C-reactive Protein Ratio Research Articles

Combining Pre- and Postoperative Lymphocyte-C-Reactive Protein Ratios Can Better Predict Hepatocellular Carcinoma Prognosis After Partial Hepatectomy.

BackgroundVarious preoperative inflammatory indicators have been identified as potential predictors of poor prognosis in patients with hepatocellular carcinoma (HCC), but the role of postoperative inflammatory indicators remains unclear. This study aimed to explore the prognostic value of the postoperative lymphocyte–C-reactive protein ratio (PostLCR) on its own and combined with preoperative LCR (PreLCR).MethodsA total of 290 patients with primary HCC were retrospectively enrolled in the study. Univariate analysis was used to identify factors significantly associated with poor disease-free survival (DFS) and overall survival (OS), then multivariate analysis was performed to identify independent prognostic indicators of poor survival. Prognostic models based on preoperative, postoperative, and both types of indicators were then constructed, and their predictive performance were evaluated using time-dependent receiver operating characteristic curves and the concordance index (C-index).ResultsPreLCR and PostLCR levels correlated with DFS and OS more strongly than other pre- and postoperative inflammatory indicators, respectively. Decreased PreLCR and PostLCR were independent prognostic factors for both DFS and OS, while HCC patients with decreased PreLCR and PostLCR had worse prognosis than patients with increased PreLCR and PostLCR. Patients into three groups based on their cut-off values of PreLCR and PostLCR, Kaplan–Meier survival analysis indicated that HCC patients with low PreLCR and PostLCR had the worst DFS and OS. The combined model showed better predictive performance at 1 and 3 years post-surgery than individual pre- and postoperative models, the American Joint Committee on Cancer/Tumor-Node-Metastasis (8th edition) staging system and the Barcelona Clinic Liver Cancer system. The combine model demonstrated a markedly superior C-index compared with the other models in DFS and OS.ConclusionOur study showed PreLCR and PostLCR are independent predictors of DFS and OS in HCC patients after partial hepatectomy. Models that include both PreLCR and PostLCR can predict prognosis better than well-established clinical staging systems.

Differences in CRP and De Ritis ratio predictive abilities of cancer specific survival between ethnic groups.

394 Background: Studies have discussed the prognostic use of C-reactive protein (CRP) and De Ritis ratio (AST/ALT or AAR) in the evaluation of renal malignant masses. Elevated pre-treatment CRP has been shown to be associated with non-cancer mortality. Additionally increased preoperative AAR has been found to be a prognostic factor for overall survival. With studies showing the ethnic disparities in mortality rate in certain underserved ethnic groups, there is a need for investigation into possible ethnic differences. Our aim is to evaluate the association between these elevated preoperative markers and all-cause mortality (ACM) and cancer specific mortality (CSM) among ethnic groups. Methods: Retrospective review of the International Marker Consortium for Renal Cancer (INMARC) was performed. Patients with renal malignancies who underwent partial or radical nephrectomy (PN, RN) were included. Patients were grouped according to ethnicity and African American (AA), White, Asian, and Hispanic ethnic groups were selected for descriptive, survival and multivariable analysis of outcomes. A Cox-regression multivariable analysis (MVA) was performed for each group. The primary outcome was overall survival and cancer specific survival from time of surgery to last follow-up, which was evaluated using Kaplan-Meyer Analysis (KMA). Results: A total of 4,810 patients were analyzed (627 AA, 2,344 White, 462 Hispanic, 1,094 Asian). Preoperative CRP and AAR were considered elevated if above 5 mg/L and 1.26, respectively. Descriptive analysis showed significant differences in age, diabetes mellitus status, hypertension status, tumor size, surgery type (PN vs. RN), preoperative CRP, preoperative AAR, ACM and CSM between ethnicities (p-value <0.001). MVA revealed elevated CRP to be predictive of ACM in AA (p<0.001, HR 2.830, 95% CI [1.728, 4.635]) and White (p<0.001, HR 2.933, 95% CI [2.272, 3.785]) patients. Elevated AAR was only predictive for all ACM in Asian (p=0.004, HR 2.546, 95% CI [1.358, 4.775]) patients. MVA showed similar results for CSM with elevated CRP found to be a significant independent risk factor for CSM in AA (p<0.001, HR 7.006, 95% CI [2.649, 18.531]) and White (p<0.001, HR 3.391, 95% CI [2.403, 4.784]) patients while elevated AAR is a significant independent risk factor for all CSM in Asian (p=0.041, HR 2.374, 95% CI [1.034, 5.448]) patients. KMA revealed statistically significant impact of elevated CRP on ACM and CSM in AA, White, and Asian patients (p<0.001). It also showed a statistically significant effect of elevated AAR in Asian patients (p<0.001). Conclusions: CRP has broad utilities in prognostic abilities for non-Asian ethnic sub-cohorts. However, AAR has predictive abilities in Asian patients. These results show the importance of using different lab markers for preoperative assessment in renal masses and the need for further research in ethnic differences in clinical presentation.

The role of C-reactive protein ratio in predicting mortality in patients with Fournier gangrene.

This study aimed to determine the C-reactive protein (CRP) ratio for the survival of patients with Fournier gangrene (FG). Fifty-two patients with FG between January 2011 and September 2018 were retrospectively analyzed. Data on clinical presentation, Fournier Gangrene Severity Index (FGSI), CRP ratio, management, and outcome were analyzed. The CRP ratio was calculated as preoperative CRP/postoperative CRP value that measured 48 hours after surgical intervention. Possible alternative cutoff points for the FGSI and CRP were determined by receiver operating characteristic (ROC) analyses. The risk factors related to the prognosis were evaluated by univariate and multivariable logistic regression analyses. The mean CRP ratios were 6.7±6.6 in the survivor group and 1.2±0.8 in the nonsurvivor group (P=0.001). FGSI was significantly higher in the non-survivor group compared to survivor group (8.5±2.5 vs. 3.5±2.2, P=0.001). There was a negative correlation between FGSI and CRP ratio (r=-0.51). ROC analysis determined the cutoff value as 1.78 for CRP (sensitivity, 86%; specificity, 82%; area under the ROC curve, 0.90) to predict death. The incidence of death for patients with CRP ratio of ≤1.78 increased 26.7 fold for those with CRP ratio of >1.78 (95% confidence interval [CI], 4.8-146.5; P=0.001). In the multivariable logistic regression model, CRP ratio (odds ratio [OR], 10.3; 95% CI, 1.5-72.2; P=0.019) and FGSI (OR, 17.8; 95% CI, 2.6-121.1; P=0.003) were independent risk factors for death. The CRP ratio is a simple method to use to predict mortality in FG.

The use of the ratio of C-reactive protein to albumin for the diagnosis of complicated appendicitis in children

No reliably specific marker for complicated appendicitis has been identified. The ratio of serum C-reactive protein (CRP) to albumin (ALB) (CRP/ALB ratio) is a new inflammation-based prognostic score that is associated with the severity of inflammation. The aim of this study was to evaluate the predictive value of CRP/ALB ratio for the diagnosis of complicated appendicitis in children. A retrospective study of 296 children with acute appendicitis was conducted with assessments of demographic data, clinical symptoms, pre-operative laboratory results, abdominal ultrasound examinations and clinical outcomes. According to the postoperative pathological results, patients were divided into a simple appendicitis group (169 patients) and a complicated appendicitis group (127 patients). SPSS version 22.0 was used to analyse the data. Of the 296 patients, CRP/ALB ratio was higher in complicated appendicitis than in simple appendicitis (P<0.05). Logistic regression analysis showed that higher levels of white blood cell count (WBC), CRP, CRP/ALB ratio, and increased incidence in submucosal layer loss and appendicolith were independent risk factors for complicated appendicitis in children. Receiver operating characteristic curve analysis showed that the area under the curve of the CRP/ALB ratio (0.883) was larger than that of WBC (0.702), CRP (0.802), ALB (0.835), submucosal layer loss (0.633) and appendicolith (0.673). A CRP/ALB ratio≥1.39 was found to be a significant marker in the prediction of complicated appendicitis, with 86.61% sensitivity and 84.62% specificity. Patients with a CRP/ALB ratio≥1.39 had a 31.263 times higher chance of having complicated appendicitis (95% CI: 16.449-59.418) than those with a CRP/ALB ratio<1.39. The admission CRP/ALB ratio was significantly higher in children with complicated appendicitis. The CRP/ALB ratio is a novel but promising haematological marker that aids in the differentiation of acute complicated and simple appendicitis.

Aging-related cell type-specific pathophysiologic immune responses that exacerbate disease severity in aged COVID-19 patients.

Coronavirus disease 2019 (COVID‐19) is especially severe in aged patients, defined as 65 years or older, for reasons that are currently unknown. To investigate the underlying basis for this vulnerability, we performed multimodal data analyses on immunity, inflammation, and COVID‐19 incidence and severity as a function of age. Our analysis leveraged age‐specific COVID‐19 mortality and laboratory testing from a large COVID‐19 registry, along with epidemiological data of ~3.4 million individuals, large‐scale deep immune cell profiling data, and single‐cell RNA‐sequencing data from aged COVID‐19 patients across diverse populations. We found that decreased lymphocyte count and elevated inflammatory markers (C‐reactive protein, D‐dimer, and neutrophil–lymphocyte ratio) are significantly associated with age‐specific COVID‐19 severities. We identified the reduced abundance of naïve CD8 T cells with decreased expression of antiviral defense genes (i.e., IFITM3 and TRIM22) in aged severe COVID‐19 patients. Older individuals with severe COVID‐19 displayed type I and II interferon deficiencies, which is correlated with SARS‐CoV‐2 viral load. Elevated expression of SARS‐CoV‐2 entry factors and reduced expression of antiviral defense genes (LY6E and IFNAR1) in the secretory cells are associated with critical COVID‐19 in aged individuals. Mechanistically, we identified strong TGF‐beta‐mediated immune–epithelial cell interactions (i.e., secretory‐non‐resident macrophages) in aged individuals with critical COVID‐19. Taken together, our findings point to immuno‐inflammatory factors that could be targeted therapeutically to reduce morbidity and mortality in aged COVID‐19 patients.

Assessment of Serum Ferritin, CRP and Insulin Levels in First Trimester of Pregnancy as a Predictive Biomarker of Gestational Diabetes Mellitus: A Longitudinal Study

Introduction: Gestational Diabetes mellitus (GDM) increases the risk of foetal morbidity and mortality heralding the future risk of development of type 2 diabetes in mother. GDM develops mainly due to insulin resistance along with interplay of risk factors like advancing maternal age, family history of diabetes, obesity, ethnicity, history of macrosomia. Aim: To detect whether estimation of serum ferritin, C-reactive protein and insulin in 1st trimester can predict the subsequent occurrence of GDM and whether susceptible mothers can be managed cautiously to prevent foeto-maternal complications. Materials and Methods: This hospital-based longitudinal study was done in Department of Gynaecology and obstetrics in collaboration with the Department of Biochemistry, Medical College and Hospital, Kolkata, West Bengal, India, from January 2018 to June 2019. The study included 80 antenatal mothers attending the Antenatal Outpatient Department in first trimester. The blood samples were collected from them during first trimester and serum ferritin, C-reactive Protein (CRP) and insulin were estimated using different methods as specified later. The anthropometric measurements of the mother {Body Mass Index (BMI), skin fold thickness and waist hip ratio} were measured. These enrolled study participants have undergone Oral Glucose Tolerance Test (OGTT) with 75 gm of anhydrous glucose at 24-28 weeks of gestation. The performance parameters like sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio of ferritin and CRP was calculated. Results: The mean age of participants who developed diabetes (n=12) 25.75±2.92 and who did not developed diabetes (n=68) 23.91±3.74 years. There was 15% prevelance of GDM in study population. The median concentration of serum ferritin and CRP was significantly higher in patients who developed GDM (n=12) among the study population (n=80). The sensitivity of serum ferritin {83.33% (95% confidence interval=51.59-97.91%)} was higher in comparison to C-reactive protein {31.82% (95% CI=13.86-54.87%)}. Conclusion: There was a remarkable decline of insulin sensitivity with the advancement of pregnancy. This implies that latent insulin resistance may start from first trimester and screening in high risk ethnicity group like India should be a routine protocol.

C-reactive Protein and Neutrophil Lymphocyte Ratio Levels as Predictive Biomarkers for Severity of COVID-19 Infection

C-reactive Protein and Neutrophil Lymphocyte Ratio Levels as Predictive Biomarkers for Severity of COVID-19 Infection

New predictors to identify severe cases during intravenous immunoglobulin therapy in Kawasaki disease.

The purpose of this study was to predict which patients would require plasma exchange therapy (PEX) using laboratory findings during intravenous immunoglobulin (IVIG) therapy in Kawasaki disease. A retrospective, single-center, cohort study was conducted. Of the 621 IVIG-treated patients, 166 patients who received a second IVIG dose on the second day after initiation of IVIG were included. The endpoint was PEX. Participants were divided into two groups: 10 patients who received PEX and 156 patients who did not. The variables were C-reactive protein (CRP), white blood cell count (WBC), and neutrophil fraction (NEUT) at three time points: pre-initial IVIG, pre-second IVIG, and post-second IVIG. The change ratio (post-IVIG value/pre-IVIG value) of each variable, with each IVIG dose, was calculated. Receiver operating characteristic analysis determined the area under the curve (AUC) and cut-off values. The variables with an AUC > 0.9 were CRP (post-second IVIG), change ratio of CRP (CRP value post-second IVIG/CRP value pre-second IVIG), NEUT (pre-second IVIG), and NEUT (post-second IVIG). Among these, the variables with high sensitivity were CRP (post-second IVIG) and the change ratio of CRP (second IVIG), with cut-off values of 9.52 mg/dL and 0.99, respectively. The sensitivity and specificity of these variables were 100% and 91%, and 100% and 80%, respectively. The combined sensitivity and specificity (95% confidence intervals) of these two variables were 100% (59-100) and 94% (89-97). High CRP levels and the change ratio of CRP after the second IVIG dose were associated with PEX.

The Prognostic Significance of C-Reactive Protein to Albumin Ratio in Newly Diagnosed Acute Myeloid Leukaemia Patients.

BackgroundThe ratio of C-reactive protein to albumin (CAR) is an inflammatory marker that has been demonstrated to be a simple and reliable prognostic factor in several solid tumours and chronic lymphocytic leukaemia (CLL). However, no studies have investigated the prognostic value of the CAR in patients with acute myeloid leukaemia (AML).Objectives and MethodsWe retrospectively analysed 212 newly diagnosed non-M3 AML patients. Using the receiver operating characteristic curve (ROC) method, the optimal cut-off value for CAR was determined. We investigated the correlations of the pretreatment CAR levels with clinical characteristics, treatment response of induction chemotherapy, overall survival (OS) and event-free survival (EFS). We also assessed the prognostic value of the CAR compared with other inflammation-based prognostic parameters by the area under the curve (AUC).ResultsAccording to the ROC curve, the optimal cut-off value of CAR was 1.015. CAR was associated with age, C-reactive protein (CRP) levels, albumin levels, ferritin levels, bone marrow blast percentage, French-American-British (FAB) classification, immunophenotype and 2017 European Leukemia Net (2017 ELN) risk stratification. Importantly, we found that high CAR was a powerful indicator of a lower complete remission (CR) rate (p<0.001), worse OS (p<0.001) and worse EFS (p<0.001). Subgroup analysis showed that a high CAR was associated with shorter OS and EFS in patients with intermediate risk stratification or those aged ≤65 years or those without haematopoietic stem cell transplantation (HSCT). In the multivariate analysis, the CAR was an independent prognostic factor for OS and EFS. Furthermore, the predictive value of CAR for OS is superior to that of CRP, albumin and GPS in de novo AML patients aged ≤65 years old.ConclusionCAR is a simple and effective prognostic marker in patients with AML. It could be an additional prognostic factor that help further precise the current risk stratification of non-M3 AML, particularly for patients in intermediate risk stratification and those aged ≤65 years and those who did not undergo HSCT.

Evaluation of inflammatory markers in COVID-19 positive patients and their correlation with age

The global widespread of Corona virus disease is still having a catastrophic impact on mankind. COVID-19 has depicted its uncertain adversity in all age groups and the coexistence of co-morbidities have further shown a critical aspect of disease which has additionally ravaged the health status of the patients. The inflammatory markers have exhibited potential usefulness in predicting the outcome of the disease. The Aim of this study is to evaluate the correlation of inflammatory markers in COVID-19 positive patients among various age groups. The study was done on 225 COVID-19 patients, admitted to Mayo Institute of Medical Sciences, Barabanki, Uttar Pradesh India, between 1st April-15th June 2021 categorizing into two groups based on their age (≤45 years and &gt;45 years) and then values of various markers were gathered and compared. Among the 225 admitted COVID-19 patients, 78(34.6%) were ≤45 years, while the remaining 147(65.4%) were &gt;45 years. Between these two age groups the aberrant values of inflammatory makers like Neutrophil count (p=0.0001), Lymphocyte count (p=0.0001), Neutrophil to Lymphocyte Ratio (NLR) (p=0.0091), Serum CRP level (p=0.0437), Lymphocyte to C-reactive protein ratio (LCR) (p=0.0007) as well as Serum Ferritin level (p=0.0097) were found to be statistically significant whereas the remaining parameters like Total leucocyte count (TLC) (p=0.0905), Platelet count (p=0.8202) and Platelet to lymphocyte ratio (PLR) (p=0.1513) were statistically insignificant. The results conclude that there was a significant correlation between the age and the inflammatory markers in these patients. Patients with &gt; 45 years had elevated/deranged levels of inflammatory markers, which were associated with the severity and poor prognosis of the disease. Thus, age can be considered as one of the important key risk factor for the severity of COVID-19 in both sexes and hence more clinical attention should be given to elderly age group.

Ferritin Lymphocyte Ratio and D-dimer C-Reactive Protein Ratio as Diagnostic Parameters in Pre-COVID-19 Healthy Individuals

Ferritin Lymphocyte Ratio and D-dimer C-Reactive Protein Ratio as Diagnostic Parameters in Pre-COVID-19 Healthy Individuals

Significance of laboratory parameters in diagnosing acute appendicitis during pregnancy

Acute appendicitis (AA) is the most frequently seen surgical emergency in pregnant women and the most frequently encountered cause of non-obstetric acute abdomen. Due to the physiological and anatomical changes that occur during pregnancy and the limited use of radiological methods, it is difficult to diagnose AA during pregnancy. These conditions increase the risk of morbidity and mortality; therefore, it is crucial to identify ideal laboratory markers that can be utilized to diagnose disease. One hundred and ten pregnancies that fulfilled the inclusion criteria for AA diagnosis were retrospectively analysed between 2010 and 2021. Markers with high diagnostic values were discussed. The patients were divided into three groups as follows; Group I: negative appendectomy (n=19); Group IIa: uncomplicated appendicitis (n=59); Group IIb: complicated appendicitis (n=32). There was no statistically significant difference in mean age or gestational week (P > 0.05). Group IIb had a higher rate of complications and a longer length of hospital stay (P < 0.05). There were significant differences between the groups in terms of white blood cell (WBC), neutrophil, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein, lymphocyte-to- C-reactive protein ratio, total, direct, and indirect bilirubin values (P < 0.05). While platelet and lactate dehydrogenase (LDH) values did not differ substantially between groups, both were found to have a high diagnostic value. It was concluded that WBC, neutrophil, NLR, PLR, total, direct and indirect bilirubin levels could be utilized to diagnose AA. Moreover, levels of WBC, neutrophil, NLR, platelet, PLR, LDH, total, direct and indirect bilirubin can be utilized to diagnose complicated appendicitis.

The pleural fluid lactate dehydrogenase /adenosine deaminase and pleural fluid adenosine deaminase /serum C-Reactive Protein ratios for differentiating between Tuberculosis and other causes in a sample of Iraqi patients

Objectives: This study aim is to evaluate the importance of pleural fluid LDH/ADA ratio and pleural fluid ADA/serum CRP ratio in differentiating tuberculous pleural effusion from other causes in a sample of Iraqi patients. Methods: A prospective study of 100 patients&nbsp; with pleural effusion whom age ranges from 18-70&nbsp; years&nbsp; where admitted at medical department at Al-Imamein Kadhimein medical city in Bagdad&nbsp; and in Marjan and Al-Sadik hospitals at Babylon province. Out of 61(61%) are males and 39 (39%) are females. The study period was 9 months started from&nbsp; 1st of February to End of October 2019. &nbsp; Results: in this study the result of comparison of mean level of pleural fluid&nbsp; LDH/ADA ratio&nbsp; and pleural fluid&nbsp; ADA/Serum CRP ratio&nbsp; between tuberculous and para pneumonic pleural effusions were significant =0.025 and 0.002 respectively. Also the comparison of pleural fluid&nbsp; LDH /ADA ratio and pleural fluid&nbsp; ADA/Serum CRP ratio between tuberculous and malignant pleural effusions were significant =0.005 in both. Conclusion: Pleural fluid LDH /ADA ratio is of great value in differentiation tuberculous pleural effusion from malignant pleural effusion with predominant lymphocytes, pleural fluid ADA/serum CRP ratio is of great value in differentiation tuberculous pleural effusion from para pneumonic pleural effusion with elevated pleural fluid ADA and elevated serum CRP.

The role of coinfection with influenza viruses in the pathogenesis of severe infection in patients with COVID-19

BACKGROUND: Despite the continuing global spread of the coronavirus infection COVID-19 caused by the SARS-CoV-2 coronavirus, the mechanisms of the pathogenesis of severe infections remain poorly understood. The role of comorbidity with other seasonal viral infections, including influenza, in the pathogenesis of the severe course of COVID-19 remains unclear.&#x0D; MATERIALS AND METHODS: The present study used sera left over from ongoing laboratory studies of patients with varying degrees of severity of COVID-19. The study was approved by the Local Ethics Committee of the Federal State Budgetary Scientific Institution IEM (protocol 3/20 from 06/05/2020). We studied 28 paired samples obtained upon admission of patients to the hospital and after 57 days of hospital stay. Paired sera of patients with COVID-19 were tested for antibodies to influenza A and B viruses. The presence of IgG antibodies specific to the SARS-CoV-2 spike (S) protein was studied using an enzyme-linked immunosorbent assay (ELISA). The serum concentration of C-reactive protein and the neutrophil-lymphocyte ratio on the day of hospitalization were also assessed.&#x0D; RESULTS: At least a 4-fold increase in serum IgG antibodies to SARS-CoV-2 S protein was found both in patients with PCR-confirmed SARS-CoV-2 infection and without PCR confirmation. It was shown that out of 18 patients with moderate and severe forms of COVID-19 infection, six of them showed at least a 4-fold increase in antibodies to influenza A/H1N1, in one to influenza A/H3N2 and in two cases to the influenza B. Laboratory data in these two groups were characterized by significant increases in serum C-reactive protein and neutrophil-lymphocyte ratio concentrations compared with the moderate COVID-19 group.&#x0D; CONCLUSIONS: Serological diagnostics can additionally detect cases of coronavirus infection when the virus was not detected by PCR. In moderate and severe cases of COVID-19, coinfections with influenza A and B viruses have been identified. The results obtained confirm the need for anti-influenza immunization during the SARS-CoV-2 pandemic. Influenza virus screening can significantly improve patient management because recommended antiviral drugs (neuraminidase inhibitors) are available.

Beneficial immune-regulatory effects of novel strains of Aureobasidium pullulans AFO-202 and N-163 produced beta glucans in Sprague Dawley rats

The beneficial immunomodulation effects of a biological response modifier glucan (BRMG) produced by two strains of Aureobasidium pullulans, AFO-202 and N-163, have already been reported. Herein, we compared their efficacy on immune-inflammatory parameters in Sprague Dawley (SD) rats. This study was performed on four groups of healthy SD rats, n=6 in each group: Group 1, euthanised on Day 0 for baseline values; Group 2, control (drinking water); Group 3, AFO-202 beta glucan, 200 mg/kg/day; and Group 4, N-163 beta glucan, 300 mg/kg/day. The neutrophil to lymphocyte ratio (NLR) decreased and leukocyte-to C-reactive protein ratio (LeCR) increased in Group 3 (AFO-202) at 15 and 29 days whereas the lymphocyte to C-reactive protein ratio (LCR) increased in group 4 (N-163), within the normal physiological range. These promising results warrant further investigations in larger numbers of healthy and diseased models to develop appropriate strategies for balancing immune system dysregulation.

C-reactive protein and Neutrophil-Lymphocyte Ratio as predictors of clinical severity of COVID-19

COVID-19 is an infectious disease that can manifest quite differently. In this study we examined the relationship between the value of serum CRP(C-reactive protein) andneutrophil-lymphocyte ratio (NLR) as predictor factors for the development of a severe clinical manifestation in COVID19 patients. Materials and methods: We followed 95 COVID-19 positive patients who were hospitalized at the University Clinic for Eye Diseases - COVID Center. We analyzed the initial laboratory parameters of white blood cells and CRP on admission of the patients and the results of laboratory analyses performed before they left the Clinic, or the last parameters before the lethal outcome in those patients who died. Several models of logistic regression were tested to analyze the predictive value of these markers of inflammation for lethal outcome in patients hospitalized for COVID-19. Results: Bivariate analysis demonstrated that the length of hospital stay was significantly shorter in patients with lethal outcome (p=0.001). The NLR was significantly higher in patients with lethal outcome at both times (p=0.005; and p=0.017). Leukocyte’s count (p=0.046, and p&lt;0.001) and CRP (p=0.013,and p=0.005) were also significantly higher in patients with lethal outcome at both times. The increase on the NLR scale both at hospitalization and at discharge (or the last analysis before death) leads to increase in the odds of lethal outcome (T1:40.4% increased odds; T2:36% increased odds). Conclusion: CRP and NLR are laboratory parameters that can predict the severity of the clinical manifestation in patients with COVID-19.

Prognostic Value of Lymphocyte–C-Reactive Protein Ratio in Patients Undergoing Radical Cystectomy for Bladder Cancer: A Population-Based Study

PurposeThis study aimed to assess the prognostic value of the lymphocyte–C-reactive protein ratio (LCR) in patients with bladder cancer (BCa) who underwent radical cystectomy (RC).Materials and MethodsBCa patients between 2009 and 2018 were retrieved from our medical center. The predictive value of LCR on survival of BCa patients was evaluated through the Kaplan–Meier survival and receiver operating characteristic (ROC) curves. The multivariate Cox regression results were used for conducting the nomogram, which were further verified by ROC, decision curve analysis (DCA), and calibration curves. Propensity score matching (PSM) was performed to validate our findings.ResultsA total of 201 BCa patients who received RC were included in this study, with 62 (30.8%) patients in the low LCR group and 139 (69.2%) in the high LCR group. Multivariate analysis results revealed that the high LCR group was significantly related to better prognosis and functioned as a prognostic biomarker for overall survival (OS) [hazard ratio (HR) = 0.41, 95% CI, 0.26–0.66; p < 0.001] and disease-free survival (DFS) [HR = 0.40, 95% CI, 0.26–0.66; p < 0.001]. The nomogram processed better predictive capability and accuracy than TNM stage from ROC results (AUC = 0.754 vs. AUC = 0.715), with the confirmation of calibration curves and DCA. The result of PSM confirmed that LCR was significantly correlated with OS and DFS.ConclusionOur finding demonstrates that LCR is a novel, convenient, and effective predictor that may provide vital assistance for clinical decision and individualized therapy in BCa patients after RC.

Longitudinal association between serum uric acid level and carotid atherosclerotic plaques in patients with new cases of hypertension

Abstract Objective To reveal the relationship between uric acid level and carotid atherosclerotic plaques in hypertensive subjects in randomized urban population according to 10-years prospective study. Design and methods A 10-years prospective study included 3,500 randomized individuals living in the district of Vitebsk (2007/2008 - 2017/2018). The coverage of the survey was 97,9% (3427 participants). There was revealed 2170 persons with normal blood pressure. 1862 of them were examined on the second stage in 2012/2013 (coverage of the survey was 85,8%). 286 new cases of hypertension were revealed and they had significant positive relationship with the IV quartile of uric acid level (≥339 μmol/l). A 10-years prospective analysis was provided in 2017/2018 and included 145 randomized subjects with hypertension diagnosed on the second stage of the study. Specially developed registration form was filled in for all the participants and it included socio-demographic data, standard questionnaires for detection of cardiovascular risk factors, anthropometry, blood pressure measurements, electrocardiography, blood chemistry, ultrasound examination of brachiocephalic arteries and echocardiography. Results According to the results of 10-years prospective study serum uric acid level ≥339 μmol/l, revealed at the start of the study, is a predictor of the detection of carotid atherosclerotic plaques in 2017/2018 in subjects with new cases of hypertension (df=1; χ2 Wald=6,63; p&amp;lt;0,05) adjusted for age and gender. Cross-sectional analysis of these subjects showed that the level of uric acid, regardless of age and gender, is associated with the level of triglycerides (p&amp;lt;0,001), apo B (p&amp;lt;0,001), apo A1 (p&amp;lt;0,05), LDL (p&amp;lt;0,05), VLDL (p&amp;lt;0,05), HDL (p&amp;lt;0,05), non-HDL-C (p&amp;lt;0,05), total cholesterol (p&amp;lt;0,05), high-sensitivity CRP (p&amp;lt;0,05), TNF-α (p&amp;lt;0,05), apoB/apoA1 ratio (p&amp;lt;0,05), glycated hemoglobin percentage (p&amp;lt;0,05), body mass index (p&amp;lt;0,001), waist circumference (p&amp;lt;0,05), metabolic syndrome (p&amp;lt;0,05) and alcohol abuse (p&amp;lt;0,05). In stepwise multiple linear regression model the most significant of these factors were the level of triglycerides (β=0,23, p&amp;lt;0,05), alcohol abuse (β=0,18, p&amp;lt;0,05), body mass index (β=0,18, p&amp;lt;0,05), apoB/apoA1 ratio (β=0,17, p&amp;lt;0,05) and level of high-sensitivity CRP (β=0,15, p&amp;lt;0,05). Conclusions Serum uric acid level ≥339 μmol/l predicted detection of carotid atherosclerotic plaques in patients with new cases of hypertension in 10-years prospective study. The most significant factors, regardless of age and gender, associated with serum uric acid levels in these patients were level of triglycerides, alcohol abuse, body mass index, apoB/apoA1 ratio and level of high-sensitivity C-reactive protein. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Republican Scientific and Practical Centre of Cardiology

Cross sectional association between cytomegalovirus seropositivity, inflammation and cognitive impairment in elderly cancer survivors.

The higher prevalence of cognitive impairment/ dementia among cancer survivors is likely multifactorial. Since both exposures to cytomegalovirus (CMV) and inflammation are common among elderly cancer survivors, we evaluated their contribution towards dementia. Data from 1387 cancer survivors and 7004 participants without cancer in the 2016 wave of the Health and Retirement Study (HRS) was used in this study. Two inflammatory biomarkers, C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR), were used to create an inflammation score. We used survey logistic regression adjusted for survey design parameters. CMV seropositivity was not associated with cognitive impairment among cancer survivors (p = 0.2). In addition, inflammation was associated with elevated odds of cognitive impairment (OR = 2.2, 95% CI [1.2, 4.2]). Cancer survivors who were both CMV seropositive and had increased inflammation had the highest odds of cognitive impairment compared to those who were CMV seronegative and had low inflammation (OR = 3.8, 95% CI [1.5, 9.4]). The stratified analysis among cancer survivors showed this association was seen only among cancer survivors in whom the cancer was diagnosed within three years of measurement of inflammation score and CMV serostatus (OR = 18.5; 95% CI [6.1, 56.1]). The CMV seropositivity and high inflammation was associated with higher cognitive impairment among cancer survivors. The stronger associations seen among cancer survivors diagnosed within the last three years suggest that strategies to reduce CMV activation and inflammation during or immediately after cancer treatment may be important in reducing the prevalence of cognitive impairment/ dementia among cancer survivors.

C-reactive protein and neutrophil-lymphocyte ratio as predictors of mortality in coronavirus disease 2019.

This study investigates whether C-reactive protein, platelet-lymphocyte ratio, and neutrophil-lymphocyte ratio could be useful to predict mortality in COVID-19. Data of 635 patients with COVID-19 followed up in Sinop Ataturk State Hospital from February to May 2020 were evaluated retrospectively. Diagnosis of COVID-19 was made according to the interim guidance of the World Health Organization. Patients were grouped into two groups based on mortality as survived and non-survived patients. Age, gender, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and C-reactive protein of the groups were investigated and compared. The mean age of the participants was 55.8±22.3 years. Among the patients, 584 survived and 51 patients died. Age was significantly different between the groups, 54.2±22.3 in the survived group and 75.6±11.1 in the dead group (p=0.000). In addition, neutrophil, C-reactive protein, and neutrophil-lymphocyte ratio values were significantly higher in the dead group (p=0.000). platelet-lymphocyte ratio was slightly higher in the dead group, but this difference was not significant (p=0.42). The area under the curve values for age, lymphocyte, platelet, C-reactive protein, and neutrophil-lymphocyte ratio are 0.797, 0.424, 0.485, 0.778, and 0.729, respectively. Our results showed that neutrophil-lymphocyte ratio and C-reactive protein are significantly higher in patients leading to death and could be effective biomarkers in predicting COVID-19 fatality. Furthermore, C-reactive protein could be used as an independent biomarker to predict death in patients with COVID-19, regardless of gender and age (p=0.000).