C-reactive Protein Levels Research Articles

Chronic low-grade inflammation in patients with systemic sclerosis is associated with increased risk for arteriosclerotic cardiovascular disease

BackgroundVasculopathy is a hallmark of systemic sclerosis (SSc) putting patients at an increased risk of cardiovascular disease. Approximately 20–25% of all SSc patients show prolonged elevated C-reactive protein (CRP) levels and thus signs of chronic low-grade inflammation. While CRP−positivity is an independent predictor of cardiovascular disease in non-SSc populations, the relationship between CRP−positivity and cardiovascular health/atherosclerosis in SSc patients is only incompletely understood. Here, we aimed to assess (1) which general, SSc disease-specific and cardiovascular parameters are associated with CRP−positivity in a cohort of SSc patients with prolonged CRP elevations (CRP+ SSc group) relative to SSc patients without CRP elevations (CRP− SSc group). In addition (2), we aimed to investigate whether prolonged CRP−positivity in SSc patients is associated with a higher cardiovascular risk and an increased atherosclerotic burden. We also aimed to (3) identify via random forest classification modeling which combined cardiovascular and/or SSc-specific parameters could differentiate best between SSc patients with elevated CRP levels (the so-called “inflammatory SSc subtype”) and SSc patients without increased CRP levels.MethodsSixty-five SSc patients were recruited and assigned to the CRP+ SSc group (n = 20) if their CRP levels were > 5 mg/L in at least three half-yearly visits within 2 years before enrolment or to the CRP− SSc group (n = 45), respectively. All patients underwent an anamnesis, physical examination, blood draw, and bilateral carotid ultrasound in order to assess arteriosclerotic burden including the presence, number and height of plaques, and carotid intima–media thickness (CIMT) as well as lipid profiles. 10-year ASCVD risk was estimated via the ASCVD risk estimator plus. Statistical evaluation included Spearman’s correlations, logistic regression and random forest modeling under 5-fold cross-validation, and permutation testing to determine combinations of cardiovascular variables highly discriminatory for CRP−positivity.ResultsSSc groups showed comparable mean age, height, and extent of SSc organ involvement. Regarding cardiovascular health, CRP+ SSc patients exhibited a significantly altered HDL-, LDL-, and triglyceride profile (0.001 ≤ p ≤ 0.017) and a significantly higher 10-year ASCVD risk (p = 0.047), relative to CRP− SSc patients. Additionally, within the subgroup of CRP+ SSc patients, positive correlations between CRP levels and CIMT right (ρ = 0.657, p = 0.002) and mean CIMT left and right (ρ = 0.497, p = 0.026) were seen. Combined ROC models identified the four lipid components (HDL, LDL, total cholesterol, and triglycerides) or the SSc duration and ASCVD category to differentiate with high cross-validated ROC-AUCs (AUC: 0.83 ± 0.15, and AUC: 0.86 ± 0.09, p < 0.001) for prolonged CRP−positivity among SSc patients.ConclusionOur data indicate that persistent CRP−positivity and thus chronic low-grade inflammation in SSc patients enhance the risk for arteriosclerotic-cardiovascular disease significantly beyond the ASCVD risk observed for our SSc patients without CRP elevations. It seems to be along with a disrupted lipid profile the hallmark of a distinct “inflammatory” subgroup of SSc patients. However, large population-based studies and clinical trials in patients with SSc are needed to validate our findings in a prospective or interventional setting.

Noninvasive, Multimodal Inflammatory Biomarker Discovery for Systemic Inflammation (NOVA Study): Protocol for a Cross-Sectional Study.

Prolonged systemic inflammation is recognized as a major contributor to the development of various chronic inflammatory diseases. Daily measurements of inflammatory biomarkers can significantly improve disease monitoring of systemic inflammation, thus contributing to reducing the burden on patients and the health care system. There exists, however, no scalable, cost-efficient, and noninvasive biomarker for remote assessment of systemic inflammation. To this end, we propose a novel, multimodal, and noninvasive approach for measuring inflammatory biomarkers. This study aimed to evaluate the relationship between the levels of inflammatory biomarkers in serum (gold standard) and those measured noninvasively in urine, sweat, saliva, exhaled breath, stool, and core body temperature in patients with systemic inflammation. This study is a single-center, cross-sectional study and includes a total of 20 participants (10 patients with systemic inflammation and 10 control patients). Eligible participants provide serum, urine, sweat, saliva, exhaled breath, and stool samples for biomarker analyses. Core body temperature is measured using a sensor. The primary end point is the level of C-reactive protein (CRP). The secondary end points are interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor-α levels. The tertiary end points are fractional exhaled nitric oxide, calprotectin, and core body temperature. Samples will be collected in 2 batches, enabling preliminary analysis of the first batch (patients 1-5 from each group). The full analysis will include both batches. CRP and cytokine levels will be measured using enzyme-linked immunosorbent assay and electrochemiluminescence immunoassay. For statistical analysis, the Shapiro-Wilk test will be used to evaluate the normality of the distribution in each variable. We will perform the 2-tailed t test or Wilcoxon rank sum test to compare the levels of inflammatory biomarkers between patients with systemic inflammations and control patients. Pearson and Spearman correlation coefficients will assess the relationship between inflammatory biomarkers from noninvasive methods and serum biomarkers. Using all-subset regression analysis, we will determine the combination of noninvasive methods yielding the highest predictive accuracy for serum CRP levels. Participants' preferences for sampling methods will be assessed through a questionnaire. The study received ethics approval from the independent research ethics committee of Canton Zurich on October 28, 2022. A total of 20 participants participated in the study measurements. Data collection started on February 22, 2023, and was completed on September 22, 2023. Participants were on average 52.8 (SD 14.4; range 24-82) years of age, and 70% (14/20) of them were women. The analysis results reporting findings are expected to be published in 2025. This study aims to evaluate the feasibility of noninvasive, multimodal assessment of inflammatory biomarkers in patients with systemic inflammation. Promising results could lead to the creation of noninvasive and potentially digital biomarkers for systemic inflammation, enabling continuous monitoring and early diagnosis of inflammatory activity in a remote setting. DERR1-10.2196/62877.

An infant case of coronary artery aneurysms with no systemic symptoms after treatment for Kawasaki disease.

This case is a 4-month-old patient with Kawasaki disease who showed coronary artery lesions after a disease relapse. Following the guidelines from the Randomised Controlled Trial to Assess Immunoglobulin plus Steroid Efficacy, the patient initially saw an improvement in symptoms. However, a relapse occurred despite low levels of C-reactive protein, leading to significant coronary artery growth. Treatment with a third dose of intravenous immunoglobulin and cyclosporine led to a slow reduction in the size of the coronary artery abnormalities. This case highlights the difficulty in monitoring Kawasaki disease progression through clinical symptoms and C-reactive protein levels alone. We also emphasise the necessity of echocardiographic monitoring in patients receiving anti-inflammatory treatments, including steroids, because coronary artery problems can arise or continue without the usual signs of Kawasaki disease or increased C-reactive protein levels.

Prevalence and aggravation of cervical spine instabilities in rheumatoid arthritis during over 10 years: a prospective multicenter cohort study.

We designed a prospective multicenter cohort study to clarify along-term, > 10-year prevalence and aggravation of cervical spine instabilities in rheumatoid arthritis (RA). In 2001-2002, 634 outpatients were enrolled, and 233 (36.8%) were followed for > 10 years. Cervical spine instability was defined as atlantoaxial subluxation (AAS, > 3-mm atlantodental interval), vertical subluxation (VS, < 13-mm Ranawat value), and subaxial subluxation (SAS, ≥ 2-mm irreducible vertebral translation). The aggravation was determined as ≥ 2mm decrease of the Ranawat value in VS, ≥ 2-mm increase of slippage in SAS, and these new developments. The prevalence of VS and SAS increased during both the initial and last > 5 years (all, p ≤ 0.049). While VS aggravation was associated with pre-existing AAS (p = 0.007) and VS (p = 0.002), SAS aggravation correlated with pre-existing VS (p = 0.002). Multivariable analysis found hand mutilating changes (odds ratio [OR] = 4.048, p = 0.008), RA duration ≥ 5 years (OR = 3.711, p = 0.013), C-reactive protein (CRP) level ≥ 3.8mg/dL (OR = 2.187, p = 0.044), and previous joint surgery (OR = 2.147, p = 0.021) as predictors for VS aggravation. Pre-existing VS (OR = 2.252, p = 0.024) and CRP ≥ 1.0mg/dL (OR = 2.139, p = 0.013) were disclosed as predictors for SAS aggravation. Low disease activity and clinical remission before the development of VS and advanced peripheral joint destruction are essential to prevent progressive cervical spine instability in RA.

The effects of spondylodiscitis on the inflammation burden in infective endocarditis.

This study investigates the effects of spondylodiscitis on the inflammation burden in infective endocarditis patients. Aprospective, observational study was conducted between September 2018 and October 2022 in anon-surgical teaching hospital. Patients with adefinite or possible and treated as infective endocarditis were recruited from the Alkmaar Endocarditis Team meetings. Spondylodiscitis was diagnosed based on symptoms and radiological findings. The inflammation burden was defined as the area under the C‑reactive protein (CRP) curve. 174 consecutive patients with infective endocarditis were included (mean age73years, 34.5% female). Concomitant spondylodiscitis was present in 32patients (18%), frequently associated with Streptococcus species (38%). At admission, the mean level of CRP was significantly higher in patients with concomitant spondylodiscitis (p = 0.004). The median CRP area under the curve was significantly higher in spondylodiscitis patients (4.2 × 106 min.mg/l [1.2 × 105 - 1.6 × 107 min.mg/l] vs 2.0 × 106 min.mg/l [8.7 × 104 - 1.6 × 107 min.mg/l], p < 0.001). This difference remained during the whole treatment period. At 6months of follow-up, rates of mortality and relapse of infective endocarditis were not significantly different. The prevalence of spondylodiscitis in non-referred patients with infective endocarditis was 18%. Endocarditis patients with spondylodiscitis had an increased inflammation burden at and during admission. This difference in normalisation of CRP levels was particularly apparent in the final phase of antibiotic treatment but not related to infectious complications. Despite an augmented inflammation burden, spondylodiscitis was not associated with mortality, cardiac surgery or infectious relapse.

The possibility of using synovial C-reactive protein, interleukin-6 and presepsin in the diagnosis of periprostheticjoint infection.

The diagnosis of infectious complications in joint prosthetics remains a pressing issue, especially in cases where pathogens do not grow during the seeding of biological material. This study analyzed the potential use of synovial biomarkers for the diagnosis of periprosthetic infections (PPI), based on literature data. The aim was to determine the significance of synovial C-reactive protein (CRP), interleukin-6 (IL-6), and presepsin in diagnosing PPI. Materials and methods: A prospective, single-center, blinded study was conducted on patients undergoing revision arthroplasty for both infectious and aseptic inflammation in the endoprosthetic area. The study included 66 patients, divided into two groups: Group I included 17 patients with periprosthetic infection diagnosed according to the ICM Philly criteria of 2018; and Group II included 49 patients with aseptic inflammation in the endoprosthetic region.Synovial fluid samples from all participants were analyzed for bacteriological and cytological analysis to determine the levels of CRP, IL-6, and presepsin. Receiver operating characteristic (ROC) analysis was performed to determine sensitivity, specificity, and accuracy, as well as thresholds for laboratory data. Results: The greatest reliability for diagnosing infectious and aseptic inflammations was shown for the number of leukocytes in synovial fluids, with an area under the curve (AUC) of 0,928 (95% confidence interval [CI]: 0,837-0,977; p0,0001), as well as for synovial CRP with an AUC of 0,776 (95% CI: 0,656-0,87; p=0,0004), and IL-6 with an AUC of 0,712 (95% CI: 0,583-0,82, p=0,0048). While the presepsin level was significantly different between groups, AUC was 0,582 (95% CI: 0,453-0,703, p=0,3344). Threshold values were calculated for CRP at 5,6 mg/L and presepsin – 1212,0 pg/mL and IL-6 – 988,5 pg/mL. The sensitivity, specificity, and accuracy of the diagnosis of PPI were 62,5%, 85,71%, and 80%, respectively for CRP; 68,5%, 63,04%, and 68,7% for IL-6; and 43,75%, 79,59%, and 70,77% for presepsin. Conclusion: IL-6 has the highest sensitivity for PPI, but it has lower accuracy and specificity than CRP. Presepsin has the lowest sensitivity, specificity and accuracy for the diagnosis of PPI.

Influence of Inflammatory State on the Need to Customize Parenteral Nutrition in Adolescents.

Parenteral nutrition (PN) can be standardized or customized according to a patient's individual needs, including clinical, metabolic, nutritional, and inflammatory conditions. The influence of inflammation on the indication of standard or customized PN for adolescents hospitalized in a quaternary hospital in the southeastern of Brazil was evaluated. A historical cohort study of 61 adolescents admitted to the hospital was conducted. Nutritional, clinical, and biochemical data from the first 7 days of PN use were analyzed. Elevated serum mineral and triglyceride levels, as well as renal or liver failure (grade III or IV), were considered unequivocal reasons for PN customization, while restoring energy-protein adequacy and low serum mineral levels were considered questionable reasons. Inflammatory status was analyzed during the study period. A total of 128 PN solutions were prescribed, comprising 55 standardized and 73 customized. Overall, 40/61 patients required customized PN. The main reason for customization was to restore energy-protein adequacy (n = 48), while 24.7% (n = 18) of individualizations were for unequivocal reasons. Restoring energy-protein adequacy in the first 48 h was shown to have contributed to high transthyretin, which reduced the need for additional customized PN (r = -0.544; p = 0.044). A positive correlation was found between the total number of PN readjustments and C-Reactive Protein levels (r = 0.509; p = 0.044). Conditions such as malnutrition or an inflammatory state in adolescents presenting metabolic changes are indications for the use of customized PN.

The safety of cell saver washing all shed mediastinal blood before re-transfusing it to the patient.

Cardiotomy suction blood is used in cardiopulmonary bypass (CPB) surgery to maintain blood volume in the CPB system, although it is known to contain micro emboli, cytokines and free plasma hemoglobin. Our aim was to investigate whether cell saver washing the cardiotomy suction blood before re-transfusing it is safe. This is a retrospective study of 1671 elective coronary artery bypass patients, 209 of whom had their pericardial blood processed in a cell saver (Ce-S group). PS matching was performed with patients who had their pericardial blood returned back to the CPB-system by the cardiotomy suction (Ca-S group). Perioperative transfusion requirements, surgical outcome, postoperative lab data and mortality were then compared. There were no differences in baseline characteristics or EuroSCORE between the groups. The number of patients requiring transfusions did not differ, but the patients in the Ca-S group received more platelets (0.34 ± 1.0 vs 0.16 ± 0.7 units, p = .03) than in the Ce-S group. CRP (c-reactive protein) levels at day 2 and 4 were higher in the Ca-S group (174.8 ± 67.2 and 148.9 ± 74.3mg/L vs 160.1 ± 64.6 and 125.9 ± 67.2mg/L, p = .03, p = .002) and so were ASAT (aspartate aminotransferase) levels (0.97 ± 0.8 vs 0.81 ± 0.6μkat/L, p = .03). Mortality, postoperative ventilation time, stroke, mediastinal infections and length of stay in the ICU were the same in both groups. In this retrospective study of patients undergoing elective CABG surgery, washing the cardiotomy suction blood before re-transfusion was not associated with higher risk of allogenic blood transfusion, postoperative stroke, mediastinal infections, or 30- and 365-days mortality. LU EPN 2016/4.

Circulating Adipokines and Response to Treatment in Patients With Early Rheumatoid Arthritis.

The objective of this study was to determine if baseline adiponectin, leptin, and resistin levels are associated with response to antirheumatic treatment in early rheumatoid arthritis (RA). This study included 341 participants of the Nordic Rheumatic Diseases Strategy Trials and Registries trial with untreated early RA, randomized at baseline into four treatment arms: methotrexate combined with (1) prednisolone, (2) certolizumab, (3) abatacept, or (4) tocilizumab. Follow-up was up to 48 weeks. Adipokines were measured in plasma at baseline with enzyme-linked immunosorbent assay. The primary outcome for this report was the difference in remission (Clinical Disease Activity Index [CDAI] ≤2.8) over 48 weeks stratified by median adipokine levels. At baseline, levels of adiponectin and leptin were not associated with markers of RA activity, whereas participants with higher resistin levels had higher C-reactive protein (CRP) levels, swollen joint count, and Disease Activity Score in 28 joints based on CRP compared to participants with lower resistin. Overall, participants with baseline adipokine levels above the median and those with adipokine levels below the median had similar mean CDAI and changes in CDAI throughout follow-up for up to 48 weeks. Adjusted Cox proportional hazards models did not show any effect of baseline adiponectin, leptin, and resistin levels on the likelihood of achieving CDAI remission (adiponectin: hazard ratio [HR] 1.08, 95% confidence interval [CI] 0.80-1.45, P = 0.62; leptin: HR 0.89, 95% CI 0.64-1.26, P = 0.52; resistin: HR 0.86, 95% CI 0.65-1.13, P = 0.26). Baseline adiponectin, leptin, and resistin levels are not associated with the likelihood of achieving CDAI remission over 48 weeks of treatment in a large cohort of people with untreated early RA.

Characterisation of incident interstitial lung disease in late systemic sclerosis.

Interstitial lung disease (ILD) is a common and potentially lethal complication of systemic sclerosis (SSc). Screening by HRCT is recommended in all patients with risk factors, including early disease. Little is known on late presentations of ILD. This study aimed to characterize the incidence, risk factors and outcomes of late-onset SSc-ILD. Subjects enrolled in the Canadian Scleroderma Research Group (CSRG) cohort from 2004 to 2020 without prevalent ILD were included. Incidence and risk factors for ILD (on HRCT) were compared according to disease duration above (late) and below (earlier) 7 years from first non-Raynaud manifestation. Risk of ILD progression was compared using Kaplan-Meier and multivariable Cox models. Overall, 199/969 (21%) patients developed incident ILD over a median of 2.4 [1.2, 4.3] years. The incidence rate in late SSc (3.7/100 person-years) was lower than in earlier SSc (relative risk 0.68, 95%CI:0.51-0.92). Risk factors for incident ILD included male sex, diffuse subtype, myositis, anti-topoisomerase I autoantibodies and higher C-reactive protein levels. Patients with late-onset ILD were also less frequently White and more frequently had arthritis and anti-RNA-polymerase III autoantibodies. Lung disease severity was similar between late- and earlier-onset SSc-ILD (FVC 88% and 87%, DLCO 64% and 62%, respectively). Progression rates were also similar between late- and earlier-onset SSc-ILD (log-rank p=0.8, hazard ratio 1.11, 95% CI: 0.58-2.10). ILD can present in late SSc. Risk factors and progression rates overlapped with earlier-onset SSc-ILD. Surveillance for ILD should continue in longstanding SSc. Frequency and modality of monitoring remain to be defined.

Thrombocytopenia With High C-reactive Protein in Myeloma Patients Treated With Proteasome Inhibitor and/or Immunomodulatory Drugs.

Background/Aim: Thrombocytopenia is a poor prognostic factor in patients with myeloma; however, the factors associated with thrombocytopenia have not been extensively discussed. This study aimed to investigate the clinical significance of thrombocytopenia, defined as 130×103/μl or less, in patients with newly diagnosed multiple myeloma (NDMM) treated with proteasome inhibitors and/or immunomodulatory drugs. This is a retrospective review of medical records of myeloma patients treated between 2000 and 2021. A total of 241 patients were included in this study, with a median age of 72 years. Overall survival (OS) and time to next treatment (TTNT) were assessed using Kaplan-Meier analysis and Cox regression analysis. Prognostic factors were evaluated by univariate and multivariate analyses. The incidence of thrombocytopenia was 17.8%. In the median follow-up period of 46.6 months, OS and TTNT in the thrombocytopenia group were significantly shorter than those in the non-thrombocytopenia group using multivariate analysis (p<0.001 and p<0.001). C-reactive protein (CRP) level was not associated with thrombocytopenia, and high CRP predicted short OS and TTNT independently from thrombocytopenia. When the low (neither thrombocytopenia nor high CRP), intermediate (either thrombocytopenia or high CRP), and high (thrombocytopenia and high CRP) risk groups were defined, the OS and TTNT among these groups showed significant differences; the hazard ratios for survival in the high and intermediate risk groups were 7.022 and 2.598, and for TTNT, they were 4.216 and 1.887, respectively, compared to the low-risk group. Thrombocytopenia was associated with the activity of NDMM and predicted prognosis in NDMM. When combined with high CRP levels, thrombocytopenia serves as a new indicator of poor prognosis in these patients.

Risk Classification of Patients With Advanced Urothelial Carcinoma Treated With Enfortumab Vedotin.

Enfortumab Vedotin (EV) is a widely used antibody-drug conjugate for patients with advanced urothelial carcinoma (UC) who have previously been treated with platinum-based chemotherapy and immune checkpoint inhibitors. However, limited information is currently available on prognostic factors and risk classification. Therefore, the present study attempted to identify clinical factors that predict outcomes in patients with advanced UC treated with EV and to develop a novel risk classification model. We conducted a multicenter retrospective study including patients with advanced UC treated with EV. Oncological outcomes were assessed using progression-free survival (PFS) and overall survival (OS), and prognostic factors for PFS and OS were investigated. We then examined the usefulness of risk classification based on the prognostic factors identified. Median PFS and OS were 7.1 and 16.3 months, respectively. High C-reactive protein levels (CRP level ≥0.5 mg/dl) and hypercalcemia (corrected calcium level >10.2 mg/dl) were identified as prognostic factors for PFS (p=0.012 and p=0.003, respectively) and OS (p=0.035 and p<0.001, respectively). We then divided patients into three risk groups: no prognostic factors group, one prognostic factor group, and two prognostic factors group. Significant differences were observed in PFS and OS among the three groups (p<0.001 and p<0.001, respectively) and c-indices were 0.766 for PFS and 0.800 for OS. The risk classification using CRP and hypercalcemia is useful for predicting the outcomes of patients with advanced UC treated with EV.

Intravenous iron sucrose when administered to moderately anemic pregnant women raises the hemoglobin concentration and replenishes body iron at 6 months

ABSTRACT Introduction: Intravenous iron sucrose (IVIS) is a rapidly acting, safe, and effective treatment for moderate anemia among pregnant women. The effectiveness of IVIS at 6 months post IVIS infusion was unknown. We, therefore, assessed the mean increase in hemoglobin concentration and body iron replenishment status at 6 months after the last dose of IVIS infusion. Methods: The study was conducted in 28 villages served by two primary health centers in district Faridabad, Haryana. The participants (n = 129), when originally recruited in 2020, were all moderately anemic (hemoglobin level 7.0 to 9.9 g/dL) pregnant women in either the second or third trimester of pregnancy. Their iron deficiency was calculated by Ganzoni’s formula with additional allowance of 500 mg of depot iron. The calculated deficit was rounded off to the nearest 100 mg. The dose of IVIS was 300 mg of iron diluted in 300 ml of normal saline administered intravenously every third day till the full calculated dose was administered. In this study, we collected the follow-up blood specimen 6 months after the last dose of IVIS and measured the hemoglobin concentration, C-Reactive protein (CRP), and serum ferritin level. Hemoglobin concentration was measured using an automated hematology analyzer (Sysmex XS-1000i). Serum ferritin and CRP were measured by enhanced chemiluminescence immunoassay and the enzymatic heterogeneous, sandwich immunoassay method, respectively (VITROS ECiQ, Ortho Clinical Diagnostics, New Jersey, USA). Results: The mean [standard deviation (SD)] duration of time elapsed since the administration of the last dose of IVIS infusion was 6.4 (0.9) months. The mean (SD) hemoglobin level at the time of original recruitment (baseline) was 8.7 ± 0.8 g/dL. The mean (SD) increase in the hemoglobin concentration at 6 months follow-up was 3.2 [95% confidence interval (CI): 3.0–3.4)] g/dL. The median [interquartile range (IQR)] serum ferritin level (ng/mL) at follow-up was 28.1 (12.7, 61.5). A total of 10.2% of the participants had a raised (&gt;10 mg/L) CRP level. Adjusting for CRP level and based on serum ferritin level, the proportion of participants who were iron-deficient was 35.3%. The proportion of participants who had any degree of anemia was 70.5%. Conclusion: Administration of IVIS infusion was effective in raising the mean hemoglobin concentration and in replenishing the body iron reserve at 6 months post infusion.

Endodontic treatment in patients undergoing hematopoietic stem cell transplantation: a retrospective cohort study

This study investigated the implications of root canal treatment (RCT) of infected teeth with apical periodontitis (AP) in patients undergoing hematopoietic stem cell transplantation (HSCT). One hundred patients were selected. Clinical data, oncological and endodontic diagnosis and treatment, and type of HSCT were recorded. Data on the exacerbation of AP was investigated. Leukocyte/neutrophil and C-reactive protein (CRP) levels were evaluated before and after RCT. One hundred patients underwent HSCT (55% autologous). The need for RCT was identified in 41% of the participants. AP was diagnosed in 75.6% of these patients and large lesions (> 5 mm) occurred in 45.2%. A higher prevalence of AP was observed in males (p=0.012). RCT was performed in 54.8% of the individuals and no AP exacerbation, pain, swelling, bacteremia, and need for additional medications was observed. Blood cultures were negative for bacteria and fungi. CRP levels were >1mg/dL in 54.9% of the individuals 1 month before RCT and <1mg/dL in 64.6% 6 months after treatment (p>0.05). RCT was effective in controlling infection with no complications in patients undergoing HSCT. Given the potential for exacerbation of endodontic infections, RCT and patient monitoring are essential and highly recommended.

Predictive Factors of Chemotherapy-Induced Peripheral Neuropathy in Breast Cancer: A Decision Tree Model Approach.

Chemotherapy-induced peripheral neuropathy (CIPN) poses a substantial challenge in breast cancer (BC) chemotherapy, affecting the patient's quality of life. Recent studies have focused on exploring predictors and patterns of CIPN occurrence. We aimed to develop a prediction model for CIPN occurrence using a classification and regression tree (CART) algorithm. In this prospective study of 170 patients with BC undergoing chemotherapy, patient-reported adaptation of the Common Terminology Criteria for Adverse Events version 4.0 was used to assess CIPN occurrence. Multivariable analysis using the CART model was tuned using 10-fold cross-validation to identify baseline predictors for CIPN throughout chemotherapy. A receiver operating characteristic curve analysis was conducted for the CART model. A multivariable logistic regression was conducted from the variables included in the CART model to assess the strength and direction of the association. The prevalence of CIPN was 64.7% (n = 110). The most decisive predictor of CIPN occurrence in the CART model was the subject's C-reactive protein (CRP) level. CRP level >3.91 mg/dL, BMI >21.85 kg/m2, and a marital status of unmarried have predicted a probability of 100% in CIPN occurrence. The CART model showed an accuracy of 65.9%, sensitivity of 51.7%, specificity of 73.2%, and an area under the curve of 0.705. A CRP level of >3.91 mg/dL and a neutrophil-to-lymphocyte ratio (NLR) of >2.82 are significantly associated with the occurrence of CIPN (odds ratio [OR], 2.01 [95% CI, 1.01 to 4.01]; P = .046, OR, 2.09 [95%, CI, 1.02 to 4.24]; P = .042, respectively). Baseline CRP, NLR, BMI level, and marital status are significant predictors of CIPN occurrence throughout chemotherapy. Our CART model was better at ruling out individuals who would not experience CIPN. The CART model may provide insight into the future development of individualized patient care and prevention strategies.

С-РЕАКТИВНЫЙ БЕЛОК КАК ПРЕДИКТОР НЕОБРАТИМОГО ПОВРЕЖДЕНИЯ ГОЛОВНОГО МОЗГА

Background. As for now, the level of C-reactive protein (CRP), which may be present in donors with traumatic and non-traumatic brain injuries, has not been reliably established, and its dynamics in patients upon the occurrence of brain death (BD) have not been studied. Objective of this study is to investigate the dynamics of CRP levels in patients with severe irreversible brain damage, which subsequently led to brain death. Material and methods. The prospective study included 106 patients with severe brain damage who were diagnosed with BD despite treatment. The CRP level was determined for patients on the 1st to 10th days of intensive therapy. Results. The CRP level upon admission to the ICU was 13.3 (3.86; 29.1) mg/l. CRP values were within normal limits only in 14 (13.2%) patients. On the 2nd day of intensive therapy, the level of CRP was higher statistically significant – 85 (45.4; 140.6) mg/l, p =0.00004 vs 1 day. On the 3rd day of intensive therapy, the level of CRP was also higher statistically significant – 135.3 (73.6; 238.2) mg/l, p =0.00001 vs 2 days. The CRP values in all patients were higher than the reference values. On the 4th day, the level of CRP in patients became 219.7 (112.7; 326.4) mg/l (p=0.00006 vs 3 days) and did not significantly change in the following days in terms of statistics. Conclusion. The dynamics of CRP levels in patients with severe brain damage can be used as a predictor of unfavorable outcome of intensive care and brain death.

Construction and validation of a risk prediction model for postoperative lung infection in elderly patients with lung cancer.

This study aimed to analyze the risk factors for postoperative lung infection in elderly patients with lung cancer (LC) and construct a predictive model. A retrospective analysis was conducted on 192 elderly patients with LC who underwent surgical treatment in our hospital between February 2020 and May 2023. According to whether there is lung infection after surgery, they were divided into an infected group (n = 55) and a noninfected group (n = 137). Binary logistic regression was used to analyze factors influencing postoperative lung infection in elderly patients with LC. Based on the logistic regression results, a predictive model for postoperative lung infection in LC patients was constructed. The receiver operating characteristic curve was used to analyze C-reactive protein (CRP), interleukin-6 (IL-6), insulin-like growth factor-1 (IGF-1), and their combination in predicting postoperative lung infection in patients with LC. There were significant differences between the infected group and the noninfected group in age, smoking history, diabetes, and perioperative antibiotic use were significantly different between the infected and noninfected groups (P < .05). The postoperative CRP, IL-6, and IGF-1 levels in the infected group were higher than those in the noninfected group on the 1st day (P < .05). Logistic regression analysis showed that age > 70 years, history of smoking, history of diabetes, prolonged use of perioperative antibiotics, and elevated CRP, IL-6, and IGF-1 levels on the 1st day after surgery were risk factors for postoperative lung infection in elderly patients with LC (P < .05). Receiver operating characteristic curve analysis showed that the area under curve values of CRP, IL-6, IGF-1, and their combination in predicting postoperative lung infection in elderly patients with LC were 0.701, 0.806, 0.737, and 0.871, P < .05), with sensitivity values of 0.443, 0.987, 0.456, and 0.835, respectively; the specificity was 0.978, 0.525, 0.991, and 0.821, respectively. Age > 70 years, smoking history, diabetes history, prolonged use of perioperative antibiotics, and elevated CRP, IL-6, and IGF-1 levels on the 1st day after surgery have an impact on postoperative lung infection in elderly patients with LC. Early postoperative monitoring of changes in CRP, IL-6, and IGF-1 levels can provide an important reference for predicting the occurrence of postoperative lung infections.

Diagnostic Accuracy of Combined Measurement of Serum Homocysteine, C-Reactive Protein, and Serum Ferritin in Mild Cognitive Impairments and Alzheimer's Disease.

Evaluation of the diagnostic accuracy of combined detection of serum homocysteine (Hcy), C-reactive protein (CRP), and serum ferritin (SF) levels in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Descriptive study. Place and Duration of the Study: Clinical Laboratory Section, Affiliated Hospital of Hebei University, Baoding, Heibei, China, from May 2022 to June 2023. Data of 120 patients with memory decline were retrospectively collected. They were divided into an MCI group and an AD group. A further 50 healthy participants were used as a normal control (NC) group. Differences in the Hcy, CRP, and SF levels between the three groups were evaluated. The specificity, accuracy, and sensitivity of these three indices in the combined or single diagnosis of AD and MCI were compared. Their associations with the severity of AD and MCI were also compared. The AD group had the highest levels of Hcy, CRP, and SF (18.79 ± 4.50, 6.35 ± 2.04, and 355.69 ± 120.36), followed by MCI (16.75 ± 3.06, 4.58 ± 2.31, and 203.48 ± 12.76), and NC group (14.32 ± 2.06, 2.06 ± 0.76, and 98.46 ± 5.06), with statistically significant differences (all p <0.001). The diagnostic efficacy of AD for CRP was 98.50%, sensitivity was 96.00%, and specificity was 94.00%, which was higher than Hcy and SF. Tested together, the area under the ROC curve was 99.90%, specificity was 98.00%, and sensitivity was 98.00%. The diagnostic efficacy of SF for MCI had sensitivity of 100.00%, and specificity of 100.00%, which was higher than that of Hcy and CRP. When the three were combined for detection, the area under the curve of SF was 100.00%, sensitivity of 100.00%, and specificity of 100.00%. The levels of Hcy, CRP, and SF were positively correlated with the severity of AD (p <0.01), while negatively correlated with the mini-mental state examination (MMSE) score (p <0.01). The combined detection of Hcy, CRP, and SF improved the diagnostic accuracy of comorbid AD and MCI. Homocysteine, C-reactive protein, Cognitive impairment, Serum ferritin, Alzheimer's disease.

Diagnostic Accuracy of Combined Measurement of Serum Homocysteine, C-Reactive Protein, and Serum Ferritin in Mild Cognitive Impairments and Alzheimer's Disease.

Evaluation of the diagnostic accuracy of combined detection of serum homocysteine (Hcy), C-reactive protein (CRP), and serum ferritin (SF) levels in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Descriptive study. Place and Duration of the Study: Clinical Laboratory Section, Affiliated Hospital of Hebei University, Baoding, Heibei, China, from May 2022 to June 2023. Data of 120 patients with memory decline were retrospectively collected. They were divided into an MCI group and an AD group. A further 50 healthy participants were used as a normal control (NC) group. Differences in the Hcy, CRP, and SF levels between the three groups were evaluated. The specificity, accuracy, and sensitivity of these three indices in the combined or single diagnosis of AD and MCI were compared. Their associations with the severity of AD and MCI were also compared. The AD group had the highest levels of Hcy, CRP, and SF (18.79 ± 4.50, 6.35 ± 2.04, and 355.69 ± 120.36), followed by MCI (16.75 ± 3.06, 4.58 ± 2.31, and 203.48 ± 12.76), and NC group (14.32 ± 2.06, 2.06 ± 0.76, and 98.46 ± 5.06), with statistically significant differences (all p <0.001). The diagnostic efficacy of AD for CRP was 98.50%, sensitivity was 96.00%, and specificity was 94.00%, which was higher than Hcy and SF. Tested together, the area under the ROC curve was 99.90%, specificity was 98.00%, and sensitivity was 98.00%. The diagnostic efficacy of SF for MCI had sensitivity of 100.00%, and specificity of 100.00%, which was higher than that of Hcy and CRP. When the three were combined for detection, the area under the curve of SF was 100.00%, sensitivity of 100.00%, and specificity of 100.00%. The levels of Hcy, CRP, and SF were positively correlated with the severity of AD (p <0.01), while negatively correlated with the mini-mental state examination (MMSE) score (p <0.01). The combined detection of Hcy, CRP, and SF improved the diagnostic accuracy of comorbid AD and MCI. Homocysteine, C-reactive protein, Cognitive impairment, Serum ferritin, Alzheimer's disease.

P45 Lupus flare with myositis: an atypical presentation in the absence of elevated creatine kinase

Abstract Introduction Systemic lupus erythematosus (SLE) is a multi-systemic disease, but the coexistence of inflammatory myositis in SLE has not been extensively studied. Myositis, a rare complication, is typically associated with elevated creatine kinase (CK) levels. We report a case of SLE presenting with a lupus flare and an atypical manifestation of myositis, confirmed by MRI despite low CK levels. This case underscores the complex nature of lupus flares and the challenges in diagnosing and managing such atypical presentations. The diagnostic dilemma of myositis with low CK levels adds a layer of complexity to understanding and treating SLE-related complication. Case description A 25-year-old lady, known patient of systemic lupus erythematosus (SLE), positive ANA, dsDNA, and anti-Ro antibodies, managed with hydroxychloroquine, experienced generalized body stiffness, aches, and lower limb weakness for the past 3 months. She was admitted with worsening lower limb pain and weakness, oral ulcers, arthralgias, myalgias and alopecia despite intramuscular steroids. On examination, her lower limb power was reduced to 3/5 with normal sensation. A detailed neurological assessment was difficult due to severe pain. Her chest was clear with normal heart sounds, and the rest of the examination was unremarkable. Her erythrocyte sedimentation rate (ESR) was 69 mm/hr, and her C-reactive protein (CRP) was 50 mg/L, with a normal white cell count and normal kidney and liver function. Her urine protein-creatinine ratio (PCR) was 50.9 mg/mmol. An ECG and chest X-ray were unremarkable. Initially, she was treated for a urinary tract infection (UTI) due to urinary symptoms, and further investigations were done to check for myositis and a lupus flare. Her CK was low at 36 U/L, with normal lactate dehydrogenase (LDH). Her complement levels were low with raised anti-dsDNA levels. An MRI of the spine was normal. Given the history and clinical signs suggestive of myositis, an MRI of the hip was performed, revealing active myositis. She was started on IV methylprednisolone for the active flare. A renal opinion was sought due to the positive urine PCR, and they advised a possible biopsy. However, her repeat urine PCR came back negative, and the renal team concluded that the abnormal result was likely secondary to the UTI, negating the need for a biopsy. Her condition and muscle power improved (4+/5) with steroid and mycophenolate mofetil. Upon tapering the steroid to 10 mg, her arthralgia recurred, but myositis was improving. Further follow-up has been arranged. Discussion This case highlights the complex nature of systemic lupus erythematosus (SLE) and the challenges in managing its multi-systemic manifestations. The patient’s presentation with generalized body stiffness, lower limb weakness, and pain, alongside oral ulcers, arthralgias, myalgias, and alopecia, exemplifies the diverse clinical spectrum of SLE. The initial differential diagnosis included a lupus flare and myositis. The elevated ESR and CRP levels, alongside low complement levels and increased anti-dsDNA titres, were indicative of active disease. Interestingly, the patient’s CK levels were low, which devi-ates from the typical presentation of myositis. Moreover, specific myositis antibodies were absent. Despite low CK, the clinical suspicion of myositis prompted an MRI scan of thigs, which confirmed active inflammation in the hip muscles. Another important aspect of this case was the initial positive urine PCR, which raised concerns about renal involvement—a serious complication of SLE. However, the resolution of this abnormality upon treating a concurrent UTI highlights the importance of re-evaluating initial findings and considering alternative explanations before proceeding with invasive procedures such as a renal biopsy. In summary, this case tells us the importance of a comprehensive and dynamic approach in the management of SLE. It illustrates the need for continuous monitoring, the utility of advanced imaging techniques in diagnosing myositis, and the cautious interpretation of laboratory results in the context of coexisting conditions. The patient’s favorable response to treatment also emphasizes the efficacy of current therapeutic strategies in controlling disease activity and preventing long-term complications Key learning points • Lupus flares can present with a wide range of symptoms, including musculoskeletal manifestations such as myositis. • The absence of typical markers, such as elevated CK and specific antibodies, should not rule out the possibility of myositis in lupus patients. • Prompt recognition and management of myositis in lupus flares are crucial to prevent further complications and improve patient outcomes. • Effective management of SLE often requires collaboration among various specialists. In this case, the involvement of the renal team was crucial for further evaluation and management, demonstrating the value of a coordinated care approach. In conclusion, this case highlights the complexity of lupus flares and the importance of considering myositis as a potential complication, even in the absence of typical markers. Early recognition and appropriate management are key to improving outcomes for patients with lupus-associated myositis.