Changes In C-reactive Protein Research Articles

Impact of Atorvastatin on C-reactive Protein, Glycaemic Status and Liver Enzymes among Non Diabetic Patients: A Prospective Study

Introduction: Atorvastatin is one of the common drugs used for primary and secondary prevention of atherosclerotic cardiovascular diseases. Various studies have suggested variation in C-reactive Protein (CRP) value, glycaemic status and liver enzymes of patients following statin therapy. However, the adequate and exact data regarding the impact of atorvastatin on the above parameters in the population of Eastern India is still limited. Aim: To estimate the effect of atorvastatin on CRP, glycaemic status and haepatic enzymes of non diabetic patients. Materials and Methods: A prospective longitudinal observational study was conducted in the Outpatient Department (OPD) of Internal Medicine at Midnapore Medical College and Hospital, Paschim Medinipur, West Bengal, India. The duration of the study was one year six months, from June 2020- December 2021. A total of 150 non diabetic patients aged between 30- 75 years receiving atorvastatin were enrolled in the present study. Patients with known Diabetes Mellitus (DM), impaired fasting glucose, impaired glucose tolerance, pregnancy and lactation were excluded. CRP, Fasting Blood Sugar (FBS), Postprandial Blood Sugar (PPBS), haepatic enzymes and lipid profile of participants were monitored at baseline, at the end of one month, six months and 12 months. The data was analysed using Statistical Package for Social Sciences (SPSS) version 22.0, Microsoft Excel and GraphPad Prism. Results: The study population were predominantly males (69.6%), with mean age of 54±8.88 years and mean weight of 60±5.86 kg. Majority of the patients were on atorvastatin 40 mg (60.86%) followed by atorvastatin 20 mg (26.8%) and atorvastatin 10 mg (12.3%). There were statistical significant changes of mean CRP (1.502 mg/L), mean FBS (86.52 mg/dL), mean PPBS (113.57 mg/dL), mean Serum Glutamic-oxaloacetic Transaminase (SGOT) (22.84 IU/L), mean Serum Glutamic Pyruvic Transaminase (SGPT) (25.24 IU/L) and lipid profile levels at the end of one year. None of the patients developed new onset DM at the end of one year. A 5% of patients developed prediabetes at the end of 3rd follow-up. Conclusion: Atorvastatin usage showed that, there was a significant increase in blood glucose and haepatic enzymes level in non diabetic population. Hence, strict monitoring of blood glucose levels along with periodic monitoring of haepatic enzyme levels should be done in regular intervals.

Proactive anti-inflammatory therapy in the advanced stages of a new coronavirus infection. Main results of the inpatient phase of the COLORIT study (Colchicin vs. Ruxolitinib and secukinumab in an open, prospective, randomized trial in patients with novel coronavirus infection COVID-19).

Aim To evaluate clinical efficacy of the proactive anti-inflammatory therapy in patients hospitalized for COVID-19 with pneumonia and a risk of "cytokine storm".Material and methods The COLORIT study was a comparative study with randomization into 4 groups: colchicine (n=21) 1 mg for the first 3 days followed by 0.5 mg/day through day 12 or discharge from the hospital; secukinumab 300 mg/day, s.c., as a single dose (n=20); ruxolitinib 5 mg, twice a day (n=10); and a control group with no anti-inflammatory therapy (n=22). The effect was evaluated after 12±2 days of inpatient treatment or upon discharge, what comes first. For ethical reasons, completely randomized recruitment to the control group was not possible. Thus, for data analysis, 17 patients who did not receive any anti-inflammatory therapy for various reasons not related with inclusion into the study were added to the control group of 5 randomized patients. Inclusion criteria: presence of coronavirus pneumonia (positive PCR test for SARS-CoV-2 RNA or specific clinical presentation of pneumonia; IDC-10 codes U07.1 and U07.2); C-reactive protein (CRP) concentration >60 mg/l or its threefold increase from baseline; at least 2 of 4 symptoms (fever >37.5 °C, persistent cough, shortness of breath with inspiratory rate >20 per min or blood saturation with oxygen <94 % by the 7th-9th day of disease. The study primary endpoint was changes in COVID Clinical Condition Scale (CCS-COVID) score. The secondary endpoints were the dynamics of CRP and changes in the area of lung lesion according to data of computed tomography (CT) of the lungs from the date of randomization to 12±2 days.Results All three drugs significantly reduced inflammation, improved the clinical course of the disease, and decreased the disease severity as evaluated by the CCS score: in the ruxolitinib group, by 5.5 (p=0.004); in the secukinumab group, by 4 (p=0.096); in the colchicine group, by 4 (p=0.017), and in the control group, by 2 (р=0.329). In all three groups, the CCS-COVID score was 2-3 by the end of observation period, which corresponded to a mild process, while in the control group, the score was 7 (р=0.005). Time-related changes in CRP were significant in all three anti-inflammatory treatment groups with no statistical difference between the groups. By the end of the study, changes in CT of the lungs were nonsignificant.Conclusion In severe СOVID-19 with a risk of "cytokine storm", the proactive therapy with ruxolitinib, colchicine, and secukinumab significantly reduces the inflammation severity, prevents the disease progression, and results in clinical improvement.

Changes in Heparin-Binding Protein, Procalcitonin, and C-Reactive Protein Within the First 72 Hours Predict 28-Day Mortality in Patients Admitted to the Intensive Care Unit with Septic Shock.

BACKGROUND This study aimed to evaluate the possible associations of heparin-binding protein (HBP), procalcitonin (PCT), and C-reactive protein (CRP) levels with 28-day mortality in septic shock patients admitted to Intensive Care Units (ICUs). MATERIAL AND METHODS Blood samples were taken at ICU admission and measured again 72 h later to calculate changes in HBP (ΔHBP), changes in PCT (ΔPCT), changes in CRP (ΔCRP), and changes in Sequential Organ Failure Assessment (DSOFA) relative to baseline. RESULTS Variables included in the univariable logistic regression model for survival were age, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, decreasing ΔSOFA, decreasing DHBP, decreasing ΔPCT, and decreasing ΔCRP. Survival was directly related to decreasing ΔHBP with odds ratio (OR)=9.95 (95% confidence interval [CI] 4.63 to 21.35; P<0.001), decreasing ΔPCT with OR=7.85 (3.74 to 16.49; P<0.001), decreasing ΔCRP with OR=5.83 (2.84 to 11.97; P<0.001), decreasing ΔSOFA with OR=1.93 (1.00 to 3.75; P=0.051) and APACHE II score with OR=1.93 (1.14 to 1.68; P=0.001). In a multivariable logistic regression model for survival, only decreasing DHBP with OR=7.18 (2.91 to 17.69; P<0.001), decreasing ΔPCT with OR=5.17 (2.12 to 12.56; P<0.001), and decreasing ΔCRP with OR=4.33 (1.77 to 10.61; P=0.001) remained significant. CONCLUSIONS Measuring changes in HBP, PCT, and CRP within 72 h of admission may aid in predicting 28-day mortality for patients with septic shock in ICUs.

The effect of targeted rheumatoid arthritis therapeutics on systemic inflammation and anemia: analysis of data from the CorEvitas RA registry

BackgroundTo evaluate the effects of tumor necrosis factor inhibitors (TNFi), interleukin-6 receptor inhibitors (IL-6Ri), and Janus kinase inhibitors (JAKi) on hemoglobin (Hb) and C-reactive protein (CRP) levels in adults enrolled in CorEvitas (formerly Corrona), a large US rheumatoid arthritis (RA) registry.MethodsPatients who initiated TNFi, IL-6Ri, or JAKi treatment during or after January 2010, had Hb and CRP measurements at baseline and 6-month follow-up (± 3 months) and had continued therapy at least until that follow-up, through March 2020, were included in the analysis. Changes in Hb and CRP were assessed at month 6. Abnormal Hb was defined as < 12 g/dL (women) or < 13 g/dL (men); abnormal CRP was ≥ 0.8 mg/dL. Differences in Hb and CRP levels were evaluated using multivariable regression.ResultsOf 2772 patients (TNFi, 65%; IL-6Ri, 17%; JAKi, 17%) evaluated, 1044 (38%) had abnormal Hb or CRP at initiation; an additional 252 (9%) had both abnormal Hb and CRP. At month 6, the IL-6Ri group had a greater Hb increase than the TNFi (mean difference in effect on Hb: 0.28 g/dL; 95% CI 0.19–0.38) and JAKi (mean difference in effect on Hb: 0.47 g/dL; 95% CI 0.35–0.58) groups, regardless of baseline Hb status (both p < 0.001). The CRP decrease at month 6 was greater with IL-6Ri compared with TNFi and JAKi, regardless of baseline CRP status (both p < 0.05).ConclusionThese real-world results align with the mechanism of IL-6R inhibition and may inform treatment decisions for patients with RA.

The Association of Prenatal C-Reactive Protein and Interleukin-8 Levels with Maternal Characteristics and Preterm Birth.

The determinants of preterm birth remain unknown. Excessive maternal inflammation during pregnancy may play an important role in the pathogenesis of preterm birth. Our objective was to describe the association of prenatal levels of proinflammatory C-reactive protein (CRP) and interleukin-8 (IL-8) with preterm birth in participants of the Vitamin D Antenatal Asthma Reduction Trial. Five hundred and twenty-eight patients with available samples of both first- and third-trimester plasma were included in this analysis. CRP and IL-8 were measured from maternal prenatal samples. We examined the association between prenatal CRP and IL-8 with maternal health characteristics and the outcome of preterm birth. We also described the patterns of change in CRP and IL-8 from first to third trimester and their association with preterm birth. A subgroup analysis comparing only those with a spontaneous preterm birth phenotype to those with term birth was also performed. Maternal characteristics including lower educational attainment, higher prepregnancy body mass index, gestational diabetes, lower vitamin D, and an unhealthy diet were associated with elevated levels of prenatal CRP and IL-8. Higher third trimester CRP and an increase in CRP from first to third trimester were associated with an increased odds of preterm birth when compared to lower levels of CRP (adjusted odds ratio [aOR] = 1.49, 95% confidence interval: 1.02, 2.23, p = 0.04) or a decrease in CRP over pregnancy (aOR = 3.06, 95% CI = 1.31,7.55, p = 0.01), after adjusting for potential confounders. These associations were strengthened when comparing only patients with spontaneous preterm birth (n = 22) to those with term births. Higher levels of the proinflammatory markers CRP and IL-8 are associated with indicators of poor maternal health and preterm birth. Prenatal CRP levels may reflect maternal prenatal health status and serve as a predictor of preterm birth, especially among those with spontaneous preterm birth. · Elevated prenatal CRP is associated with poor maternal health.. · High prenatal CRP may predict premature birth, especially spontaneous premature birth phenotypes.. · Vitamin D insufficiency may be a modifiable risk factor for prenatal inflammation..

Associations of liver fat content with cardiometabolic phenotypes and outcomes in a multi-ethnic population: Results from the Dallas Heart Study.

To evaluate the associations between liver fat content and cardiometabolic parameters to explore potential threshold values that define metabolically healthy liver fat content, and to examine the association of liver fat content with cardiovascular events as well as its longitudinal progression. Participants in the Dallas Heart Study underwent clinical evaluation, including laboratory testing, and liver fat quantification by magnetic resonance spectroscopy (MRS) at baseline (N=2287) and at follow-up (N=343) after a mean of 7.3 years. Cardiovascular events were adjudicated (>12 years). The mean age at study entry was 44 years, 47% of participants were men, and 48% were African American. The following cardiometabolic biomarkers worsened across liver fat quintiles (P < 0.0001): body mass index (BMI); waist circumference; prevalence of hypertension; prevalence of diabetes; cholesterol, triglyceride, high-sensitivity C-reactive protein (CRP), leptin and fasting glucose levels; homeostatic model assessment of insulin resistance index (HOMA-IR); coronary artery calcium score; visceral adipose tissue; abdominal subcutaneous adipose tissue; and lower body subcutaneous adipose tissue. Cardiovascular events were comparable across groups defined by tertile of baseline liver fat content. Change in BMI (R=0.40), waist circumference (R=0.35), CRP (R=0.31), alanine aminotransferase (R=0.27), HOMA-IR (R=0.26), aspartate transaminase (R=0.15) and triglycerides (R=0.12) significantly correlated with change in liver fat content (P < 0.01 for all). Clinically relevant metabolic abnormalities were higher across quintiles of liver fat, with increases noted well within normal liver fat ranges, but cardiovascular events were not associated with liver fat content. Longitudinal changes in metabolic parameters, especially adiposity-related parameters, were correlated with change in liver fat content.

Diagnostics of macrophage activation syndrome, depending on IL-6 initial level in patients with a novel coronavirus infection

Introduction. The novel coronavirus infection caused by the SARS-CoV-2 remains the main problem, which is being studied by all the efforts of the global scientific community. Large clinical recourse has been accumulated that allows to conduct more effective treatment of patients, but there are still unresolved issues on the pathogenesis for development and course of the disease.&#x0D; Materials and methods. The study included 163 patients admitted to the infectious diseases hospital diagnosed with Novel coronavirus infection caused by the SARS-CoV-2. Upon admission, all patient serum samples were quantified for IL-6 level that allowed to stratify patients into three groups: A 55 patients with IL-6 below 5.0 pg/ml. The mean age in the group was 57.314.9 years, body mass index (BMI) was 28.25.6 kg/m2; C 52 patients whose serum IL-6 level was in the range of 549 pg/ml. The average age in the group was 60.811.8 years, BMI 29.65.5 kg/m2; C 56 patients in whom the level of IL-6 in the blood serum ranged within 50300 pg/ml. The average age in the group was 62.515.6 years, BMI 28.85.6 kg/m2. Patients at admission were analysed for serum level of IL-6, IL-8, and C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH) were also determined on day 3 and 7.&#x0D; Results. The minimum production of IL-6 within the range of 0.15 pg/ml, corresponds to the minimum changes in IL-8, CRP, and ferritin as well as LDH that was within the range of physiological values. Moderate cytokinemia, IL-6 is within the range of 549 pg/ml was associated with elevated ferritin and LDH not tending to decline by the end of treatment. Significant cytokinemia, the level of IL-6 within the range of 50300 pg/ml was associated with hyperferritinemia and increased LDH. The course of COVID-19 in such patients is characterized by increased ferritin by day 3 of treatment, consistently high level of LDH, without a significant trend towards a decline in the studied markers by the end of treatment.&#x0D; Conclusion. The risk of developing macrophage activation syndrome is not observed of the serum IL-6 level was below 5 pg/ml, whereas ferritin and LDH were within the range of physiological values, with no/degree I ARF. Moderate macrophage activation syndrome is characterized by increased serum IL-6 level within the range 549 pg/ml, a moderate increase in LDH and ferritin, as well as signs of ARF III degree. Severe signs are diagnosed in case of serum IL-6 level exceeded 50 pg/ml, along with significant increase in LDH and ferritin, as well as signs of IIIII degree ARF.

Abstract 13353: Association of Plasma Metabolites With Inflammatory Markers CRP and GlycA and Their Responses to Exercise Training

Introduction. C-reactive protein (CRP) and GlycA are established biomarkers of inflammation. Regular exercise tends to decrease CRP and GlycA levels. However, the spectrum of molecules associated with the anti-inflammatory effects of regular exercise are less well understood. Hypothesis. We hypothesized that distinct metabolite signatures exist for both baseline levels and exercise responsiveness of CRP and GlycA. Methods. Measures were performed before and after 20 weeks of endurance exercise training in 652 Black and White adults from the HERITAGE Family Study. A total of 300 targeted plasma metabolites were measured using LC-MS. High-sensitivity CRP and GlycA were measured using automated assays and NMR spectroscopy (LabCorp), respectively. Linear mixed models were used to test: 1) Association of baseline metabolites with baseline hsCRP and GlycA and 2) Association of changes in metabolite with changes in hsCRP and GlycA. Models were adjusted for age, sex, race, BMI, with family membership as a random variable, with change models also adjusting for baseline trait value. Significance was determined as FDR&lt;0.05. Results. Baseline levels and changes of hsCRP and GlycA were moderately correlated (r=0.51 and 0.31, p&lt;0.0001 for both, respectively). At baseline, 40 and 94 metabolites were associated with hsCRP and GlycA, respectively, with 30 metabolites associated with both phenotypes. The top baseline associations for both traits included multiple species of lysophosphatidylcholine (LPC) and phosphatidylethanolamine (PE), while cortisol, biliverdin, and bilirubin were among the metabolites associated with GlycA only. The changes in only one metabolite were associated with concomitant changes in CRP, while no associations were found for change in GlycA. Conclusions. Plasma metabolite associations with baseline hsCRP overlapped with those associated with baseline GlycA levels. Several unique metabolite associations with baseline GlycA were identified, including molecules in established inflammatory pathways. Metabolite changes with exercise were not associated with changes in either measure. These findings have implications for the use of metabolites as signatures of systemic inflammation vs as targets of lifestyle interventions.

The Effect of Dietary Patterns on Inflammatory Biomarkers in Adults with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Some evidence supports the fact that chronic low-grade inflammation contributes to the physiopathology of type 2 diabetes mellitus (T2DM), and circulating markers of inflammation (e.g., C-reactive protein (CRP), pro- and anti-inflammatory biomarkers (e.g., adiponectin), and endothelial function markers could indicate an ongoing pathology. Following certain dietary patterns (DPs) may result in favorable changes in inflammatory biomarkers. The overarching aim of this systematic review and meta-analysis is to explore the inflammatory effect of healthy DPs on inflammatory biomarkers in adults with T2DM. A systematic search of the literature was conducted using the electronic databases MEDLINE, SCOPUS, and Cochrane Central Register of Controlled Trials. A total of 10 randomized controlled clinical trials (RCTs) were analyzed. In our linear meta-analysis, the random-effects model was applied to estimate standardized mean differences (SMD) to associate the effect of the interventions. Dietary Approaches to Stop Hypertension (DASH), Diabetes UK healthy eating, Mediterranean Diet (MD), Diabetes Prevention Program (DPP), and the American Heart Association's Therapeutic Lifestyle Changes diet were associated with a significant reduction in CRP (SMD: -0.83, 99% CI -1.49, -0.17, p &lt; 0.001; I2 94%), while plasma levels of adiponectin were significantly higher with the intake of MD, DPP, and Diabetes UK healthy eating (SMD: 0.81, 99% CI 0.06,1.56, p &lt; 0.005; I2 96%), both of which indicate less inflammation. Sensitivity analyses were carried out, and potential publication bias was examined. In conclusion, low- moderate-quality evidence from RCTs suggests that, for the DPs evaluated, there are favorable changes in CRP and adiponectin.

The Association of Preoperative Depression, and C-Reactive Protein Levels with a Postoperative Length of Stay in Patients Undergoing Coronary Artery Bypass Grafting

This study aimed to explore the role of preoperative and postoperative C-reactive protein (CRP) levels in mediating the association between the preoperative depression symptoms and postoperative length of stay in patients undergoing coronary artery bypass grafting (CABG). Preoperative depression symptoms of 212 elective CABG patients were measured using the Beck Depression Inventory (BDI-II). The patient’s demographic and clinical parameters were collected from medical records prior to surgery. Patients were followed up during their in-hospital stay to measure early (1–3 days post-surgery) and persistent (4–6 days post-surgery) CRP response to CABG surgery. The higher persistent CRP response was significantly (p &lt; 0.001) associated with a longer postoperative hospital stay. The binary logistic regression analysis confirmed the association of persistent CRP change with prolonged hospital stay (OR = 1.017, 95% CI = 1.005–1.029, p = 0.009). However, when the gender subgroups were analyzed separately, that remained significant (OR = 1.016, 95% CI = 1.004–1.028, p = 0.005) only for the male subgroup. There was no significant association between elevated BDI-II depression scores and longer postoperative hospital stay. Additionally, no significant influence of BDI-II scores on preoperative or postoperative CRP levels, or vice versa, was detected. Further work is needed to explore the extent and pathways through which depression might influence the postoperative recovery of CABG patients.

Effects of dulaglutide on endothelial progenitor cells and arterial elasticity in patients with type 2 diabetes mellitus

BackgroundRandomised controlled trial showed that dulaglutide can reduce the risk of atherosclerotic cardiovascular disease (ASCVD) in patients with type 2 diabetes mellitus (T2DM), but the underlying mechanisms remain unclear. This study aimed to investigate the effect of dulaglutide on the number and function of endothelial progenitor cells (EPCs) in the peripheral blood of patients with T2DM and its role in improving arterial elasticity, so as to determine potential mechanisms of preventive effect of dulaglutide on ASCVD.MethodsSixty patients with T2DM were treated with 1000 mg/day of metformin and randomly divided into two groups for 12 weeks: metformin monotherapy group (MET group, n = 30), and metformin combined with dulaglutide group (MET-DUL group, n = 30). Before and after treatment, the number of CD34+CD133+KDR+ EPCs and the brachial–ankle pulse wave velocity (baPWV) of the participants were measured, and EPC proliferation, adhesion, migration, and tubule formation were assessed in vitro.ResultsThere were no significant differences in the number and function of EPCs and baPWV changes in MET group (P > 0.05). In MET-DUL group, nitric oxide (NO) levels and the number of EPCs increased after treatment (P < 0.05), while the levels of C-reactive protein (CRP), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), advanced glycation end products (AGEs), and baPWV decreased (P < 0.05). EPC proliferation, adhesion, migration, and tubule formation abilities were significantly enhanced (P < 0.05). Correlation analysis showed that in MET-DUL group, the changes in CRP, IL-6, TNF-α, and AGEs were negatively correlated with the number of EPCs and their proliferation and migration abilities (P < 0.05). Body weight, NO, CRP, and IL-6 levels were independent factors affecting the number of EPCs (P < 0.05). The changes in number of EPCs, proliferation and migration abilities of EPCs, and NO and IL-6 levels were independent influencing factors of baPWV changes (P < 0.05).ConclusionDulaglutide can increase the number and function of EPCs in peripheral blood and improve arterial elasticity in patients with T2DM; it is accompanied by weight loss, inflammation reduction, and high NO levels. Dulaglutide regulation of EPCs may be a mechanism of cardiovascular protection.

S1056 Change in C-Reactive Protein 72 Hours Following Admission Associates With Inpatient and One-Year Colectomy Risk in Severe Ulcerative Colitis

Introduction: Ulcerative colitis (UC) morbidity remains high despite multiple therapeutic advances. Early identification of risk for failure of medical therapies and need for colectomy becomes pivotal to avoid unnecessary and dangerous delays in care. Many presently-validated risk appraisal scores require subjective data to inform risk. Our study aimed to determine the predictive value of the change in C-reactive protein (CRP) during hospitalization for severe UC. Methods: We designed a retrospective study including patients ≥ 18 years old with an admission for UC at a single academic center between 1/1/2013 and 4/1/2018. Cases were identified using the ICD-9 code 556.X and ICD-10 code K51.X and separately, manually verified. Clinical variables of interest and laboratory values were obtained via chart review or extracted from the electronic medical record. Data was analyzed using Wilcoxon rank-sum test for continuous variables, and Fischer’s exact test for categorical variables. Statistical analysis was conducted using JMP ® 13.1.0. Results: 122 hospitalized patients met the inclusion criteria with a median age of 30.2 (IQR: 22.8-46.9) years. 72 (59%) patients were male and 89 (73.6%) were Caucasian. 27 (22.3%) patients required inpatient colectomy and 49 (41.5%) had a colectomy within one year of index admission. Percent change in CRP between admission and 72 hours was predictive of inpatient colectomy (P=0.051), whereas the value of CRP on admission or at 72 hours was not (Table). Among patients with an increase in CRP at 72 hours, 9/21 (42.9%) required inpatient colectomy as compared to 18/101 (17.8%) without an increase in CRP (P=0.019). The percent change in CRP at 72 hours was also predictive of 1-year colectomy risk (-53.3 (50.7) vs -33.7 (49.6), P=0.003). Conclusion: Percent change in CRP between admission and 72-hours predicts both inpatient and 1-year colectomy risk in patients hospitalized with UC. Percent change better prognosticates the need for surgery compared to CRP on admission alone. Herein, we show that a reduction in CRP by 50% 72 hours from admission is an objective and easily determined measurement to risk stratify patients early in the admission for UC. Table 1. - Predictors of colectomy during inpatient admission Risk Factors: Colectomy No Colectomy P-value Age (years), mean (SD) 37.98 (18.51) 35.08 (14.3) 0.644 Male Sex, n (%) 14 (51.85) 58 (61.05) 0.506 White Race, n (%) 21 (77.78) 68 (72.34) 0.631 Presentation with Severe Colitis, n (%) 27 (100) 82 (86.32) 0.07 Prior Admission requiring IV Steroids, n (%) 17 (62.96) 34 (35.79) 0.015 Hospitalization in prior 4 weeks, n (%) 23 (39.0%) 50 (24.5%) 0.047* Biologic naïve, n (%) 7 (25.93) 50 (52.63) 0.024 Single prior biologic class 12 (44.44) 33 (34.74) Multiple prior biologic classes 8 (29.63) 12 (12.63) Steroids usage prior to Presentation, n (%) 17 (62.96) 53 (55.79) 0.66 Inpatient salvage therapy 13 (48.15) 61 (64.21) < 0.001 Laboratory Data: Mean (SD) Admission CRP 45.7 (35.1) 52.89 (56.31) 0.7 72 hour CRP 37.41 (45.03) 26.52 (34.43) 0.178 72 hour change in CRP % -26.5 (58.74) -47.19 (55.81) 0.051

Meta-analysis of the effect of sodium-dependent glucose transporter 2 inhibitors on C-reactive protein in type 2 diabetes.

Background:As novel hypoglycemic drugs, the effects of sodium-dependent glucose transporter 2 inhibitors (SGLT-2I) on inflammatory factors such as C-reactive protein (CRP) remain unclear.Methods:We conducted a meta-analysis of studies on SGLT-2I in the treatment of type 2 diabetes (T2DM) to observe the changes of CRP in patients with T2DM. We searched 4 electronic databases (CNKI, PubMed, EMBASE, and Cochrane Library) for articles published up to December 31, 2021. Studies were analyzed using a random-effects model to obtain standard deviation mean differences (SMDs) and 95% confidence intervals (CIs). Sensitivity and subgroup analyses were performed. Publication bias was evaluated using funnel plots and Egger test.Results:We included data from 927 patients in 13 confirmatory trials that showed a significant decrease in CRP among patients with T2DM treated with SGLT-2I. The decrease was more significant with than without SGLT-2I. In subgroup analysis according to nationality, medication, and comorbidities, CRP reduction was associated with nationality, SGLT-2I type, and the presence of comorbidities. Sensitivity analysis showed that our results were reliable and found no evidence of substantial publication bias.Conclusions:SGLT-2I could reduce CRP levels in patients with T2DM.Registration:International Prospective Register for Systematic Reviews (PROSPERO) number CRD42021268079.

Preoperative homocysteine modifies the association between postoperative C-reactive protein and postoperative delirium.

BackgroundHomocysteine and C-reactive protein (CRP) may serve as biomarkers of postoperative delirium. We set out to compare the role of blood concentration of homocysteine versus CRP in predicting postoperative delirium in patients.Materials and methodsIn this prospective observational cohort study, the plasma concentration of preoperative homocysteine and postoperative CRP was measured. Delirium incidence and severity within 3 days postoperatively were determined using the Confusion Assessment Method and Confusion Assessment Method-Severity algorithm.ResultsOf 143 participants [69% female, median (interquartile range, 25th–75th) age of 71 (67–76) years] who had knee or hip surgery under general anesthesia, 44 (31%) participants developed postoperative delirium. Postoperative plasma concentration of CRP was associated with postoperative delirium incidence [adjusted odds ratio (OR) per one standard deviation change in CRP: 1.51; 95% Confidence Interval (CI): 1.05, 2.16; P = 0.026], and severity [in which each one standard deviation increase in postoperative CRP was associated with a 0.47 point (95% CI: 0.18–0.76) increase in the severity of delirium, P = 0.002] after adjusting age, sex, preoperative Mini-Mental State Examination score and the days when postoperative CRP was measured. A statistically significant interaction (adjusted P = 0.044) was also observed, in which the association between postoperative plasma concentration of CRP and postoperative delirium incidence was stronger in the participants with lower preoperative plasma concentrations of homocysteine compared to those with higher preoperative levels.ConclusionPending validation studies, these data suggest that preoperative plasma concentration of homocysteine modifies the established association between postoperative plasma concentration of CRP and postoperative delirium incidence.

Reduction of C-reactive protein, low-density lipoprotein cholesterol, and its relationship with cardiovascular events of different lipid-lowering therapies: A systematic review and meta-analysis of randomized controlled trials.

Background:To evaluate the reductions of C-reactive protein (CRP) and low-density lipoprotein cholesterol (LDL-C) in different lipid-lowering drugs, and to assess the relationships between the reductions of CRP, LDL-C, and cardiovascular (CV) events.Methods:We searched MEDLINE, EMBASE, and Cochrane CENTRAL up to September 1, 2021. Randomized controlled trials (RCTs) comparing statins, proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9-mAbs), or ezetimibe against placebo with a treatment duration of at least 4 weeks and data on the effects of cholesterol-lowering interventions on LDL-C and CRP were included in this meta-analysis. The weighted mean difference (WMD) and 95% confidence interval (CI) were calculated.Results:Compared with placebo treatment, statins and ezetimibe treatments resulted in a significant decrease in LDL-C level (statins: WMD −47.94 mg/dL, 95% CI −51.21 to −44.67 mg/dL; ezetimibe: WMD −22.84 mg/dL, 95% CI −26.76 to −18.92 mg/dL) and CRP level (statins: WMD −0.67 mg/L, 95% CI −0.90 to −0.45 mg/dL; ezetimibe: −0.64 mg/L, 95% CI −1.07 to −0.21 mg/dL). Compared with placebo treatment, treatment with PCSK9-mAbs resulted in significant decrease in LDL-C level (WMD −54.24 mg/dL, 95% CI −59.77 to −48.70 mg/dL), while the concentration of CRP did not decrease significantly. Meta-regression analysis showed no significant association between change in CRP level and change in LDL-C level. Subgroup comparisons suggested that treatment with PCSK9-mAbs showed a greater reduction in LDL-C level when compared with the statins group and ezetimibe group, while the risks of CV death, myocardial infarction (MI), and stroke showed no significant differences.Conclusion:Based on the current study, our results suggested that statins, ezetimibe, and PCSK9-mAbs are effective in reducing LDL-C levels. Treatment with statins and ezetimibe also demonstrated a significant effect on CRP. The traditional lipid-lowering strategy including statin and ezetimibe showed similar benefit on CV outcomes compared with the PCSK9-mAbs treatment.

Biomarker Response to Mindfulness Intervention in Veterans Diagnosed with Post-traumatic Stress Disorder.

This study evaluates the effects of treatment with mindfulness-based stress reduction (MBSR) compared to the active control, present-centered group therapy (PCGT), on morning plasma cortisol, interleukin-6 (IL-6), and C-reactive protein (CRP) in veterans diagnosed with post-traumatic stress disorder (PTSD). In a post hoc exploratory analysis, we pooled biomarkers and clinical outcomes of mindfulness, PTSD, and depression from two randomized controlled trials comparing MBSR (n = 104) to PCGT (n = 106) in U.S. military veterans diagnosed with PTSD. Linear mixed-effects modeling was used to evaluate associations between changes in biomarkers and clinical outcomes from baseline to 9-week primary endpoint and 16-week follow-up endpoint. Cortisol levels were inversely related to self-reported PTSD symptoms at baseline (p = 0.02). Cortisol increased from baseline to 9-week endpoint for both groups, but significantly less so in the MBSR group compared to PCGT group (mean difference 1.69 ± 0.8 SE; p = 0.035). Changes in IL-6 and CRP did not differ between groups at either baseline or week 9. From baseline to week 9, increased mindfulness was significantly associated with increased cortisol (p = 0.02) and decreased PTSD and depression severity (p < 0.01). Increased IL-6 and CRP were significantly associated with decreased PTSD severity (p < 0.05), but not depression. Pooled analysis corroborated earlier findings that MBSR is significantly better than PCGT in improving clinical outcomes. Increased mindfulness was strongly associated with improved symptoms. Increased mindfulness is associated with a recalibration of cortisol levels which may be indicative of therapeutic response, especially in patients with lower baseline cortisol. Furthermore, mindfulness-based practices improve symptoms of PTSD and depression in a significant correlation with self-reported levels of mindfulness. NCT01532999 and NCT01548742.

Against the Norm: Do Not Rely on Serum C-Reactive Protein and White Blood Cell Count Only When Assessing Eradication of Periprosthetic Joint Infection.

Introduction: Periprosthetic joint infections (PJI) following primary arthroplasty continue to be a serious complication, despite advances in diagnostics and treatment. Two-stage revision arthroplasty has been commonly used as the gold standard for the treatment of PJI. However, much discussion persists regarding the interim of the two-stage procedure and the optimal timing of reimplantation. Serology markers have been proposed as defining parameters for a successful reimplantation. The objective of this matched-pair analysis was to assess the role of serum C-reactive protein (CRP) and white blood cell count (WBC) in determining infection eradication and proper timing of reimplantation. We investigated the delta (∆) change in CRP and WBC values prior to both stages of two-stage revision arthroplasty as a useful marker of infection eradication. Methods: We analyzed 39 patients and 39 controls, matched by propensity score matching (BMI, age, ASA-classification), with a minimum follow-up of 24 months and treated with a two-stage revision THA or TKA in our institution. Data of serum CRP and WBC values were gathered at two selected time points: prior to the explantation of the implant (preexplantation) and following the completion of antibiotic treatment regimen, both systemic and with a drug-eluting cement spacer (prereimplantation). Patient records were reviewed electronically for preexisting comorbidities, overall health status, synovial fluid cultures, inflammatory serologies, revision surgeries, and recurrent or persistent infection based on the modified Musculoskeletal Infection Society criteria. Patient demographics, ∆CRP, ∆WBC, and time interval to reimplantation were statistically analyzed using receiver operator curves (ROC), Pearson’s correlation coefficient, Levene’s test, and Student’s t-test. Results: Infection-free patients exhibited higher mean CRP and WBC than did patients who were reinfected at both time points. When comparing preexplantation with prereimplantation values, the median ∆CRP was 9.48 mg/L (interquartile range (IQR) 2.3–36.6 mg/L) for patients who did not develop a reinfection versus 2.74 mg/L (IQR 1.4–14.2 mg/L) for patients who developed reinfection (p = 0.069). The median ∆WBC was 1.5 × 109/L (IQR 0.6–4.0 × 109/L) for patients who remained infection-free versus 1.2 × 109/L (IQR 0.8–2.2 109/L) for patients who developed reinfection (p = 0.072). Analysis of areas under the curve (AUC) using ROC demonstrated poor prediction of persistent infection by ∆CRP (AUC = 0.654) and ∆WBC (AUC = 0.573). Although a highly significant correlation was found between the interim interval and infection persistence (r = 0.655, p < 0.01), analysis using ROC failed to result in a specific threshold time to reimplantation above which patients are at significantly higher risk for reinfection (AUC = 0.507). Conclusion: No association could be determined between the delta change in serum CRP and WBC before and after two-stage revision arthroplasty for PJI and reinfection risk. Even though inflammatory serologies demonstrate a downtrending pattern prior to reimplantation, the role of CRP and WBC in determining the optimal timing of reimplantation seems to be dispensable. Planning a second-stage reimplantation requires assessing multiple variables rather than relying on specific numeric changes in these inflammatory marker values.

Non-invasive early prediction of immune checkpoint inhibitor efficacy in non-small-cell lung cancer patients using on-treatment serum CRP and NLR.

We determined the clinical relevance of early C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) change in blood as surrogate markers of pro-tumor inflammation (PTI) for predicting clinical outcome of programmed cell death (PD)-1/programmed cell death ligand (PD-L) 1 inhibitor treatment in non-small-cell lung carcinoma (NSCLC). We retrospectively reviewed NSCLC patients treated with anti-PD-1 or PD-L1 inhibitors. Early CRP change was defined as the ratio of 6weeks CRP to baseline CRP, and early NLR change was defined as that of the 6weeks NLR to baseline NLR. PTI index was determined by combinatorial evaluation of early CRP change and early NLR change, PTI index low: both of these were low, intermediate: either of these was low, high; both of these were high. The study included 217 patients. Early CRP change and early NLR change were both associated with PFS and OS. The combinatorial evaluation using these two markers enabled the clear stratification of PFS and OS. The median PFS in patient with PTI index low was 13.9months, while the median PFS in those with PTI index high was 2.5months (p < 0.01, log-rank test). The median OS in patients with PTI index low was not reached; the median OS in those with PTI index high was only 15.4months (p < 0.01, log-rank test). The combinatorial early CRP change and early NLR change as PTI biomarkers have clinical potential in identifying NSCLC patients who can achieve a durable response and long-term survival using PD-1/PD-L1 inhibitors.

Changes in Serum CRP and PCT Levels in Patients with Acute Simple Lower Urinary Tract Infection and Evaluation of the Efficacy of Treatment with Shuangdong Capsules.

Objective The aim of this study is to investigate the changes and significance of serum C-reactive protein (CRP) and procalcitonin (PCT) levels in patients with acute simple lower urinary tract infection (ALUTI) and to analyze the efficacy of treatment with Shuangdong capsules, so as to provide a basis for the rational clinical application of drugs. Methods 92 patients with ALUTI (observation group) were randomly divided into 46 cases each in group A and group B. Group A was treated with basic anti-infective drugs, while group B was treated with Shuangdong capsules, and the duration of treatment in both groups was 14 days. The curative effect of the two groups was analyzed, and the changes in serum PCT and CRP levels were compared before and after treatment and compared with 40 healthy people in the control group. Results The serum PCT and CRP levels, the number of urinary leukocyte count (LEU), and the number of urinary bacterial count (BACT) were significantly higher in Group A and Group B than in the healthy control group before treatment (P < 0.05). After treatment, the total clinical efficiency of patients in group B (97.83%) was significantly higher than that in group A (78.26%) (P < 0.05). The serum PCT and CRP levels, the number of urinary LEU, and the number of urinary BACT decreased in both groups after treatment compared with those before treatment, and all of them were significantly lower in group B than in group A (P < 0.05). The area under the curve (AUC) values of serum PCT and CRP levels for the diagnosis of acute simple lower urinary tract infection were 0.747 (95% CI 0.633–0.860) and 0.926 (95% CI 0.870∼0.982), both with high sensitivity and specificity. Conclusion The Shuangdong capsule combined with conventional antibacterial drugs has better clinical efficacy in the treatment of acute simple lower urinary tract infection; serum CRP and PCT levels in patients with acute simple lower urinary tract infection can be used as indicators for diagnosis and efficacy determination of the infection.

Complete blood count in the elderly vs. selected biochemical parameters associated with inflammation. Results of PolSenior2 study

Introduction: Complete blood counts provide a lot of valuable information about the health condition. As the value of individual morphological parameters depends on many factors, the interpretation of the test result should be carried out taking into account clinical data and the results of other laboratory tests. Inflammation activates mechanisms that affect the amount of blood cells produced. Deviations in blood level of inflammatory markers (such as C-reactive protein (CRP), transferrin) and iron, may account hematological abnormalities. Aim: The assessment of the relationship between the examinated biochemical parameters and changes in selected hematological parameters. Material and methods: This analysis was based on laboratory data from 5623 participants of the nationwide PolSenior2 study, assessing the health of Poles over 60 years of age. Results: It was shown that in the study population with age, the concentrations of CRP, iron and transferrin change. Concentration of iron correlates positively with the concentration of transferrin, and negatively with CRP. It has been found that the incidence of anemia increases with age. Higher CRP levels and lower iron and transferrin levels were more frequently observed in the anemic group. Changes in the analyzed biochemical parameters correlated with a change (decrease or increase) in the red blood cell indices, the majority of leukocyte subpopulations and platelets. Conclusions: The analysis shows that inflammation, as expressed by changes in the concentrations of related biochemical parameters, can affect blood morphology. Therefore, when assessing abnormalities in blood morphology, the results of other laboratory assays, including biochemical markers associated with inflammation, should be taken into account.