastomotic leakage development were significantly lower with acellular dermal matrix reinforcement of surgical anastomosis. This finding is worthy of further investigation, as reduction of inflammation with anastomotic site reinforcement is a novel finding, and more in-depth research may lead to discoveries on the physiologic role of the surgical anastomosis in post-gastrectomy patients. In addition, lower CRP and NUn scores for the intervention arm suggest potential for larger studies to detect reduction in clinical leak rates after acellular dermal matrix reinforcement.

1249. Images vs. C-Reactive Protein Follow-up of Patients with Organ/space Surgical Site Infections

BackgroundEnd-of-treatment images of infections after intra-abdominal infection could increase costs. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are used to define and predict the evolution of infectious diseases. The aim of this study was to describe clinical outcomes of adult patients with end-of-treatment images or CRP and ESR follow-up, during treatment of organ/space (OS) (intra-abdominal) surgical site infection (SSI).MethodsObservational retrospective cohort. Hospitalized patients older than 16 years were included, who developed OS SSI after abdominal surgery, in a general hospital, from June 2014 to June 2018. Population variables: age, gender, comorbidities (cancer, diabetes mellitus, cirrhosis, chronic renal failure, tobacco, immunosuppressants, Charlson score and obesity), ESR, quantitative CRP, imaging study (tomography (CT)/ ultrasound), type of drainage route (surgical, percutaneous). Outcomes variables: antibiotic patient-days, time to infection (TTI), CRP and ESR at the time of diagnosis (TD) and at the end of treatment (TET), rate of relapsing infection. Statistical analysis: Description of variables sort by patients under images follow-up and patients under CRP and ESR follow-up. Fisher test of relapsing infection was calculated between groups.ResultsIncluded: 76 patients. Twenty-six were followed with CT or ultrasound and 50 were followed with CRP and ESR. Forty women, with a mean age of 55 years (19–91) and an average score of the Charlson of 3.64 (0–10). Forty patients had cancer before surgery (52.63%). Microbiological diagnosis: 70/76 patients, the majority was polymicrobial. Average of antibiotics patient-days was 24.4 days (14 days of intravenous therapy). TTI: 8.65 days. Average CRP at the TD was 87.5 mg/L and 17.5 mg/L at TET. No differences in ESR values (31.9 mm to 33.5 mm). Percutaneous drainage: 46 patients. Surgical procedure: 27. Relapsing infection: 11,5% in images group vs. 4% in no images group; P = 0.33.ConclusionQuantitative CRP monitoring was useful to guide the duration of antimicrobial treatment. No differences of relapsing infection between groups was found.Disclosures All authors: No reported disclosures.

The effect of appendix diameter on perforation in acute appendicitis cases

Objective: The aim of the study is to examine the association between appendix diameter and perforation and to show the significance of appendix diameter in acute appendicitis cases. Method: The data of 286 cases who were older than 18 years of age and who were operated in a tertiary hospital between 2017 and 2018 with a diagnosis of acute appendicitis were examined retrospectively. The patients’ ages, genders, pathology results, appendix diameter at abdominal tomography, white blood cell (WBC) and C-reactive protein (CRP) values were analyzed. The patients were grouped in three as perforated, non-perforated and negative appendectomy group. Results: Of the 286 patients operated with a diagnosis of AA, 166 (58%) were male, while 122 (42%) were female and average age of the patients was 37±16.79 years. Non-perforated group consisted of 194 patients, while perforated group consisted of 56 patients and negative appendectomy group consisted of 36 patients. Average appendix diameter of the patients was 8.84±3.29 mm, while average WBC value was 13071±3726/mm 3 and average CRP value was 3.44±5.15mg/L. When the patients’ appendix diameters and CRP values were compared, statistically significant difference was found between the groups (p<0.001). Average value of white blood cell was the lowest in negative appendectomy group, while it was the highest in perforated group. There was a statistically significant difference between negative appendectomy group and the other two groups in terms of white blood cell (p<0.001). There was a positive correlation between the groups in terms of appendix diameter, white blood cell and CRP (p<0.001). Conclusions: Appendix diameter is important in the diagnosis of acute appendicitis and detection of perforated appendicitis. Appendix diameter is correlated with white blood cell and CRP.

Percutaneous Pedicle Screw Fixation Alone Versus Debridement and Fusion Surgery for the Treatment of Early Spinal Tuberculosis: A Retrospective Cohort Study.

BackgroundAdvances in diagnostic imaging techniques make it possible to detect tuberculosis (TB) lesions earlier, when only bone destruction or inflammatory infiltration is demonstrated. These techniques provide doctors with more opportunities to treat TB in the early stages of the disease. Traditional aggressive debridement surgery increases the risk of surgical complications. Therefore, we aimed to determine whether using percutaneous pedicle screw (PPS) fixation alone for the treatment of early spinal TB was a valid and less invasive surgical technique.Material/MethodsWe retrospectively reviewed the clinical and radiographic outcomes in cases with thoracic or lumbar TB treated with PPS surgery or hybrid surgery between January 2010 and January 2017. The operative time, blood loss, length of hospital stay, and hospitalization costs in the 2 groups were recorded and compared. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) before and at 18 months after surgery were tested to evaluate TB progress. Back pain was measured using the visual analog scale (VAS) before the operation and at the final follow-up. Radiological outcomes were evaluated at 1, 6, 12, and 18 months after surgery. A paired t-test was used to evaluate preoperative and postoperative clinical outcomes using SPSS 19.0 software. P values less than 0.05 were considered to be significant.ResultsA total of 42 patients were involved in this retrospective study. In both groups, the average preoperative ESR, CRP level, and VAS score for back pain significantly decreased after surgery. In the PPS group, the operative time, blood loss, hospital stay, and hospitalization costs were all significantly lower than those in the hybrid group. X-ray and CT images showed satisfactory bone fusion and good maintenance of spinal alignment in both groups at the final follow-up.ConclusionsPPS fixation alone was a valid and less invasive surgery for the treatment of early spinal TB. Furthermore, the recovery process of spinal TB can be facilitated using a “simple” internal fixation procedure, and bone fusion can be achieved without aggressive debridement and bone graft surgery.

Cumulative Inflammation Could Be a Risk Factor for Intestinal Failure in Crohn's Disease.

Intestinal failure is the most critical complication of Crohn's disease. Intestinal failure requires home parenteral nutrition, which worsens the quality of life of the patients and sometimes causes life-threatening complications. The purpose of this study was to investigate the incidence and risk factors for intestinal failure in Crohn's disease. We performed a retrospective analysis of Crohn's disease patients (162 cases) at Osaka University Hospital between January 2000 and December 2017. Kaplan-Meier analysis was used to investigate the cumulative incidence of intestinal failure. To identify the risk factors of intestinal failure, patient characteristics were analyzed by multivariate analysis, including disease classification, surgical history, medical treatment other than surgery, and cumulative inflammation was calculated using the average C-reactive protein value and disease duration. The cumulative incidence of intestinal failure 5, 10, and 15years after Crohn's disease diagnosis was 2.6%, 3.4%, and 8.6%, respectively. Multivariate analysis identified the following as independent risk factors for intestinal failure in Crohn's disease: residual small intestinal length < 200cm (odds ratio 7.51, 95% confidence interval 2.14-29.96), non-use of anti-tumor necrosis factor-alpha therapy (3.34, 1.22-10.74), and cumulative inflammation (1.01, 1.001-1.038). We created a new predictive nomogram consisting of these risk factors. Intestinal failure occasionally occurred during long-term treatment of Crohn's disease. Cumulative inflammation for the first time, in addition to short residual small intestinal length and non-use of anti-tumor necrosis factor-alpha therapy, was shown to be potential risk factors for intestinal failure in Crohn's disease.

C-reactive protein as predictor of anastomotic complications after minimally invasive oesophagectomy.

Background:Anastomotic leaks after oesophagectomy with tabularised stomach replacement are a significant factor in post-operative mortality and morbidity. Early detection and treatment of this complication allow for improving operative and oncological results. When assessing laboratory values – elevation of inflammatory parameters – complicated interpretation is an issue (systemic inflammatory response syndrome, surgical versus non-surgical complication). Results studying the relationship between C-reactive protein (CRP) and complications following oesophagectomies are inconsistent. The aim of our work was to find relationships between the development of post-operative CRP values and the occurrence of anastomotic complications following minimally invasive oesophagectomy (MIE).Materials and Methods:Analysis of the relationship between CRP values and the occurrence of anastomotic complications or the necessity of reoperation following oesophagectomy with tabularised stomach replacement and cervical anastomosis performed using thoracoscopy and laparoscopy in a group of patients operated on for malignancies at our department between 2012 and 2015.Results:A significant difference was found in average CRP values on the 5th day and 7th day following operation between patients with and without leaks (233 mg/l vs. 122.8 mg/l P = 0.003, respectively 208.9 mg/l vs. 121.3 mg/l P = 0.014). However, on the 5th day, the leak was clinically apparent only in one case out of 11 leaks. A significant difference in CRP values on the 5th day was found between patients who needed revision surgery and patients without revision surgery (294 mg/l vs. 133.5 mg/l P = 0.01).Conclusions:Patients after MIE with tabularised stomach replacement and cervical anastomosis complicated by anastomotic leaks or with the necessity for reoperation had a significantly higher CRP values on the 5th day following operation than patients without complications, regardless of the presence of clinical signs of leaks.