Elevated C-reactive Protein Research Articles

The Role of Systemic Health Indicators, Including C-Reactive Protein and eGFR, in Predicting Periodontal Disease: A Longitudinal Study

C-reactive protein (CRP) and estimated glomerular filtration rate (eGFR) are key biomarkers reflecting systemic inflammation and metabolic dysfunction. This study explored systemic and oral health indicators, including CRP and eGFR, as potential factors associated with periodontitis, using a longitudinal clinical dataset comprising 23,742 records from patients identified by ICD-10 codes between 2015 and 2022. Univariate Cox analysis and Gompertz models, selected based on AIC and BIC after evaluating alternative models, were employed to assess the predictive roles of CRP and eGFR in periodontitis incidence, adjusting for oral and systemic health factors. Elevated CRP (>15 mg/L) and reduced eGFR (<60 mL/min/1.73 m2) were significant predictors of periodontitis, with hazard ratios (HR) of 1.36 [1.05–1.77] and 1.39 [1.08–1.78], respectively. Atherosclerosis (HR: 2.12 [1.11–4.06]), diseases of the hard tissues of the teeth (HR: 7.30 [5.45–9.78]), and disorders of the teeth and supporting structures (HR: 3.02 [2.05–4.43]) also demonstrated strong predictive associations. CRP and eGFR emerged as potential biomarkers for predicting periodontitis, enabling early interventions to prevent tooth loss and systemic complications. Patients with chronic kidney disease, atherosclerotic heart disease, and lipid metabolism disorders are at higher risk, emphasizing the need for integrated care addressing both systemic and oral health factors.

Impact of Preoperative and Intraoperative Factors on Postoperative Outcomes in Patients with Colorectal Cancer: A 10-Year Retrospective Study

Background and Objectives: Colorectal cancer is a major contributor to global cancer morbidity and mortality. Surgical resection remains the cornerstone of treatment, but postoperative complications can significantly affect patient outcomes. Identifying factors that influence postoperative morbidity and mortality is crucial for optimizing patient care. This study aims to evaluate the impact of preoperative, intraoperative, and postoperative factors on surgical outcomes in patients with colorectal cancer. Methods: A retrospective cohort study was conducted on 688 patients who underwent colorectal cancer surgery within a 10-year period. Data collected included demographic information, comorbidities, laboratory values, surgical details, and postoperative outcomes. Statistical analyses were performed using chi-square tests for categorical variables and t-tests for continuous variables. Multivariate logistic regression was used to identify independent predictors of postoperative complications and mortality. Results: Postoperative complications occurred in 28.5% of patients, and the 30-day mortality rate was 5.2%. Preoperative factors such as elevated C-reactive protein (CRP) levels (p < 0.001), low albumin levels (p = 0.003), a high American Society of Anesthesiologists (ASA) score (p < 0.001), and presence of comorbidities like diabetes and hypertension (p = 0.005) were significantly associated with increased postoperative complications. Intraoperative factors such as blood loss greater than 500 mL (p < 0.001) and longer operative time (p = 0.021) were also significant predictors of adverse outcomes. Multivariate analysis identified elevated CRP (OR 2.1, 95% CI 1.5–2.9), low albumin (OR 1.8, 95% CI 1.3–2.5), and blood loss > 500 mL (OR 2.4, 95% CI 1.7–3.4) as independent predictors of postoperative complications. Conclusions: Preoperative inflammatory markers, nutritional status, ASA score, comorbidities, and intraoperative factors like blood loss significantly influence postoperative outcomes in colorectal cancer surgery. Recognizing these risk factors allows for better preoperative optimization and surgical planning, potentially reducing postoperative morbidity and mortality.

Prognostic role of midregional proadrenomedullin in predicting infection in pediatric cancer with febrile neutropenia.

Febrile neutropenia (FN) remains an important complication of cytotoxic chemotherapy for which an urgent and appropriate evaluation is imperative. To assess the diagnostic and prognostic roles of mid-regional pro-adrenomedullin (MR-ProADM) levels in predicting infection in patients with FN. This comparative cross-sectional study included 137 patients with chemotherapy-induced FN. Complete blood count, C-reactive protein (CRP), procalcitonin, and MR-ProADM were evaluated on the 1st day of FN. Chest computed tomography (CT) was performed on the 5th day. MR-ProADM levels were significantly higher in patients with FN than in controls. CRP and MR-ProADM levels were significantly higher and ANC was significantly lower in patients with versus without bacterial infections. CRP, procalcitonin, and MR-ProADM levels were significantly negatively correlated with absolute neutrophil count (ANC). CRP, procalcitonin, and MR-ProADM levels were significantly and positively correlated with FN degree, FN duration, and hospital stay length. A multivariate regression analysis showed that a longer FN duration and hospital stay length, along with elevated CRP, procalcitonin, and MR-ProADM levels, were significant risk factors for mortality. MR-ProADM is a reliable prognostic and diagnostic tool for predicting infection in patients with FN.

C-reactive protein/albumin ratio as a prognostic biomarker in myasthenia gravis

Aims: Limited research has explored novel inflammatory targets in myasthenia gravis (MG). This study aimed to investigate the role of the C-reactive protein (CRP)/albumin ratio (CAR) in disease activity and prognosis in MG patients. Methods: CRP, albumin, and CAR levels were compared between MG patients and healthy controls. The relationships of these parameters with MG activities of daily living (MG-ADL) scores and mortality were examined. Results: Sixty-six patients and 51 controls participated. CRP and CAR levels were significantly higher in the patient group (p=0.002, 0.003). No significant difference was found in albumin levels (p=0.154). A positive correlation was observed between the MG-ADL stage and both CRP and CAR levels (p=0.000 for both), with these markers increasing as MG-ADL worsened. A negative correlation was found between the MG-ADL stage and albumin (p=0.003). CRP, CAR, and albumin levels were significantly associated with mortality (p=0.000, 0.000, 0.005). Conclusion: Elevated CRP and CAR levels in MG patients suggest acute inflammation contributing to clinical decline. Albumin’s decrease with worsening MG-ADL suggests its value as a prognostic marker rather than a diagnostic. CAR proved to be a stronger marker than albumin for disease diagnosis, severity monitoring, and mortality prediction. Our findings could help illuminate inflammatory mechanisms in MG and other neuromuscular diseases.

Elevated High Sensitivity C-Reactive Protein and Risk of Abdominal Aortic Aneurysm: A Prospective Population Based Study in The Norwegian HUNT Study.

Inflammation seems to be crucial in the pathogenesis of abdominal aortic aneurysm (AAA). Previous research links inflammatory biomarkers, such as high sensitivity C-reactive protein (HS-CRP), to AAA. Few studies, however, have used a prospective design. The aim of this study was to examine whether individuals with elevated HS-CRP have increased risk of AAA, using a prospective and population based design. This prospective, population based, cohort study included 46 322 participants in the Trøndelag Health Study (HUNT) in Norway (53.7% women). During a median follow up time of 12.6 years (range 0 - 26 years), 407 individuals were diagnosed with AAA (28.8% women). Cox proportional hazard regression was applied to examine associations between HS-CRP and risk of AAA. HS-CRP was treated either as a continuous or a categorical variable (dichotomised at 2 mg/L, 1 mg/L, median (1.2 mg/L), or as quartiles). The hazard ratio (HR) of developing AAA per 1 mg/L increase in HS-CRP (continuous HS-CRP) was 1.02 (95% CI 1.01 - 1.03) in the analysis adjusted for smoking, coronary heart disease, hypertension, diabetes, body mass index, and total cholesterol. Individuals with HS-CRP 2 mg/L or above had almost twice the risk of AAA compared with individuals with HS-CRP less than 2 mg/L (adjusted HR 1.84; 95% CI 1.51 - 2.25). Dichotomising HS-CRP at a clinical cut off point of 1 mg/L (adjusted HR 2.13, 95% CI 1.64 -2.76), or at the median of 1.2 mg/L (adjusted HR 2.12, 95% CI 1.62 - 2.76), slightly strengthened the HR. The adjusted HR gradually increased through the ordered HS-CRP quartiles, and was almost four times higher (HR 3.87, 95% CI 2.54 - 5.92) in the highest HS-CRP quartile (HS-CRP > 2.7 mg/L) compared with the lowest quartile (HS-CRP ≤ 0.6 mg/L). Individuals with elevated HS-CRP had significantly increased risk of developing AAA.

Cat Scratch Disease in Pediatrics: Who Has Systemic Involvement?

Bartonella henselae is the agent responsible for cat scratch disease (CSD). Although lymphadenopathy is typically the defining symptom, some patients develop potentially severe systemic compromise. It is unknown why some patients progress to systemic disease. The objective of this study was to describe the clinical, epidemiologic and laboratory characteristics of children with CSD and to analyze the differences between systemic versus localized infections. Patients were identified by a retrospective review of medical records at a tertiary pediatric care hospital in Buenos Aires, Argentina, from January 2012 to July 2021. A CSD case was defined as any patient who presented compatible clinical findings with a positive serologic test (IgG >1/64 or IgM immunofluorescence) for B. henselae. A total of 197 patients were identified, with a median age of 8 years (range: 1-17.4 years). The most frequent clinical symptoms were fever and lymphadenopathy. Systemic involvement was present in 34.5% (n = 68) of patients and the most common presentation was splenic abscess (n = 51), followed by liver abscess (n = 23), chorioretinitis (n = 9), osteomyelitis (n = 5) and pneumonitis (n = 3). Patients with invasive disease more frequently presented with fever (79.4% vs. 50.3%) ( P <0.001) and had higher C-reactive protein levels (24.9 vs. 6.7 mg/L) ( P <0.001). Antibiotic therapy was administered to 95.9% (n = 187) of patients and most with systemic disease (77%) used combination treatment. Most patients recovered fully, and there were no reported deaths. CSD must be considered a potential cause of lymphadenopathy. Patients with fever and elevated C-reactive protein should be evaluated to rule out systemic compromise.

Construction and validation of a predictive model for allergic rhinitis complicating children with bronchial asthma.

This study aimed to investigate the factors influencing the complication of allergic rhinitis in children with bronchial asthma and to construct a nomogram model to predict the occurrence of allergic rhinitis. A total of 190 children with bronchial asthma admitted to our hospital from August 2020 to August 2024 were retrospectively analyzed. The children were randomly divided into the training cohort (133 cases) and validation cohort (57 cases) in a ratio of 7:3. The children in the modeling set were divided into an allergic rhinitis group (n=44) and a nonallergic rhinitis group (n=89) depending on the presence or absence of concomitant allergic rhinitis. A total of 62 cases in 190 children with bronchial asthma had complications with allergic rhinitis, with an incidence of 32.63%. In the training cohort, compared with the children in the nonallergic rhinitis group, percentage of smokers in the household, C-reactive protein (CRP), white blood cell count (WBC), and neutrophils/lymphocytes (NLR) were significantly higher in the allergic rhinitis group (P < 0.05). Multivariable logistic regression analysis showed that smokers in the household; IgE; early use of antibiotics; and elevated CRP, WBC, and NLR were all risk factors for the complication of allergic rhinitis in children with bronchial asthma (P < 0.05). A nomogram prediction model was constructed based on the above risk factors. The C-index of the nomogram was 0.919 (95% CI: 0.742-0.934) and 0.841 (95% CI: 0.773-0.902) for the training cohort and validation cohort, respectively. The Hosmer-Lemeshow test results of the training and validation cohorts were both P > 0.05, suggesting a good model fit. The results of DCA showed that the training and validation cohorts had good threshold probability and clinical net benefit. Smokers in the household, IgE, CRP, WBC, and NLR levels were all risk factors for the complication of allergic rhinitis in children with bronchial asthma. A nomogram model based on these risk factors may be a valuable clinical tool for predicting allergic rhinitis in children with bronchial asthma.

Etiology and Clinical Prediction of Community-Acquired Lower Respiratory Tract Infection in Children.

Community acquired lower respiratory tract infection (LRTI) is a leading cause for hospitalization in children and important cause for antibiotic prescription. We aimed to describe the aetiology of LRTI in children and analyse factors associated with bacterial or viral infection. Patients aged < 19 years with a diagnosis of LRTI were identified from the Observational Medical Outcomes Partnership Common Data Model Database of Seoul National University Bundang Hospital from January 2005-July 2019, and their clinical characteristics were obtained from the electronic medical records and retrospectively reviewed. Among 5,924 cases of LRTI, 74.2% were pneumonia and 25.8% were bronchiolitis/bronchitis. Patients' median age was 1.8 (interquartile range, 3.1) years and 79.9% were < 5 years old. Pathogens were identified in 37.8%; 69.1% were viral and 30.9% were bacterial/Mycoplasma pneumoniae. Respiratory syncytial virus was most common (70.9%) among viruses and M. pneumoniae (94.6%) was most common among bacteria. Viral LRTI was associated with winter, age < 2 years, rhinorrhoea, dyspnoea, lymphocytosis, thrombocytosis, wheezing, stridor, chest retraction, and infiltration on imaging. Bacteria/M. pneumoniae LRTI was associated with summer, age ≥ 2 years, fever, decreased breathing sounds, leucocytosis, neutrophilia, C-reactive protein elevation, and positive imaging findings (consolidation, opacity, haziness, or pleural effusion). In children with LRTI, various factors associated with viral or bacterial/M. pneumoniae infections were identified, which may serve as guidance for antibiotic prescription.

Loss of PKM2 dysregulates inflammatory signaling in the infarcted murine heart.

Inflammation and a metabolic shift from oxidative metabolism to glycolysis are common in the ischemic heart, the latter partly controlled by pyruvate kinase (muscle, PKM). We previously identified alternative splicing promoting the PKM2 isoform after myocardial infarction (MI). We examined the role of PKM2 physiological upregulation after MI, modeled by ligation of the left anterior descending coronary artery, using global PKM2 knockout (PKM2-/-) mice. Echocardiography showed similar cardiac function between PKM2-/- and control mice after MI. However, PKM2-/- infarcted hearts had increased abundances of transcripts associated with oxidative stress and immune responses. Immunohistochemistry revealed greater abundance of macrophages in PKM2-/- hearts prior to MI, with a small increase in CD86+ macrophages in PKM2-/- infarcted hearts. Elevated baseline plasma IL-6, IL-1β, and C-reactive protein, and cardiac IL-6, 3 days post-MI, were observed in PKM2-/- mice. Oxidative lipid products were also elevated in baseline PKM2-/- hearts, while antioxidant glutathione peroxidase 4 was reduced. Greater fibrosis was seen in PKM2-/- hearts 28 days after MI. These findings suggest Pkm2 ablation primes the heart for increased oxidative stress, inflammation, and fibrosis post-MI. The natural upregulation of PKM2 may mitigate fibrosis by reducing oxidative stress and inflammation, highlighting its protective role in the infarcted heart.

Evaluation of the C-reactive protein serum levels in periodontitis patients with or without atherosclerosis – A clinical study

Background: Periodontitis is a bacterial infection that can originate in the gums and progress to damage the bone and other structures supporting the teeth. One indicator of systemic inflammation caused by various triggers such as injuries, infections, and hypoxia is the highly potent C-reactive protein (CRP). Atherosclerosis is a progressive arterial disease that is characterized by the thickening of subintimal layers in muscular and elastic arteries of intermediate-to-large size due to the accumulation of athermanous plaque. Therefore, our objective in this research is to evaluate CRP levels in individuals with periodontitis, with or without atherosclerosis, after diagnosis. It is important to determine if there is a correlation between periodontitis, a common inflammatory condition of the gums, and elevated CRP levels, which could potentially contribute to the development of atherosclerosis. Methodology: The Department of Periodontics and Implantology at Bhabha College of Dental Sciences conducted the study, which involved the random assignment of 60 participants of both sexes, aged between 30 and 60 years, using a cross-sectional design. The participants were selected from the Department of Periodontics and Implantology, and venous blood samples were taken before and after nonsurgical periodontal treatment to evaluate serum CRP and complete blood count levels. Results: Higher blood CRP levels were seen in individuals with chronic periodontitis, regardless of the presence or absence of atherosclerosis. When comparing the groups of people with and without atherosclerosis and chronic periodontitis, the rise in blood CRP levels was almost double in the group with atherosclerosis. To prevent the progression of atherosclerotic lesions, chronic periodontitis must be treated aggressively. Conclusion: Chronic periodontitis, with or without atherosclerosis, leads to high CRP levels in the blood. Those with both conditions have almost twice the CRP levels compared to those without atherosclerosis. Proper treatment is necessary due to chronic periodontitis’ association with atherosclerotic lesions.

Fatal C-Reactive Protein-less Sepsis with Anti-IL-6 Autoantibody Production after Administration of Durvalumab.

Durvalumab plus platinum-based chemotherapy is the first-line treatment for extensive-stage small-cell lung cancer. Immune checkpoint inhibitors (durvalumab) can cause immune-related adverse events (irAEs). We herein report the first case of fatal sepsis with anti-interleukin-6 autoantibody production following durvalumab administration. A 62-year-old woman with extensive-stage small-cell lung cancer received carboplatin-etoposide plus durvalumab chemotherapy. Serum C-reactive protein (CRP) levels decreased below the detection sensitivity post-treatment. She developed severe sepsis during maintenance durvalumab therapy; however, her serum CRP level did not increase. The serum tested positive for anti-interleukin-6 autoantibodies, which can cause CRP-less infections. Anti-interleukin-6 autoantibody production and subsequent sepsis without serum CRP elevation are possible irAEs.

Post-Pericardiotomy Syndrome Following Mitral Valve Replacement Surgery in a Patient with Rheumatic Fever: A Case Report

Background: Post-cardiac injury syndrome (PCIS) is an inflammatory condition triggered by immune responses following cardiac injury. PCIS encompasses post-myocardial pericarditis, post-pericardiotomy syndrome (PPS), and post-traumatic pericarditis, whether iatrogenic or not. In this case report, we describe a patient who developed PPS after undergoing mitral valve replacement surgery. Case presentation: A young African woman with mitral stenosis caused by rheumatic fever underwent successful mitral valve replacement surgery. Approximately one month later, she developed post-pericardiotomy syndrome, which was subsequently diagnosed and treated. The patient initially presented to the hospital with exertional dyspnoea, and echocardiography revealed severe mitral stenosis, leading to the scheduling of surgery. While awaiting the procedure, she developed atrial fibrillation (AF) and congestive heart failure. In 2022, she underwent mitral valve replacement surgery and was discharged one week later after experiencing a smooth recovery. Two weeks after discharge, she visited the emergency department due to shortness of breath, but no concerning signs were found upon examination. She was prescribed diuretics and discharged. One week later, she was admitted to the hospital again due to chest pain, dyspnoea, and an elevated C-reactive protein (CRP) level of 123. Echocardiography and chest computed tomography (CT) scans were normal. She was treated with antibiotics under suspicion of pneumonia and subsequently discharged. Ten days later, she returned to the emergency department with high fever, chest pain, and dyspnea, and her CRP level had risen to 240. Echocardiography revealed no signs of endocarditis or pericardial effusion. Considering the patient's surgical history and frequent hospitalizations for similar symptoms, PPS was suspected. The patient was administered a first-line treatment of colchicine 0.5mg once a day. As a result, CRP levels decreased, fever and chest pain resolved, and she was discharged in a stable condition. A month later she was re-admitted to the hospital due to PPS relapse, Colchicine dose was elevated to 1mg a day and was discharged in good condition. Colchicine was planned to be continued for six months. Conclusion: PPS is a common complication following open-heart surgery, characterized by a generally mild course but with the potential for severe complications. Treatment typically involves anti-inflammatory agents, aspirin, and colchicine. The recurrence rate is approximately 10-15%. Early diagnosis and treatment of PPS can minimize frequent hospitalizations and reduce the need for extensive testing

Research Progress on the Correlation between Oral Diseases and Chronic Kidney Diseases

Objective: To review the research progress on the correlation between oral diseases and chronic kidney diseases. Methods: Recent Chinese literature on the treatment, analysis, and correlation studies of oral diseases and chronic kidney diseases was collected. A comprehensive review, analysis, induction, and organization of the literature were conducted. Results: A high correlation exists between oral diseases and chronic kidney diseases, which mutually reinforce each other. Conclusion: A deep-level association exists between oral diseases and chronic kidney diseases. Persistent inflammatory symptoms can promote the elevation of C-reactive protein, interleukin-6, and tumor necrosis factor-alpha, thereby exacerbating the development of chronic kidney diseases. Therefore, clinicians should comprehend the mechanism of interaction between oral diseases and chronic kidney diseases to foster diverse clinical thinking, improve the treatment efficacy of chronic kidney diseases, and effectively shorten disease duration.

Diagnostic Value of the Alveolar-Arterial Oxygen Gradient in Pulmonary Embolism: A Cross-Sectional Study.

Background/Objectives: Pulmonary embolism (PE) is a potentially serious condition characterized by the blockage of blood vessels in the lungs, often presenting significant diagnostic challenges due to its non-specific symptoms. This study aimed to evaluate the utility of the alveolar-arterial (A-a) oxygen gradient as a diagnostic tool for PE, hypothesizing that it could enhance early detection when combined with other clinical markers. Methods: We retrospectively analyzed 168 patients at the University Hospital Center Split. This study correlated A-a gradients with PE confirmed by CT pulmonary angiography. Key clinical and biochemical markers, including heart rate, C-reactive protein (CRP), pro-brain natriuretic peptide (NT-proBNP), D-dimer, high-sensitivity troponin (hs-troponin), and arterial oxygen pressure (PaO2), were assessed. Results: Our findings revealed that patients with PE had significantly higher A-a gradients than those without PE. The observed-to-expected ratio for the A-a gradient was notably increased in the PE group. Additionally, patients with PE exhibited elevated heart rate, CRP, NT-proBNP, D-dimer, and hs-troponin levels, while PaO2 levels were notably lower. Conclusions: This study demonstrates that an elevated A-a gradient reflects the severity of gas exchange impairment in PE. The results suggest that early diagnosis of PE may be improved by incorporating A-a gradient analysis alongside other clinical markers, potentially leading to more effective and timely interventions.

Risk Factors for Infection-Attributable Mortality in Patients With Staphylococcus aureus Bacteremia: A Competing Risk Analysis.

Identifying risk factors for mortality in patients with Staphylococcus aureus bacteremia (SAB) is crucial due to its high fatality. However, data on risk factors for infection-attributable deaths considering competing risk events such as non-infection-attributable deaths remain limited. We performed a competing risk analysis to elucidate risk factors associated with 30-day infection-attributable mortality in a large cohort of patients with SAB. This retrospective cohort study included adult patients diagnosed with SAB at a tertiary hospital from August 2008 to December 2019. Competing risk analysis was performed using Fine and Gray models to estimate subdistribution hazard ratios (sHRs) for 30-day infection-attributable death. Among 1936 patients, 444 (22.9%) died within 30 days. Of these, 338 (76.1%) were infection-attributable and 106 (23.9%) were non-infection-attributable deaths. The multivariable Fine and Gray model identified significant risk factors for 30-day infection-attributable death (sHRs with 95% confidence intervals): an increase in age by 10 years (1.14 [1.02-1.26]), presence of malignancy (1.54 [1.17-2.02]), liver cirrhosis (2.15 [1.56-2.97]), corticosteroid use (1.61 [1.19-2.17]), septic shock (3.28 [1.98-5.42]), elevated C-reactive protein (1.60 [1.19-2.14]), pneumonia (1.81 [1.21-2.72]), persistent bacteremia (1.73 [1.31-2.30]), and failure to remove the eradicable focus (2.40 [1.38-4.19]) or absence of an eradicable focus (1.49 [1.08-2.04]). Except for age and malignancy, these factors were not significantly associated with non-infection-related death. Specific risk factors for infection-attributable death in patients with SAB were identified, distinct from those for nonattributable death. These findings can aid in the early identification of patients at risk for SAB-attributable mortality.

The potential utility of synovial C-reactive protein, interleukin-6, and presepsin in diagnostics of periprosthetic joint infection

Background. Diagnostics of infectious complications in joint replacement surgery remains a significant challenge, particularly when microbiological analysis of biological material fails to reveal pathogen growth. The aim of the study was to determine threshold values for C-reactive protein, interleukin-6, and presepsin levels, and to assess their diagnostic value in detecting periprosthetic joint infection. Methods. A prospective cohort single-center blinded study was conducted involving cases of revision arthroplasty for periprosthetic joint infection (PJI) and aseptic prosthetic loosening. The study included 66 patients divided into two groups: Group I (n = 17), with confirmed PJI using the 2018 ICM criteria, and Group II (n = 49), with aseptic prosthetic loosening. Synovial fluid samples were subjected to bacteriological and cytological analysis, measuring levels of C-reactive protein (CRP), presepsin, and interleukin-6 (IL-6). ROC analysis, sensitivity, specificity, accuracy, and threshold values were determined for laboratory data. Results. The highest diagnostic accuracy in distinguishing between PJI and aseptic loosening was observed in the leukocyte count in synovial fluid (AUC 0.928; 95% CI: 0.837-0.977, p0.0001). Elevated synovial CRP levels were associated with infection, with an AUC of 0.776 (95% CI: 0.656-0.870, p = 0.0004), and IL-6 had an AUC of 0.712 (95% CI: 0.583-0.820; p = 0.0048). Presepsin levels, however, showed no significant difference between groups (AUC 0.582; 95% CI: 0.453-0.703; p = 0.3344). Threshold values were set at 5.6 mg/l for CRP, 1212.0 pg/ml for presepsin, and 988.5 pg/ml for IL-6. Sensitivity, specificity, and accuracy for PJI diagnosis were determined for CRP at 62.5%, 85.7%, and 80.0%; for IL-6 at 87.5%, 63.0%, and 69.4%; and for presepsin at 43.8%, 79.6%, and 70.8%, respectively. Conclusion. In cases where synovial leukocyte counts are at borderline levels, the additional assessment of synovial fluid cellular composition and simple, cost-effective markers such as synovial CRP and IL-6 may be recommended to confirm PJI.

Early discharge with elevated C-reactive protein levels is safe after endoscopic-assisted coronary bypass grafting: Optimisation of postoperative care.

This study describes the perioperative kinetics of C-reactive protein in patients undergoing endoscopic coronary artery bypass grafting for single target vessel left anterior descending disease, with early postoperative discharge. From July 2021 to April 2024, patients were included in this single-centre retrospective study (N = 208), excluding C-reactive protein-modulating complications. Perioperative and 14-day follow-up C-reactive protein levels and clinical signs of infections were analysed. After endoscopic coronary artery bypass grafting, the C-reactive protein values on the first postoperative day were 44 [24-65] and 140 [88-200] mg/L at Day 3. Most patients were discharged after 3 days (64.4%), regardless of the level of C-reactive protein, and the majority experienced a return of C-reactive protein levels to baseline during follow-up, 6 [6-15] mg/L. Two patients had an infection requiring intervention and readmission (1.0%). The return of C-reactive protein to baseline levels at follow-up and the low incidence of clinical infections suggest that patients can be discharged safely, and prolonged hospitalisation is unnecessary. For perioperative care practitioners, these findings underscore the value of shorter hospital admissions in optimising resource use and improving patient flow, enhancing both patient outcomes and operational efficiency.

Prediction of Bacterial Etiology in Pediatric Patients with Acute Epididymitis: A Comparison of C-Reactive Protein and Urinalysis in Terms of Diagnostic Accuracy.

Background/Objectives: We aimed to determine the proportion of bacterial etiology in pediatric acute epididymitis (AE) and to compare the predictive accuracy of C-reactive protein (CRP) and urinalysis. Methods: Pediatric patients diagnosed with AE in National Taiwan University Hospital from 2009 to 2018 were retrospectively identified. Patient profiles, including clinical symptoms, physical findings, laboratory data, and treatment types, were collected. Patients were categorized into acute bacterial epididymitis (ABE) or acute non-bacterial epididymitis (ANBE) groups based on the presence or absence of bacterial growth in urine cultures. The primary endpoints were the proportion of patients with ABE and those who received antibiotic therapy. The secondary endpoint was to assess the diagnostic accuracy of CRP and urinalysis for ABE. Results: The final cohort comprised of 289 patients, of whom 216 (74.7%) received antibiotics. Urine culture was obtained for 167 (57.8%) patients, and 52 (31.1%) were positive for a bacterial source. The median CRP and positive rate for urinalysis were significantly higher in the ABE group compared to the ANBE group (CRP: 3.68 vs. 0.25 mg/dL; p < 0.001; urinalysis: 41% vs. 23%; p = 0.005). Multivariate analysis revealed that elevated CRP was significantly associated with AE (odds ratio [OR], 61.96; p < 0.001), whereas positive urinalysis was not (OR, 2.09; p = 0.33). The area under the receiver operating characteristic curves for CRP was higher than that for urinalysis (0.82 vs. 0.72). Conclusions: Serum CRP proved to be a more accurate and reliable tool than urinalysis for predicting pediatric ABE. This could provide guidance to practitioners when prescribing antibiotics in the future.

Prolonged fever in a 13-year-old girl misdiagnosed as Ochrobactrum spp. bacteremia-the pitfalls of diagnostic Brucella spondylitis in a non-endemic country.

Brucellosis is a zoonosis with non-specific clinical symptoms involving multiple systems and organs. Its prevalence is low in most of EU countries, which can lead to the difficulties in laboratory and clinical diagnostic. Due to its relationship to the Ochrobactrum spp., it may be misclassified in rapid identification systems. We present a case of a 13-year-old immunocompetent girl who was examined several times for fever, fatigue, night sweats and weight loss; laboratory results showed mildly elevated C-reactive protein, anaemia and leukopenia. Four weeks before the onset of symptoms, she had been on a family holiday in Egypt. Given her symptoms, a haemato-oncological or autoimmune disease was considered more likely. The diagnosis of Brucella spondylitis was made after 4months. The main reasons for this delay were as follows: low specificity of clinical symptoms, delay in completing the travel history, inconclusive initial serological results and misidentification of the blood culture isolate as Ochrobactrum sp. Even in countries with a low incidence of brucellosis, it is essential to educate healthcare professionals about the disease. Low specificity of symptoms and limited experience of laboratory staff may lead to late diagnosis with risk of complications and poor outcome. If Ochrobactrum spp. is detected in clinical specimens by rapid identification, careful re-evaluation must follow and all measures to prevent laboratory-acquired infections must be taken until Brucella spp. is unequivocally excluded.

Plant‐Based Meat Alternatives Intake and Its Association With Health Status Among Vegetarians of the UK Biobank Volunteer Population

ABSTRACTConsumption of plant‐based meat alternatives (PBMAs) within the vegetarian population is increasing. This study assessed the relationship between PBMA intake and health markers using the UK Biobank cohort. Participants were categorized into vegetarian PBMA consumers and vegetarian PBMA nonconsumers. Nonparametric statistical tests were used to evaluate differences in participants’ characteristics, food intake, and 30 blood biochemistry measures after assessing data distributions. Metabolomics (168 metabolites) and proteomics (2923 proteins) data were further examined to identify significant differences between the two participant groups. Relative risks (RRs) for 45 chronic diseases and mental conditions were calculated using Poisson regression. Sensitivity analysis accounted for sociodemographic factors, and the proportion of energy from ultra‐processed food (UPF) intake was determined. No substantial differences in sodium, free sugar, total sugar, or saturated fatty acids intake between vegetarian PBMA consumers and nonconsumers were found. However, PBMA consumers exhibited higher blood pressure (130/79 and 129/78 mmHg for consumer and nonconsumer groups, respectively) and elevated C‐reactive protein (CRP) levels (1.76 ± 3.12 and 1.57 ± 3.17 mg/L for consumer and nonconsumer groups, respectively). Metabolite and protein abundance analysis showed no notable differences. Pathway enrichment analysis suggested that PBMAs may influence immune reactions through cell signaling pathways. PBMA consumers had a 42% increased risk of depression (p = 0.03) and a 40% reduction in irritable bowel syndrome (IBS) risk (p = 0.02), compared to nonconsumers. In conclusion, while no clear health risks or benefits were associated with PBMA consumption in vegetarians, the higher risk of depression, elevated CRP, and lower apolipoprotein A levels in PBMA consumers suggest potential inflammatory concerns that warrant further investigation.