C-reactive Protein Ratio Research Articles

Biochemical predictors in presentations to the emergency department after a suicide attemp.

This study was conducted with an aim to determine whether biochemical parameters could be used to identify the individuals at risk of suicide. The experimental group consisted of a total of 46 patients that presented to the emergency department after a suicide attempt. 45 healthy individuals constituted the control group. All subjects were evaluated by using the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the Beck ScaleforSuicidal Ideation(BSSI). All subjects were evaluated for leukocyte count, mean platelet volume (MPV), C-reactive protein (CRP), cholesterol, triglyceride levels and neutrophil-lymphocyte ratio (NLR). The Vitamin D levels of the subjects in the experimental group were also measured. The BAI (p < 0.01), BDI (p < 0.01), and BSSI (p < 0.01) scores of the two groups were significantly different. The two groups were also significantly different in terms of CRP (p < 0.01), cholesterol (p < 0.05), NLR (p < 0.01), MPV (p < 0.01), triglyceride (p < 0.01) and leukocyte (p < 0.01) results. The vitamin D levels of the experimental group were found to be below normal vitamin D levels. High CRP levels were found to be a predictor of anxiety symptoms, and MPV and triglyceride levels were found to be predictors of depressive symptoms. We believe that biochemical parameters can be used to identify people with increased suicide risk, and suicide rates can be reduced by ensuring that these patients receive mental health care in the early period (Tab. 5, Ref. 42).

Prediction of severity and outcomes of colon ischaemia using a novel prognostic model: a clinical multicenter study

Objective To identify risk factors of disease severity and between mild and severe colon ischaemia (CI) patients and to improve clinical outcomes, this study aimed to explore a novel scoring model. Methods Retrospective analyses of hospital records between January 2009 and December 2019 were included. Clinical manifestations, mortality, Oakland score, laboratory tests, colonoscopy, and histopathology were collected. Risk factors of severe CI were determined by univariate and multivariate logistic regression and used for the predicting model. Results A total of 203 patients with CI were included. Serum C-reactive protein (CRP) and albumin ratio (CAR) were much higher in the severe CI group compared with that of the mild CI group (3.33 ± 1.78 versus 0.68 ± 0.97, p < .001). The Oakland score was much higher in the severe CI group (12.00 ± 3.02 versus 8.77 ± 1.63, p < .001). The histopathological finding of fibrin thrombi was an independent risk factor that predicted poor outcomes (20.00% versus. 1.09%, p < .001). Patients present with CAR ≥3.33, Oakland score ≥12, and histopathological fibrin thrombi were independent risk factors. In addition, the final scoring model was 0.042 × Oakland score + 1.040 × CAR + 3.412 × fibrin thrombi, the area under the curve (AUC) was 0.960 (95% confidence interval:0.930–0.990), and the sensitivity and specificity of the novel scoring model were 95% and 92%, respectively. Conclusions The novel prognostic model was established to predict CI severity and clinical outcomes efficiently. Key messages In this article, we discuss the scoring model for clinical outcomes of colon ischaemia patients. In our study, the sensitivity and specificity of a novel scoring model are very high. Thus, laboratory tests (CRP albumin ratio), Oakland score, and histopathological findings (fibrin thrombi) can be assessed efficiently for colon ischaemia outcomes.

Neutrophil to C-reactive protein ratio: An estimating factor for intestinal ischemia before the surgery of incarcerated inguinal hernia.

Objective:An inguinal hernia may transform to an incarcerated hernia, which would require emergency surgery with increased morbidity and mortality. This study aims to analyze whether it is possible to predict intestinal ischemia in incarcerated hernia using complete blood count parameters and serum C-reactive protein (CRP).Methods:Medical records of 129 patients were used to analyze whether there is a correlation between intestinal ischemia and laboratory parameters. Receiver operating characteristics analysis and Youden index were used to determine cutoff values, sensitivity, and specificity.Results:Female patients, those with a femoral type hernia, and patients with additional diseases were found to be more prone to bowel resection. CRP, lymphocyte to CRP ratio (LCR), and neutrophil to CRP ratio (NCR) parameters were significant (AUC=0.914, p<0.001; AUC=0.901, p<0.001; and AUC=0.908, p<0.001, respectively). A value <0.45 for NCR has a sensitivity of 93.3% and specificity of 87.8%; a value >19 in CRP has a 90% sensitivity and 88.9% specificity.Conclusion:Decreased pre-operative NCR and LCR, and increased CRP levels can be used as a predictor for estimating intestinal ischemia.

Prognostic value of inflammatory biomarkers for predicting the extent of lung involvement and final clinical outcome in patients with COVID-19.

Background:Inflammation plays a major role in coronavirus disease (COVID-19). Factors that convey information about the status of inflammation could predict disease severity and help identify patients prone to clinical deterioration. Here, we aimed to evaluate the predictive value of inflammatory markers on the extent of lung involvement and survival of patients with COVID-19.Materials and Methods:Eighty patients with confirmed COVID-19 were enrolled. Demographic, clinical, and laboratory data were collected at admission. All patients underwent chest computed tomography (CT); the extent of lung involvement was assessed by a scoring system. Patients were followed up until death or discharge occurred. Logistic regression analysis was performed to evaluate the association of investigated variables with COVID-19-related death. The association between different variables and CT score was assessed using linear regression model. Receiver operator characteristic curve analysis was applied to identify the predictive value of inflammatory markers and CT score on survival.Results:The mean age of patients was 54.2 ± 15.2 years; 65% were male. Increased neutrophil-to-lymphocyte ratio (β =0.69, odds ratio [OR] =1.50), platelet-to-lymphocyte ratio (β =0.019, OR = 1.01), and decreased lymphocyte to C-reactive protein ratio (LCR) (β = −0.35, OR = 0.62) were significantly associated with a higher CT score and increased odds of death (P < 0.05). Lactate dehydrogenase level was also positively related with extensive lung involvement and death (β =1.15, OR = 1.52, P < 0.05). The LCR threshold for identifying survivors from nonsurvivors was 0.53 (area under curve [AUC] =0.82, 78% sensitivity and 74% specificity). Lung involvement ≥50% on chest CT was an excellent predictor of death (AUC = 0.83, 81% sensitivity and 79% specificity).Conclusion:Daily-performed laboratory tests that represent inflammation have great value for predicting the amount of disease burden and risk of mortality. Moreover, their cost-effectiveness and feasibility turn them into ideal prognostic markers.

Clinical characteristics and management of Petersen hernia after gastrectomy in patients with gastric cancer

Objective: Petersen hernia is a rare but severe complication after gastrectomy, which has been reported by very few studies. This study is dedicated to summarize the clinical characteristics and management of Petersen hernia after gastrectomy in patients with gastric cancer in order to provide reference to clinical practice. Methods: A descriptive case-control study was carried out. All the qualified patients were screened from the database of digestive malignancies in Nanjing Drum Tower Hospital. The inclusion criteria were as follows: Petersen hernia confirmed during operation; previous gastrectomy history due to gastric cancer; complete clinical data. The clinical manifestation, perioperative data and follow-up outcome were summarized. Results: A total of 12 qualified patients were included. They were all male with a mean age of (65.3±8.5) years old, and whose clinical presentation had last for (6~143) hours (median: 21 hours). Common complaints included abdominal pain and bloating. All the patients were admitted to the emergency department. Preoperative CT showed dilatation and effusion of small intestine. Other imaging manifestations included whirlpool sign, target sign, mesenteric retraction or congestion and edema, abdominal and pelvic effusion, etc. Hematological examination showed white blood cell count, ratio of neutrophils, procalcitonin and C-reactive protein were higher than the normal range. The median interval to previous gastrectomy is 20.5 (0.5-55.0) months. The previous gastrectomy of 12 cases included 2 cases of laparoscopic surgery and 10 of laparotomies. Ten cases underwent emergency surgery immediately, and 2 cases underwent surgery after ineffective conservative treatment. Six cases received small bowel restoration without bowel resection, and the other 6 cases received small bowel resection with a mean length of 76 (11~300) cm. Six cases were transferred into ICU with a stay of (2.5±0.8) days. One case deceased at postoperative day 2, due to subtotal small bowel resection, and the other 11 cases survived without grade III or above complication according to Clavien-Dindo classification. The overall postoperative hospitalization was (9.2±3.6) days. During the postoperative follow-up, no acute gastrointestinal symptoms or acute abdomen recurred. Conclusions: Petersen hernia is more common in male, whose onset and progress are rapid and emergent, and prognosis is poor.

C-reactive protein for simple prediction of mortality in patients with acute non-variceal upper gastrointestinal bleeding: A retrospective analysis.

In upper gastrointestinal bleeding (UGIB), scoring systems using multiple variables were developed to predict patient outcomes. We evaluated serum C-reactive protein (CRP) for simple prediction of patient mortality after acute non-variceal UGIB.The associated factors for 30-day mortality was investigated by regression analysis in patients with acute non-variceal UGIB (N = 1232). The area under the receiver operating characteristics (AUROC) curve was analyzed with serum CRP in these patients and a prospective cohort (N = 435). The discriminant validity of serum CRP was compared to other prognostic scoring systems by means of AUROC curve analysis.Serum CRP was significantly higher in the expired than survived patients (median, 4.53 vs 0.49; P < .001). The odds ratio of serum CRP was 4.18 (2.10-9.27) in multivariate analysis. The odds ratio of high serum CRP was higher than Rockall score (4.15 vs 1.29), AIMS65 (3.55 vs 1.71) and Glasgow-Blatchford score (4.32 vs 1.08) in multivariate analyses. The AUROC of serum CRP at bleeding was 0.78 for 30-day mortality (P < .001). In the validation set, serum CRP was also significantly higher in the expired than survived patients, of which AUROC was 0.73 (P < .001). In predicting 30-day mortality, the AUROC with serum CRP was not inferior to that of other scoring systems.Serum CRP at bleeding can be simply used to identify the patients with high mortality after acute non-variceal UGIB.

Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio Might Predict Pediatric Ovarian Torsion: A Single-Institution Experience and Review of the Literature.

To determine clinical and laboratory characteristics of ovarian torsion (OT; n=28) compared with a non-OT control (OC; n=64) group. Retrospective single-center review performed between January 2006 and December2016. Academic department of pediatric surgery. Postoperative diagnosis of pediatric ovarian pathology (International Classification of Diseases, 10th Revision code N83) in 88 patients who underwent 92 surgeries for suspected OT, aged from 3days to 17.8years. Predictive value for OT according to biometric, procedural, and laboratory parameters at the time of admission. Compared with OC, OT in patients aged older than 1year was associated with elevated values regarding white blood cell count, neutrophils, neutrophil to lymphocyte ratio (NLR; all P<.001), platelet to lymphocyte ratio (PLR; P=.003), platelets (P=.011), and a trend toward raised C-reactive protein (P=.054), whereas lymphocytes and lymphocyte to C-reactive protein ratio (both P<.001) were decreased. Using receiver operating characteristic analysis for differentiating OC from OT, besides lymphocytes and NLR (both area under the curve>0.9), PLR elicited strongest discriminatory accuracy (area under the curve=0.946±0.037; P<.001; sensitivity 82%; specificity 90%). At binary logistic regression analysis PLR (P=.018) was independently predictive of OT. OT was suspected on ultrasound imaging in 15/18 (83%), showed a right-sided dominance in 13/18 (72%), and was associated with younger age (P=.003). No differences regarding laboratory or procedural parameters in patients aged younger than 1year were discerned. Blood count indices such as PLR, NLR, and lymphocyte to C-reactive protein ratio might be helpful in identification of inflammatory processes as induced by ischemia in OT. Together with ultrasound and clinical features, these parameters constitute potential predictors of OT in girls aged older than 1year.

Use of the alkaline phosphatase to prealbumin ratio as an independent predictive factor for the prognosis of gastric cancer.

BACKGROUNDGastric cancer (GC) is characterized by a low 5-year survival rate. The prognosis is still not satisfactory although it has significantly improved due to developments in medicine. Thus, the identification of more efficient indices for the evaluation of GC prognosis is required. We propose, for the first time, that the alkaline phosphatase (ALP) to prealbumin (PA) ratio (APR) can be used as an independent prognostic factor in GC.AIMTo evaluate the prognostic value the APR in GC.METHODSAccording to the exclusion strategy, we collected the preoperative serologic examination results and clinical information of 409 GC patients treated in Shandong Provincial Hospital from January to December, 2016. By calculating the APR, the neutrophil and lymphocyte ratio (NLR), C-reactive protein (CRP) and albumin (ALB) ratio, platelet and lymphocyte ratio, lymphocyte and monocyte ratio, and the relationship with clinical information, we verified the role of preoperative APR ratio in the prognosis of GC. In addition, we used a Cox model combined with the APR and tumor stage to demonstrate its efficacy in assessing the prognosis of GC patients.RESULTSPreoperative APR was an independent prognostic factor for GC. The median age of patients in the APR-high group was greater compared with that in the APR-low group. Patients with a higher APR had a more advanced clinical stage, higher neutrophil to lymphocyte, CRP to ALB, and platelet to lymphocyte ratios, but a lower lymphocyte to monocyte ratio (P < 0.05). The APR-high group also had higher glycoprotein antigen 199 and carbohydrate antigen 125 levels than the APR-low group (P < 0.05). Median overall survival and disease-free survival were significantly longer in the APR-low group than in the APR-high group. In addition, a Cox model based on the APR and tumor stage was more effective in evaluating the prognosis of patients than models based on stage alone or stage plus the NLR.CONCLUSIONA higher APR is an independent and negative prognostic factor for GC. The prognosis of GC can be better evaluated using a Cox model based on the APR and stage.

The relationship between glomerular filtration rate, and metabolic and inflammatory parameters in obese and non-obese patients with polycystic ovary syndrome

AimTo investigate the relationship between glomerular filtration rates (GFR), and homeostasis model assesment of insulin resistance (HOMA-IR), C-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR) in patients with polycystic ovary syndrome (PCOS). Material and methodsThirty-one overweight and obese PCOS patients with body mass index (BMI)≥25kg/m2 and 25 non-obese PCOS patients with BMI<25kg/m2 were included into patients’ group, while 23 overweight and obese, and 25 non-obese age-and BMI-matched healthy individuals (aged between 18 and 40 years), were enrolled as controls. Levels of serum creatinine, glucose, insulin, CRP, and complete blood count were measured. eGFR, HOMA-IR and NLR were also calculated. ResultsIn PCOS group, HOMA-IR (p=0.001), CRP (p=0.025) and waist hip ratio (WHR) (p=0.011) were higher than controls. In obese PCOS sub-group, HOMA-IR (p=0.004) and WHR (p=0.002) were higher than obese controls. In non-obese PCOS sub-group, HOMA-IR (p=0.001) were higher than non-obese controls. In obese PCOS sub-group; HOMA-IR (p=0.001) and CRP (p=0.001) levels were significantly higher than non-obese PCOS sub-group. In terms of other parameters, no significant difference was found between the groups. The analysis showed a negative correlation between GFR, and BMI and HOMA-IR in PCOS group, between GFR, WHR and insulin levels in obese PCOS sub-group, and between BMI, and HOMA-IR and NLR in non-obese PCOS sub-group. ConclusionAlthough HOMA-IR and CRP were higher in PCOS group, there was no difference in NLR and GFR levels between those with PCOS and controls.

Clinical implications of the preoperative lymphocyte C-reactive protein ratio in esophageal cancer patients.

We recently revealed the preoperative lymphocyte C-reactive protein ratio (LCR) to be a new marker for predicting various outcomes in malignancies. The aim of our present study was to clarify the potential utility of the preoperative LCR for predicting the perioperative risk and oncological outcome in esophageal cancer patients. We analyzed the preoperative LCR from 153 esophageal cancer patients to clarify its clinical relevance. The preoperative LCR was significantly decreased in a stage-dependent manner, and a decreased preoperative LCR was significantly associated with the occurrence of postoperative surgical site infection. Esophageal cancer patients with a low LCR showed a poor outcome in both the overall survival and disease-free survival compared with those who had a high LCR. Multivariate analyses showed that a decreased LCR was an independent prognostic factor for both a poor overall survival and disease-free survival. A decreased preoperative LCR was an independent predictive factor for postoperative surgical site infection and significantly correlated with nutritional and inflammatory indicators. In addition, the LCR was useful for identifying esophageal cancer patients likely to have a poor outcome among patients with and without neoadjuvant chemotherapy. Assessing the preoperative LCR might help physicians identify populations at high risk for perioperative complication and oncological outcomes, and determine individualized perioperative therapeutic strategies.

Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comparative analysis

ABSTRACT Background and Objectives: COVID-19 is a global pandemic. In our study, we aimed to utilize the hematological parameters in predicting the prognosis and mortality in COVID-19 patients. Materials and methods: A retrospective, observational study was conducted to include all the admitted patients (n = 191) having COVID-19 Polymerase chain reaction (PCR) positive, and evaluated those for prognosis and disease outcome by utilizing several biochemical and hematological markers. Results: Amongst the patients admitted in the ward versus in the intensive care unit (ICU), there were significant differences in mean hemoglobin (P = 0.003), total leukocyte count (P = 0.001), absolute neutrophil and lymphocyte counts (P < 0.001), absolute monocyte count (P = 0.019), Neutrophil-to-Lymphocyte ratio (NLR) and Lymphocyte-to-Monocyte ratio (LMR) (P < 0.001), Platelet-to-Lymphocyte ratio (PLR) and Lymphocyte-to C-reactive protein ratio (LCR) (P = 0.002), and C-reactive protein (CRP) levels (P < 0.001). Amongst the deceased patients, there was significant leukocytosis (P = 0.008), neutrophilia and lymphopenia (P < 0.001), increased NLR (P = 0.001), decreased LMR (P < 0.001), increased PLR (p = 0.017), decreased LCR (p = 0.003), and elevated CRP level (P < 0.001). A receiver operating characteristic curve obtained for the above parameters showed NLR (AUC: 0.841, PPV: 83.6%) and PLR (AUC: 0.703, PPV: 81.8%) for ICU patients, while NLR (AUC: 0.860, PPV: 91.1%) and PLR (AUC: 0.677, PPV: 87.5%) for the deceased patients had significant accuracy for predicting the disease severity of COVID-19 in comparison to survivors. Conclusion: The inflammatory markers and hematological indices are a good guide for predicting the severity and disease outcome of coronavirus disease. NLR and PLR are elevated in severe disease while LMR and LCR are inversely correlating with disease severity.

Procalcitonin to C-reactive protein ratio is associated with short-term mortality in ischemic stroke patients: preliminary report

IntroductionInflammation is associated with the development and progression of ischemic stroke. In this study, we tested the diagnostic ability of procalcitonin (PCT) to C-reactive protein (CRP) ratio (PC ratio; ×10–6) to predict 90-day mortality in ischemic stroke patients.Material and methodsWe retrospectively collected the medical records of patients with a diagnosis of ischemic stroke from February 2008 to January 2018. We analyzed the data of study patients with both PCT and CRP results, and evaluated the relationship between PC ratio and 90-day mortality. Logistic regression was adjusted for confounders and survival analysis was conducted using the Kaplan-Meier estimation.ResultsA total of 333 patients were analyzed in this study. As compared with the lowest PC ratio quartile (0–2.1), the odds ratios for 90-day mortality were; 1.47 (95% CI: 0.62–4.20) for the 2nd quartile (2.2–6.3, p = 0.440), 2.54 (95% CI: 0.95–5.91) for the 3rd quartile (6.4–19.6, p = 0.048), and 4.10 (95% CI: 1.73–9.80) for the 4th quartile (≥ 19.7, p = 0.002), after adjusting for age, sex, medical history, and laboratory results. A higher PC ratio (≥ 2.2) was associated with higher mortality (p < 0.05) in ischemic stroke patients in Kaplan-Meier estimation, and this was confirmed by the log-rank test (p < 0.001).ConclusionsProcalcitonin to C-reactive protein ratio was found to be positively associated with 90-day mortality in ischemic stroke patients. Our findings indicate that PC ratio may be a useful marker for predicting mortality after ischemic stroke. Further prospective studies are required to investigate and validate the use of PC ratio in clinical practice.

Combination of Hematology Indicators and Oncological Characteristics as a New Promising Prognostic Factor in Localized Clear Cell Renal Cell Carcinoma.

PurposeThis study aimed to construct a predictive model for recurrence and metastasis in patients with localized clear cell renal cell carcinoma (ccRCC) based on multiple preoperative blood indexes and oncological characteristics.Patients and MethodsOverall, 442 patients with localized ccRCC between 2013 and 2015 were included. Using least absolute shrinkage and selection operator (LASSO) Cox regression analysis, the top three risk factors from the peripheral blood indicators were screened to construct a risk score, and a prognostic model was established. Harrell’s concordance index (C-index) was applied to evaluate the predictive accuracy of the model for predicting disease-free survival (DFS) in ccRCC.ResultsOut of 38 blood indexes, the top three predictors were fibrinogen (FIB), C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR). The FIB-CRP-NLR (FCN) score (hazard ratio [HR]: 1.86, 95% confidence interval [CI]: 1.21–2.9, P = 0.005) was an independent prognostic factor in multivariate analysis. Furthermore, the FIB-CRP-NLR-T-Grade (FCNTG) risk model combining FCN score, T stage and Furhman grade achieved a higher prognostic accuracy (mean C-index, 0.728) than both the FCN score alone (mean C-index, 0.675) and the stage, size, grade, and necrosis (SSIGN) score (mean C-index, 0.686) in the validation cohort.ConclusionThe FCN score combining peripheral blood indicators of inflammation and coagulation is an independent prognostic marker of ccRCC. The FCNTG model, which systemically incorporates preoperative blood indexes to oncological characteristics, shows its advantages of convenience and high prediction efficiency.

Characterization of Immune Checkpoint Inhibitor-Related Cardiotoxicity in Lung Cancer Patients From a Rural Setting

BackgroundImmune checkpoint inhibitor (ICI)-related cardiotoxicity (iRC) is uncommon but can be fatal. There have been few reports of iRC from a rural cancer population and few data for iRC and inflammatory biomarkers. ObjectivesThe purpose of this study was to characterize major adverse cardiac events (MACE) in ICI-treated lung cancer patients based in a rural setting and to assess the utility of C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) in the diagnosis of iRC. MethodsPatients with lung cancer treated with ICIs at Vidant Medical Center/East Carolina University (VMC/ECU) between 2015 and 2018 were retrospectively identified. MACE included myocarditis, non-ST-segment elevated myocardial infarction (NSTEMI), supraventricular tachycardia (SVT), and pericardial disorders. Medical history, laboratory values, pre-ICI electrocardiography (ECG), and echocardiography results were compared in patients with and without MACE. ResultsAmong 196 ICI-treated patients, 23 patients (11%) developed MACE at a median of 46 days from the first ICI infusion (interquartile range [IQR]: 17 to 83 days). Patients who developed MACE experienced myocarditis (n = 9), NSTEMI (n = 3), SVT (n = 7), and pericardial disorders (n = 4). Ejection fraction was not significantly different at the time of MACE compared to that at baseline (p = 0.495). Compared to baseline values, NLR (10.9 ± 8.3 vs. 20.7 ± 4.2, respectively; p = 0.032) and CRP (42.1 ± 10.1 mg/l vs. 109.9 ± 15.6 mg/l, respectively; p = 0.010) were significantly elevated at the time of MACE. ConclusionsNLR and CRP were significantly elevated at the time of MACE compared to baseline values in ICI-treated patients. Larger datasets are needed to validate these findings and identify predictors of MACE that can be used in the diagnosis and management of ICI-related iRC.

The relationship between glomerular filtration rate, and metabolic and inflammatory parameters in obese and non-obese patients with polycystic ovary syndrome

AimTo investigate the relationship between glomerular filtration rates (GFR), and homeostasis model assesment of insulin resistance (HOMA-IR), C-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR) in patients with polycystic ovary syndrome (PCOS). Material and methodsThirty-one overweight and obese PCOS patients with body mass index (BMI)≥25kg/m2 and 25 non-obese PCOS patients with BMI<25kg/m2 were included into patients’ group, while 23 overweight and obese, and 25 non-obese age-and BMI-matched healthy individuals (aged between 18 and 40 years), were enrolled as controls. Levels of serum creatinine, glucose, insulin, CRP, and complete blood count were measured. eGFR, HOMA-IR and NLR were also calculated. ResultsIn PCOS group, HOMA-IR (p=0.001), CRP (p=0.025) and waist hip ratio (WHR) (p=0.011) were higher than controls. In obese PCOS sub-group, HOMA-IR (p=0.004) and WHR (p=0.002) were higher than obese controls. In non-obese PCOS sub-group, HOMA-IR (p=0.001) were higher than non-obese controls. In obese PCOS sub-group; HOMA-IR (p=0.001) and CRP (p=0.001) levels were significantly higher than non-obese PCOS sub-group. In terms of other parameters, no significant difference was found between the groups. The analysis showed a negative correlation between GFR, and BMI and HOMA-IR in PCOS group, between GFR, WHR and insulin levels in obese PCOS sub-group, and between BMI, and HOMA-IR and NLR in non-obese PCOS sub-group. ConclusionAlthough HOMA-IR and CRP were higher in PCOS group, there was no difference in NLR and GFR levels between those with PCOS and controls.

Significance of the ratio of C-reactive protein to prealbumin in patients with traumatic brain injury

To investigate the value of serum C-reactive protein/prealbumin ratio (CRP/PA) in predicting the disease progression of adult patients with traumatic brain injury. A prospective study was conducted. Patients with traumatic brain injury who were over 18 years old and were followed up for more than 72 hours admitted to the department of emergency of Huashan North Hospital Affiliated to Fudan University from May 2018 to December 2019 were enrolled. The levels of serum CRP, PA were measured immediately after injury and at 6, 24, 48 and 72 hours after injury, and the CRP/PA ratio was calculated. Glasgow coma score (GCS) was dynamically measured and head CT was reviewed regularly. If the GCS decreased by more than 3 and/or the intracranial injury was aggravated by CT scan within 72 hours after injury, the patients were included in the aggravating group. If there were no above changes, they were included in the stable group. The differences of each index between the two groups were compared, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each index at different time points on the patient's disease progress. A total of 106 patients were selected, including 89 patients in the stable group and 17 patients in the aggravating group, and the baseline data of the two groups were balanced. CRP, CRP/PA increased and PA decreased in brain trauma patients 6 hours after injury, and reached the peak value or valley value at 48 hours. Compared with the stable group, CRP/PA significantly increased at 24, 48 and 72 hours in the aggravating group [24 hours: 34.18 (20.19, 67.10) vs. 13.98 (4.36, 38.30), 48 hours: 71.10 (45.55, 96.97) vs. 16.02 (5.05, 41.76), 72 hours: 23.25 (4.46, 38.61) vs. 4.72 (2.38, 12.95), all P < 0.05]. ROC curve analysis showed that CRP/PA ratio at 24 hours and 48 hours after injury could be used as a predictor of disease progression. The area under the ROC curve (AUC) of 24 hours CRP/PA was 0.71, 95% confidence interval (95%CI) was 0.58-0.84, the cut-off value was 28.29, the sensitivity was 76.5%, and the specificity was 73.0%. The AUC of 48 hours CRP/PA was 0.76, 95%CI was 0.62-0.90, and the cut-off value was 37.18, the sensitivity was 88.2%, and the specificity was 70.8%. The dynamic monitoring of CRP/PA ratio in adult after traumatic brain injury can evaluate the disease condition, and the CRP/PA ratio of 24 hours and 48 hours can predict the progress of the disease.

Ratio of total leukocyte count to C-reactive protein: does it help to differentiate infectious fever from engraftment fever in patients undergoing autologous hematopoietic stem cell transplant?

Engraftment fever (EF) is a common complication of autologous HSCT (AHSCT). It is difficult to discern it from infectious fever (IF). We studied the significance of total blood leucocyte count (TLC) to C-reactive protein (CRP) ratio in differentiating EF from IF. 109 consecutive AHSCT patients were retrospectively analysed between March 2011 and August 2013. Breakthrough fever (BF) was defined as new-onset fever preceded by an afebrile period of at least 48 hours. The BF episodes were classified as IF or EF. Infectious fever was diagnosed in case of blood culture positivity, radiological signs of infection, or fever subsiding within 48 hours of changing the antibiotics. Engraftment fever was defined in cases associated with rising leucocyte counts without identifiable infective focus. EF responded well to steroid therapy. Daily TLC and CRP values were obtained from patients’ records. Optimal cut-off value of ratio on day of BF was obtained by plotting ROC curve. Sensitivity and specificity were calculated at this value. Among 109 cases, the breakthrough fever manifested in seventy patients. The median term for BF was day +9. Sixty-two patients had the EF. Median value of TLC/CRP ratio on the day of BF was significantly higher in patients with EF than with IF (0.139 vs 0.038, p=0.013). With ROC analysis, the AUC value was 0.78 (95%CI – 0.66-0.89, p&lt;0.0001). The ROC curve provided the optimal TLC/CRP value of 0.056. Using a ratio &gt;0.056 for EF, the sensitivity and specificity were 63% (95%CI 50-75%) and 100% (95%CI 63-100%) respectively. TLC/CRP ratio &gt;0.056 is highly specific for EF. Prospective studies are warranted to confirm these findings.

A Retrospective Study of the C-Reactive Protein to Lymphocyte Ratio and Disease Severity in 108 Patients with Early COVID-19 Pneumonia from January to March 2020 in Wuhan, China.

BackgroundThe aim of this study was to determine the effect of C-reactive protein (CRP), lymphocytes (LYM), and the ratio of CRP to LYM (CRP/LYM) on assessing the prognosis of COVID-19 severity at early stages of disease.Material/MethodsA total of 108 hospitalized patients diagnosed with COVID-19 in Zhongnan Hospital of Wuhan University from January 17, 2020 to March 12, 2020 were enrolled. Data of demographic parameters, clinical characteristics, laboratory indicators, clinical manifestation, and outcome of disease were collected. The patients were divided into a severe group and a non-severe group according to diagnosis and classification, which followed the guidelines and management of the Chinese National Health Council COVID-19. The receiver-operating characteristic (ROC) analysis and comparison of ROC curves were used for the laboratory findings for assessment of COVID-19 severity.ResultsOf the 108 patients, 42 patients (38.9%) were male and 24 patients (22.2%) were considered severe cases, with the mean age of 51.0 years old. Males and patients with comorbidities were more likely to become severe cases. CRP increased and LYM decreased in the severe group.The results for the areas under the curve (AUC) of CRP/LYM and CRP used to assess severe COVID-19 were 0.787 (95% CI 0.698–0.860, P<0.0001) and 0.781 (95% CI 0.693–0.856, P<0.0001), respectively; both results were better than that of LYM. The associated criterion value of CRP/LYM was calculated, with an excellent sensitivity of 95.83%.ConclusionsThe effect of CRP/LYM and CRP on the assessment for severe COVID-19 may be superior to LYM alone. CRP/LYM is a highly sensitive indicator to assess the severity of COVID-19 in the early stage of disease.

Procalcitonin, C-reactive Protein, and Neutrophil Ratio Contribute to the Diagnosis and Prognosis of Severe Acute Pancreatitis

We aimed to explore the significance of procalcitonin (PCT), C-reactive protein (CRP) and neutrophil ratio (N%) in the early diagnosis, treatment, and prognosis of severe acute pancreatitis (SAP). A total of 104 patients with SAP (SAP group) and 101 patients with mild acute pancreatitis (MAP) (MAP group) admitted to Affiliated Hospital of Jining Medical University, Jining, China were enrolled. The PCT and CRP in serum were detected by a full-automatic biochemical analyzer, and N% in peripheral blood was measured by a hemocyte analyzer. The peripheral blood PCT, CRP, and N% in the SAP group were significantly higher than those in the MAP group (P<0.001). Multivariate Logistic regression analysis showed that acute physiology and chronic health evaluation II (APACHE II) score, Ranson score, PCT, CRP, and N% were independent risk factors for SAP. The receiver operating characteristic (ROC) curve showed that the area under curve (AUC) of PCT, CRP, and N% in diagnosing SAP were 0.906, 0.840, and 0.834 respectively, while that of combined detection was 0.972. The AUC of PCT, CRP, and N% in diagnosing SAP death were 0.907, 0.900, and 0.894, respectively. Peripheral blood PCT, CRP, and N% contribute to the diagnosis and prognosis of SAP.

The Level of Serum C-Reactive Protein and Neutrophil Lymphocyte Ratio According to Thyroid Function Status

Objective: We aimed to investigate neutrophil lymphocyte ratio (NLR), leukocyte count (WBC), mean platelet volume (MPV) and C-reactiveprotein levels (CRP) as inflammatory markers according to thyroid function status in hypo-hyperthyroidism patients.Methods: Data of patients (n=454, age&amp;gt;18) who applied to the Eskisehir Osmangazi University Hospital between March 2018 and December2018 were evaluated retrospectively. There were 79 patients in hyperthyroidism group (TSH&amp;lt;0.27 μIU/ml, group I), 297 patients in euthyroidgroup (TSH=0.27-4.2 μIU/ml, group II) and 78 patients in hypothyroidism group (TSH&amp;gt;4.2 μIU/ml, group III).Results: Serum TSH, fT4, fT3, anti-TG and anti-TPO levels were found statistically different between groups (p&amp;lt;0.001) but there were nosignificant difference in WBC, NLR and MPV between groups. There was a positive correlation between the NLR and CRP (r=0,295, p&amp;lt;0.01). Inaddition, NLR was positively correlated with WBC (r=0,412, p&amp;lt;0.001). Serum CRP levels were statistically higher in group I (3.5 mg/L [1.50-11])than group II (2.1 mg/L [0.86-5.42]), (p&amp;lt;0.001). Although CRP levels were higher in group III (2.5 mg/L [1.18-5.73]) than group II, there was nosignificant difference. CRP showed weak positive correlation with fT4 (r=0,118, p&amp;lt;0.05) and negative correlation with TSH (r=-0,108, p&amp;lt;0.05).Conclusion: High CRP levels may play an important role in the evaluation of hyperthyroidism in terms of thyroid dysfunction observed in thepresent study.