C-reactive Protein In Group Research Articles

C‐reactive protein, delirium, and other psychological symptoms among patients with advanced cancer

AbstractBackgroundIt remains unclear whether a relationship exists between elevated C‐reactive protein (CRP) levels and delirium. The primary aim was to investigate the relationship between CRP and delirium in advanced cancer.MethodsThis study was a multicenter prospective cohort study conducted in palliative care units. At baseline, the physicians diagnosed delirium. On the seventh day, they evaluated whether new delirium had occurred. Subjects were divided into four groups according to CRP levels. We assessed the associations between CRP levels and proportions of delirium. To evaluate the relationship between CRP and delirium, adjusted odd ratios (ORs) and 95% confidence intervals (CIs) were calculated in the logistic models.ResultsAmong 1896 patients, 1354 patients were eligible for analyses. We classified them into four groups: low (CRP < 1 mg/dl) (n = 170), moderate (1 ≤ CRP < 5 mg/dl) (n = 453), high (5 ≤ CRP < 10 mg/dl) (n = 334), and very high (10 mg/dl ≤ CRP) (n = 397). The incidence of delirium significantly increased with increasing CRP levels (P = 0.02). In model 1, significantly higher adjusted ORs than in the low CRP group were observed in the high CRP and very high CRP groups (1.63 [95% CI 1.06–2.50], P = 0.03; 1.72 [95% CI 1.13–2.62], P = 0.01, respectively). In model 2, a significantly higher adjusted OR than in the low CRP group was observed in the very high CRP group (1.61 [95% CI 1.05–2.45], P = 0.03).ConclusionsRelationships existed between elevated CRP levels and delirium.

Elevated Serum C-reactive Protein (CRP) Level Predicts Increased Post-Implant Mortality in Patients Undergoing HeartMate 3 LVAD Implantation

C-reactive protein (CRP) emerged as a biomarker of inflammation in heart failure patients and associated with increased morbidity and mortality. We hypothesized that higher serum CRP level prior to Heartmate 3 LVAD implantation is associated with increased risk of post-implant adverse events and mortality. 123 patients who underwent Heartmate 3 LVAD implantation at a tertiary care center and had a CRP level measured prior to device implant were included in the analysis. Optimal CRP cut-off was determined used ROC curve and patients were categorized into high vs. low CRP groups accordingly. Study end-points included RVAD use, need for CVVH, in-hospital mortality, and 2-year survival. Mean and median pre-implant CRP levels in HM3 patients were 35.5±43.6 mg/L and 15.0 mg/L respectively. Patients with an elevated pre-implant CRP (≥12 mg/L) were more likely to be in INTERMACS Class I or II (78.4% vs. 46.6%), to have temporary MCS (49.2% vs. 27.5%), and elevated WBC count (9.1 vs. 7.5) compared to those with a pre-implant CRP less than 12 mg/L (all p <0.05). High CRP group had significantly higher RVAD use (32.3% vs. 15.5%, p=0.030), need for CVVHD (13.8% vs. 3.4%), and in-hospital mortality (14.0% vs. 1.8%, p=0.028). Patients with elevated pre-implant CRP had significantly lower survival compared to those with lower pre-implant CRP (74.2% vs. %96.1, log-rank p =0.020) and a trend-towards lower freedom from post-implant stroke (%89.2 vs. %98.3, log-rank p =0.072) at 2-year follow-up (Figure). After adjustment for age, ischemic etiology, creatinine, bilirubin, albumin, and INTERMACS Class, high CRP (≥ 12 mg/L) remained as an independent predictor of survival on LVAD support (HR 3.81 [1.35 - 10.75], p=0.011). Pre-implant CRP is a strong predictor of morbidity and mortality in patients undergoing HM3 implantation. Routine assessment of CRP prior to implant may improve patient selection and outcomes in this population.

The Pre-Treatment C-Reactive Protein Represents a Prognostic Factor in Patients with Oral and Oropharyngeal Cancer Treated with Radiotherapy.

The purpose of the present study was to evaluate the prognostic significance of the pre- treatment C-reactive protein (CRP) level in a cohort of 503 patients with oral and oropharyngeal cancer treated at a tertiary academic center between 2000 and 2017. Cancer-specific survival (CSS), overall survival (OS) and loco-regional control (LC) were calculated using Kaplan-Meier analysis. To evaluate the prognostic value of the CRP level for the clinical endpoints, univariate and multivariate Cox regression models were applied. The median follow-up period was 61 months. Patients were divided into elevated CRP (≥5 mg/L) and normal CRP groups, according to pre-treatment plasma levels. An increased CRP level was significantly associated with shorter CSS (p < 0.001, log-rank test), as well as with shorter OS (p < 0.001, log-rank test) and loco-regional control (p = 0.001, log-rank test). In addition, multivariate analysis identified CRP as an independent predictor for CSS (hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.08–2.35; p = 0.020) as well as for OS (HR 1.62, 95%CI 1.17–2.24; p = 0.004) and LC (HR 1.50, 95%CI 1.06–2.14; p = 0.023). In subgroup analysis, Kaplan Meier curves revealed that an elevated pre-treatment CRP level was a consistent prognostic factor for poor CSS (p = 0.003, log-rank test), OS (p = 0.001, log-rank test), and LC (p = 0.028, log-rank test) in patients treated with definitive (chemo-) radiotherapy, whereas a significant association in patients undergoing surgery and postoperative radiotherapy was not detected. The pre-treatment CRP level seems to represent a prognostic factor for CSS, OS, and LC in patients with oral and oropharyngeal cancer, particularly in those treated with definitive (chemo-) radiotherapy. Additional large-scale prospective studies are warranted to confirm and extend our findings.

Survey of Japanese dermatological vasculitis specialists on cases of cutaneous arteritis (cutaneous polyarteritis nodosa).

We developed a questionnaire to examine the findings of cutaneous arteritis among dermatological specialists experienced in vasculitis as certified by the Committee for guidelines for the management of vasculitis and vascular disorders of the Japanese Dermatological Association. We sent a questionnaire to 12 dermatological facilities identified through the revised Committee for guidelines for the management of vasculitis and vascular disorders of the Japanese Dermatological Association. Retrospective data obtained from 84 patients at the 12 dermatological facilities between 2012 January 2016 December were evaluated. The 84 patients were categorized into two groups, a systemic steroid treatment group (group 1, n=52) and a no systemic steroid treatment group (group 2, n=32). C-reactive protein in group 1 patients was significantly higher than that in group 2 patients. Frequency of fever, arthritis, myalgia- and peripheral neuropathy in group 1 was significantly higher than that in group 2. We propose that these symptoms could serve as early markers for the transfer from cutaneous arteritis to systemic polyarteritis nodosa. We further suggest that patients who are subsequently associated with cerebral hemorrhage and infarction, who are originally diagnosed as having cutaneous arteritis, could progress to systemic polyarteritis nodosa. The study demonstrated that it is important for dermatologists to detect these findings early in order to establish an accurate diagnosis and a timely treatment.

Prognostic Values of LDH and CRP in Cervical Cancer.

PurposeCervical cancer is one of the deadliest tumors among women in China. C-reactive protein (CRP), an indicator of inflammation, and lactate dehydrogenase (LDH), an enzyme ubiquitously expressed in cells, both play important roles in tumor growth and metastasis.Patients and MethodsBased on pre-radiotherapy LDH and CRP median levels, we divided patients into four groups: high LDH and CRP group, high LDH group, high CRP group, and low LDH and CRP group. Then, based on pre-/post-radiotherapy LDH and CRP ratios, we divided patients into four groups: high LDH and CRP ratio group, high LDH ratio group, high CRP ratio group, and low LDH and CRP ratio group. Kaplan–Meier (KM) curves were constructed to show overall survival (OS). A multivariate Cox regression model was employed to identify the independent risk factors.ResultsHigh pre-radiotherapy LDH and CRP levels and increased pre-/post-radiotherapy LDH and CRP ratios were correlated with worst OS compared with the other three groups.ConclusionLDH and CRP were correlated with outcomes in patients with locally advanced cervical cancer.

Low or no CRP at the point of admission to a medical admissions unit is associated with a low rate of 48-hour antimicrobial review amongst patients prescribed antibiotics

Introduction: Antibiotic resistance is rising and multi-resistant organisms are readily being identified; therefore fear of mortality rates rising due to infection is becoming a genuine prospect. We sought to measure clinical review post antimicrobial prescription in two acute hospitals in Wales to establish whether review is undertaken at 48-hours and whether likelihood of clinical review taking place depends on C reactive protein (CRP) levels on admission. Methods: An audit across two hospitals in South Wales assessing compliance of antimicrobial review as recommended by NICE guidelines was undertaken over a three week period. In addition, univariate odds ratios for 48-hour referral stratified by CRP test results (excluding patients with no CRP test) were calculated in a logistic regression model using the high CRP group as the referent. Following initial results intervention (education and prompt stickers) were introduced to prompt 48-hour review. Results: 139 patients were included in the pre-intervention audit from both sites. 53% were reviewed at 48 hours. Initial interventions demonstrated an improvement in compliance in all CRP categories. In the logistic regression analysis setting the highest CRP group (CRP &lt;=100) as referent showed that the likelihood of a 48 hour review was lower in patients with lower CRP test results, or no CRP test than those with a CRP of &gt;=100. Conclusion: Patients with low or no CRP on admission are less likely to have their antimicrobial prescriptions reviewed when compared 48 hours. Intervention should continue to be sought to raise awareness of this.

Relation between mean platelet volume and C-reactive protein

Mean platelet volume (MPV) is a measure of platelet activation, and C-reactive protein (CRP) is an established marker of inflammation. Studies on the correlation between MPV and CRP have produced ambiguous results. We undertook a population study with the National Health and Nutrition Examination Survey (NHANES) data (2005-2010) to investigate the relationship between CRP and MPV. CRP was analyzed both as a continuous variable and as a categorical variable (low, intermediate, or high). Multivariate ordinary least squares regression analysis was used to predict the association. Statistical analyses were performed with Stata MP 15.1. In 16,329 participants, mean MPV was 7.9 fL (standard deviation 0.87). Overall mean CRP in the population was 0.4 mg/dL (standard deviation 0.78). In adjusted regression models with CRP as a continuous measure, individuals with high CRP had significantly lower MPV (b = −0.04; standard error 0.01; 95% confidence interval −0.06 to −0.01; P = 0.002). In adjusted regression models using CRP categories, participants with high CRP (>3 mg/dL) had significantly lower MPV compared with the low CRP group (b = −0.20; standard error 0.09; 95% confidence interval −0.38 to −0.01; P = 0.035). Our study revealed a significant inverse correlation between MPV and CRP in NHANES participants.

Expression of serum BMP6 and hepcidin in cancer-related anemia

ABSTRACT Objective: To study the function of human bone morphogenetic protein-6 (BMP6) and hepcidin in cancer-related anemia. Methods: The levels of Hemoglobin (Hb), serum C-reactive protein (CRP), BMP6, hepcidin and ferritin (SF) were measured in 115 patients with solid tumors, who were divided into elevated CRP group and normal CRP group, and further divided into anemia subgroup and non-anemia subgroup according to the CRP level. Results: The prevalence of anemia was 53.9% in all patients. In the elevated CRP group, the levels of CRP, hepcidin and SF of the anemia subgroup were higher than the non-anemia subgroup (P < 0.05); the BMP6 levels had no difference between the subgroups (P > 0.05). In the normal CRP group, the BMP6 level in the anemia subgroup was higher than the non-anemia subgroup (P < 0.01); the CRP, hepcidin and SF levels showed no difference between the subgroups (P > 0.05). Among the 115 patients, CRP and SF were both positively correlated with hepcidin (P < 0.05), and CRP and hepcidin were negatively correlated with Hb (P < 0.05), while SF had no correlation with Hb (P > 0.05); BMP6 was negatively correlated with Hb (P < 0.05) while had no correlation with CRP, hepcidin and SF (P < 0.05). Conclusions: The occurrence of anemia in patients with elevated CRP is associated with hepcidin over-expression, while in patients with normal CRP is associated with BMP6 over-expression. We speculate BMP6 and hepcidin likely play different roles in the occurrence of cancer-related anemia.

The Effect of Mindfulness-Based Stress Reduction Group Counseling on Psychological and Inflammatory Responses of the Women With Breast Cancer.

Introduction: Breast cancer is common among women and reduces their quality of life. The current study aimed to investigate the effectiveness of mindfulness-based stress reduction group counseling in alleviating psychological responses such as anxiety, depression, stress, and regulating laboratory tests including cortisol and C-reactive protein (CRP) in women with breast cancer. Methods: This randomized clinical trial was conducted based on convenience sampling. Participants were divided into 2 groups (control and intervention groups) with block randomization. The intervention group received mindfulness-based stress reduction group counseling during 8 weeks. The participants completed the Beck anxiety inventory, Beck-II depression inventory, and perceived stress scale before and after the intervention and their blood samples were taken to check their cortisol and CRP. Results: After the intervention, the MBSR group had significantly lower anxiety compared with the control group (P < .001). No significant difference was found between the 2 groups in the reduction of perceived stress and depression (P < .05). In addition, no significant difference was found between the 2 groups in CRP and cortisol levels after the intervention (P > .05). Conclusion: The present study showed the effectiveness of mindfulness-based cognitive therapy in improving anxiety rather than the stress, depression, and inflammatory laboratory factors such as cortisol and CRP in women with breast cancer. Therefore, the psychological symptoms of these patients can be improved at different stages of treatment by providing this type of training.

C-Reactive Protein as a Predictor for Early Intervention in Patients with Ureteric Calculus- A Prospective Study

Introduction: Inflammation of ureteric wall may impede the passage of calculus which reduces the chances of spontaneous expulsion. C-Reactive Protein (CRP) being an acute phase reactant elevates in almost all inflammatory conditions. Aim: To determine whether CRP levels can predict the need for early intervention in symptomatic ureteric calculus. Materials and Methods: The sample was estimated to be 140 patients over the age of 18 years during the study duration of six months. Ureteric calculus measuring 5-10 mm were subjected to Medical Expulsion Therapy (MET) (Silodosin 8 mg at night). CRP levels were estimated on day 1 and day 7 from the presentation. CRP less than 6 mg/L was considered normal, represented as ‘negative’ in the present study; more than or equal to 6 mg/L was taken as ‘positive’. Patients who demonstrated rising/elevated CRP were considered for early endoscopic/surgical intervention. Data was analysed by Statistical Package for the Social Sciences (SPSS) v19.00. Results: Out of the 140 patients, 56 patients had positive CRP on day 7, of which only nine patients had expelled the stone at the end of two weeks (16.07%). Out of 84 negative CRP group patients, 56 showed evidence of spontaneous calculus expulsion within one week and 18 patients at the end of two weeks and 10 patients did not demonstrate spontaneous expulsion at the end of two weeks and required intervention. The present study showed a statistically significant correlation between the positive CRP levels and the rates of spontaneous expulsion of ureteric calculus (p=0.0001). Conclusion: CRP can be used as a predictor for an early intervention of symptomatic ureteric calculus.

Preoperative C-reactive protein level has a dose-response relationship with postoperative complications in elderly patients with femoral neck fracture

To analyze the association of preoperative C-reactive protein (CRP) level with postoperative complications in elderly patients undergoing surgeries for femoral neck fracture. We retrospectively analyzed the data of 147 elderly patients (median age 80 years; 73.5% of the patients were female) undergoing surgeries for femoral neck fracture. According to preoperative CRP level, the patients were divided into normal CRP (< 10 mg/L) group (31 patients), mild elevation group (CRP level of 10-40 mg/L; 51 patients), and severe elevation group (CRP ≥40 mg/L; 65 patients). The association of preoperative CRP levels with postoperative complications was analyzed. Preoperative CRP level was significantly correlated with the occurrence of postoperative complications (P=0.003). Compared with that in normal CRP group, the unadjusted ORs in mild and severe elevation groups were 0.97 (95%CI: 0.29-3.27) and 3.04 (95%CI: 1.03-8.98) with the adjusted ORs of 1.13 (95%CI: 0.33-3.90) and 4.89 (95%CI: 1.47-16.26), respectively. Preoperative CRP level has a dose-response relationship with complications in elderly patients following arthroplasty for femoral neck fracture, and the patients with a preoperative CRP level ≥40 mg/L are exposed to a significantly increased risk for postoperative complications by 3.89 folds compared with the patients with a normal CRP level.

Allerjik Hastalıkları olan Hastaların Deri Prik Testi Sonuçlarının Obezite, C-Reaktif Protein (CRP) ve Serum Total IgE ile ilişkisi

Objective: To evaluate relationship between skin prick test results and serum total IgE,C-reactive protein, body mass index in patients with allergic diseases.Material and methods: This study was conducted in university hospital between October 2011 and September 2018. Skin Prick test (SPT) was applied to 433 patients in chest diseases clinic who were referred with diagnosis of asthma, allergic rhinitis, chronic urticaria and atopic dermatitis. Also patients’ serum total IgE, C-reactive protein (CRP) levels and body mass index (BMI) measurements were evaluated.Results: The study group were consisted of 433 patients, 189 (43.6%) male, and 244[G1] (56.4%) female. According to the diagnosis, 177 (40.9%) patients had asthma, 108 (24.9%) had allergic rhinitis, 82(18.9%) had atopic dermatitis and 66 (15.2%) had chronic urticaria. SPT was positive in 285 (65.8%) patients while negative in 148(34.2%). Most frequently seen allergens were the mixture of trees 23.2%, home dust 19.2%, savage grass 14.8%. Total IgE, CRP, and BMI values were statistically higher in SPT positive group. (p[G2] ˂0.001). Obese patients had statistically significant positive skin prick results (p=0.036). Also, positive total IgE and CRP groups were significantly higher in positive SPT group (p ˂0.001 and p=0.008). There was a moderate level and significant positive correlation between total IgE levels and SPT (r=0.463, p˂0.001). Also CRP levels (r= 0.128, p=0.008) and obesity (r=0.101, p=0.036) had a low level and significant positive correlation with SPT. Only total IgE was the statistically significant risk factor for [G3] the SPT.[G4] Positive total IgE level increases the probability of positive SPT by 8.11 times. Conclusion: This study suggests that elevated levels of total IgE, CRP and obesity may have relationship with atopy by increased likelihood of positive skin prick test. Positive Total IgE level can be a strong predictor for skin prick test positivity.

The impact of postoperative inflammation on recurrence in patients with colorectal cancer.

Systemic inflammatory response is strongly linked to among cancer development, progression and poor prognosis. The aim of this study was to clarify the impact of postoperative serum C-reactive protein (CRP) levels on the prognoses of patients with colorectal cancer (CRC). A total of 467 patients with stage I-III CRC who underwent curative surgery were retrospectively analyzed. To precisely evaluate the effect of postoperative inflammatory status on prognosis in CRC patients, we excluded patients with postoperative complication or elevated preoperative CRP level (CRP > 1.0mg/dL). Patients were divided into two groups based on their highest post-resection CRP levels (max CRP): the low CRP group (LCG; < 9.0mg/dL, n = 385) and high CRP group (HCG; ≥ 9.0mg/dL, n = 82). Furthermore, the effect of inflammation on malignant potential of CRC cells was evaluated using in vitro peritoneal dissemination model. HCG patients showed significantly worse recurrence-free survival (RFS) than LCG patients (p = 0.012). Multivariate analysis revealed that a higher max CRP was an independent prognostic factor for RFS (HR: 2.07, 95% CI 1.04-3.96, p = 0.038). Concerning the risk factors for high max CRP level, multivariate analysis revealed that older age (p < 0.001), male sex (p < 0.001), higher BMI (p = 0.005), right-sided colorectal cancer (p = 0.008), and longer operative time (p = 0.007) were independent risk factors. A higher max CRP was also significantly associated with peritoneal recurrence (p < 0.001). Additionally, recombinant cytokines enhanced the adhesive ability of CRC cells to mesothelial cell in vitro (p < 0.05). Postoperative inflammation may be a possible mechanism portending the poor prognosis of CRC patients.

Role of sterile pyuria in association to elevated PSA values in the diagnosis of non-palpable prostate cancer?

Although cancer is believed to develop and progress with the involvement of inflammation, it is still unclear what the correlation between inflammation and prostate cancer is. This study based on results of transrectal ultrasound-guided prostate biopsies aimed to determine whether C-reactive protein (CRP) and sterile pyuria were clinically useful in the evaluation of patients with suspect of prostate cancer. This study is a cross-sectional prospective study of patients without clinical prostatitis symptoms. Characteristics of the 200 consecutive patients recruited were 3-20 ng/mL value of serum prostate-specific antigen (PSA), normal digital rectal examination finding, and sterile urine culture result. All patients underwent 12-core prostatic biopsy. 163 of the 200 patients had benign prostatic hyperplasia confirmed through histology, while the residual 37 patients had prostate cancer. Patients with pre-treatment urinary leukocyte count ≤ 3/high power field were categorized as non-pyuria, whilst those with pre-treatment urinary leukocyte count > 3/high power field were categorized as pyuria. The serum CRP level was also used to differentiate patients before the biopsy. Subgroups were compared regarding a number of clinical variables. Histology revealed that 70% of pyuria patients and 38.5% of non-pyuria patients presented inflammation (p = 0.001). The pyuria group exhibited significantly higher total PSA compared to the non-pyuria group (p = 0.044). The two groups did not differ significantly regarding cancer detection rate (p = 0.752). CRP groups were similar regarding cancer detection and histologically-detected inflammation rates. In patients with no evidence of clinical prostatitis, sterile pyuria should be considered as a cause of increased PSA. Although sterile pyuria cannot predict non-palpable prostate cancer, it should be taken into account in urological evaluation in order to demonstrate minute prostatic inflammation due to its simplicity, convenience and non-invasiveness.

P3798High levels of C-reactive protein after coronary artery bypass graft surgery is associated with postoperative atrial fibrillation

Abstract Background Postoperative atrial fibrillation (POAF), a common complication following coronary artery bypass graft (CABG) surgery, is associated with increased morbidity and mortality. Inflammation seems to be an important pathogenic factor and elevated preoperative levels of C-reactive protein (CRP) are associated with POAF. However, the association between postoperative CRP and POAF is less established. Purpose To examine the association between postoperative levels of CRP and POAF after CABG. Methods Patients undergoing first-time isolated CABG (Jan 01, 2000 to Dec 31, 2016) were identified using Danish nationwide administrative registries. Patients with CRP measurements from the fourth postoperative day and no history of atrial fibrillation were included. POAF was defined as a postoperative atrial fibrillation rhythm that required medical therapy or cardioversion, with patients being followed for POAF until discharge. The study population was divided into quartiles based on CRP levels. A Cochran-Armitage trend test was used to examine the trend of increased levels of CRP and the associated risk of POAF. The association between CRP levels and POAF was investigated using a multivariable logistic regression analysis adjusted for other patient characteristics. Results The study included 6,711 patients with mean CRP values from the lowest to the highest CRP groups being 66, 109, 150 and 228 mg/L, respectively. Patients in the highest CRP group were older and more likely to be male compared with the lowest CRP group (median age 67 years [P25-P75: 61–73] and 84.7% men vs. median age 64 years [P25-P75: 56–70] and 77.9% men). In the highest CRP group, 35% of patients developed POAF vs. 25% in the lowest CRP group. A dose-response relationship was seen between increasing levels of CRP and the associated risk of POAF (p&lt;0.0001 for trend). An adjusted analysis showed a statistically significant association between the highest CPR group and POAF (OR: 1.44; 95% CI: 1.24–1.69) compared with the lowest CRP group (figure 1). Conclusion High postoperative CRP levels after CABG were associated with POAF development. Future studies may examine whether CRP also predicts worse outcomes and whether these factors could be modified in the development of POAF. Acknowledgement/Funding Internal grant from Copenhagen University Hospital

2929 Correlation of Body Mass Index (BMI) and C-Reactive Protein (CRP) With Inflammatory Bowel Disease Progression in an Urban, Afro-Caribbean Population

INTRODUCTION: Inflammatory Bowel Disease (IBD) is associated with changes in body composition of patients. Recent studies have shown that the prevalence of obesity is rising in patients with IBD, where 15-40% of adults are obese and 20-40% are considered overweight. One prospective study analyzed body composition in IBD patients overtime and noted that despite an overall increase in adiposity, the total muscle mass was decreased. Low lean muscle mass has an association with poor response to therapy, surgical outcomes and the quality of life in IBD patients. Low C-reactive protein (CRP) levels after initiation of anti-TNF therapy have been associated with mucosal healing on surveillance colonoscopies and clinical disease remission. The aim of this study is to analyze the association between BMI and CRP with progression of IBD, using anti- TNF use as a surrogate marker for disease severity. METHODS: Medical records at Kings County Medical Center in Brooklyn, New York were queried for patients with the ICD 9 and 10 code diagnoses for Crohn's disease (CD) and Ulcerative Colitis (UC) from 2015 to 2018. Biographical, laboratory and endoscopic data, including BMI and CRP, was collected and analyzed. RESULTS: 148 patients with IBD were analyzed from 2015-2018; where 57.2% had UC and 42.8% had CD. Mean age of patients was 47.4 years, and 53.4% of patients were females. The average BMI prior to initiation of therapy was 27.6 kg/m2. The average years diagnosed with IBD was 11.1 years. Of the total patients, 37 were on biologic therapy. In the BMI group, the odds ratio was 0.905 indicating that patients with a lower BMI had more severe disease. The P value was 0.068, not significant but trended towards significance. In the CRP group, the odds Ratio was 1.020, which signified that patients with higher CRP values had more severe disease, with a P value of 0.046. CONCLUSION: The results of our small retrospective study suggest that a lower BMI and higher CRP are independent predictors of severe disease. Our study demonstrated that severe IBD, as measured by anti-TNF use, is associated with high CRP levels. We believe that low BMI and high CRP measurements may be used in conjunction with endoscopic findings and clinical presentation to escalate therapy early preventing worsening of disease. Further studies can be done to also incorporate endoscopic scoring system on surveillance colonoscopies to confirm the correlation between lower BMI and higher CRP with severity of disease.

Benefits of aerobic training in girls with precocious puberty: involvement of CRP and cortisol.

Background The aim of this study was to investigate the effect of 12 weeks of aerobic training, 4 weeks of detraining and use gonadotropin-releasing hormone agonist (GnRHa) on serum C-reactive protein (CRP) and cortisol levels in girls with central precocious puberty (CPP). Methods Forty-five girls (aged 6-8 years) with precocious puberty were randomly divided into three groups (medication, training and medicine + training groups). Fifteen healthy girls (without precocious puberty) were also included as the control group. Serum CRP and cortisol levels were measured at baseline by the enzyme-linked immunosorbent assay (ELISA) technique. Then, the experimental groups performed an aerobic training program for 3 days/week 20-75 min per day at 45-75% maximum heart rate for 12 weeks. The medication groups also received GnRHa during the study, once a month (1 mL every 4 weeks) by intramuscular injection. Serum CRP and cortisol levels were measured again 48 h after the last training session and also after 4 weeks of detraining. Results Analysis of variance (ANOVA) with repeated measures showed a significant decrease in CRP (p = 0.02) and cortisol levels (p = 0.01) in the training group and the medicine + training group. Detraining led to return of CRP and cortisol levels to the pre-training levels (p = 0.001). No significant difference in serum CRP (p = 0.43) and cortisol levels (p = 0.06) was observed in the medication group. Further, no significant difference was observed between groups in CRP and cortisol. Conclusions Long-term regular moderate training decreases inflammation indices, and detraining eliminates the benefits of training in girls with precocious puberty.

Combined Effects of A Body Shape Index and Serum C-reactive Protein on Ischemic Stroke Incidence among Mongolians in China

ObjectiveWe aimed to evaluate the combined effects of a high body shape index (ABSI) and a high serum C-reactive protein (CRP) level on the incidence of ischemic stroke in a Mongolian population in China. MethodsA prospective cohort study was conducted among 2,589 participants from June 2002 to July 2012 in Inner Mongolia, China. The participants were categorized into 4 groups according to their level of ABSI and CRP. Cox proportional hazards models were used to assess the hazard ratios (HRs) and 95% confidence intervals (CIs) for ischemic stroke among all groups. ResultsThe multivariate adjusted HRs (95% CI) of ischemic stroke for high ABSI and high CRP level were 1.46 (0.89-2.39) and 1.63 (0.95-2.79), respectively. Compared with the low ABSI/low CRP level group, the multivariate adjusted HRs (95% CI) of ischemic stroke in the low ABSI/high CRP, high ABSI/low CRP, and high ABSI/high CRP groups were 1.04 (0.46-2.35), 1.06 (0.58-1.95) and 2.52 (1.27-5.00), respectively. The HR of ischemic stroke for the high ABSI/high CRP level group was the highest and most statistically significant. ConclusionWe found that participants with simultaneously high ABSI and high CRP levels had the highest risk of ischemic stroke in the Mongolian population. Our findings suggest that the combination of high ABSI and high CRP levels may increase the risk of ischemic stroke.

Temporal Value of C-Reactive Protein and Erythrocyte Sedimentation Rate after Total Knee Arthroplasty in Patients with Elevated Preoperative C-Reactive Protein: A Matched-Pair Analysis.

Background:We aimed to determine whether temporal values of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) after total knee arthroplasty (TKA) differ between patients with and without elevated preoperative CRP. We hypothesized that temporal pattern of CRP and ESR change would differ between the two groups.Materials and Methods:This retrospective study included 30 TKAs with a diagnosis of osteoarthritis with elevated preoperative CRP (>1 mg/dl) without clinical signs and symptoms of infection before surgery (elevated CRP group). Patients without elevated preoperative CRP were matched in a 1:10 fashion according to age, sex, number of comorbidities and whether TKA was unilateral or bilateral (nonelevated CRP group). The temporal values of CRP and ESR after TKA were compared between the two groups until 2 months after surgery.Results:The mean peak values of CRP and ESR after surgery were similar between the two groups in both unilateral and bilateral TKAs. In the unilateral TKA, mean values of CRP and ESR and the proportions of the knees with normal CRP and ESR at 2 months after surgery were similar in the two groups. However, in the bilateral TKA, mean values of CRP and ESR were higher and the proportions of the knees with normal CRP and ESR at 2 months after surgery were lower in the elevated CRP group compared to the nonelevated CRP group.Conclusions:When performing TKA in patients with elevated preoperative CRP, the fact that the levels of CRP and ESR may not be normalized until 2 months after surgery should be considered during followup.

Prognostic value of serum C-reactive protein level prior to second-line treatment in intermediate risk metastatic renal cell carcinoma patients.

e16065 Background: The later-line treatment of metastatic renal cell carcinoma (mRCC) has been drastically changing by the development of immune-oncology drugs and molecular targeted treatment in recent years. Although the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model is useful for second-line setting, this model has the problem that over 50% patients are classified as intermediate risk group. The aim of this study is to evaluate whether the serum C-reactive protein (CRP) levels prior to second-line treatment could divide intermediate risk group patients. Methods: We retrospectively reviewed 150 mRCC patients received second-line molecular targeted therapy. We assessed the prognostic impact of serum CRP levels prior to second-line treatment initiation to predict overall survival (OS) especially in intermediate risk group. Results: The median OS from second-line treatment of whole cohort and intermediate risk group were 24.6 (95%confidence interval, 95%CI:18.2-31.0) and 23.6 (95%CI:15.1-32.1) months. Thirty-three out of 82 (40%) intermediate risk patients demonstrated elevated baseline CRP levels. The median OS of elevated and non-elevated CRP group were 13.4 (95%CI:5.9-20.8) and 29.4 (95%CI:25.5-33.5) months, respectively (p = 0.001). The serum CRP elevation could predict prognosis in intermediate risk patients treated with second-line treatment (HR 2.5,95%CI:1.4-4.2, p = 0.001). Conclusions: The serum CRP levels at second-line treatment initiation could divide intermediate risk mRCC patients into two prognostic subgroups.