Changes In CRP Research Articles

The Effect of Dexmedetomidine on Inflammatory Factors and Clinical Outcomes in Patients With Septic Shock: A Randomized Clinical Trial

PurposeDexmedetomidine is a sedative-analgesic that is widely used in sepsis. However, its effect on septic shock remains unclear. This study aimed to investigate dexmedetomidine's effect on inflammatory biomarkers in septic shock. MethodsThe present study was a randomized controlled clinical trial. Patients with inclusion criteria were randomly allocated into either the dexmedetomidine (n = 24) or morphine + midazolam group (n = 24). The primary outcome was changes in inflammatory factors, including IL-1, IL-6, TNF-α, ESR, and CRP. The serum levels of inflammatory factors were measured at baseline and the end of the intervention. Secondary outcomes included the change in norepinephrine dose, vital signs, and SOFA scores. FindingsOf the 48 subjects, 52.08% were male. After intervention, IL-1, IL-6, and TNF-α levels significantly differed between the 2 groups (p = 0.011 and p < 0.001 and p < 0.001, respectively). Heart rate and systolic blood pressure decreased over time, but the two groups had no significant difference (p-value > 0.05). In addition, there was no significant difference in norepinephrine dose and SOFA score between the 2 groups (p-value > 0.05). ImplicationsSedation with dexmedetomidine can attenuate the inflammatory factors in septic shock. Also, dexmedetomidine did not worsen the hemodynamic parameters in septic shock patients.

Dynamics of Biomarkers in COVID-19 Patients Treated with Anakinra

Background: SARS-CoV-2 can trigger hyperinflammation, leading to severe COVID-19, presenting with pneumonia, acute respiratory distress syndrome (ARDS), and multiple organ failure. Specific biomarkers like leukocytes, CRP, NLR, AST, LDH, D-dimer, ferritin, and IL-6 are associated with disease severity. Anakinra, an IL-1 receptor antagonist, has been proposed to mitigate hyperinflammation, but its clinical efficacy remains uncertain. This study aimed to evaluate the effect of Anakinra on inflammatory biomarkers, oxygenation status, and survival outcomes in hospitalized patients with moderate to severe COVID-19 (according to the National Institute of Health severity scale), compared to standard treatment. Methods: A retrospective analysis included 65 patients (mean age 75.51 ± 9.54 years; 58.5% male, 41.5% female) hospitalized with moderate to severe COVID-19. Patients were divided into two groups: a control group receiving standard treatment (n = 24) and a target group treated with Anakinra (n = 41). Biomarkers and oxygenation status were assessed on Days 0, 3, and 7. Statistical analyses compared the groups for changes in leukocytes, NLR, CRP, AST, LDH, D-dimer, ferritin, and IL-6. Results: Anakinra treatment was associated with significant reductions in leukocytes, NLR, D-dimer, ferritin, IL-6, and CRP by Days 3 and 7. Improvements in oxygenation status were observed, although no survival benefits were noted. The control group showed no significant biomarker changes except for AST and LDH on Day 7. Conclusions: Anakinra demonstrated favorable effects on biomarkers and oxygenation in moderate to severe COVID-19 but did not improve survival. Further studies are needed to validate these findings.

“Rest of the folks are tired and weary”: The impact of historical lynchings on biological and cognitive health for older adults racialized as Black

Childhood structural racism may lead to poorer health and longevity for individuals racialized as Black. Racism-related stress cumulatively taxes the body resulting in worsening biological and cognitive health. This study examines the association between state-level exposure to historical lynchings (adverse childhood racism for modern older adults), with C-reactive protein (CRP, a marker of systemic inflammation), and global cognitive performance (modified TICS). We linked the percentage of lynchings of people racialized as Black at the state-level between 1882 and 1968 from the Archives at Tuskegee Institute with repeated CRP and cognitive test scores at baseline (2006/2008), year 4 (2010/2012), and year 8 (2014/2016) for a national sample of older adults in the Health and Retirement Study (N = 10,500, aged >50). In multivariable generalized estimating equation models, we compared participants (by racialized group) living in states with high lynching proportions (>50th percentile) on changes in CRP and cognitive test scores adjusting for demographics, health conditions, and behaviors. Mean age was 69 (SD = 9.9) and most participants were cisgender women (59%). On average participants racialized as non-LatinX Black living in states with high lynching proportions experienced 18.5% (95% CI 3%, 36%) higher CRP levels and −0.92 (95% CI -1.34, −0.50) lower cognitive test scores than participants racialized as non-LatinX Black that lived in states with lower lynching proportions. As artist Marvin Gaye sang in Flyin’ High (in the Friendly Sky), “Rest of the folks are tired and weary,” which describes how adverse childhood racism is associated with inflammation and dementia risk for people racialized as Black.

An Application of Mist Generator as a Way to Reduce Particulate Matter during High Concentration Episodes in Urban Forests

Previous conventional mist devices can induce a detrimental effect of leaf burn by intense, focused sunlight in summer. A mist generator is designed to prevent particulate matter (PM) damage to trees by combining mist with PM during high PM episodes. We measured changes in microclimate conditions and the concentration of PM before, during, and after mist spraying in urban parks (Yangjae Citizen Forest, YCF; Cheongdam Road Park, CRP) from May 6 to 8, 2020. PM changes in YCF and CRP were observed immediately after mist spraying and were found to return to the previous concentrations. Mist spraying had no significant effects on the meteorological traits of air temperature, humidity, and wind speed but had significant effects on the concentration of PMx and the ratio of PM during a short time. Also, the ratio of PMx was partially affected by mist spraying. During the morning rush hour and lunch, mist, high wind speed, and low relative humidity conditions were related to the increase in mist movement, resulting in increasing PM (2.5–10 μm) and the deposition of these PM. During the evening rush hour, high relative humidity and low wind speed affected PM concentrations more than mist. This prototype of mist spraying could effectively condense and deposit the PM during high PM episodes.

Effect of Probiotic Supplementation on Disease Activity in Rheumatoid Arthritis Patients

Abstract Background Rheumatoid arthritis (RA), a prevalent inflammatory arthritis with a global incidence of 0.5–1%, is characterized by autoimmune-driven articular pain, cartilage degradation, bone destruction, and functional disability. Emerging evidence suggests a potential link between alterations in gastrointestinal microflora and the development of autoimmune diseases, including RA. Probiotic bacteria have gained attention as a potential adjunctive therapy due to their immunomodulatory properties, offering promise for improving clinical and metabolic outcomes in RA patients. Aim of the Work To study the effects of probiotic supplementation on clinical status of patients with RA. Patients and Methods Sixty Egyptian RA patients aged 18-60 years, diagnosed and screened in the Rheumatology department at Ain Shams University Hospital, were enrolled in this study. The patients were divided into two groups: group A received daily probiotic supplementation for 8 weeks, while group B served as the control. Detailed clinical assessments and laboratory investigations were conducted. Results There were no significant differences in age, sex distribution, disease duration, or disease- modifying antirheumatic drugs (DMARDs) usage between the two groups, consistent with previous research. The probiotic regimen included Lactobacillus acidophilus and Bifidobacterium animalis. Conclusion Probiotic supplementation in RA patients yielded mixed results in this study, with improvements in TJC and ESR but no significant changes in SJC, CRP, or disease activity scores. Further research is needed to elucidate the complex relationship between gut microbiota and RA pathogenesis and to determine the optimal probiotic regimen for improving clinical outcomes in RA patients.

Longitudinal course of inflammatory-cognitive subgroups across first treatment severe mental illness and healthy controls.

While inflammation is associated with cognitive impairment in severe mental illnesses (SMI), there is substantial heterogeneity and evidence of transdiagnostic subgroups across schizophrenia (SZ) and bipolar (BD) spectrum disorders. There is however, limited knowledge about the longitudinal course of this relationship. Systemic inflammation (C-Reactive Protein, CRP) and cognition (nine cognitive domains) was measured from baseline to 1 year follow-up in first treatment SZ and BD (n = 221), and healthy controls (HC, n = 220). Linear mixed models were used to evaluate longitudinal changes separately in CRP and cognitive domains specific to diagnostic status (SZ, BD, HC). Hierarchical clustering was applied on the entire sample to investigate the longitudinal course of transdiagnostic inflammatory-cognitive subgroups. There were no case-control differences or change in CRP from baseline to follow-up. We confirm previous observations of case-control differences in cognition at both time-points and domain specific stability/improvement over time regardless of diagnostic status. We identified transdiagnostic inflammatory-cognitive subgroups at baseline with differing demographics and clinical severity. Despite improvement in cognition, symptoms and functioning, the higher inflammation - lower cognition subgroup (75% SZ; 48% BD; 38% HC) had sustained inflammation and lower cognition, more symptoms, and lower functioning (SMI only) at follow-up. This was in comparison to a lower inflammation - higher cognition subgroup (25% SZ, 52% BD, 62% HC), where SMI participants showed cognitive functioning at HC level with a positive clinical course. Our findings support heterogenous and transdiagnostic inflammatory-cognitive subgroups that are stable over time, and may benefit from targeted interventions.

Methylene blue for COVID-19 ARDS: insights from a randomized Clinical Trial.

Around the world, the COVID-19 pandemic has presented many difficulties, and acute respiratory distress syndrome (ARDS) has become a major worry. The antiviral and anti-inflammatory characteristics of methylene blue (MB) have garnered interest for potential medicinal applications. The object of the current study is to assess the effect of orally administered MB on the treatment of ARDS associated with COVID-19. A randomized clinical study was carried out on 122 hospitalized patients who had ARDS related to COVID-19. Patients who met the eligibility requirements were randomized at random to either the control group (CG) (n = 60) or the intervention group (IG) (n = 62). Standard treatments were administered to both groups, with the addition of oral MB to the IG. Clinical outcomes, including SpO2 levels, CRP levels were assessed on the third and fifth days. Additionally, at the time of discharge, patients' assessments were made in terms of APACHE II scores, SOFA scores, LDH and CRP levels, SpO2, and respiratory rate in comparison to the day prior to the intervention. Patients were followed for mortality outcomes at one month and three months after the intervention. Significant changes were observed in SpO2 levels over time (P < 0.001) and between groups (P = 0.022), with higher levels in the MB-treated group. The interaction between time and group (P = 0.019) indicated a stronger increase in SpO2 in the IG, with the IG's SpO2 level increasing by 6.42%. Furthermore, CRP levels showed significant changes over time (P < 0.001), but not between groups (P = 0.092). However, the interaction between group and CRP change over time (P = 0.019) suggested a distinct pattern of CRP decrease in the IG. Significant improvement in RR, SpO2, CRP, and APACHE II score were found according to discharge results. However, in terms of SpO2 and the APACHE II score, this improvement was noteworthy for IG. The length of hospitalization and mortality rates at one- and three-month follow-ups did not differ significantly. Oral administration of MB demonstrated positive effects on improving SpO2 levels and reducing inflammatory markers in COVID-19-related ARDS patients. Despite no significant impact on survival rates or hospitalization length, the study supports the potential efficacy of MB as an alternative treatment for COVID-19 ARDS. This study was registered with the Iranian Registry of Clinical Trials ( http://www.irct.ir ) under the registration code IRCT20200409047007N2 on 11/29/2021.

Effect of biologic agents and inflammation on lipid levels and cardiovascular risk in rheumatoid arthritis patients

BackgroundCardiovascular disease (CVD) is the main cause of mortality in Rheumatoid Arthritis (RA). ObjectiveTo investigate the effect of biologic disease modifying anti-rheumatic drugs (bDMARDs) on lipids and CVD risk and evaluate associations with changes in systemic inflammation. MethodsPatients with RA initiating a bDMARD were evaluated at baseline, 3 and 6 months later. Longitudinal mixed effects models examined the association of individual biologics with changes in lipid levelsm Reynolds Risk Score (RRS) and Framingham risk score. Mediation by CRP, clinical disease activity index (CDAI) or swollen joint count on lipid changes were modeled using structural equation models. The correlation between CRP changes and LDL changes was estimated. Changes of LDL-C at 6 months among patients with low baseline LDL-C (<90 mg/dl) vs higher baseline LDL-C(90–130, and >130 mg/dl) were compared. The association between LDL-C changes across baseline LDL-C groups and disease activity improvement was evaluated. Results1698 bDMARD initiations were analyzed. Patients initiating tocilizumab had a significant increase in lipid levels but RRS at 3 and 6 months was similar across all biologics. Framingham risk score increased for patients treated with tocilizumab. Mediator analyses were statistically significant for the effects of CRP on lipid levels. Increases in LDL-C from baseline were independent of clinical response. An association of changes from baseline CRP and LDL-C were observed across all of the bDMARDs studied. ConclusionModerate increases in lipid levels on bDMARD treatment were not associated with an increased CVD risk by RRS regardless of the bDMARD initiated. Changes in CRP were significantly associated with changes in lipids in a mediator analysis.

C-Reactive Protein as a Predictor of Severe Respiratory Complications in Measles.

Background and Objectives: Even though measles is easily prevented by vaccination, infection outbreaks are not rare. Infection carries a great risk for pulmonary complications, which are sometimes hard to predict, especially in a group of outpatients. This study aims to evaluate the association between serum CRP changes and the severity of respiratory complications in the group of inpatients treated for measles. Materials and Methods: A total of 207 patients admitted and treated at the Clinic for Infectious Diseases, University Clinical Center, Nis, for measles infection were included in the analysis. The data collected from the patients' medical records included demographic characteristics, disease duration, blood and serum biochemical analysis, general measles-associated symptoms, and disease outcome. Results: Results of the study revealed that there are almost no differences in the clinical presentation of patients with measles and those complicated with pneumonia. The examined CRP changes are found to correlate with the observable degree of pneumonia; however, they do not correspond to the changes visible in chest X-rays. Conclusions: CRP changes in the serum of patients with measles with mild clinical pictures could be a potential predictor for the development of some pulmonary complications.

The Effect of Deferoxamine and Vitamin C Supplementation on Ferritin and CRP Levels in COVID-19 Patients

Background: Today, the COVID19 pandemic is one of the most important health system challenges in the world, which doesn’t have specific treatment yet. It includes a wide range of respiratory and non-respiratory signs and symptoms, that lead to hospitalization and intensive care units. Methods: In this study, 78 patients in two groups of 39 patients were included. The case group included 39 COVID19 patients who had specified sign in CT scans and factors of viral infection, high serum ferritin, increased inflammatory factor in the blood. There were two intervention groups (receiving deferoxamine and vitamin C) and the control group (receiving only official protocol drugs of the country). All patients were admitted to the ICU of Shohada-e-Tajrish Hospital and underwent complete cardiorespiratory monitoring. All changes in Spo2, hemodynamics, serum ferritin and CRP were recorded before the study. Results: This study presented that improved patient had lower ferritin levels than those who were still ill. In addition, prescribing deferoxamine as an adjunct to vitamin C can prevent cytokine storms that was effective for improving the patients with COVID19. Conclusion: In conclusion. According to the role of deferoxamine and vitamin C in significantly reducing inflammatory factors of ferritin and CRP, they can be used as an adjunctive therapy in patients with COVID19.

Effects of Omega-3 Supplementation on the Delayed Onset Muscle Soreness after Cycling High Intensity Interval Training in Overweight or Obese Males.

People with overweight or obesity preferred high-intensity interval training (HIIT) due to the time-efficiency and pleasure. However, HIIT leads to delayed onset muscle soreness (DOMS). The present study aimed to investigate the effects of omega-3 supplementation on DOMS, muscle damage, and acute inflammatory markers induced by cycling HIIT in untrained males with overweight or obesity. A randomized, double-blinded study was used in the present study. Twenty-four males with a sedentary lifestyle were randomly assigned to either receive omega-3 (O3) (4 g fish oil) or placebo (Con). Subjects consumed the capsules for 4 weeks and performed cycling HIIT at the 4th week. After 4 weeks-intervention, the omega-3 index of O3 group increased by 52.51% compared to the baseline. All subjects performed HIIT at 4th week. The plasma creatine kinase (CK) level of Con group increased throughout 48h after HIIT. While the CK level of O3 group increased only immediately and 24h after HIIT and decreased at 48h after HIIT. The white blood cell count (WBC) of Con group increased immediately after the HIIT, while O3 group did not show such increase. There was no change of CRP in both groups. O3 group had a higher reduction of calf pain score compared to Con group. O3 group also showed a recovery of leg strength faster than Con group. Omega-3 supplementation for 4 weeks lower increased CK level, reduced calf pain score, and recovery leg strength, DOMS markers after cycling HIIT.

#1533 The relationship between the severity of anemia, the level of inflammation markers and the dose of epoetin in patients in pre-dialysis stages of CKD

Abstract Background and Aims Inflammation is known to be an important factor associated with hemoglobin variability in patients with anemia of chronic disease. However, the question remains whether high levels of C-reactive protein, a widely used marker of inflammatory activity, and other inflammatory markers predict less stable anemia control in patients with CKD. The purpose of this study was to establish the relationship between the severity of anemia with the levels of inflammatory markers (C-reactive protein, IL-6) and the dose of epoetin in patients with pre-dialysis stages of CKD. The purpose of our study was to study the age-related characteristics of the nutritional status in patients with CKD of the dialysis stages who are on parenteral nutrition. Method 180 patients (96 men and 84 women) with CKD as a result of nephropathies of diabetic and non-diabetic etiology were examined. Chronic pyelonephritis was diagnosed in 96 patients, chronic glomerulonephritis - in 73, polycystic kidney disease - in 11 patients. Glomerular filtration rate was calculated based on serum creatinine concentration using the CKD-EPI formula (2011). The patients were divided into 2 groups, depending on the achievement of the target hemoglobin value. Thus, group 1 included patients with CKD C3, C4, whose hemoglobin concentration was above 110 g/l (n = 101). Group 2 included patients whose hemoglobin concentration was less than 110 g/l in at least one analysis (n = 79). Results In the examined patients, a significant correlation was found between the range of hemoglobin concentration and the range of CRP concentration (p &amp;lt; 0.05), as well as between the range of hemoglobin concentration and the variation in the percentage of hypochromic erythrocytes (p &amp;lt; 0.05), between the range of hemoglobin concentration and the variation of ferritin ( p &amp;lt; 0.05). The change in the percentage of hypochromic erythrocytes also correlated with the change in IL-6 (p &amp;lt; 0.05) and the change in CRP ( p &amp;lt; 0.05). We found an association between the average weekly dose of epoetin and the levels of CRP, IL-6 and TNF-α. Patients with TNF-α levels ≥2 ng/mL and IL-6 ≥40 ng/mL required a significantly higher dose of epoetin than patients with lower levels of these markers (128 U/kg per week versus 57 U/kg at week). Conclusion The establishment of a relationship between inflammatory markers and hemogram and iron parameters suggests that inflammation had an indirect effect on the increase in hemoglobin through its effect on iron metabolism. The results of the study indicate the presence of diabetic and non-diabetic etiology of systemic inflammation in CKD, more so in the group of patients with type 2 diabetes mellitus.

Markers of enterocyte damage, microbial translocation, and systemic inflammation following 9 h of heat exposure in young and older adults.

Heat stress induced damage to the gastrointestinal barrier can induce local and systemic inflammatory reactions implicated in heat-stroke. Gastrointestinal barrier damage has been shown to be greater in older relative to young adults following hyperthermia. However, comparisons between young and older adults have been limited to brief exposures (3 h), which may not reflect the duration of heat stress experienced during heat waves. We therefore evaluated markers of intestinal epithelial damage (log transformed intestinal fatty acid binding protein, IFABPLOG), microbial translocation (soluble cluster of differentiation 14, sCD14LOG), and systemic inflammation (tumour necrosis factor alpha, TNF-αLOG; interleukin 6, IL-6LOG; C-reactive protein, CRP) in 19 young (interquartile range: 21-27years; 10 females) and 37 older (68-73years; 10 females) adults before and after 9 h of rest in 40°C (9% relative humidity). The magnitude of the increase in IFABPLOG was 0.38 log pg/mL (95% CI, 0.10, 0.65 log pg/mL) greater in the older relative to young cohort (P=0.049) after 9 h heat exposure. At baseline both IL-6LOG and CRP concentrations were higher in the older (IL-6: 2.67 (1.5) log pg/mL, CRP: 0.28 (1.5) mg/mL) relative to the young (IL-6: 1.59 log pg/mL, SD 1.2; CRP: 0.11mg/mL, SD 1.7) group (both P≤0.001). The change in IL-6 and CRP was similar between groups following 9 h heat exposure (IL-6: P=0.053; CRP: P=0.241). Neither sCD14LOG and TNF-αLOG were different between groups at baseline nor altered after 9 h heat exposure. Our data indicate that age may modify intestinal epithelial injury following 9 h of passive heat exposure.

The Effect of Whole-Body Electromyostimulation on Inflammatory Biomarkers and Adipokines in Overweight to Obese Adults with Knee Osteoarthritis: a Randomized Controlled Study

Evidence of an anti-inflammatory effect of WB-EMS is growing. However, applying comparable impulse-protocols, studies reporting positive effects on inflammatory markers, possibly including adipokines, used high volume, superimposed WB-EMS protocols that differ from the time-efficient, non-superimposed concepts mainly used in scientific and commercial settings. The aim of the present trial was to determine the effect of “standard WB-EMS” on inflammatory markers and adipokines in overweight to obese adults. Seventy-two overweight to obese adults 40-70 years old with osteoarthritis (OA) of the knee, were randomly allocated to a 29-week standard WB-EMS application 1.5x20min/week (WB-EMS) or to a usual care control groups (CG) with six sessions of physiotherapy. Study outcomes were changes of ultra-sensitive CRP, IL-1b, adiponectin, leptin, total and LDL-cholesterol. Intention to treat analyses with multiple imputation with an ANCOVA adjusted for baseline group difference was applied. Six participants (WB-EMS=5) were lost to follow-up. Attendance rate averaged 88±10% in the WB-EMS group and &gt;90% in the CG. After the intervention, we did not observe any significant change of usCRP, IL-1b, adiponectin, leptin, total and LDL-cholesterol levels or significant between group differences (i.e. “effects”). Adverse effects related to the intervention were not observed or reported. The present low-volume, non-superimposed WB-EMS (standard) approach does not seem to have a significant effect on the analyzed inflammatory biomarkers and adipokines in overweight to obese adults with knee OA.

Natural Autoantibodies in Biologic-Treated Rheumatoid Arthritis and Ankylosing Spondylitis Patients: Associations with Vascular Pathophysiology.

Cardiovascular (CV) morbidity and mortality have been associated with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Natural autoantibodies (nAAb) are involved in innate immunity, as well as autoimmunity, inflammation, and atherosclerosis. There have not been any studies assessing the effects of biologics on nAAbs in RA and AS, also in relation to vascular pathophysiology. Fifty-three anti-TNF-treated RA and AS patients were included in a 12-month follow-up study. Anti-citrate synthase (CS) and anti-topoisomerase I fragment 4 (TOPO-F4) IgM and IgG levels were determined by ELISA. Ultrasonography was performed to assess brachial artery flow-mediated vasodilation (FMD), common carotid intima-media thickness (ccIMT), and arterial pulse-wave velocity (PWV). Other variables were also evaluated at baseline and 6 and 12 months after treatment initiation. Anti-TNF therapy improved FMD in RA and PWV in AS and stabilized ccIMT. TNF inhibition increased anti-CS IgM and IgG, and possibly also anti-TOPO-F4 IgG levels. Various correlation analyses revealed that nAAbs might be independently involved in autoimmunity as well as changes in inflammation and vascular pathology over time in biologic-treated patients (p < 0.05). We also found associations between anti-TOPO-F4 IgG and anti-Hsp60 IgG (p < 0.05). Baseline nAAb levels or nAAb level changes might determine changes in CRP, disease activity, FMD, PWV, and ccIMT over time (p < 0.05). The interplay between arthritis and inflammatory atherosclerosis, as well as the effects of anti-TNF biologics on these pathologies, might independently involve nAAbs.

Removal of inflammatory factors and prognosis of patients with septic shock complicated with acute kidney injury by hemodiafiltration combined with HA330-II hemoperfusion.

To explore the effect of CRRT using CVVHDF + HP on the removal of inflammatory mediators in patients with septic shock complicated with AKI. A total of 20 patients between January 1, 2018, and December 31, 2021, were included. The patients were randomly divided into the treatment group (CVVHDF + HP) and the control group (CVVHDF). Changes in inflammatory factors, including IL-1β, IL-6, IL-8, TNF-α, PCT, and CRP were compared. Other observed measures were also analyzed, for example, Lac, Scr, BUN, SOFA, and norepinephrine (NE) dosage. The clinical outcomes of both groups were followed up for 28 days. The IL-6 and PCT levels in the treatment group were significantly lower (p = 0.005, 0.007). Although the IL-1β, TNFα, and CRP levels in the treatment group decreased, there were no statistical differences (p > 0.05). There were significant differences in Lac, SOFA, and NE dosage levels between both groups (p = 0.023, 0.01, 0.023). Survival analysis showed that the 28-day survival rate was significantly higher in the treatment group. CRRT using CVVHDF+HP can effectively remove inflammatory factors and improve the prognosis of patients.

P997 New Objective Assessment of perianal Crohn’s disease, Perianal Lesion Index; PLI

Abstract Background In the previous survey, decisions of biological treatment (Bio) success for perianal Crohn’s disease (pCD) were made by the patient’s subjective improvement and physician’s assessment, so it lacks objectivity. Moreover, physicians, surgeons, and proctologists are related to treating pCD. This aspect is the difficulty of the treatment of pCD. We need a common assessment for each area’s doctor. We aimed to develop a new objective assessment of pCD, including endoscopic findings, and assess the efficacy of the newly launched Bio except anti-TNFα agents for pCD. Methods Usually, perianal abscesses and fistula are derived from ulcers in the lower rectum and anal canal, so we adapted SES-CD to the location and checked discharge and needs of setons, and finally scored it (Table 1). We named this assessment Perianal Lesion Index; PLI. We retrospectively evaluated 20 pCD patients who received Ustekinumab (UST) and Vedolizumab (VDZ) from March 2017 to March 2023 at our institute. We checked each patient’s PLI, CRP, LRG, and CDAI and compared them before starting Bio and eight weeks after initiation of Bio using a paired T-test. Finally, we used the Pearson correlation coefficient to examine the correlation between PLI and conventional serum biomarkers and CDAI. Results The male-to-female ratio was 4.0, the average age at the treatment initiation was 35. Eighteen patient’s diseases were located in the small and large intestines, 10 patients were penetrating type, and 2 patients were stenotic type. We used UST for 16 patients and VDZ for 4 patients. Seven patients were naïve for Bio, 8 patients were treated by one Bio, and 5 patients were treated by two Bio.PLI was positively correlated with CRP (r=0.59, p&amp;lt;0.001) but not correlated with LRG (r=0.77, p=0.077) and CDAI (r=0.35, p=0.07). The pretreatment average PLI was 8.5 and significantly decreased to 3.9 (p&amp;lt;0.001) 8 weeks after Bio initiation. There was a significant change in CRP (3.1 to 0.9, p =0.03) but not CDAI (193 to 147, p=0.2). There were significant PLI changes in each treatment group; the UST group’s PLI change was 8.3 to 3.1 (p&amp;lt;0.001), and the VDZ group's PLI was 9.5 to 8.0 (p=0.02) (Figure 1). Conclusion PLI seems to be an objective assessment for pCD, and it was positively correlated to CRP. We could assess each drug’s efficacy for pCD. Further investigation is needed to establish PLI’s accuracy, and we hope this assessment will contribute to the choices of Bio for pCD and the evaluation of its efficacy

P681 Preliminary data from the Biologic and Partial Enteral Nutrition in Crohn’s Disease Study (BIOPIC)

Abstract Background Biologics such as adalimumab (ADA) are used to induce clinical remission (CR) in individuals with active Crohn’s disease (CD) but around 50% of patients actually achieve clinical remission. Exclusive enteral nutrition is also an effective induction treatment, but tolerability limits its use, especially in adults. This study aimed to assess the efficacy and tolerability of partial enteral nutrition (PEN) in combination with ADA compared to ADA monotherapy. Methods In this multi-centre (n=8) RCT (NCT04859088), adults with active CD (Crohn’s Disease Activity Index, CDAI ≥ 150) due to start ADA as their first-line biologic were randomised to either continue their habitual unrestricted diet (UD) or to replace half of it with PEN during their first 6 weeks of induction treatment Primary outcome clinical efficacy (i.e., clinical response, CDAI baseline decrease of ≥ 70 or CR, CDAI score &amp;lt;150) was assessed after 12 weeks of ADA initiation. Secondary outcomes included changes in inflammatory markers (faecal calprotectin, (FCAL), CRP) and quality of life (SIBDQ), at 3 (only FCAL), 6 and 12 weeks. To calculate adherence to PEN, used/unused tins were returned and compared to number provided. Analysis was performed using intention-to-treat analysis. Results 32 participants (13 UD, 19 PEN) have completed the study; 29 (13 UD, 16 PEN) of whom completed the full 12 weeks of the study. Adherence rate to PEN was high (~96%). Clinical efficacy (response &amp; remission) was UD: 92% vs PEN: 84%, p=0.490 at 6 weeks and UD: 85% vs PEN: 58%, p=0.11 at week 12. FCAL data was available for 22 participants (9 UD, 13 PEN). FCAL (g/g) significantly decreased after 12 weeks in patients receiving PEN (mean difference 189, p=0.009) but this effect did not quite reach statistical significance (p=0.052) in the UD group (Fig 1). Proportionally more patients from the PEN group had FCAL &amp;lt;100 mg/kg compared to the UD group (3, 6, 12 weeks, PEN: 62%, 69%, 69% vs UD: 33%, 33%, 56%) during the study course. CRP (mg/L) significantly decreased at week 6 and 12 in patients receiving PEN (week 6 &amp; week 12, p&amp;lt;0.0001) and in patients continuing their UD (week 6, p=0.001, week 12, p=0.007). SIBDQ score increased in both groups (PEN, p=0.023 vs UD, p=0.008). Conclusion Preliminary data from the BIOPIC study suggests equivalence in clinical efficacy between the two groups but better responses to blood and gut inflammatory markers when ADA is combined with PEN. High tolerability of PEN suggests it can be a viable option for adult patients with active luminal CD.

P872 PREDICT UC: Optimising Infliximab Induction therapy for Acute Severe Ulcerative Colitis – A Randomised Controlled Trial

Abstract Background The optimal dosing strategy of infliximab (IFX) in Acute Severe Ulcerative Colitis (ASUC) is unknown. We compared intensified and standard dose IFX strategies in ASUC. Methods In this open-label randomised trial (NCT02770040), patients from 13 Australian centres with intravenous steroid-refractory ASUC were randomised to receive a first dose of 10mg/kg or 5mg/kg IFX in a 1:2 ratio. Patients in the 10mg/kg group (intensified induction [II]) received a second dose at day 7 or earlier at time of non-response; all 5mg/kg patients were re-randomised 1:1 to standard (SI) or accelerated induction (AI), which produced three induction groups: II, SI and AI. SI patients received 5mg/kg at week 0, 2 and 6, with an extra 5mg/kg dose before day 7 if non-response. AI patients received 5mg/kg at week 0, 1 and 3, with the week 1 dose increased to 10mg/kg and given earlier if non-response. Primary outcome: clinical response by day 7 (reduction in Lichtiger score to &amp;lt;10, with decrease of ≥3 points and improvement in rectal bleeding and stool frequency to ≤4/day). Secondary outcomes compared induction regimens until month 3. Analysis was by intention to treat. Results Between July 2016 &amp; September 2021, 138 patients were randomised; 46 received a first IFX dose of 10mg/kg and 92 received 5mg/kg. Primary outcome: day 7 clinical response was observed in 65% (30/46) of 10mg/kg vs 61% (56/92) of 5mg/kg patients (P=0.76). In the 5mg/kg group, the rate of day 7 response was numerically lower in those with albumin &amp;lt;25g/L vs ≥25g/L [47% (15/32) vs 68% (41/60), P=0.07]. No difference in clinical response was observed in the 10mg/kg group when stratified by albumin [64% (9/14) vs 66% (21/32) P&amp;gt;0.99]. There was no difference in time to clinical response, change in Lichtiger score or CRP from baseline to day 7. Two patients who received 10mg/kg IFX underwent colectomy in the first 7 days vs 0 in the 5mg/kg group (P=0.21). Comparison of induction regimens (II, SI &amp; AI): no difference in clinical remission rates between weeks 2 and 6 were observed. AI and II groups had higher rates of combined clinical and biochemical remission compared to SI between weeks 2 and 6 (P=0.042). At 3 months, there was no difference in rates of endoscopic and steroid-free remission, as well as rates of colectomy (II 7%; SI 12%; AI 19%, P=0.20). Conclusion In steroid-refractory ASUC, a first dose of 10mg/kg or 5mg/kg IFX achieved similar clinical response rates by day 7. Patients receiving intensified or accelerated induction achieved clinical and biochemical remission earlier compared to standard induction; however, outcomes at three months were similar. Patients with a lower albumin may benefit from proactive intensified dosing strategies.

Retracted: 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.

[This retracts the article DOI: 10.1155/2022/9750237.].