High C-reactive Protein Group Research Articles

Joint association of diabetes mellitus and inflammation status with biological ageing acceleration and premature mortality

We aimed to investigate the associations of diabetes mellitus (DM) and C-reactive protein (CRP) with biological ageing acceleration and mortality risk. We analyzed data from 41,634 adults with CRP and DM at baseline. Subjects were categorized into high CRP (>3mg/L) and low CRP (≤3mg/L) groups. The cross-sectional endpoints of the study were biological ageing indicators Klemera-Doubal method BioAge acceleration (KDMAccel) and Phenotypic age acceleration (PhenoAgeAccel), and the follow-up endpoints were all-cause mortality and cardiovascular mortality. In adults with high CRP, compared with those without DM, PhenoAgeAccel increased by 1.66 years (95% CI: 1.38-1.93), and 8.74 years (95% CI: 8.25-9.22) in adults with prediabetes and DM, respectively (p for interaction <0.001). Using the CRPlow/non-DM group as a reference, adults in the CRPhigh/non-DM, CRPlow/DM, and CRPhigh/DM groups had significantly advanced biological ageing. Compared to adults without DM, low CRP, and no ageing acceleration, the multivariable-adjusted HRs (95%CIs) of all-cause and cardiovascular mortality in those with DM, CRP, and ageing acceleration were 3.22 (2.79-3.72), and 3.57 (2.81-4.54), respectively. These findings suggest that the joint presence of low-grade inflammation and DM might be associated with higher odds of biological ageing acceleration and premature mortality.

Preoperative C-reactive Protein as a Prognostic Factor in Stage IV Colorectal Cancer

Background A prognosis for stage IV colorectal cancer is generally poor. As a result, the development of an appropriate treatment strategy for each individual with this disease within a limited time frame is important. Few studies have been made of C-reactive protein (CRP) in stage IV cases of colorectal cancer, so it is unclear whether CRP is a useful prognostic marker for this disease. Thus, the purpose of this study was to clarify the relationship between the preoperative CRP level and the prognosis of stage IV colorectal cancer. Patients and methods Between April 2007 and December 2015, a total of 384 patients with stage IV colorectal cancer who underwent primary resection were included. Patients were divided into high (HCG) and low (LCG) CRP groups based on a preoperative CRP cutoff value of 1.0 mg/dL. Postoperative short- and long-term results were examined retrospectively. Results The 5-year survival rate was 24.6% for HCG and 36.7% for LCG, indicating the survival rate for HCG was lower. The study was limited to patients who were unable to undergo R0 surgery. Preoperative CEA levels were higher in HCG, whereas the postoperative chemotherapy induction rate was lower. HCG also showed a significantly lower survival rate than LCG. Multivariate analysis showed that CRP levels above 1.0 mg/dL, poorly differentiated histopathology, and the absence of chemotherapy were risk factors affecting overall survival. Conclusion These results suggest that the preoperative CRP level may be a useful biomarker for the prognosis of incurable stage IV colorectal cancer.

High level of C-reactive protein as a predictive factor for immune-related adverse events of immune checkpoint inhibitors in non-small cell lung cancer: a retrospective study.

Several risk factors for the immune-related adverse events (irAEs) during treatment with immune checkpoint inhibitors (ICIs) have been reported, of which include high levels of C-reactive protein (CRP). In this study, we aim to evaluate CRP levels before ICIs treatments as potential predictive biomarkers of irAEs incidence rate and overall survival (OS) in patients with advanced non-small cell lung cancer (NSCLC). Between December 1, 2015 to December 31, 2019, we retrospectively collected all adult patients with NSCLC who received at least one dose of an ICI targeting the PD-1/PD-L1 axis at the Iwate Medical University Hospital in Japan. In this study the patients were categorized into low and high groups with a cut-off value of 10 mg/L as the baseline level of CRP before the ICI treatment. The primary endpoint was relationship between CRP levels at baseline and incidence of irAEs. The secondary endpoints were the relationship of progression-free survival (PFS) and OS. A total of 101 irAEs, and 25 severe irAEs were observed. The incidence of the most irAEs was higher in the high CRP group compared to the low CRP group (54.4% vs. 34.5%, respectively, P=0.003). The most frequent irAEs were skin rush (28.8%), followed by pneumonitis (19.2%), hypothyroidism (15.4%), and hepatotoxicity (9.6%). The most common grade 3 or 4 irAEs was pneumonitis (7.9%), which tended to be more frequent in the high CRP group. In multivariate analysis, patients with high CRP levels had an adjusted OR of 2.41 and were associated with an increased risk of developing irAEs (95% CI: 1.16-4.43, P=0.020). The high CRP group was related with shorter PFS compared to the low CRP group (2.2 vs. 3.3 months, respectively, P=0.006). The high CRP group were also related with shorter OS compared to the low CRP group (8.9 vs. 39.1 months, respectively, P<0.001). The results suggest that higher level of pretreatment CRP is involved in the development of irAE and poor prognosis. Identification of patients at high risk of irAEs would be of great help. Future multicenter prospective studies are needed to expand on this study.

Association of peak C-reactive protein with long-term clinical outcomes in patients with ST-segment elevation myocardial infarction.

Peak C-reactive protein (CRP) levels following ST-segment elevation myocardial infarction (STEMI) are associated with left ventricular thrombus formation or cardiac rupture. However, the impact of peak CRP on long-term outcomes in patients with STEMI is not completely understood. The purpose of this retrospective study was to compare the long-term all-cause death after STEMI between patients with and without high peak CRP levels. We included 594 patients with STEMI, and divided them into the high CRP group (n = 119) and the low-moderate CRP group (n = 475) according to the quintile of peak CRP levels. The primary endpoint was all-cause death after the discharge of the index admission. The mean peak CRP level was 19.66 ± 5.14mg/dL in the high CRP group, whereas that was 6.43 ± 3.86mg/dL in the low-moderate CRP group (p < 0.001). During the median follow-up duration of 1045days (Q1 284days, Q3 1603days), a total of 45 all-cause deaths were observed. The Kaplan-Meier curves showed that all-cause death was more frequently observed in the high CRP group than in the low-moderate CRP group (p = 0.002). The multivariate Cox hazard analysis revealed that high CRP was significantly associated with all-cause death (hazard ratio 2.325, 95% confidence interval 1.246-4.341, p = 0.008) after controlling for confounding factors. In conclusion, high peak CRP was significantly associated with all-cause death in patients with STEMI. Our results suggest that peak CRP may be useful to stratify patients with STEMI for the risk of future death.

Derived Neutrophil-Lymphocyte Ratio and C-Reactive Protein as Prognostic Factors for Early-Stage Non-Small Cell Lung Cancer Treated with Stereotactic Body Radiation Therapy.

Objectives: To explore the relationship between peripheral blood inflammation parameters and overall survival (OS) and progression-free survival (PFS) of early-stage non-small cell lung cancer patients who underwent stereotactic body radiotherapy (SBRT). Patients and methods: In this study, eligible patients treated with SBRT from 2013 to 2018, and both serum complete blood count and blood biochemical results were available prior to (within 60 days) radiotherapy were included. Results: A review of hospital registries identified 148 patients, and the 5-year OS and PFS of the entire cohort were 69.8% and 65.6%, respectively, with the median follow-up time was 52.8 months. Multivariable analysis showed that derived neutrophil-lymphocyte ratio (dNLR) ≥1.4 and C-reactive protein (CRP) ≥2.9 were statistically and independently associated with worse OS (HR = 4.62, 95% CI 1.89-11.27, p = 0.001; HR = 2.92, 95% CI 1.49-5.70, p = 0.002, respectively). The 5-year OS for patients with dNLR below and equal to or above the 1.4 were 85.3% and 62.9% (p = 0.002), respectively, and 76.7% for the low CRP group versus 58.5% for the high CRP group (p = 0.030). Higher serum level of post-treatment CRP also independent parameters for inferior PFS (HR = 4.83, 95% CI 1.28-18.25, p = 0.020). Conclusions: Our results demonstrate that dNLR and CRP are associated with the outcomes of early-stage NSCLC patients treated with SBRT, which may assist in selecting optimal nursing care and therapeutic scheme for every individual.

PS-C14-6: THE USEFULNESS OF C-REACTIVE PROTEIN TO PREDICT IMPROVING LEFT VENTRICULAR FUNCTION AFTER AORTIC VALVE REPLACEMENT IN AORTIC REGURGITATION PATIENTS

Background: We aimed to clarify the predictive factors for left ventricular (LV) function after aortic valve replacement (AVR) in patients with aortic regurgitation (AR). Methods and Results: Among 555 patients who underwent AVR at our institution from January 2015 to December 2020, we enrolled 44 patients for whom only AVR (or AVR + aortic replacement) was performed. We defined LV dysfunction under any of the following criteria: LV ejection fraction (LVEF) &lt; 50%, LV diastolic dimension&gt; 65 mm, LV systolic dimension (LVDs) &gt; 50 mm, or LVDs/body surface area &gt; 25 mm/m2. Multivariable logistic regression analysis revealed high natural logarithm (ln) C reactive protein (CRP) and low LVEF in the pre AVR period significantly associated with LV dysfunction after AVR (ln CRP: odds ratio [OR] 4.15, 95% confidence interval [CI] 1.44 to 11.98, p &lt; 0.01; LVEF: OR 0.79, 95%CI 0.65 to 0.97, p &lt; 0.05). Receiver operating characteristic analysis revealed an area under curve of CRP and LVEF in the pre AVR period for LV dysfunction after AVR of 0.84 and 0.83, respectively. Upon dividing the patients into four groups according to cutoff values of CRP (0.13 mg/dL) and LVEF (50%) in the pre AVR period, no patients (0/19) had LV dysfunction in the low CRP (&lt; 0.13 mg/dL) and high LVEF ( 50%) group, and all patients (5/5) in the high CRP ( 0.13 mg/dL) and low LVEF (&lt; 50%) group had LV dysfunction after AVR. Conclusion: High CRP level was significantly and independently associated with LV dysfunction after AVR. Combination of CRP and LVEF values might be useful for predicting improvement in LV function after AVR.

Preoperative CRP(-)/CEA(-)/CA19-9(-)/non-T4 in Stage III Colorectal Cancer Is Favorable Risk for Recurrence.

We evaluated the prognostic impact of a novel C-reactive protein (CRP) cut-off value (0.6 mg/dl) and carcinoembryonic antigen (CEA)/carbohydrate antigen 19-9 (CA19-9) in stage II/III colorectal cancer. Four hundred ninety-eight patients with stage II (n = 275) or stage III (n = 223) colorectal cancer, surgically treated between January 2010 and December 2016, were analyzed. The optimal CRP cut-off value was fixed at 0.6 mg/dl to predict recurrence based on the receiver operating characteristic curve. Prognostic factors, including CRP/CEA/CA19-9 status, for relapse-free survival (RFS) were evaluated by multivariate analysis. Recurrent rates were 15% and 32% in stages II and III, respectively. In stage II, CRP, CEA, and CA19-9 were not significant prognostic factors for RFS. In stage III, the RFS of the low CRP group was significantly better than that of the high CRP group (p = 0.002). In stage III, the RFS of CRP(-)/CEA(-) or CRP(-)/CA19-9(-) was significantly better than the other group, as opposed to the RFS of the CEA(-)/CA19-9(-) group that was not. The CRP(-)/CEA(-)/CA19-9(-) group recurrence rate in stage III was significantly better than the CRP(+)/CEA(-)/CA19-9(-) group (20% vs. 50%, p = 0.006). Multivariate analysis revealed that CRP(-)/CEA(-)/CA19-9(-) (p = 0.04) and non-T4 (p < 0.001) were good independent prognostic factors in stage III. The CRP(-)/CEA(-)/CA19-9(-)/non-T4 group recurrence rate in stage III was 11% (8 out of 73). In stage III, the CRP(-)/CEA(-)/CA19-9(-)/non-T4 group is favorable risk for recurrence.

Baseline C-reactive protein levels are predictive of treatment response to a neuroimmune modulator in individuals with an alcohol use disorder: a preliminary study

ABSTRACT Background: Inflammation is implicated in alcohol use disorder (AUD). Ibudilast, a neuroimmune modulator, shows promise for the treatment of AUD. Elevated inflammation, indicated by high levels of C-reactive protein (CRP), represents a possible subtype of AUD, which may be associated with treatment response to ibudilast. Objectives: The current study evaluated CRP as a predictor of treatment response to ibudilast; hypothesizing that ibudilast would be more effective at reducing drinking and alcohol cue-reactivity in individuals with higher CRP levels. Methods: This is a secondary analysis of a clinical trial of ibudilast for AUD, which found that ibudilast reduced heavy drinking in individuals with AUD. Fifty-one individuals were randomized to receive ibudilast (n = 24 [16 M/8F]) or placebo (n = 27 [18 M/9F]) for two weeks. Participants provided blood samples at baseline to assess CRP levels, completed daily assessments of alcohol use, and an fMRI alcohol cue-reactivity task at study mid-point. Models tested the effects of medication, CRP levels, and their interaction on drinks per drinking day and alcohol cue-reactivity. Results: There was a significant interaction between medication and CRP (F = 3.80, p = .03), such that the ibudilast high CRP group had fewer drinks per drinking day compared to the ibudilast low CRP group. CRP moderated the effect of medication on brain activation in a cluster extending from the left inferior frontal gyrus to the right-dorsal striatum (Z = 4.55, p < .001). This interaction was driven by attenuated cue-reactivity in the ibudilast high CRP group relative to the ibudilast low CRP and placebo high CRP groups. Conclusions: This study serves as an initial investigation into predictors of clinical response to ibudilast treatment and suggests that a baseline proinflammatory profile may enhance clinical efficacy.

Impact of severe postoperative inflammatory response on recurrence after curative resection of colorectal cancer.

The relationship between recurrence and systemic inflammation in the early postoperative period of colorectal cancer (CRC) is unclear, and no study has examined changes in recurrence risk resulting from postoperative inflammation. This study aimed to investigate the prognostic impact of severe postoperative inflammatory response after curative resection of CRC. Subjects were 422 consecutive CRC patients who underwent curative surgery between 2012 and 2016, with a follow-up period of 5years after surgery. The prognostic impacts of high and low postoperative C-reactive protein (CRP) levels were examined, and temporal changes in recurrence risk were examined using hazard function analysis. Patients were divided into high (n = 68) and low (n = 354) CRP groups using CRP 12.5mg/dL as the cut-off based on receiver-operating characteristic (ROC) curve analysis. Multivariable analysis revealed that high CRP was a significant predictor of recurrence (hazard ratio: 2.21; p < 0.001). According to the hazard function of recurrence risk, the hazard rate of the low CRP group peaked at 8.4months postoperatively (peak hazard rate: 0.0073/month) and decreased thereafter, while that of the high CRP group peaked at 5.6months (0.0142/month) and was persistently higher than that of the low CRP group for the study duration. A severe inflammatory response in the early postoperative period of CRC increased the recurrence risk, and the recurrence hazard of patients with high CRP levels was earlier and persistently higher than that of patients with low CRP levels. CRC patients with high CRP levels may require more frequent follow-up.

Development and Validation of a Deep-Learning Model to Detect CRP Level from the Electrocardiogram.

Background: C-reactive protein (CRP), as a non-specific inflammatory marker, is a predictor of the occurrence and prognosis of various arrhythmias. It is still unknown whether electrocardiographic features are altered in patients with inflammation. Objectives: To evaluate the performance of a deep learning model in detection of CRP levels from the ECG in patients with sinus rhythm. Methods: The study population came from an epidemiological survey of heart disease in Guangzhou. 12,315 ECGs of 11,480 patients with sinus rhythm were included. CRP > 5mg/L was defined as high CRP level. A convolutional neural network was trained and validated to detect CRP levels from 12 leads ECGs. The performance of the model was evaluated by calculating the area under the curve (AUC), accuracy, sensitivity, specificity, and balanced F Score (F1 score). Results: Overweight, smoking, hypertension and diabetes were more common in the High CRP group (p < 0.05). Although the ECG features were within the normal ranges in both groups, the high CRP group had faster heart rate, longer QTc interval and narrower QRS width. After training and validating the deep learning model, the AUC of the validation set was 0.86 (95% CI: 0.85–0.88) with sensitivity, specificity of 89.7 and 69.6%, while the AUC of the testing set was 0.85 (95% CI: 0.84–0.87) with sensitivity, specificity of 90.7 and 67.6%. Conclusion: An AI-enabled ECG algorithm was developed to detect CRP levels in patients with sinus rhythm. This study proved the existence of inflammation-related changes in cardiac electrophysiological signals and provided a noninvasive approach to screen patients with inflammatory status by detecting CRP levels.

C-reactive protein elevation is associated with increased morbidity and mortality in elderly burned patients

BackgroundC-reactive protein (CRP) is an acute-phase protein produced in response to inflammation after traumatic injury. We posit that C-reactive protein (CRP) is reliable in predicting morbidity and mortality following severe burn. In this study, we explored the relationship between serum CRP values and clinical outcomes in the severely burned. MethodsUsing the Research Network within the TriNetX database, we queried de-identified burn patient data across the United States and enrolled 36,556 burn patients with reported CRP values from 2006 to 2020. ResultsCirculating CRP levels were elevated significantly in patients ≥60 years as well as in males and African Americans (p < 0.05). CRP levels reached the zenith on the first day after burn, and were highest when burn size reached 60% total body surface area (TBSA). After bisecting the data at 10 mg/L of CRP, we compared clinical findings between patient groups (n = 16,284/18,647 in high/low CRP levels). The risk of patient death doubled in the high CRP group from 4.687% to 9.313%, with higher incidences of sepsis, skin infection, and myocardial infarction (p < 0.05). Moreover, mortality increased from 0.9% to 1.926% in those younger than 20 years when comparing the low and high CRP groups, whereas mortality significantly increased from 8.84% to 15.818% in those ≥60 years old (p < 0.05). Both elderly and paediatric groups had significant increases in the diagnosis of sepsis-associated with increased CRP expression. However, incidences of skin infection, pneumonia, and acute kidney injury increased significantly only in the elderly group (p < 0.05). ConclusionElevated CRP expression is common in burn patients. The factor of age influenced the association of CRP expression to clinical outcomes.

MP12-04 PREDICTIVE IMPACT OF EARLY CHANGES IN SERUM C-REACTIVE PROTEIN LEVELS IN NIVOLUMAB PLUS IPILIMUMAB THERAPY FOR METASTATIC RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 May 2022MP12-04 PREDICTIVE IMPACT OF EARLY CHANGES IN SERUM C-REACTIVE PROTEIN LEVELS IN NIVOLUMAB PLUS IPILIMUMAB THERAPY FOR METASTATIC RENAL CELL CARCINOMA Hidekazu Tachibana, Yuki Nemoto, Hiroki Ishihara, Hironori Fukuda, Kazuhiko Yoshida, Junpei Iizuka, Yasunobu Hashimoto, Tsunenori Kondo, Kazunari Tanabe, and Toshio Takagi Hidekazu TachibanaHidekazu Tachibana More articles by this author , Yuki NemotoYuki Nemoto More articles by this author , Hiroki IshiharaHiroki Ishihara More articles by this author , Hironori FukudaHironori Fukuda More articles by this author , Kazuhiko YoshidaKazuhiko Yoshida More articles by this author , Junpei IizukaJunpei Iizuka More articles by this author , Yasunobu HashimotoYasunobu Hashimoto More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , Kazunari TanabeKazunari Tanabe More articles by this author , and Toshio TakagiToshio Takagi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002534.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Serum C-reactive protein (CRP) is reportedly associated with metastatic renal cell carcinoma (mRCC) activity. However, in the era of immune checkpoint inhibitors, the predictive value of CRP is unclear. In this study, we investigated the predictive impact of pretreatment CRP levels and early changes in CRP levels for the treatment of mRCC with nivolumab plus ipilimumab (NIVO-IPI) therapy. METHODS: Forty-eight patients with mRCC treated with NIVO-IPI as a first-line therapy were retrospectively analyzed. First, patients were divided into 2 groups: initial CRP ≥1.0 mg/dL and <1.0 mg/dL. Progression-free survival (PFS) was compared between the 2 groups. Second, based on the CRP change within the first three months of NIVO-IPI, patients were placed in the normal group (CRP remains <1.0 mg/dL), normalized group (CRP decreased <1.0 mg/dL), and non-normalized group (CRP remained or increased to ≥1.0 mg/dL). The predictive association between CRP change and PFS was evaluated. RESULTS: PFS was significantly lower in the high initial CRP group (n=24, 50%) compared to the normal CRP group (n=24, 50%) (median: 4.3 vs. 28.1 months, P=0.03). As for the early CRP change, the normal (2.7 vs. 28.1, P=0.0002) and normalized (2.7 vs. 11.0, P=0.0094) groups showed significantly higher PFS, compared to the non-normalized group. Meanwhile, there was no significant difference between normal and normalized groups (P=0.51). The objective response rate was higher in the normal (57.1% vs. 18.7%, P=0.015) and normalized (81.8 vs. 18.7%, P=0.0008) groups, compared to the non-normalized group. Multivariate Cox regression analysis showed that normal [Hazard ratio (HR)=0.15, 95% Confidence interval (CI)=0.02-0.70, P=0.026] and normalized (HR 0.21, 95% CI=0.05-0.73, P=0.015) CRP showed significant association with PFS. CONCLUSIONS: In the NIVO-IPI therapy for mRCC, early changes in CRP could predict PFS. This data may be useful for the early detection of ineffective NIVO-IPI therapy and conversion to subsequent therapies. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e166 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hidekazu Tachibana More articles by this author Yuki Nemoto More articles by this author Hiroki Ishihara More articles by this author Hironori Fukuda More articles by this author Kazuhiko Yoshida More articles by this author Junpei Iizuka More articles by this author Yasunobu Hashimoto More articles by this author Tsunenori Kondo More articles by this author Kazunari Tanabe More articles by this author Toshio Takagi More articles by this author Expand All Advertisement PDF DownloadLoading ...

The usefulness of C-reactive protein to predict improving left ventricular function after aortic valve replacement in patients with aortic regurgitation

BackgroundWe aimed to clarify the predictive factors for left ventricular (LV) function after aortic valve replacement (AVR) in patients with aortic regurgitation (AR). Methods and resultsAmong 555 patients who underwent AVR at our institution from January 2015 to December 2020, we enrolled 44 patients for whom only AVR (or AVR + aortic replacement) was performed. We defined LV dysfunction under any of the following criteria: LV ejection fraction (LVEF) <50 %, LV diastolic dimension >65 mm, LV systolic dimension (LVDs) >50 mm, or LVDs/body surface area > 25 mm/m2. Multivariable logistic regression analysis revealed high natural logarithm (ln) C-reactive protein (CRP) and low LVEF in the pre-AVR period significantly associated with LV dysfunction after AVR (ln CRP: odds ratio [OR] 4.15, 95 % confidence interval [CI] 1.44–11.98, p < 0.01; LVEF: OR 0.79, 95%CI 0.65–0.97, p < 0.05). Receiver-operating characteristic analysis revealed an area under curve of CRP and LVEF in the pre-AVR period for LV dysfunction after AVR of 0.84 and 0.83, respectively. Upon dividing the patients into four groups according to cutoff values of CRP (0.13 mg/dL) and LVEF (50 %) in the pre-AVR period, no patients (0/19) had LV dysfunction in the low CRP (<0.13 mg/dL) and high LVEF (≥50 %) group, and all patients (5/5) in the high CRP (≥0.13 mg/dL) and low LVEF (<50 %) group had LV dysfunction after AVR. ConclusionHigh CRP level was significantly and independently associated with LV dysfunction after AVR. Combination of CRP and LVEF values might be useful for predicting improvement in LV function after AVR.

Association between Inflammation and Functional Outcome in Patients with Sarcopenic Dysphagia.

This study aimed to investigate whether inflammation affects the outcome of swallowing ability to improve treatment for sarcopenic dysphagia. A retrospective observational cohort study was performed using data from the Japanese sarcopenic dysphagia database. The database was constructed using data from 19 hospitals and one home visiting rehabilitation team. Patients with sarcopenic dysphagia with measurements of C-reactive protein (CRP) and serum albumin (Alb) were included. Patients were assigned to two groups using CRP, Alb, and the Japanese modified Glasgow Prognostic Score (mGPS). The Food Intake LEVEL Scale (FILS) was measured at the times of admission and follow-up (FILS follow-up) to assess swallowing function. A total of 197 patients were included. Mean or median values of each parameter were as follows: age: 83.8±8.7, Alb: 3.2 ± 0.6 g/dL, CRP: 8.0 [3.0, 29.0] mg/L, mGPS: 1 [1-2], FILS: 7 [6-8], FILS follow-up: 8 [7-8], and duration of follow-up: 57.0 [27.0, 85.0] days. The FILS score at follow-up was significantly lower in the high CRP group (≥ 5.0 mg/L) than in the low CRP group (< 5.0 mg/L) (p = 0.01). Further, the FILS score at follow-up was significantly lower in the high mGPS group (class; 2) than in the low mGPS group (class; 0 and 1) (p = 0.03). In the multiple linear regression analyses without FILS at baseline, CRP and mGPS were independent risk factors for FILS follow-up. When FILS at baseline was entered, CRP and mGPS were not an independent risk factors for FILS follow-up. Inflammation could modify the outcome of the patients with sarcopenic dysphagia. Inflammation may be an important risk factor in evaluating patients with sarcopenic dysphagia.

The albumin to globulin ratio is associated with clinical outcome in Japanese patients with ulcerative colitis.

The albumin to globulin ratio (AGR) is a recognized chronic inflammation marker. No evidence regarding the relationship between AGR level and ulcerative colitis (UC) exists. The aim of this study was to evaluate the association between AGR and clinical outcomes among Japanese subjects with UC. The study subjects consisted of 273 Japanese individuals with UC. AGR was divided into 4 categories (low, moderate, high, and very high). The definition of complete mucosal healing (MH) was based on the Mayo endoscopic subscore of 0. Clinical remission (CR) was defined as no rectal bleeding and no abnormally high stool frequency (<3 times per day). The percentage of MH was 26.4%. High AGR and very high AGR were significantly positively correlated with CR (adjusted odds ratio [OR], 5.85; 95% confidence interval [CI], 2.52-14.18 and adjusted OR, 4.97; 95% CI, 2.14-12.04) and complete MH (adjusted OR, 4.03; 95% CI, 1.56-11.51 and adjusted OR, 5.22; 95% CI, 1.97-14.89), respectively after adjustment for confounding factors (P for trend=0.001). Only in the low C-reactive protein (CRP) group (≤0.1 mg/dL), very high AGR was significantly positively correlated with complete MH but not CR (adjusted OR, 4.38; 95% CI, 1.06-21.77; P for trend=0.017). In the high CRP group, no correlation between AGR and complete MH was found. Among Japanese patients with UC, AGR may be independently positively correlated with complete MH. In particular, among UC patients with low CRP, AGR might be a useful complementary marker for complete MH.

Prognostic impacts of serum levels of C-reactive protein, albumin, and total cholesterol in patients with myelodysplastic syndromes.

Various systems for predicting the prognosis of patients with myelodysplastic syndromes (MDS) have been developed. However, associations between performance status (PS) and prognosis of MDS require further investigation. To objectively assess the impact of PS on survival, we examined laboratory findings associated with PS, including serum levels of C-reactive protein (CRP), albumin (ALB), and total cholesterol (CHOL). Patients (n = 123; male 86, female 37; median age 74 yrs.) diagnosed with MDS or myelodysplastic/myeloproliferative neoplasms at Kanazawa Medical University Hospital between 2010 and 2020 were enrolled and grouped by cutoff values determined by receiver operating characteristic analysis: 0.44mg/dL for CRP, 4.0g/dL for ALB, and 120mg/dL for CHOL. The median follow-up period was 17.6months. Kaplan-Meier analysis revealed that overall survival (OS) in the high CRP, low ALB, and low CHOL groups was significantly shorter than in the low CRP, high ALB, and high CHOL groups, respectively. Multivariable analysis revealed that elevated serum CRP was an independent prognostic risk factor independent of gender, bone marrow blast percentage, and cytogenetics.

The association of C-reactive protein with responses to escitalopram antidepressant treatment in patients with major depressive disorder

BackgroundThe effects of escitalopram vary markedly among MDD patients, and approximately one-third of patients fail to respond. A poor antidepressant response might be associated with excessively high C-reactive protein (CRP) levels, but the impact is not clear. We hypothesized that in adults with major depressive disorder, the peripheral biomarker, CRP, was associated with the response to escitalopram (SSRI). MethodsThis was a prospective follow-up study. All 71 patients were treated with escitalopram for 12 weeks. Blood samples were collected at baseline and week 12. Remission was defined as a score of 7 or less on the HAMD-17 scale at week 12. Spearman correlations and multiple linear regressions were used to explore the relationship between continuous CRP levels and the HAMD-17 scores. Logistic regression was used to determine the predictors for remission. The restricted maximum likelihood (REML)-based mixed-effect model for repeated measures (MMRM) was used to examine the change of the HAMD-17 total scores between high and low CRP groups. ResultsCompared with the high CRP group (≥0.8 mg/l), the low baseline CRP group had a higher remission rate (22.73% vs. 48.89%, χ2 = 4.2, p = 0.0403). Logistic regression revealed that patients with lower CRPs were 3.920 times (95% CI: 1.142, 13.460) more likely to experience remission (p = 0.0300). The multiple linear regression model showed that the HAMD-17 total score reduction (baseline to week 12) was negatively correlated with the baseline CRP level (t = −2.00, p = 0.0494). ConclusionsWe observed a predictive role of CRP for remission and symptomatic improvement after escitalopram treatment of MDD patients based on continuous or categorical CRP levels.

Predictive Impact of Early Changes in Serum C-Reactive Protein Levels in Nivolumab Plus Ipilimumab Therapy for Metastatic Renal Cell Carcinoma.

Serum C-reactive protein (CRP) is reportedly associated with metastatic renal cell carcinoma (mRCC) activity. However, in the era of immune checkpoint inhibitors, the predictive value of CRP is unclear. In this study, we investigated the predictive impact of pretreatment CRP levels and early changes in CRP levels for the treatment of mRCC with nivolumab plus ipilimumab (NIVO-IPI) therapy. Forty-eight patients with mRCC treated with NIVO-IPI as a first-line therapy were retrospectively analyzed. First, patients were divided into 2 groups: initial CRP ≥ 1.0 mg/dL and < 1.0 mg/dL. Progression-free survival (PFS) was compared between the 2 groups. Second, based on the CRP change within the first 3 months of NIVO-IPI, patients were placed in the normal group (CRP remains < 1.0 mg/dL), normalized group (CRP decreased < 1.0 mg/dL), and non-normalized group (CRP remained or increased to ≥ 1.0 mg/dL). The predictive association between CRP change and PFS was evaluated. PFS was significantly lower in the high initial CRP group (n=24, 50%) compared to the normal CRP group (n=24, 50%) (median: 4.3 vs. 28.1 months, P=.03). As for the early CRP change, the normal (2.7 vs. 28.1, P=.0002) and normalized (2.7 vs. 11.0, P=.0094) groups showed significantly higher PFS, compared to the non-normalized group. Meanwhile, there was no significant difference between normal, and normalized groups (P=.51). The objective response rate was higher in the normal (57.1% vs. 18.7%, P=.015) and normalized (81.8 vs. 18.7%, P=.0008) groups, compared to the non-normalized group. Multivariate Cox regression analysis showed that normal [Hazard ratio (HR)=0.15, 95% Confidence interval (CI)=0.02-0.70, P=.026] and normalized (HR 0.21, 95% CI=0.05-0.73, P=.015) CRP showed significant association with PFS. In the NIVO-IPI therapy for mRCC, early changes in CRP could predict PFS. This data may be useful for the early detection of ineffective NIVO-IPI therapy and conversion to subsequent therapies.

Prognostic Value of Combined Lactate Dehydrogenase, C-Reactive Protein, Cancer Antigen 153 and Cancer Antigen 125 in Metastatic Breast Cancer.

BackgroundBreast cancer (BC), especially metastatic BC, is one of the most lethal diseases in women. CA 125 and CA 15-3 are commonly used indicators for diagnosis and prognosis of BC. Some serological indicators, such as lactate dehydrogenase (LDH) and C-reactive protein (CRP), can also be used to assess the prognosis and progression in BC.MethodsUnivariate Cox regression analysis and LASSO regression analysis were performed to identify prognostic factors and build prognostic models. We distributed the patients into 2 groups based on the median risk score, analyzed prognosis by Kaplan–Meier curve, and screened independent prognostic factors by multivariate Cox regression analysis.ResultWe identified 4 indicators-LDH, CRP, CA 15-3, and CA 125—related to the prognosis in BC and established a prognostic model. The high LDH group showed worse overall survival (OS) than low LDH group (P = .017; hazard ratio (HR), 1.528; 95% confidence interval (CI), 1.055-2.215). The high CRP group showed worse OS than low CRP group (P = .004; HR, 1.666; 95% CI, 1.143-2.429). The high CA153 group showed worse OS than low CA 15-3 group (P=.011; HR, 1.563; 95% CI, 1.075-2.274). The high CA 125 group showed worse OS than low CA 125 group (P = .021; HR, 1.499; 95% CI, 1.031-2.181). The area under the curve for risk score was .824, Ki-67 was .628, age was .511, and grade was .545. Risk score was found to be an independent prognostic factor using multivariate Cox regression analysis.ConclusionWe successfully established an optimization model by combining 4 prognosis-related indicators to assess the prognosis in patients with metastatic BC.

Association between Insufficient Interleukin-6 (IL-6) Inhibition and Worsening Outcomes in COVID-19 and Idiopathic Multicentric Castleman Disease (iMCD), and a Mathematical Model to Predict Optimal Dosing to Completely Block IL-6 Activity

Association between Insufficient Interleukin-6 (IL-6) Inhibition and Worsening Outcomes in COVID-19 and Idiopathic Multicentric Castleman Disease (iMCD), and a Mathematical Model to Predict Optimal Dosing to Completely Block IL-6 Activity