Elevated Serum C-reactive Protein Research Articles

Galectin-9 as an indicator of functional limitations and radiographic joint damage in patients with rheumatoid arthritis.

Previous studies have revealed that Galectin-9 (Gal-9) acts as an apoptosis modulator in autoimmunity and rheumatic inflammation. In the present study, we investigated the potential role of Gal-9 as a biomarker in patients with rheumatoid arthritis (RA), especially as an indicator of functional limitations and radiographic joint damage. A total of 146 patients with RA and 52 age- and sex-matched healthy controls were included in this study. Clinical data including disease activity, physical function, and radiographic joint damage were assessed. Functional limitation was defined as the Stanford Health Assessment Questionnaire (HAQ) disability index >1. Subjects with joint erosion >0 or joint space narrowing >0 were considered to have radiographic joint damage. Serum Gal-9 levels were detected by an enzyme-linked immunosorbent assay. Univariate and multivariate logistic regression analysis were used to evaluate the association between Gal-9 and high disease activity and functional limitations, and a prediction model was established to construct predictive nomograms. Serum levels of Gal-9 were significantly increased in patients with RA compared to those in healthy controls (median 13.1 ng/mL vs. 7.6 ng/mL). Patients with RA who were older (>65 years), had a longer disease duration (>5 years), longer morning stiffness (>60mins), elevated serum erythrocyte sedimentation rate and C-reactive protein, and difficult-to-treat RA had significantly higher Gal-9 levels than those in the corresponding control subgroups (all p <0.05). Patients with RA were divided into two subgroups according to the cut-off value of Gal-9 of 11.6 ng/mL. Patients with RA with Gal-9 >11.6 ng/mL had a significantly higher core clinical disease activity index, HAQ scores, Sharp/van der Heijde modified Sharp scores, as well as a higher percentage of advanced joint damage (all p<0.05) than patients with Gal-9 ≤11.6 ng/mL. Accordingly, patients with RA presenting either functional limitations or radiographic joint damage had significantly higher serum Gal-9 levels than those without (both p <0.05). Furthermore, multivariate logistic regression analysis showed that a serum level of Gal-9 >11.6 ng/mL was an independent risk factor for high disease activity (OR=3.138, 95% CI 1.150-8.567, p=0.026) and presence of functional limitations (OR=2.455, 95% CI 1.017-5.926, p=0.046), respectively. Gal-9 could be considered as a potential indicator in patients with RA, especially with respect to functional limitations and joint damage.

“Does the Gut microbiome influence disc health and disease?—the interplay between dysbiosis, pathobionts, and disc inflammation: a Pilot Study”

BACKGROUND CONTEXTGut microbiome alterations resulting in inflammatory responses have been implicated in many distant effects on different organs. However, its influence on disc health is still not fully investigated. PURPOSEOur objective was to document the gut biome in healthy volunteers and patients with disc degeneration and to understand the role of gut dysbiosis on human disc health. STUDY DESIGNExperimental case-control study. PATIENT SAMPLEWe included 40 patients with disc degeneration (DG) and 20 healthy volunteers (HV). HV comprised of age groups 30 to 60 years with no known record of back pain and no clinical comorbidities, with normal MRI. Diseased group (DG) were patients in the same age group undergoing surgery for disc disease (disc herniation-25; discogenic stenosis-15) and without instability (with Modic-20; and non-Modic-20). OUTCOME MEASURESN/A. METHODSWe analyzed 16S V3-V4 rDNA gut metagenome from 20 healthy volunteers (HV) and compared the top signature genera from 40 patients with disc degeneration (DG) across Modic and non-Modic groups. Norgen Stool DNA Kit was used for DNA extraction from ∼200 mg of each faecal sample collected using the Norgen Stool Collection Kit.16S V3-V4 rDNA amplicons were generated with universal bacterial primers 341F and 806R and amplified with Q5 High-Fidelity DNA Polymerase. Libraries were sequenced with 250×2 PE to an average of 0.1 million raw reads per sample (Illumina Novaseq 6000). Demultiplexed raw data was assessed with FastQC, and adapter trimmed reads >Q30 reads were processed in the QIME2 pipeline.Serum C-reactive protein (CRP) was measured by the immunoturbimetry method and Fatty acid-binding protein 5 (FABP5) was measured in albumin-globulin-depleted plasma through global proteome analysis. RESULTSWe observed significant gut dysbiosis between HV and DG and also between the Modic and non-Modic groups. In the Modic group, commensals Bifidobacterium and Ruminococcus were significantly depleted, while pathobionts Streptococcus, Prevotella, and Butryvibrio were enriched. Firmicutes/Bacteroidetes ratio was decreased in DG (Modic-0.62, non-Modic-0.43) compared to HV (0.70). Bacteria-producing beneficial short-chain fatty acids were also depleted in DG. Elevated serum CRP and increased FABP5 were observed in DG. CONCLUSIONThe study revealed gut dysbiosis, an altered Firmicutes/Bacteroidetes ratio, reduced SCFA-producing bacteria, and increased systemic and local inflammation in association with disc disease, especially in Modic changes. The findings have considerable importance for our understanding and prevention of disc degeneration.

Inflammatory biomarkers and frailty transitions in older adults with cancer: Findings from a national cohort study.

e13772 Background: Approximately 67% of cancer survivors were aged 65 or older in the U.S.; they face a heightened risk of frailty, as both cancer and anti-cancer treatment impose additional stressors on the older adults’ physiological reserves. Inflammatory biomarkers such as serum C-reactive protein (CRP) and Interleukin-6 (IL-6) levels were associated with frailty. However, the role of inflammatory biomarkers on the transitions of frailty states remains unclear. This study aimed to describe transitions between frailty states and death and quantify the predictive effect of inflammatory biomarkers on transitions. Methods: We used data from the National Health and Aging Trends Study (NHATS) from 2017 to 2022. A total of 1,219 older cancer survivors (&gt;67 years) were included. Frailty was assessed annually using the Fried Frailty Phenotype (exhaustion, low physical activity, shrinking, low walking speed, and weakness) to categorize participants as “non-frail,” “pre-frail,” and “frail.” Inflammatory biomarkers were obtained via dried blood spots at baseline (2017). Plasma-equivalent values of CRP and IL-6 were used. Covariates included sex, age category, race, education level, marital status, obesity, and number of comorbidities. We defined four states that included three frailty states (non-frail, pre-frail, and frail) and an absorbing state of death. The multi-state Markov models were performed to capture possible transitions between frailty states and examine the effect of CRP and IL-6 on the five main transitions between states (non-frail to pre-frail, pre-frail to non-frail, pre-frail to frail, frail to pre-frail, frail to death). Results: At baseline, 25.27% were non-frail, 52.34% were pre-frail, and 22.40% were frail. During the follow-up time of 5 years, 1,396 transitions were observed, with 950 (68.05%) progressions (or to death) and 446 (31.95%) reversals. For participants who were non-frail, they were highly likely to develop pre-frailty (transition intensity=0.63). For participants with pre-frailty, progression to frailty was a little more likely than recovery to non-frailty (0.25 vs 0.21). Once entering the frail state, the likelihood of death outweighed that of recovery (0.30 vs 0.28). A higher level of CRP or IL-6 was associated with frailty progression (non-frail to pre-frail and frail to death), while a lower level of CRP or IL-6 was associated with recovery of frailty (pre-frail to non-frail and frail to pre-frail). Conclusions: This study is the first to investigate the longitudinal relationship between inflammatory biomarkers and frailty transitions in older cancer survivors using a nationally representative survey dataset. Our findings outlined potential transitions between frailty states and death, highlighting the role of elevated serum CRP and IL-6 levels on the increased risk of frailty progression and reduced risk of frailty recovery over 5 years.

Serum C-reactive protein value on day 14 as a possible prognostic factor of aneurysmal subarachnoid hemorrhage.

Serum C-reactive protein (CRP), as a reflection of early brain injury at onset, is a prognostic factor in aneurysmal subarachnoid hemorrhage (aSAH). However, in some severe cases, patients exhibit a good prognosis despite their elevated serum CRP level. Therefore, we examined the relationship between serum CRP transitions in the acute phase of aSAH and the prognosis. We recruited 63 patients with aSAH and retrospectively analyzed the relationships between the serum CRP transitions during the acute phase and the prognosis, patient background, and clinical course. Serum CRP values on days 1, 3, and 14 were significantly lower in the good prognosis group than those in the poor prognosis group. Moreover, serum CRP values on days 1 and 14 significantly affected the prognosis in the multiple regression analysis. A low serum CRP value on day 14, in addition to that on day 1 as reported previously, is associated with a good prognosis of aSAH. Furthermore, a good prognosis of aSAH is determined not only by absence of early brain injury at onset but also by appropriate management to obtain a low serum CRP value on day 14.

Clinical Characteristics and Outcomes of Unvaccinated Kidney Transplant Recipients Infected with the SARS-CoV-2 Omicron Variant: A Case Series

ABSTRACT Background: Due to their chronic immunocompromised status, kidney transplant (KT) recipients face escalated risks from coronavirus disease 2019 (COVID-19), which may be exacerbated by lower vaccination rates. However, there is a paucity of information regarding the clinical traits of unvaccinated KT recipients with COVID-19. We aimed to investigate the clinical characteristics and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron infection in unvaccinated KT recipients. Methods: In this retrospective study, we analyzed the clinical outcomes of 36 unvaccinated KT recipients diagnosed with SARS-CoV-2 Omicron infection, as confirmed by reverse transcription polymerase chain reaction. Clinical characteristics, laboratory tests, treatment regimens, and outcomes were examined, and 2-month follow-up assessments were conducted. Results: KT recipients had a high incidence of severe infection, with 66.7% classified as having severe/critical illness. Factors associated with severe/critical illness included age; diabetes mellitus; lung infection computed tomography score; and elevated serum D-dimer, interleukin-6, C-reactive protein, procalcitonin, and ferritin levels. The patients in the severe/critical group also had significantly lower blood lymphocyte counts and serum albumin levels. Treatment strategies included discontinuation of antimetabolic drugs, reduction or discontinuation of calcineurin inhibitor drugs, antiviral therapy, and early patient-tailored nutritional support. Acute kidney injury was observed in 19.4% of patients. Four (11.1%) patients died during the observation period, with two (5.6%) succumbing hospitalization and two (5.6%) during the 2-month follow-up period due to infection. The remaining patients did not report any significant symptoms and are still undergoing follow-up. Conclusion: Early diagnosis, personalized treatment, and vigilant monitoring are all crucial aspects of the clinical management of unvaccinated KT recipients with COVID-19. These findings contribute to the understanding of the clinical characteristics and management of COVID-19 in patients undergoing KT.

C-reactive protein, cardiovascular issues of an acute-phase protein: an update for theclinician

Inflammation is an important pathogenic factor for the development of atherosclerotic cardiovascular disease. Currently, the most frequently used biomarker reflecting systemic inflammation is C-reactive protein (CRP), an acute-phase protein produced primarily by hepatocytes under the influence of interleukin-6, interleukin-1 beta, and tumor necrosis factor. Growing evidence from epidemiological studies has shown a robust association between elevated serum or plasma CRP concentrations and the incidence of a first cardiovascular adverse event (including acute myocardial infarction, ischemic stroke, and sudden cardiac death) in the general population, as well as recurrence of major adverse cardiovascular events among patients with established disease. The additive value that CRP measurement gives to traditional risk factors is reflected in novel cardiovascular risk calculators and in current intervention regimens, which already consider CRP as a target therapeutic. However, the variations in CRP levels, that depend on sex, ethnicity, hormonal status, and some peculiarities of the measurement assays, must be taken into consideration when deciding to implement CRP as a useful biomarker in the study and treatment of atherosclerotic cardiovascular disease. This review aims to offer an updated vision of the importance of measuring CRP levels as a biomarker of cardiovascular risk beyond the traditional factors that estimate the risk of atherosclerotic disease.

Inflammatory biomarkers predict higher risk of hyperglycemic crises but not outcomes in diabetic patients with COVID-19.

Inflammation is a predictor of severe complications in patients with COVID-19 infection under a variety of clinical settings. A few studies suggested that COVID-19 infection was a trigger of hyperglycemic crises including diabetic ketoacidosis (DKA) and/or hyperglycemic hyperosmolar state (HHS). However, the association between inflammation and hyperglycemic crises in diabetic patients with COVID-19 infection is unclear. One hundred and twenty-four patients with type 2 diabetes mellitus (T2DM) and COVID-19 infection from January 2023 to March 2023 were retrospectively analyzed. Demographic, clinical, and laboratory data, especially inflammatory markers including white blood cell (WBC), neutrophils, neutrophil-to-lymphocyte ratio (NLR), c-reactive protein (CRP) and procalcitonin (PCT) were collected and compared between patients with or without DKA and/or HHS. Multivariable logistic regression analysis was conducted to explore the association between inflammatory biomarkers and the prevalence of hyperglycemic crises. Patients were followed up 6 months for outcomes. Among 124 diabetic patients with COVID-19, 9 were diagnosed with DKA or HHS. Comparing COVID-19 without acute diabetic complications (ADC), patients with DKA or HHS showed elevated levels of c-reactive protein (CRP, P=0.0312) and procalcitonin (PCT, P=0.0270). The power of CRP and PCT to discriminate DKA or HHS with the area under the receiver operating characteristics curve (AUROC) were 0.723 and 0.794, respectively. Multivariate logistic regression indicated 1.95-fold and 1.97-fold increased risk of DKA or HHS with 1-unit increment of CRP and PCT, respectively. However, neither CRP nor PCT could predict poor outcomes in diabetic patients with COVID-19. In this small sample size study, we firstly found that elevated serum CRP and PCT levels increased the risk of hyperglycemic crises in T2DM patients with COVID-19 infection. More study is needed to confirm our findings.

The demographic, laboratory and genetic factors associated with long Covid-19 syndrome: a case–control study

Long Covid-19 syndrome (LCS) manifests with a wide range of clinical symptoms, yet the factors associated with LCS remain poorly understood. The current study aimed to investigate the relationships that demographic characteristics, clinical history, laboratory indicators, and the frequency of HLA-I alleles have with the likelihood of developing LCS. We extracted the demographic characteristics and clinical histories from the medical records of 88 LCS cases (LCS+ group) and 96 individuals without LCS (LCS− group). Furthermore, we evaluated the clinical symptoms, serum levels of interleukin (IL)-6 and tumor necrosis factor-α, laboratory parameters, and the frequencies of HLA-I alleles. Following this we used multiple logistic regression to investigate the association these variables had with LCS. Subjects in the LCS+ group were more likely to have experienced severe Covid-19 symptoms and had higher body mass index (BMI), white blood cell, lymphocyte counts, C-reactive protein (CRP), and IL-6 levels than those in the LCS− group (for all: P < 0.05). Moreover, the frequencies of the HLA-A*11, -B*14, -B*38, -B*50, and -C*07 alleles were higher in the LCS+ group (for all: P < 0.05). After adjusting for the most important variables, the likelihood of suffering from LCS was significantly associated with BMI, CRP, IL-6, the HLA-A*11, and -C*07 alleles, as well as a positive history of severe Covid-19 (for all: P < 0.05). Our study showed that a history of severe Covid-19 during the acute phase of the disease, the HLA-A*11, and -C*07 alleles, higher BMI, as well as elevated serum CRP and IL-6 levels, were all associated with an increased likelihood of LCS.

Association between anti-Helicobacter pylori immunoglobulin G status and coronary artery disease among hypertensives: Myth or fact?

Abstract Background: Chronic persistent inflammation associated with Helicobacter pylori (H. pylori) infection accelerates vascular complications which are prone to cause atherogenesis and coronary artery disease (CAD). This study was undertaken to assess the significance of the association between H. pylori immunoglobulin G (IgG) serostatus and the occurrence of CAD among hypertensives. Materials and Methods: A total of 90 hypertensive subjects without stroke and CAD symptoms were tested for serum H. pylori IgG. Their electrocardiogram and echocardiogram (ECHO) outcomes were analyzed after 3 months. Results: Among the 90 subjects, 52 (57.8%) were H. pylori IgG positive. The adjusted odds ratio for abnormal ECHO outcome and H. pylori IgG positivity was 2.494. There was a positive correlation between H. pylori IgG positivity, sedentary lifestyle, alcoholism, and elevated serum C-reactive protein and abnormal ECHO findings suggestive of CAD. Conclusions: This study found a positive correlation between H. pylori IgG seropositivity and abnormal ECHO outcomes. The prevention of CAD with antimicrobial therapy for H. pylori is simple and innovative. Lifestyle modification and hand hygiene can obviate the adverse circumstances of CAD to some extent.

Association of heart rate variability and C-reactive protein in patients with depression.

Depression has been shown to be correlated with cardiovascular (CV) morbidity and mortality. Inflammation and autonomic nervous system (ANS) dysfunction are possible causes. Numerous clinical studies have found an association between inflammatory pathways and the ANS. The aim of this study was to investigate the relationship between different heart rate variability (HRV) parameters and C-reactive protein (CRP) levels in depressed patients without concomitant diseases. Sixty-five depressed patients who were not taking medication participated in this cross-sectional study. The Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD-10) categorization of mental and behavioral disorders served as the basis for the diagnosis of depression. HRV processing and analysis were performed using ADInstrument's Pro LabChart (PowerLab 8Pro) data analysis software. HRV was recorded for 5 min in an upright sitting position using a lead II electrocardiogram (ECG) (short-term HRV). CRP levels were measured using an ELISA (enzyme-linked immunosorbent assay) test. None of the measures of HRV showed a significant relationship with pulse rate, systolic blood pressure, diastolic blood pressure, or body mass index (BMI). Weight and BMI were strongly positively related (r = 0.420, P = 0.003) to pRR50 (percentage of successive RR intervals differing by more than 50 ms). Very low frequency (VLF), low frequency (LF), and the LF/HF (high frequency) ratio were all strongly positively correlated with CRP (r = 0.595, P = 0.001), whereas HF was also significantly negatively correlated (r = 0.383, P = 0.007). CRP had a significant negative correlation with the logarithm (ln) HF and a significant positive correlation with lnVLF, lnLF, and lnLF/HF. Measurement of resting HRV and CRP may be helpful in detecting CV disease in depressed patients. Low HRV and elevated serum CRP should prompt physicians to begin treatment for risk CV as soon as possible.

Adult-Onset Still's Disease: A Rare Cause of Pyrexia Of Unknown Origin (Case Report with Literature Review)

Adult-onset Still's disease (AOSD) is a remarkably rare illness. One well-known pathogenic process that results in systemic manifestations is auto-inflammatory disease. We report on a young man who complained of joint pain, sore throat, and a high spiking fever. After a thorough assessment using the Yamaguchi criteria, the patient's clinical examination, elevated serum ferritin and C-reactive protein (CRP), absence of serologic markers (RA factor, Antinuclear antibody levels), and lymphadenopathy all contributed to the diagnosis of AOSD. He was treated with analgesics, steroids, and disease-modifying anti-rheumatic drugs (DMARDs). Three weeks later, at the follow-up, his symptoms and lab parameters had improved.

Evaluation of Periodontal Status and Serum C-Reactive Protein Levels in Adult Cigarette Smokers

Background: This study aimed to evaluate the periodontal status of adult smokers and assess their serum C-reactive protein (CRP) levels, hypothesizing an association between periodontal inflammation, smoking, and elevated serum CRP, a marker for cardiovascular diseases. The primary objective is to contribute to the assessment and prevention of potential cardiovascular diseases in adult smokers. Methods: This cross-sectional study was conducted at HIT Hospital and Dental Hospital HITEC-IMS Taxila Cantt over five months from October 20, 2021, to March 31, 2022, the study included 60 healthy male adult smokers and 20 healthy male non-smokers as a control. Basic periodontal examination involved the use of a periodontal probe, assessing parameters such as gingival index, bleeding on probing, oral pigmentation, presence of periodontal pockets, and gingival recession. Blood samples were collected to evaluate serum CRP levels. Results: Smokers exhibited higher rates of gingival recession (38.3%), gingival pigmentation (43.3%), and periodontal pocket formation (33.3%) compared to the nonsmokers control group, with significant p-values of 0.040 in gingival recession and 0.035 in the presence of periodontal pockets. Serum CRP levels were significantly elevated in adult smokers, with a significant p-value of 0.024. Conclusion: The study concluded that adult smokers show signs of periodontitis, and their serum CRP levels are elevated. Assessing periodontal status and serum CRP in adult smokers may aid in risk assessment and reducing the likelihood of developing future cardiovascular diseases.

Immune-Mediated Non-Infectious Periaortitis After Aortic Graft Replacement Surgery: A Case Report Highlighting the Need for Immunosuppressive Therapy.

BACKGROUND A non-infectious inflammatory reaction against replaced aortic graft for aortic dissection often manifests as fever, malaise, and peri-graft effusion. It usually lasts less than 1 month and subsides spontaneously without immunosuppressive treatment. CASE REPORT A 49-year-old man underwent ascending aorta and total arch replacement for acute thoracic aortic dissection. He had fever, malaise, nausea, and elevated serum C-reactive protein for 1 month postoperatively. Pathological examination of the aorta revealed no aortitis, and repeated blood cultures were negative. We also noted periaortic graft fluid collection, and a small amount of pleural and pericardial effusions. We suspected post-pericardiotomy syndrome. Colchicine and prednisolone were administered, with an excellent clinical response. Three weeks after discontinuation of a 7-week prednisolone treatment, the same symptoms recurred and gradually worsened. Prednisolone was restarted 6 months after the first surgery, with good clinical response. Thereafter, he developed left-sided weakness and dysarthria, being diagnosed as ischemic stroke. Contrast-enhanced computed tomography revealed fluid collection with contrast leak around the aortic grafts, suggesting peel dehiscence, and thrombus formation in anastomotic pseudoaneurysm. He underwent surgical repair. He was diagnosed with non-infectious periaortitis, likely due to an immune reaction to the grafts, based on an excellent clinical response to immunosuppressive therapy. CONCLUSIONS We report a case of non-infectious periaortitis around a thoracic aortic graft, probably with an immune-mediated mechanism, requiring immunosuppressive treatment. When fever persists after aortic graft replacement surgery, non-infectious periaortitis should be considered and immunosuppressive treatment should be considered to prevent critical complications of anastomotic pseudoaneurysm and graft dehiscence.

Impact of SARS-CoV-2 Infection on the Association Between Laboratory Tests and Severe Outcomes Among Hospitalized Children.

To assist clinicians with identifying children at risk of severe outcomes, we assessed the association between laboratory findings and severe outcomes among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children and determined if SARS-CoV-2 test result status modified the associations. We conducted a cross-sectional analysis of participants tested for SARS-CoV-2 infection in 41 pediatric emergency departments in 10 countries. Participants were hospitalized, had laboratory testing performed, and completed 14-day follow-up. The primary objective was to assess the associations between laboratory findings and severe outcomes. The secondary objective was to determine if the SARS-CoV-2 test result modified the associations. We included 1817 participants; 522 (28.7%) SARS-CoV-2 test-positive and 1295 (71.3%) test-negative. Seventy-five (14.4%) test-positive and 174 (13.4%) test-negative children experienced severe outcomes. In regression analysis, we found that among SARS-CoV-2-positive children, procalcitonin ≥0.5 ng/mL (adjusted odds ratio [aOR], 9.14; 95% CI, 2.90-28.80), ferritin >500 ng/mL (aOR, 7.95; 95% CI, 1.89-33.44), D-dimer ≥1500 ng/mL (aOR, 4.57; 95% CI, 1.12-18.68), serum glucose ≥120 mg/dL (aOR, 2.01; 95% CI, 1.06-3.81), lymphocyte count <1.0 × 109/L (aOR, 3.21; 95% CI, 1.34-7.69), and platelet count <150 × 109/L (aOR, 2.82; 95% CI, 1.31-6.07) were associated with severe outcomes. Evaluation of the interaction term revealed that a positive SARS-CoV-2 result increased the associations with severe outcomes for elevated procalcitonin, C-reactive protein (CRP), D-dimer, and for reduced lymphocyte and platelet counts. Specific laboratory parameters are associated with severe outcomes in SARS-CoV-2-infected children, and elevated serum procalcitonin, CRP, and D-dimer and low absolute lymphocyte and platelet counts were more strongly associated with severe outcomes in children testing positive compared with those testing negative.

Association between different obesity measurement indexes and serum C-reactive protein in adult women

Objective: To explore the association of different obesity measurement indexes on serum C-reactive protein (CRP) in Chinese adult women. Methods: The data were obtained from baseline and follow-up surveys of the urban Breast Cancer Screening Program in Shuangliu District, Chengdu. A total of 441 adult women were included in the study. A questionnaire survey, physical examination, and laboratory testing were conducted on the subjects. Multivariate logistic regression model, two-level mixed effects logistic regression model, and restricted cubic spline method were used to investigate the linear and nonlinear correlation between different obesity measurement indexes and serum CRP in adult women. Results: For every 1 unit increase in BMI, waist circumference (WC), and adiposity, the risk of elevated serum CRP or exacerbation of chronic low-grade inflammation in adult women increased by 16.5%, 5.0%, and 11.1% (P<0.05), respectively. Both BMI and adiposity were nonlinear correlated with serum CRP. Using BMI=24.0 kg/m2 as the reference point, serum CRP level increased with the increase of BMI when BMI >24.0 kg/m2. Using adiposity=30% as the reference point, serum CRP level increased with the increase of adiposity when adiposity >30%. Conclusions: Overall, obesity reflected by BMI had the strongest association with serum CRP in adult women, followed by body fat content reflected by adiposity, and central obesity reflected by WC had the weakest association with CRP. Adult women with BMI >24.0 kg/m2 or adiposity >30% are at high risk for obesity-related inflammatory manifestations.

Dietary inflammatory index and elevated serum C-reactive protein: A systematic review and meta-analysis.

Diet can affect the inflammatory state of the body. Accordingly, the dietary inflammatory index (DII) has been developed to quantify the inflammatory properties of food items. This study sought to investigate the association between dietary inflammation index (DII) and the odds ratio of elevated CRP (E-CRP) through a systematic review and meta-analysis study. The International electronic databases of PubMed, Web of Science (ISI), and Scopus were searched until May 2023 to find related articles. From 719 studies found in the initial search, 14 studies, with a total sample size of 59,941 individuals, were included in the meta-analysis. The calculated pooled odds ratio (OR) of E-CRP in the highest DII category was 1.39 (95% CI: 1.06, 1.14, test for heterogeneity: p = .63, and I 2 = .0%) in comparison with the lowest DII category. Also, the results of this study showed that each unit increase in DII as a continuous variable generally elicited a 10% increase in the odds of E-CRP (OR 1.10, 95% CI 1.06, 1.14, test for heterogeneity: p = .63, and I 2 = .0%). Subgroup meta-analyses showed that there is a higher E-CRP odds ratio for the articles that reported energy-adjusted DII (E-DII) instead of DII, the studies that measured CRP instead of hs-CRP, and the studies that used 24-h recall instead of FFQ as the instrument of dietary intake data collection. Individuals with a higher DII were estimated to have higher chances of developing elevated serum CRP. This value was influenced by factors such as the participants' nationality, instruments of data collection, methods used to measure inflammatory biomarkers, study design, and data adjustments. However, future well-designed studies can help provide a more comprehensive understanding of the inflammatory properties of diet and inflammatory serum biomarkers.

High serum IgA levels inpatients with IgG4-related disease are associated with mild inflammation, sufficient disease-specific features, andfavourable responses to treatments.

Although elevated serum immunoglobulin A (IgA) levels are thought to exclude a diagnosis of IgG4-related disease (IgG4-RD), IgG4-RD has been definitively diagnosed in some patients despite elevated serum IgA levels. This study aimed to clarify the prevalence of elevated IgA levels in patients with IgG4-RD and to compare the clinical features of IgG4-RD patients with and without elevated IgA levels. The clinical features of 169 IgG4-RD patients were retrospectively compared among those with and without elevated serum IgA levels. Of the 169 patients with IgG4-RD, 17 (10.1%) had elevated serum IgA levels. Those with elevated serum IgA levels showed higher serum C-reactive protein levels and lower prevalence of relapse than those without. Other clinical features did not differ significantly, including inclusion scores of the American College of Rheumatology/European League Against Rheumatism classification criteria. Cox regression analysis showed that elevated serum IgA levels were associated with a lower incidence of relapse. Moreover, patients with elevated serum IgA levels showed prompt improvement in response to glucocorticoids in the IgG4-RD responder index. Some patients diagnosed with IgG4-RD have high serum IgA levels. These patients may form a subgroup, characterized by good response to glucocorticoids, less frequent relapse, mildly elevated serum C-reactive protein levels, and possible complications of autoimmune diseases.

Surgical stress markers for postoperative complications: a prospective prognostic factor study

Background: Postoperative complications have previously been defined as “deviation from the normal postoperative course”. Although surgical advancements have reduced the postoperative mortality over the last few decades, the postoperative morbidity has remained high. Multiple factors as well as the severity of the surgical procedure itself are associated with adverse postoperative outcomes. Having prognostic factors established and available to assist with prognosis would be helpful in treatment planning and decision-making in post-operative patients. Objective of the study was to assess surgical stress markers as potential prognostic factors for postoperative complications. Methods: This is a prospective cohort study conducted in department of general surgery over a period of 4 months. A total of 120 patients were included in the study. Data entry and statistical analysis were done using statistical package for the social sciences (SPSS) version 23. Chi-square test was used. Area under curve (AUC) and logistic regression were applied and odd’s ratio was calculated in 95% confidence interval. Results: Serum C-reactive protein (CRP) levels done at 72 hours, ALB levels at 24 hours were most predictive postoperative levels compared to the other perioperative serum levels. Conclusions: Elevated serum CRP, albumin were associated with infective and non-infective complications and longer length of hospital stay and duration of the procedure.

A Population Pharmacokinetic Model of Pentobarbital for Children with Status Epilepticus and Severe Traumatic Brain Injury.

Pentobarbital pharmacokinetics (PK) remain elusive and the therapeutic windows narrow. Administration is frequent in critically ill children with refractory status epilepticus (SE) and severe traumatic brain injury (sTBI). To investigate pentobarbital PK in SE and sTBI patients admitted to the paediatric intensive care unit (PICU) with population-based PK (PopPK) modelling and dosing simulations. Develop a PopPK model with non-linear mixed-effects modelling (NONMEM®) with retrospective data (n = 36; median age 1.3 years; median weight 10 kg; 178 blood samples) treated with continuous intravenous pentobarbital. An independent dataset was used for external validation (n = 9). Dosing simulations with the validated model evaluated dosing regimens. A one-compartment PK model with allometrically scaled weight on clearance (CL; 0.75) and volume of distribution (Vd; 1) captured data well. Typical CL and Vd values were 3.59 L/70 kg/h and 142 L/70 kg, respectively. Elevated creatinine and C-reactive protein (CRP) levels significantly correlated to decreased CL, explaining 84% of inter-patient variability, and were incorporated in the final model. External validation using stratified visual predictive checks showed good results. Simulations demonstrated patients with elevated serum creatinine and CRP failed to achieve steady state yet progressed to toxic levels with current dosing regimens. The one-compartment PK model of intravenous pentobarbital described data well whereby serum creatinine and CRP significantly correlated with pentobarbital CL. Dosing simulations formulated adjusted dosing advice in patients with elevated creatinine and/or CRP. Prospective PK studies with pharmacodynamic endpoints, are imperative to optimise pentobarbital dosing in terms of safety and clinical efficacy in critically ill children.

Do Elevated Serum C-Reactive-Protein Levels Excuse Delayed Surgery for Femoral Neck Fractures?

In elderly patients with femoral neck fractures, preoperative serum C-reactive protein (CRP) values might be elevated due to active infections. Although there are limited data on CRP as a predictor of periprosthetic joint infection (PJI), out of concern, this could lead to delayed surgery. Therefore, we aim to investigate whether elevated serum-CRP levels justify delayed surgery for femoral neck fractures. A retrospective analysis was performed of the records of patients undergoing arthroplasty who were found to have an elevated CRP level of 5 mg/dL or more between January 2011 to December 2020. The patients were stratified to three groups, according to initial serum CRP levels at a cut off of 5 mg/dL and the time between admission and surgery (<48 vs. ≥48 h after admission). This study revealed that the patients with elevated serum CRP levels and delayed surgery showed a worse survival rate and significantly more postoperative complications than the patients on whom surgery was performed immediately. There were no significant differences in terms of PJI and prolonged wound healing in the inter-group comparison. Therefore, delays to surgery on the basis of elevated CRP values offer no benefits to patients with femoral neck fractures.