CRP Score Research Articles

The impact of diabetes on Sepsis-induced cardiomyopathy.

This study investigated the association between diabetes and Sepsis-induced cardiomyopathy (SIC), focusing on how changes in inflammatory response and cardiac function influence SIC prognosis. The aim is to provide clinicians with more accurate treatment and management strategies, ultimately enhancing patient outcomes and quality of life. This retrospective cohort study analyzed 258 Sepsis-induced cardiomyopathy (SIC) patients, stratified by diabetes status and HbA1C levels. Data were collected from electronic medical records. Statistical tests included the Kolmogorov-Smirnov, t-test, Mann-Whitney U, Kruskal-Wallis, chi-square, and Spearman correlation. Univariate and multivariate logistic regression assessed diabetes' impact on SIC severity. Model fit was evaluated with the Hosmer-Lemeshow and negative log-likelihood ratio tests. A nomogram was constructed and validated using ROC curves, calibration curves, and decision curve analysis. Subgroup and interaction analyses were performed (P<0.05). Diabetes worsened inflammation and immune responses in SIC, significantly affecting markers like LVEF, TnI, CK-MB, BNP, NLR, IL-6, PCT, CRP, APACHE II, and SOFA scores (P<0.05). Grouping by HbA1C levels revealed no significant differences in LVEF (P=0.078), Alb (P=0.105), or L/A (P=0.211), but differences were found for TnI, CK-MB, BNP, NLR, IL-6, PCT, CRP, APACHE II, and SOFA (P<0.05). HbA1C strongly correlated with CRP (rs=0.8664). BNP (OR 1.001) and HbA1C (OR 1.302) were significant risk factors for SIC, with the nomogram showing good predictive performance (AUC 0.693). No significant interaction between HbA1C and BNP on SIC severity was observed (P=0.791). Diabetes exacerbates inflammatory and immune responses in Sepsis-induced cardiomyopathy patients, leading to worsened cardiac function.

P0218 Dietary Inflammatory Index and disease activity in patients with IBD: is there an association? A Preliminary Analysis

Abstract Background Inflammatory bowel disease (IBD) is increasing in incidence in recently industrialized and developing countries, and this increment is paralleled by Westernization of lifestyle.1 In fact, specific nutrients and additives instigate gut inflammation and increasing evidence demonstrates its impact on developing IBD and disease behavior.2,3 Dietary Inflammatory Index (DII) was developed to assess the inflammatory properties of a diet.4 The aim of this study is to assess the association between higher DII scores and disease activity in patients with ulcerative colitis (UC) and Crohn’s disease (CD). Methods A cross-sectional study was conducted from June to October 2024. Patients undergoing ambulatory treatment at a day care IBD unit were consecutively recruited. A self-applied semiquantitative food frequency questionnaire, validated for the adult Portuguese population, was applied and medical charts reviewed. Blood and feces were collected, and anthropometric parameters measured by a body composition analyzer (Tanita DC-430MA). DII score was calculated according to the Shivappa et al. method, using 30 parameteres.4 The primary outcome was to assess the association between DII scores and 4 disease activity levels defined by clinical and biological activity markers (table 1). Clinical activity was classified according to Mayo Partial score for UC and Harvey-Bradshaw index (HBI) for CD. Biological activity was evaluated through fecal calprotectin. Results A total of 100 IBD patients (37 UC, 61 CD and 2 non-classified) were included; mean age 43.47 ±16.03 years, 41% female. Mean disease duration was 9.72±7.62 years. Baseline characteristics are described at table 2. Mean DII score was 1.49±2.43. The calculated DII score was categorized into quartiles. Comparison of calprotectin, CRP and Mayo Partial score by DII quartile was performed using Kruskal-Wallis test, and HBS using one-way ANOVA. No statistically significant correlations were found. Chi-square test for the association between activity levels and DII quartiles showed no statistically significant differences (p 0.496 DC; p 0.492 UC). Conclusion An association between DII scores and disease activity was not observed. Further studies with larger and more homogeneous samples are needed in the future to clarify the utility of this score in clinical practice. Given the undeniable and growing importance of these tools, other scales should also be studied and validated in IBD population.

P0864 Real-world effectiveness of upadacitinib for perianal Crohn’s disease: A multi-center retrospective study

Abstract Background There is limited data on the clinical effectiveness of upadacitinib (UPA), an oral selective inhibitor of Janus kinase 1 (JAKi), in patients with perianal Crohn's disease (pCD). The objective of this study was to evaluate the real-world effectiveness of UPA in pCD. Methods This retrospective analysis utilized data on adults (&amp;gt;17 years) who initiated UPA at 45 mg/day for active pCD across 10 centers in the United States and Canada. Standardized data extraction and entry protocols were followed. The primary outcome was clinical response, defined as a ≥3-point reduction in Perianal Disease Activity Index (PDAI) between baseline and follow-up. Secondary outcomes included normalization of CRP (&amp;lt;5 mg/L) or hsCRP (&amp;lt;1 mg/L), clinical remission (PDAI ≤4), and rates of hospitalization, antibiotic use, corticosteroid initiation, and new pCD-related surgeries. Fistula healing on MRI pelvis fistula protocol was defined as an absence of T2-weighted hyperintensity and post-contrast enhancement on T1-weighted images. Predictive analyses used Cox proportional hazards models to evaluate baseline factors influencing time to PDAI remission, including BMI, CRP, albumin, PDAI, pCD disease duration, Montreal location and prior biologic exposure (&amp;lt;2 vs 2+). Results A total of 81 patients were treated with UPA for pCD (median age 35 years and 54.3% male). Most had ileocolonic disease (65.4%), with 54% presenting with complex fistulas. Of these, 92.6% had prior anti-TNF exposure, and 91 (88.9%) had prior exposure to 2+ biologics (Table 1). During a median follow-up of 4 months, clinical response (PDAI) was achieved in 17.3%. Improvement was observed in pain and restriction of activities (27.2%), restriction of sexual activity (13.6%), reduction in number of fistulas (11.1%), degree of induration (11.1%), and discharge (35.8%). Median CRP reduction was 21.05% [IQR: 0.00–74.53], and 21.0% achieved a ≥50% reduction in CRP. MRI healing was limited to 17.7% (6/34). Proctitis decreased from 23.5% at baseline to 7.4% at follow-up. During follow-up, hospitalizations occurred in 9.9%, 14.8% required antibiotics, 8.6% underwent examination under anesthesia in 8.6%, seton placement in 6.2%, and abscess drainage in 6.2%. Patients with ileocolonic disease showed the highest remission (54%) and response (15%) rates, while MRI healing was limited across all Montreal locations (7.4%). Lower baseline CRP (p &amp;lt; 0.05) and PDAI scores (p &amp;lt; 0.01) predicted shorter time to remission. Number of prior biologic exposures (p =0.2) and Montreal location (p = 0.7) were not predictive of time to PDAI remission (Figure 1). Conclusion UPA in a real-world cohort is effective in the management of treatment-refractory pCD. Randomized trials are needed to confirm these observations.

P0799 Efficacy and Safety of Dual Therapy for Refractory Inflammatory Bowel Disease in a Danish Cohort

Abstract Background Patients with Crohn’s disease (CD) and ulcerative colitis (UC) may become refractory to monotherapy with biologics or small molecules. Dual therapy, combining biologics and small molecules, has been proposed for this challenging population. While awaiting randomized studies, real-world data on its efficacy and safety are crucial. This study contributes to the evidence on dual therapy in a Danish adult IBD cohort. Methods Medical records from May 2018 to May 2023 were reviewed for CD and UC patients undergoing dual therapy with biologics and/or small molecules in outpatient gastroenterology clinics at Aarhus University Hospital and Regional Hospital Randers. Patients treated for at least three months were included and followed until treatment discontinuation or the end of the study period. Patient characteristics, clinical outcomes, adverse events, and efficacy data were collected at baseline and follow-up. Results Seventy-four patients (47 with CD and 27 with UC) received a total of 79 dual therapies. The median duration of dual therapy was 488 days for CD and 412 days for UC. The most common combinations were adalimumab and ustekinumab in CD (46%) and adalimumab and vedolizumab in UC (35%). Clinical remission was achieved in 56% of CD patients and 62% of UC patients. Steroid-free follow-up was observed in 81% of CD patients and 52% of UC patients (Table 1). In CD, dual therapy significantly reduced stool frequency, bloody stools, calprotectin levels, and Harvey-Bradshaw Index (HBI) scores. In UC, stool frequency, nighttime stools, abdominal pain, CRP, calprotectin, and Simple Clinical Colitis Activity Index (SCCAI) scores significantly decreased, while hemoglobin and albumin levels significantly improved. Serious adverse events (SAEs) occurred in 12% of UC patients and 14% of CD patients, consistent with prior studies of adult and pediatric cohorts [1, 2]. No UC patients required colectomy during the study period. Conclusion This retrospective study demonstrates a substantial rate of clinical remission and acceptable safety in refractory IBD patients receiving dual therapy. The findings highlight prolonged treatment duration, significant clinical improvements, and a manageable SAE profile. Dual therapy represents a promising approach for refractory and complex IBD, though the risk of SAEs must always be balanced against therapeutic benefits.

Inhibition of Interleukin-40 prevents multi-organ damage during sepsis by blocking NETosis

Despite intensive clinical and scientific efforts, the mortality rate of sepsis remains high due to the lack of precise biomarkers for patient stratification and therapeutic guidance. Interleukin 40 (IL-40), a novel cytokine with immune regulatory functions in human diseases, was elevated at admission in two independent cohorts of patients with sepsis. High levels of secreted IL-40 in septic patients were positively correlated with PCT, CRP, lactate (LDH), and Sequential Organ Failure Assessment (SOFA) scores, in which IL-40 levels were used to stratify the early death of critically ill patients with sepsis. Moreover, genetic knockout of IL-40 (IL-40−/−) improved outcomes in mice with experimental sepsis, as evidenced by attenuated cytokine storm, multiple-organ failure, and early mortality, compared with those of wild-type (WT) mice. Mechanistically, single-cell RNA sequencing (scRNA-seq) and bulk RNA sequencing (RNA-seq) have revealed that S100A8/9hi neutrophil influx into the peritoneal cavity along with neutrophil extracellular trap (NETs) formation accounts predominantly for the IL-40-mediated worsening of sepsis outcomes. Clinically, the IL-40 level was positively correlated with the NET-related MPO/dsDNA ratio in septic patients. Finally, with antibiotics (gentamycin), genetic knockout of IL-40 prevented polymicrobial sepsis fatalities more efficiently than without gentamycin treatment. In summary, these data reveal a novel prognostic strategy for sepsis and that IL-40 may serve as a novel therapeutic target for sepsis.Graphical abstract

Combined detection of monocyte distribution width and procalcitonin for diagnosing and prognosing neonatal sepsis

BackgroundTo assess the value of combined Monocyte Distribution Width (MDW) and Procalcitonin (PCT) detection in diagnosing and predicting neonatal sepsis outcomes.MethodsThis retrospective study, conducted from January 2022 to December 2023.A retrospective analysis of 39 neonatal sepsis and 30 non-infectious systemic inflammatory response syndrome (SIRS) cases was conducted. MDW, PCT, and CRP levels were compared. Relationships between variables were analyzed with Pearson correlation and Cox regression models; diagnostic performance was assessed using ROC curves.ResultsMDW, PCT, and CRP were significantly elevated in sepsis cases (p < 0.001). In non-survivors, MDW was higher and correlated with CRP, PCT, and SNAP scores. MDW was identified as an independent predictor of 28-day mortality. Optimal MDW, PCT, and CRP cut-offs (21.3, 1.23 ng/ml, 32.8 mg/L) achieved AUCs of 0.80, 0.84, and 0.60, respectively. Combined MDW/PCT detection achieved an AUC of 0.90 with 88.2% sensitivity and 88.7% specificity.ConclusionMDW, especially when combined with PCT, improves diagnostic accuracy for neonatal sepsis management.

Molecular insights into the therapeutic mechanisms of Bushen-Qiangdu-Zhilv decoction for ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic rheumatic immune disease characterized by high disability rates, significantly affecting patients' quality of life. BuShen-QiangDu-ZhiLv Decoction (BQZD), developed by the renowned traditional Chinese medicine practitioner Jiao Shude, has been traditionally used for AS treatment. However, the bioactive components and the precise mechanisms underlying BQZD's therapeutic effects remain largely unexplored. To investigate the protective effects and elucidate the molecular mechanisms of BQZD in treating ankylosing spondylitis. Ultra Performance Liquid Chromatography coupled with tandem mass spectrometry (UPLC-MS/MS) was used to identify active compounds in BQZD. Bulk RNA-seq and Gene Set Variation Analysis (GSVA) were conducted to assess changes in pathway activity in AS patients before and after three months of BQZD treatment. We also utilized network pharmacology and molecular docking analyses to predict potential mechanisms, identifying key target genes such as IL-6, NFATc1, and c-FOS. Animal experiments were performed to validate these findings. UPLC-MS/MS identified 28 active compounds in BQZD capable of entering the bloodstream, with potential anti-inflammatory, immunomodulatory, and bone metabolism-regulating effects. BQZD treatment led to a significant reduction in ESR, CRP, and ASDAS-CRP scores, indicating clinical improvement in AS patients. RNA-seq analysis showed decreased GSVA scores for the ossification pathway, with moderate reductions in inflammatory response and RANKL signaling pathways. Positive correlations were found between pathway activity and clinical indicators. Network pharmacology and transcriptomic analysis identified IL-6, NFATc1, and c-FOS as key targets. In vivo experiments confirmed that BQZD reduced TNF-α and IL-1β levels, inhibited ectopic ossification, and modulated the expression of DKK-1, MMP-9, and OPN in the CAIA model. BQZD exerts therapeutic effects in AS by regulating inflammation and abnormal ossification through multi-pathway, multi-target mechanisms. The identification of key target genes such as IL-6, NFATc1, and c-FOS provides a solid foundation for future research and clinical applications of BQZD in AS management.

Tofacitinib versus Vedolizumab Among Bio-naïve Patients with Ulcerative Colitis: A Real-World Propensity-Weighted Comparison.

Over the last decade, treatment options for moderate-to-severe ulcerative colitis (UC) have expanded. However, comparative studies between these agents are limited, especially among biologic-naïve patients. We aimed to compare the persistence, effectiveness and safety of tofacitinib and vedolizumab as the first advanced treatment for patients with UC. Patients who received either tofacitinib or vedolizumab as their first advanced therapy for UC in NHS Lothian were included. We used inverse probability of treatment weighting (IPTW). The probability of treatment assignment was calculated via logistic regression using age, sex, UC duration, Montreal extent, CRP, concomitant corticosteroids, and partial Mayo score at drug commencement. We included n=158 patients, of whom n=81 (51.3%) received vedolizumab and n=77 (48.7%) tofacitinib. Median follow-up for vedolizumab patients was 3.1 years (IQR 1.6-4.8) and for tofacitinib patients 1.5 years (IQR 0.3-2.3). The cohort was 59.5% male with a median age of 41.1 years (IQR 31.5-51.8). At two years, vedolizumab persistence was superior to tofacitinib (p=0.005). At week 12 and week 52 clinical, biochemical and fecal biomarker steroid free remission were comparable between groups. Primary non-response and secondary loss of response were 9.9% and 17.3% for vedolizumab and 23.4% and 13% for tofacitinib respectively. Frequency of adverse events was comparable (11 [13.6%] vedolizumab vs 19 [24.7%] tofacitinib, p=0.629). We found that the persistence and tolerability of vedolizumab was superior to tofacitinib in bio-naïve UC, although the rates of clinical and biomarker remission were comparable. These data may help inform positioning of advanced therapy.

“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.

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.

Early Diagnostic and Prognostic Value of the Urinary TIMP-2 and IGFBP-7 in Acute Kidney Injury in Critically Ill Children.

Acute kidney injury (AKI) is a hidden complication among children within pediatric intensive care units (PICU). To evaluate the early predictive and diagnostic value of Urinary [TIMP-2][IGFBP7] to detect AKI in PICU patients. A case-control study was conducted on 112 children (72 admitted to PICU and 40 healthy controls) Urinary [TIMP-2][IGFBP7] was measured within 24 hours of PICU admission. Acute kidney injury developed in 52 (72.2%) out of 72 critically ill patients. The AKI group had significantly higher serum creatinine, CRP, and pediatric sequential organ failure assessment score (pSOFA) score (p = 0.001, 0.01, and 0.001, respectively) and significantly lower estimated creatinine clearance (eCCl) (p = 0.001). Urinary [TIMP-2][IGFBP7] was significantly higher in the AKI group as compared with the non-AKI group (p = 0.007). The duration of the PICU stay was 1.8-fold higher in the AKI group (p = 0.004). At the time of study enrollment, 7 (13.5%) patients had normal initial eCCl. 26 patients (50.0%) fulfilled the "Risk," 18 patients (34.6%) the "Injury," 1 patient (1.9%) the "Failure" and 0 patient (0%) the "Loss" criteria. Nine (17%) patients progressed to the next higher pediatrics risk, injury, failure, loss, end-stage renal disease (pRIFLE) stage. Urinary [TIMP-2][IGFBP7] was significantly higher in the "Failure" stage followed by "Injury," stage then the "Risk," stage (p = 0.001). Hypovolemia/dehydration had the highest [TIMP-2][IGFBP7] values followed by sepsis. Urinary [TIMP-2][IGFBP7] was significantly increased in mechanically ventilated and patients who received inotropic medications. [TIMP-2]·[IGFBP7] was higher in AKI patients compared with non-AKI ones especially cases with hypovolemia and sepsis. It may predict severe morbidity and mortality because its higher levels in mechanically ventilated children and those on positive inotropic support. Ismail M, Abdelhamid N, Hasanin HM, Hamed HM, Motawie A, Kamel S, et al. Early Diagnostic and Prognostic Value of the Urinary TIMP-2 and IGFBP-7 in Acute Kidney Injury in Critically Ill Children. Indian J Crit Care Med 2024;28(10):970-976.

Sexual Dysfunction in Women with Asthma and Associated Factors

Background: Asthma is a common chronic inflammatory airway disease. Female sexual dysfunction (FSD) is frequently seen in asthmatics but often unnoticed in clinical practice. This study evaluated the associations between asthma disease characteristics and (FSD). Methods: A total of 73 female asthma patients who visited the chest department outpatient clinic and age-matched 73 healthy controls were enrolled. All the participants completed the questionnaires: female sexual function index (FSFI), BECK depression, and BECK anxiety inventory, and underwent pulmonary function tests. Patients with asthma completed an asthma quality of life questionnaire (AQLQ) and asthma control test (ACT). FSD risk factors were analyzed using logistic regression analysis. Results: About 68.8% of asthmatics had female sexual dysfunction. BECK anxiety and FSFI scores with all six subsets were statistically significantly lower than healthy individuals in asthmatics (p &lt; 0.001). CRP levels, BECK anxiety, and depression scores had inverse (r = -0.386 r = -0.343 r = -0.286), and FEV1% had a positive correlation with FSFI total scores. About 37.5% of asthma patients with FSD were current smokers, the most compromised domain of the FSFI scale was sexual arousal with a mean of 2.94 ± 0.56 and their FEV1% was lower, and CRP was higher than the asthma patients without FSD (p &lt; 0.001, p &lt; 0.021). Smoking, high levels of CRP and BECK anxiety scores, and low FEV1% were found to be risk factors for FSD in regression analysis. Conclusions: Female sexual dysfunction is frequently present in asthma patients. Smokers, patients who have anxiety, lower FEV1% predicted values, and higher CRP levels tend to be susceptible to sexual dysfunction, which implicates inflammation as an underlying mechanism.

Association between nutritional scores and multilevel vertebral involvement in tubercular spine: a retrospective cohort study.

The objective of this study is to evaluate the prognostic value of nutritional scores comprising the Controlling Nutritional Status (CONUT) score and the Prognostic Nutritional Index (PNI), in prediction of multilevel vertebral involvement (> 2 vertebra) in Spinal Tuberculosis (STB). Retrospective analysis of 39 STB patients was conducted to assess nutritional indices (CONUT and PNI) and the numbers of vertebral affection. Spearman's correlation was used to examine the association between these variables. Receiver Operating Characteristic (ROC) curves were utilized to determine optimal cutoff values, with Area Under the Curve (AUROC) evaluation. Additionally, multiple logistic regression was performed as a predictive model. There were 24 males and 15 females, with a mean BMI of 18.88kg/m² (± 1.37). Spearman's correlation analysis revealed negative correlations between BMI, PNI (rho - 0.68, p < 0.001) and multilevel vertebra involvement, while ESR (rho 0.83, p < 0.001), CRP (rho 0.81, p < 0.001), and CONUT score (rho 0.83, p < 0.001) positively correlated with multilevel vertebral affection (> 2 vertebra). Age and comorbidities showed no correlation with the level of vertebral affection. ROC analysis revealed a CONUT Score ≥ 3 cutoff (sensitivity-95.7%, specificity-87.5%) and PNI ≤ 38.605 (sensitivity-78.3%, specificity-93.8%) for predicting multilevel STB (> 2). PNI exhibited superior specificity and positive predictive value where as CONUT score was a better parameter for sensitivity, negative predictive value and diagnostic accuracy. Both CONUT score and PNI were significant predictors of vertebral involvement in univariate analysis, with multivariate analysis identifying CONUT score as the sole predictor of multilevel vertebral affection. Nutritional scores, including CONUT score and PNI, emerged as significant predictors of multilevel STB. CONUT score displayed superior sensitivity, negative predictive value, and overall diagnostic accuracy, while PNI served as a nutritional marker with high specificity and positive predictive value in predicting multilevel involvement in spinal tuberculosis.

Perioperative bleeding control in total hip arthroplasty: hemostatic powder vs. tranexamic acid-a prospective randomized controlled trial.

Perioperative bleeding in total hip arthroplasty (THA) can lead to various problems, so effective management of blood loss is needed. This prospective, single-blind, randomized controlled trial aimed to compare the efficacy of topical administration of SURGICEL® (a hemostatic agent of oxidized regenerated cellulose) powder (SP) and tranexamic acid (TXA) in controlling perioperative bleeding during THA. In total, 114 patients undergoing THA for osteoarthritis were randomized to either group S (THA with SP) or group T (THA with TXA). Data including patient demographics, laboratory data (C-reactive protein [CRP], hemoglobin, and hematocrit), operative time, and intraoperative blood loss were analyzed. Clinical outcomes were assessed using WOMAC, JOA, FJS scores, and visual analog scale (VAS) scores. Primary outcomes were estimated total and postoperative blood loss, while secondary outcomes included hematological test results and various clinical scores. 57 patients were allocated to each group, with 55 in group S and 56 in group T were finally included in the analysis. There was no significant difference (p = 0.141) in estimated total blood loss between group S (788.2 ± 350.1ml) and group T (714.1 ± 318.4ml). Hemoglobin and hematocrit levels and WOMAC, and FJS scores were not significantly different between the two groups at any time point. CRP levels were significantly different on postoperative days 4 and 7, and JOA score was significantly different on preoperative and postoperative period. However, the differences in CRP and JOA score values themselves were relatively small and not clinically different. Topical administration of SP is as effective as TXA in reducing perioperative bleeding in patients undergoing THA. Additionally, no significant difference was observed in early postoperative clinical outcomes between SP and TXA. Therapeutic Level I. The University Hospital Medical Information Network (UMIN) registration number UMIN000047607.

Serum Ferritin and Cellular Reactive Protein (CRP) in Non Alcoholic Fatty liver Disease (NAFLD) and Non Alcoholic Steatohepatitis (NASH) Patients

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world, and it comprises a spectrum of hepatic abnormalities from simple hepatic steatosis to steatohepatitis, fibrosis, cirrhosis, and liver cancer. Simple steatosis (i.e., NAFL) rarely progresses to advanced disease whereas, in approximately 20% of patients with NASH, it progresses to fibrosis and cirrhosis and potentially to hepatocellular carcinoma over a 15-year time period. Aim of the Work To study the relation between serum ferritin and CRP levels and severity of non- alcoholic fatty liver disease NAFLD and non-alcoholic steatohepatitis NASH. Patients and Methods This case control study was conducted on patients attending the Hepatology Outpatient Clinic at Ain Shams University Hospital between December 2019 to May 2020. Results In group A there is significant correlation between ferritin and age, ALT, AST, albumin, CRP, LDL, BMI, cholesterol, triglycerides and NAFLD fibrosis score. But there is no significant correlation between ferritin and Hb, platelets, HDL and fasting blood sugar FBS in group A. In group B there is significant correlation between ferritin and ALT. Ferritin has cutoff point of &amp;gt; 168 with 80% sensitivy &amp; 80% specificity. In group A there is significant correlation between CRP and age, BMI, ALT,AST, albumin, LDL, cholesterole, triglycerides and NAFLD fibrosis score. In group A there is no significant correlation between CRP and Hb, platelets, FBS and HDL. While in group B there is significant correlation between CRP and BMI, ALT, albumin, LDL, cholesterole and triglycerides. CRP cutoff point of &amp;gt; 1.3 with specificity 90% but sensitivity 35%. Conclusion In conclusion, in this study we tried to find a relation between serum ferritin and CRP levels and severity of non-alcoholic fatty liver disease NAFLD and non-alcoholic steatohepatitis NASH. We found that s. ferritin and CRP are significantly elevated in NAFLD and more elevated in NASH with a link between serum ferritin and insulin resistance and the whole metabolic syndrome. Serum ferritin and CRP are related to disease progression with significant correlation with NAFLD fibrosis score.

Exploring the Impact of Adequate Energy Supply on Nutrition, Immunity, and Inflammation in Elderly Patients with Chronic Obstructive Pulmonary Disease.

Chronic Obstructive Pulmonary Disease (COPD) progression in the elderly is notably influenced by nutritional, immune, and inflammatory status. This study aimed to investigate the impact of adequate energy supply on these indicators in COPD patients. COPD patients meeting specific criteria were recruited and categorized into energy-adequate and energy-deficient groups based on their energy supply. Comparable demographic factors such as age, gender, smoking and drinking history, COPD duration, inhaled drug classification, and home oxygen therapy application were observed. Notable differences were found in BMI and inhaled drug use between the two groups. The energy-adequate group exhibited significant improvements in various health indicators, including lymphocyte count, hemoglobin, CRP, total cholesterol, prealbumin, albumin, PNI, SII, SIRI, CAR, and CONUT scores in the secondary auxiliary examination. These positive changes suggest a notable enhancement in nutritional, immune, and inflammatory status. This research highlights the substantial benefits of adequate energy supply in elderly COPD patients. The observed improvements in nutritional, immune, and inflammatory markers underscore the importance of addressing energy needs to positively influence disease-related outcomes in this population. These findings have implications for developing targeted interventions to optimize the well-being of elderly individuals with COPD.

P065 Patient-initiated follow up in rheumatoid arthritis: a systematic review and meta-analysis

Abstract Background/Aims Inflammatory arthritides including rheumatoid arthritis (RA) typically require lifelong outpatient care. Patient-initiated follow up (PIFU) has been employed to alleviate burdens on over-stretched rheumatology clinics, aiming to eliminate unnecessary clinic visits and reduce waiting times. There is a paucity of robust data to establish whether clinical outcomes differ under PIFU compared to clinician-mandated follow up. We examined the effect of PIFU on key outcomes in patients with inflammatory arthritis. Methods We searched MEDLINE, Embase, PsycInfo and CENTRAL for randomised controlled trials comparing PIFU (and similar patient-directed strategies) with clinician-mandated follow up in patients with inflammatory arthritis. Publications were screened in accordance with PRISMA guidelines and included based on pre-specified criteria. Risk of bias was assessed using the Cochrane ROB2 tool. Outcome measures analysed were disease activity, serum C-reactive protein, disability, service use and satisfaction with care. Standardised mean differences (SMD) were used to account for variable use of outcome measures between papers. Results Six studies were included with a total of 1,059 patients, all of whom had RA, followed up for between one and six years. Two trials were conducted in Denmark, two in the UK and one each in Sweden and the Netherlands. Two involved two sites; four were single centre. Three studies were deemed to be at high risk of bias, two at moderate risk and one at low risk. The data demonstrated a reduced burden of clinic visits for patients under PIFU (all studies; SMD -0.56, [95% CI -0.85 to -0.28]) equivalent to a reduction in approximately one clinic visit for every two patients over the course of the study period. This was balanced by an increased number of telephone consultations (4 studies, 817 patients; SMD 0.40 [0.13 to 0.66]) equating to an extra consultation per 2.5 patients under PIFU. Non-significant trends were seen towards higher patient satisfaction (all studies; SMD 0.28 [-0.12 to 0.68]) for patients under PIFU. However, there were also trends towards higher CRP (three studies, 490 patients; SMD 0.22 [-0.08, 0.52]) and DAS28 score (4 studies, 658 patients; SMD 0.08[-0.20, 0.36]. No significant difference was seen in patient-reported disability. There was substantial statistical heterogeneity between studies. Conclusion PIFU is associated with a reduction in outpatient clinic appointments but increased numbers of telephone consultations, while maintaining patient satisfaction. Current data do not exclude the possibility of inferior long-term clinical outcomes for patients receiving PIFU. Transition to PIFU risks reducing services’ capacity to assess and modify clinically important parameters (e.g. cardiovascular risk) through regular scheduled review. These studies highlight the challenges in conducting meaningful trials on this question due to the heterogeneity of interventions and outcomes and the already-widespread use of some aspects of PIFU in routine care. Disclosure E. Alveyn: Other; Educational support from UCB. R. Crowder: None. M. Perry: None. S. Norton: None. J. Galloway: Honoraria; from AbbVie, Celgene, Chugai, Gilead, Janssen, Eli Lilly, Pfizer, Roche and UCB.

The Role of CRP and mNUTRIC score in predicting outcome in critically ill elderly.

The Role of CRP and mNUTRIC score in predicting outcome in critically ill elderly.

Gastric myoelectrical associations with autonomic and central nervous system activity during state negative emotionality and perseverative negative thinking: A two-study investigation

BackgroundDistress is known to set off a variety of physiological dysfunctions. There have been previous investigations of central and peripheral (e.g., cardiac) correlates of distress and a burgeoning field examining immunological and inflammatory relationships to distress. However, despite a connection between gastrointestinal symptoms and distress at the clinical level, little research has connected this activity to other biological correlates of distress. Heightened negative emotions and dysregulation of emotions in the form of perseverative negative thinking (PNT, e.g., worry, rumination) are two components that underlie distress. Investigating the effect that these components have on gastric and related biological measures is crucial to better understanding the relationship between distress and health outcomes. We present results from two studies, which examined the impact of experimentally induced negative emotionality and PNT on gastric, autonomic nervous system, central nervous system, and inflammatory processes. MethodIn Study 1 (N = 95), we examined changes in electrogastrogram (EGG), respiratory sinus arrythmia (RSA), and alpha- and beta-band electroencephalogram (EEG) power at baseline and during experimental inductions of fear and sadness in a diverse sample of undergraduate students. In Study 2 (N = 30), we examined changes in EGG, RSA, and EEG at baseline and during worry and rumination inductions. We also collected inflammatory markers post-inductions in Study 2. ResultsIn Study 1, normal gastric activity, vagal tone, and alpha- and beta-band power decreased, whereas EGG cycle length and variability increased during fear and sadness compared to baseline. We also observed significant relationships among EGG, RSA, and EEG during fear and sadness. In Study 2, normal gastric activity and RSA decreased, whereas EGG cycle length and variability increased during rumination compared to baseline. We also observed increases in frontal alpha-band power during worry and rumination compared to baseline. Regarding relationships among EGG, RSA, EEG, and inflammation, greater EGG cycle variability was associated with higher vagal tone during worry; additionally, EGG cycle length and variability during rumination were positively related to CRP and TNF-α inflammation composite scores post-inductions. ConclusionsThese findings offer insight into how negative emotionality and PNT might relate to gastric, ANS, CNS, and inflammatory processes.

Intelligent diagnosis of the severity of disease conditions in COVID-19 patients based on the LASSO method.

The purpose of this study is to develop an intelligent diagnosis model based on the LASSO method to predict the severity of COVID-19 patients. The study uses the clinical data of 500 COVID-19 patients from a designated hospital in Guangzhou, China, and selects eight features, including age, sex, dyspnea, comorbidity, complication, lymphocytes (LYM), CRP, and lung injury score, as the most important predictors of COVID-19 severity. The study applies the LASSO method to perform feature selection and regularization, and compares the LASSO method with other machine learning methods, such as ridge regression, support vector machine, and random forest. The study finds that the ridge regression model has the best performance among the four models, with an AUROC of 0.92 in the internal validation and 0.91 in the external validation. The study provides a simple, robust, and interpretable model for the intelligent diagnosis of COVID-19 severity, and a convenient and practical tool for the public and the health care workers to assess COVID-19 severity. However, the study also has some limitations and directions for future research, such as the need for more data from different sources and settings, and from prospective, longitudinal, multi-class classification models. The study hopes to contribute to the prevention and control of COVID-19, and to the improvement of the diagnosis and treatment of COVID-19 patients.