High C-reactive Protein Levels Research Articles

C-reactive protein after discharge and infarct size in patients with ST segment elevation myocardial infarction

Abstract Background C-reactive protein (CRP) peaks at 2 days in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) and can predict final infarct size. It is, however, unknown whether CRP level after discharge, indicative of prolonged inflammation, plays a prognostic role in myocardial damage. Purpose To investigate the prevalence of high CRP level within 3 months after discharge in patients with STEMI and its association with myocardial damage. Methods In the current study, all patients were identified through the xx database and treated with timely PCI at xx hospital from 2011 to 2014. Blood samples were retrieved within 3 months after discharge. High CRP level was defined as CRP >=3 mg/L. Only patients with a cardiac magnetic resonance (CMR) at baseline or follow-up were recruited. The primary outcome was final infarct size. Multiple regression was performed to adjust for potential confounders using any baseline variable with P<0.10 for the difference between groups. Results Of the 1603 patients from xx, 273 patients had CRP measured following discharge and at least one CMR measured. Of them, 200 (73.3%) had high CRP level after discharge. There was no difference in period from PCI to CRP testing between patients with high CRP and those with low CRP [11 days, interquartile range (IQR) (4, 40) vs. 21 days, IQR (4, 42), P=0.31]. Patients with high CRP level showed larger final infarct size [12.5% left ventricle (LV) vs. 7.0% LV, P <0.001] and larger acute infarct size [15.2% LV vs. 10.6% LV, p=0.004] compared with those with low CRP level. Patients with high CRP level also had lower final myocardial salvage index (MSI) (0.67 vs. 0.75, P=0.003) and lower acute MSI (0.47 vs. 0.61, P=0.006). The results persisted after adjusting for potential confounders in multiple regression. Conclusions A large proportion of patients with STEMI undergoing PCI persisted high CRP within 3 months after discharge. High CRP level after discharge was associated with larger acute and final infarct size as well as lower acute and final MSI level.

Predictors of B-line count in hospitalized patients with COVID-19

Abstract Background B-lines on lung ultrasound (LUS) are non-specific signs of increased density within lung tissue, which can be secondary to pulmonary congestion, pneumonia, or fibrosis. LUS is recommended for managing acute heart failure (HF); however, its value in non-HF populations is less clear. Purpose To identify clinical, laboratory, and echocardiographic predictors of B-lines in a population with Coronavirus disease 2019 (COVID-19). Methods In the ECHOVID-19 study, hospitalized non-ICU patients ≥18 years with confirmed laboratory diagnosis of COVID-19 in Eastern Denmark underwent 8-zone LUS and echocardiography. We used trend and regression analyses to identify associations with the number of B-lines and adjusted for potential confounders (age, sex, body mass index, C-reactive protein, and pandemic wave). Results Among 270 (89%) patients with adequate LUS images, the mean age was 69±14 years, 58% were male and 11% had prior HF. Median time from hospital admission to LUS was 4 [2-8] days. In total, 263 (97%) had ≥1 B-line (median B-line number 14 [9-22]) and median left ventricular ejection fraction [LVEF] was 59 [54-63]). In adjusted models, more B-lines were associated with higher levels of C-reactive protein with an incidence rate ratio (IRR) of 16% (95%CI: 8%-24%) per log-unit increase (P<0.001) and higher Early Warning Score (IRR 5% [95%CI: 1%-0%] per point, P=0.02). Higher tricuspid regurgitation gradient was associated with more B-lines: IRR 2% (95%CI: 1%-3%) per mmHg, P<0.001) (Figure 1). Echocardiographic measures of left ventricular (LV) function (including LVEF and global longitudinal strain, left atrial volume, and LV filling pressures (E/e’)) and right ventricular function were not significantly associated with the number of B-lines. B-lines were not associated with N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations, even in patients with established HF. Lastly, B-lines were not associated with 30-day mortality. Conclusions Among hospitalized patients with COVID-19, B-lines on LUS are associated with markers of infectious disease severity and pulmonary hypertension but not with markers of left-sided HF.Figure1.Predictors of B-lines

Chronic inflammation is associated with impaired cardiac structure and function in patients with inflammatory arthritis: the ARTCADIA Study

Abstract Background Inflammation as an underlying cause of cardiac dysfunction has been underscored in recent years. Patients with inflammatory arthritis (IA) are at risk of being exposed to a high degree of chronic and systemic inflammation. It is therefore important to investigate whether high inflammatory burden impacts cardiac structure and function in patients with IA. Purpose To examine the impact of long-term inflammation on measures of cardiac structure and function in individuals with rheumatoid arthritis (RA) and axial Spondyloarthritis (axSpA), collectively referred to as IA, in a large cohort. Methods In a prospective cohort study, outpatients with a diagnosis of IA were included over two years during their biannual rheumatological routine appointment. In total, 1,285 participants were included. Participants were evaluated at a cardiology research center where echocardiography was performed following a pre-defined protocol. To evaluate chronic inflammation, C-reactive protein (CRP) was averaged from clinical outpatient visits registered in a rheumatological database. Uni- and multivariable linear regressions were used to examine the relationship between echocardiographic measures and log-transformed CRP. Results Among the 1,285 participants, 903 (70%) were diagnosed with RA, 358 (28%) with axSpA, and 24 (2%) with other forms of IA. Mean age was 60 ± 13 years, 64% were female. The median number of outpatient visits was 30 (Interquartile range (IQR): 18 - 48), median disease duration was 12 (IQR: 6 - 20) years, and the median outpatient CRP was 5.7 (IQR: 3.7 – 9.8) mg/L. 519 (40%) patients had hypertension (HT), 113 (9%) diabetes mellitus (DM), 76 (5.9%) ischemic heart disease (IHD) and 35 (2.5%) heart failure (HF). Mean left ventricular (LV) ejection fraction was 54.6 ± 5.7%, mean numerical global longitudinal strain (GLS) was 17.8 ± 2.4%, mean LV mass index (LVMi) was 73 ± 18 g/m2 and mean tricuspid annular plane systolic excursion (TAPSE) was 2.5 ± 0.4 cm. In univariable analyses, higher levels of CRP were significantly associated with lower GLS, p < 0.001; higher E/e’, p = 0.001; higher LVMi, p < 0.001 and lower TAPSE, p = 0.005 (Figure). The associations remained significant after adjusting for clinical characteristics including disease duration, age, sex, blood pressure, body mass index, physical activity, pack-years of smoking, cholesterol, HT, DM, heart rate, atrial fibrillation, IHD and HF (p < 0.05 for all associations). We observed no significant interactions between the IA diagnosis and inflammation across the significant echocardiographic measures. Conclusion In a large cohort of patients with IA, increasing levels of chronic inflammation determined by outpatient CRP was associated with impaired measures of cardiac structure and function and remained significant after adjusting for clinical characteristics. The prognostic and clinical implication of these findings needs to be explored in future studies.Linear regression splines

Coronary plaque volume burden and composition in patients with non-hemodynamically significant coronary artery plaques and systemic inflammation

Abstract Introduction Atherosclerotic coronary disease is a leading cause of morbidity and mortality worldwide. Systemic inflammation can affect plaque composition and thus increase cardiovascular risk. Identifying plaque characteristics in these patients could be useful to learn how inflammation (identified by easy to access parameters, like high ferritin and CRP) affects plaque composition in these challenging patients. Purpose We aimed to evaluate the association of systemic inflammation identified by high ferritin and/or high C-reactive protein (CRP) with coronary plaque volume and composition in patients with non-hemodynamically significant coronary artery plaques (stenosis <50%). Methods We prospectively recruited 109 patients referred for noninvasive CT angiography (from November 2023 to January 2024) with suspected coronary artery disease. 20 had totally/partially non-calcified, non-significant coronary plaques (stenosis <50%). Plaque volume was measured. Plaque components were stablished as calcified (>200 UH), lipidic (<60 UH) and fibrous (60-200 UH). Systemic inflammation was identified when ferritin was >300 ng/mL and/or C-reactive protein CRP was >5 mg/L, according to our laboratory high normal limits. CT scan images were acquired with a 128 detectors dual-layer CT scan with prospective-retrospective/synchronization. Intravascular iodine-based contrast agent was administered. Results Mean age was 60 ± 11 years old and 75% of patients were men. 55% had high blood pressure, 65% were current or previous smokers and 40% had dyslipidemia (35% received statins). 10% were diabetic. There were no difference between groups for these characteristics. We analyzed 33 plaques. Fibrous plaque volume was found to be significantly higher in patients with high ferritin (66.9 vs 32.5 mm3; p = 0.04) and in patients with high CRP (78.7 vs 36.4 mm3; p = 0.05). The percentage of fibrous plaque tended to be higher in patients with higher ferritin and CRP (54.9 vs 38.9; p = 0.06 and 60.6 vs 40.7%; p = 0.07, respectively). Conclusions Systemic inflammation affecting coronary plaque composition in non-hemodynamically significant coronary atherosclerotic disease can by identified by high ferritin and high CRP levels. It is associated with higher fibrous plaque volumes. This finding suggest that systemic inflammation can associate more vulnerable plaques and might benefit from more aggressive management of non-hemodynamically significant atherosclerosis.TableFigure

Mildly elevated left ventricular outflow tract gradients are associated with increased short term mortality in inpatients without septal hypertrophy

Abstract Background The significance of left ventricular outflow tract gradients (LVOTG) on the clinical outcomes of hypertrophic cardiomyopathy (HCM) has been well studied. An LVOTG of ≥ 30 mmHg is considered significant. However, mildly elevated LVOTG at rest in individuals without basal septal hypertrophy is sometimes encountered in the echocardiography laboratory and data on its association with survival in this group is lacking. Purpose Here we explore the association between LVOTG and short term all cause mortality in inpatients without basal septal hypertrophy. Methods We retrospectively reviewed 47,866 consecutive inpatients who had an echocardiography study during their hospital stay between March 2010 and February 2021 . After excluding cases with incomplete data (10,882) and patients with basal septal hypertrophy > 12 mm (9,486), we remained with 27,498 patients. Demographic, baseline clinical and echocardiographic characteristics were derived from electronic records. Mortality data was validated against the ministry of health national records. A binary logistic regression model for predicting 30-day mortality according to LVOTG dichotomized at each point was used. Then we divided the cohort into 4 LVOTG groups (0-6, 6-10, 10-20 and > 20 mmHg) and the same regression model was used to compare between the groups. Results The mean age in our cohort was 66 ± 17 years and 54% were male. The mean LVOTG was 4.2 ± 2.4 mmHg (Median 4 (IQR=3-5) and the mean left ventricular ejection fraction was 55 ± 9%. A binary logistic regression model showed that when different LVOTG cut-points were used, even a mildly elevated LVOTG predicted short-term survival in this population (figure 1). We then divided our cohort into 4 groups based on LVOTG. There were 24,703 (90%) patients in group 1, 2549 (9%) in group 2, 201 (1%) in group 3 and 25 (0.1%) individuals in group 4. Patients in groups 1 and 2 were younger, had higher hemoglobin levels, lower C-reactive protein (CRP) levels, mildly lower septal thickness, and lower left ventricular ejection fraction compared to the groups with higher LVOTG (table 1). We then applied the same multivariate binary regression model to predict short term mortality with group 1 as a reference. The hazard ratio (HR) for group 2 was 1.3 (CI 95%: 1-1.6, p=0.03), for group 3 HR=2.8 (CI 95%: 1.6-5.1, p<0.001) and for group 4 HR=2.8 (CI 95%: 0.6-12.8, p=0.18). Conclusions We have shown in a large cohort of inpatients without basal septal hypertrophy that a mildly elevated rest LVOTG (6-10 and 10-20 mmHg) predicted all cause 30-day mortality. Patients in the elevated LVOTG groups were older with lower hemoglobin and higher CRP levels, but LVOTG remained an independent predictor in a multivariate regression model. This could potentially aid early detection of at-risk populations.Mortality at different LVOTG cut-pointsBaseline characteristics

Dynamic changes in hs-CRP and risk of all-cause mortality among middle-aged and elderly adults: findings from a nationwide prospective cohort and mendelian randomization

IntroductionThe general population experiences mortality rates that are related to high levels of high-sensitivity C-reactive protein (hs-CRP). We aim to assess the linkage of longitudinal trajectories in hs-CRP levels with all-cause mortality in Chinese participants.MethodsWe utilized data from the China Health and Retirement Longitudinal Study (CHARLS). The exposures were dynamic changes in the hs-CRP and cumulative hs-CRP from 2012 to 2015, and the outcome was all-cause mortality. All participants were categorized into four trajectories according to hs-CRP levels. Multivariable logistic regression analysis, adjusted for potential confounders, was employed to evaluate the relationship of different trajectories of hs-CRP with mortality risk. A two-sample Mendelian randomization (TSMR) method and SHapley Additive exPlanations (SHAP) for identifying determinants of mortality risk were also employed.ResultsThe study included 5,445 participants with 233 deaths observed, yielding a mortality proportion of 4.28%. Compared to individuals maintaining low, stable levels of hs-CRP (Class 1), individuals with sustained elevated levels of hs-CRP (Class 4), those experiencing a progressive rise in hs-CRP levels (Class 2), or those transitioning from elevated to reduced hs-CRP levels (Class 3) all faced a significantly heighted death risk, with adjusted Odds Ratios (ORs) ranging from 2.34 to 2.47 across models. Moreover, a non-linear relationship was found between them. Further TSMR analysis also supported these findings. SHAP showed that hs-CRP was the fifth most important determinant of mortality risk.ConclusionsOur study shows all-cause mortality increases with dynamic changes in hs-CRP levels among middle-aged and elderly adults in China, and cumulative hs-CRP shows an L-shaped relationship with all-cause mortality.

Synergistic effect of periodontitis and C-reactive protein levels on mortality: NHANES 2001-2004.

Periodontitis is associated with elevated C-reactive protein (CRP) levels. Although the coexistence of periodontitis and elevated CRP levels may heighten the risk of mortality, previous studies have not confirmed their synergistic effect. Understanding this interaction is crucial for identifying potential interventions to reduce mortality risk in individuals with periodontitis. This study aimed to assess the synergistic effects of periodontitis and elevated CRP levels on mortality in 7,938 adult individuals who participated in the National Health and Nutrition Examination Study 2001-2004. The association of periodontitis status and CRP levels with mortality was assessed using a survey-weighted Cox model. The interactive effect was estimated; the synergistic effect of CRP levels and periodontitis status on mortality was assessed using the relative excess risk due to interaction (RERI). Periodontitis was diagnosed in 1,065 (13.4%) participants. Compared with the participants without periodontitis and possessing CRP levels of ≤ 0.5 mg/dL, those with periodontitis (hazard ratio [HR], 1.38) or CRP levels of > 0.5 mg/dL (HR 1.23) had higher HRs. The participants with both periodontitis and CRP levels of > 0.5 mg/dL had the highest HR of 2.01. The additive scale interactive effect of the periodontal status and CRP levels, measured using RERI 0.41 (-0.07, 0.95), was positive and nearly significant in the total population. The synergy between the periodontal status and CRP levels was more prominent in the participants aged ≥60 years than that in younger individuals. Periodontitis with high CRP levels may indicate a high mortality rate, indicating the importance of active monitoring and intensive management of periodontitis and inflammatory markers.

Impact of Obesity Severity on Hepatic Steatosis and Systemic Inflammatory Markers: A Comparative Analysis Across Obesity Classes

Introduction: Obesity has become a global health issue, with its prevalence steadily increasing. It is closely linked to several metabolic disorders, cardiovascular diseases, non-alcoholic fatty liver disease, and chronic low-grade inflammation and can progress to more severe liver conditions. This study evaluates the relationship between obesity and inflammatory markers in individuals with different obesity levels. Methods: A cross-sectional study was conducted among 50 patients categorized into three obesity classes based on body mass index (BMI). Blood samples were taken to evaluate inflammatory and metabolic markers, including white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP). Results: There were no statistically significant differences in inflammatory markers such as WBC, NLR, or CRP; a trend toward higher CRP levels was observed in Class 3 obesity. Conclusion: In our study, no statistically significant association was observed between inflammatory markers and the degree of obesity. Although the sample size was relatively small, it is essential to acknowledge that obesity is a multifaceted condition, and genetic variations may play a role in these results.

Impact of High-Intensity Statin on Atrial Fibrillation After Off-Pump Coronary Artery Bypass.

There is uncertainty regarding the impact of high-intensity statins on postoperative outcomes in patients undergoing surgical myocardial revascularization. This study was conducted to evaluate the impact of high-intensity statin treatment on the occurrence rate of new-onset postoperative atrial fibrillation (POAF) after off-pump coronary artery bypass grafting (OPCAB). Six hundred thirteen patients (66.8±9.8 years, male:female = 476:137) who underwent isolated OPCAB were retrospectively enrolled. Hypertension (n = 409, 66.7%), diabetes mellitus (n = 343, 59.6%) and chronic kidney disease (n = 138, 22.5%) were common comorbidities. Statins and beta-blockers were administered to all patients until the day of surgery and resumed within 6 hours after surgery. Risk factors associated with POAF were analyzed, including the use of high-intensity statins (atorvastatin 40 mg-80 mg or rosuvastatin 20 mg), as well as baseline characteristics and preoperative risk factors. High-intensity statins were used in 158 patients (25.8%). POAF occurred in 184 patients (30.0%). The use of high-intensity statins was not correlated with preoperative levels of low-density lipoprotein (P = 0.135) or high sensitivity C-reactive protein (P = 0.365). Multivariate logistic regression analysis revealed that the use of high-intensity statins was significantly associated with a reduced occurrence of POAF (P = 0.022, odds ratio [95% confidence interval] = 0.592 [0.378-0.926]). Age, acute coronary syndrome, insulin-dependent diabetes mellitus and chronic kidney disease were also significantly associated with POAF. Preoperative administration of high-intensity statins was associated with a 41% reduction in the occurrence rate of POAF in patients who underwent OPCAB.

Evaluation of functional measures and laboratory parameters to portend limitations of spinal mobility in patients with radiographic axial spondyloarthritis

Aim of the workTo specify clinical and laboratory parameters related to limited spinal mobility in radiographic axial spondyloarthritis (r-axSpA) patients. Patients and methodsThe study included 202 adult r-axSpA patients. Clinical characteristics, medications, investigations including serum C-reactive protein (CRP) and human leukocytic antigen-B27 positivity were noted. Lateral lumbar flexion (LLF), chest expansion (CE) and tragus-to-wall distance (TWD) were measured. Values <2.5 percentile in LLF, CE and TWD were noted as reduced mobility of lumbar, thoracic and cervical spine, respectively. ResultsThe median age of patients was 43 years, male:female was 3.7:1. The time to diagnosis was 7.5 (3–40) years and were followed-up for 7.2 (4–22) years. Disease duration and high baseline CRP (>10 mg/L) were critical risk factors for reduced spinal mobility (p = 0.001 and p < 0.01). The duration to impaired LLF was significantly shorter in smokers (n = 105) (10.3;0–30.5 years) vs non-smokers (15.2;4.5–35 years) (p = 0.001) and in those with positive family history (n = 50) (9.7;0–20 years) compared to those without (12.9;4–35 years) (p = 0.09). LLF, CE and TWD were impaired in 40 % vs 75 %, 10 % vs 55 % and 12 % vs 60 % of patients with symptom duration of 10 vs 30 years respectively. Those with delayed introduction of biologics had significantly more impaired LLF, CE and TWD: 10.1(2–25) vs 14(3–33) years; 10.4(3–26) vs 17.5(8–33) years; 10.7(3–27) vs 16.7(5–33) years; p = 0.001 for all, respectively). ConclusionsThe most prominent factors affecting spinal mobility were the duration of symptoms and high serum CRP levels. The decreased spinal mobility was markedly less in patients with the early introduction of biologic therapy.

Suspected contained rupture of a coronary artery aneurysm followed by a re-rupture: a case report

Abstracts Background Most coronary artery aneurysms (CAAs) are clinically asymptomatic and are only detected incidentally during cardiac imaging. However, CAAs can cause fatal complications such as cardiac tamponade following a rupture. Reports of contained ruptures of CAAs are limited. Case Summary An 89-year-old man had a severe, acute-onset chest pain two days prior. The patient was referred to our hospital because of residual dyspnoea and a fever. The blood tests exhibited high C-reactive protein (CRP) and D-dimer levels; moreover, contrast-enhanced computed tomography (CT) and transthoracic echocardiography revealed a diffuse mild pericardial effusion, which had not been detected six months prior. The fever and pericardial effusion persisted, and the main cause was not clearly understood. On day 19, the patient had a sudden loss of consciousness after chest pain. Contrast-enhanced CT showed an increase in the pericardial effusion, and coronary angiography showed a CAA in the proximal right coronary artery with extravasations that probably sealed. A re-rupture following a contained rupture of the CAA was considered, and it was suspected that the prolonged fever and pericardial effusion were related to the contained rupture associated with the first episode of chest pain. Discussion Our case showed that a contained rupture of a CAA can cause a fatal event by a re-rupture and may present with a prolonged fever and pericardial effusion. A contained rupture of a CAA should be considered as a differential diagnosis in patients with a prolonged fever and pericardial effusion of unknown origin after an acute onset of chest pain.

Association of High-sensitivity C-reactive Protein Level with Obese Normal individuals in North Indian Population.

One of the major inflammatory markers, C-reactive protein (CRP), is often elevated in people who have had a heart attack, vascular problems, stroke, or sudden cardiac death. Obesity is associated with higher CRP levels because adipose tissue activates cytokines. Obesity and overweight increase the risk of heart disease, as does an elevated CRP level. The purpose of this study was to evaluate the association of high-sensitivity CRP (hs-CRP) level with obese normal individuals in North Indian population. This cross-sectional study included 50 individuals between the ages of 18 and 50 years who were overweight or obese. The degree of obesity was determined by anthropometric measurements. The patients' height, weight, waist circumference (WC), hip circumference, and blood pressure were measured. Enzyme-linked immunosorbent assay-based CRP level was determined from the blood. The mean WC (cm) was significantly higher in the obese (103.42 ± 9.79) than in the overweight (89.00 ± 8.72). The mean hip circumference (cm) was also significantly smaller in the obese group (99.95 ± 8.07) than in the overweight group (131.29 ± 15.82). The waist-to-hip ratio (WHR) was significantly more in the obese group (88.37%) than in the overweight group (0.00%). WC (cm), hip circumference (cm), WHR, systolic blood pressure (mmHg), and diastolic blood pressure (mmHg) were not significantly correlated with hs-CRP in overweight and obese participants. Compared with obesity, hs-CRP was not related to obesity. A relationship between hs-CRP and WC, hip circumference, and WHR was not found.

Associations Between Clinical Factors and Postoperative Thrombosis in Pediatric Cardiac Surgery Patients: A Single-Center Retrospective Study.

Postoperative thrombosis is a significant complication in pediatric cardiac surgery patients, contributing to morbidity and mortality. Identifying clinical factors associated with thrombosis can improve patient outcomes by guiding early detection and intervention. This study aimed to assess factors associated with postoperative thrombosis or thromboembolism in pediatric patients under 12 months old who underwent surgery for congenital heart disease (CHD). Design, Setting, and Participants: This retrospective cohort study analyzed electronic medical records from pediatric patients admitted to the Pediatric Cardiovascular Intensive Care Unit (PCICU) at the German Paediatric Heart Center, Bonn, between March 1, 2020, and March 1, 2021. A total of 197 children under 12 months old who underwent cardiac surgery were included in the analysis. Thrombosis was diagnosed postoperatively using imaging modalities such as ultrasound, echocardiography, and computed tomography. The primary outcome was the incidence of thrombosis and its association with clinical factors such as age, central venous catheter (CVC) duration, CRP levels, and D-dimer levels. Among 197 patients, the incidence of thrombosis was 8.63%, predominantly venous (70.6%). Initial associations were observed between thrombosis and younger age, lower body weight, higher hematocrit, cyanosis, longer central venous catheter (CVC) use, and elevated C-reactive protein (CRP) and d-dimer levels. Receiver operating characteristic analysis indicated a higher risk in patients with d-dimer levels above 5.47 mg/L. The stepwise multiregression analysis identified longer CVC duration in situ (β = 0.553; p < 0.001), higher CRP levels (β = 0.217; p = 0.022), and younger age at admission (β = -0.254; p = 0.006) as significant predictors of thrombosis. Decision tree analysis identified CVC use longer than 12.5 days and CRP levels above 118.01 mg/L as the most critical risk factors. Postoperative thrombosis is a notable risk in pediatric CHD patients, particularly in neonates. Prolonged CVC use and elevated CRP levels are critical risk factors. Routine monitoring of D-dimer and CRP levels, along with timely sonographic screening, can aid early thrombosis detection and intervention. Further research is warranted to optimize thrombosis prevention strategies in this population.

CRP Levels and Vitamin D as Predictors of Asthma Control: A Data-Driven Approach

Background: Asthma is a chronic inflammatory disease of the airways characterized by episodic exacerbations and airflow obstruction. Elevated C-reactive protein (CRP) levels indicate systemic inflammation and are associated with increased disease severity in asthma. Additionally, vitamin D is thought to modulate immune responses and inflammation, potentially influencing asthma control. This study explores the relationships between CRP levels, vitamin D levels, and asthma control, as measured by the Asthma Control Test (ACT). Objectives: The primary objective of this study was to assess the correlation between CRP levels, vitamin D levels, and asthma control in adult patients with asthma. The study aimed to determine whether CRP and vitamin D could serve as predictive markers for asthma control. Methods: This single-center, prospective observational study enrolled 40 adult patients with confirmed asthma from the outpatient pulmonary clinic of ESIC Government Hospital, Guwahati, Assam, India. Asthma control was evaluated using the ACT, with scores categorized as well-controlled (ACT ≥ 20) or poorly controlled (ACT &lt; 20). Serum CRP and vitamin D levels were measured using the ELISA method. Pearson’s correlation coefficient and ANOVA were employed to analyze the relationships between these variables. Results: The study found a moderate negative correlation between CRP levels and ACT scores (r = -0.58), indicating that higher CRP levels were associated with poorer asthma control. Patients with CRP levels greater than 10 mg/dL had significantly lower mean ACT scores compared to those with lower CRP levels. In contrast, a strong positive correlation was observed between vitamin D levels and ACT scores (r = 0.879), with higher vitamin D levels associated with better asthma control. The ANOVA test revealed significant differences in ACT scores across different vitamin D and CRP categories (p &lt; 0.05). Conclusions: The study suggests that elevated CRP levels are indicative of poorer asthma control, while higher vitamin D levels are associated with better control of asthma. CRP and vitamin D levels may serve as valuable biomarkers for assessing asthma severity and guiding treatment strategies. However, the variability in response to vitamin D supplementation highlighted the need for personalized approaches to asthma management. Further research is required to confirm these findings and explore the underlying mechanisms.

The effect of zinc-containing calcium phosphate coating on the osseointegration of transcutaneous implants for limb prosthetics

Introduction Increasing the integration of transcutaneous implants is an important goal for their application in clinical practice.The purpose of the work was to evaluate the osseointegration of transcutaneous titanium implants with calcium-phosphate coating containing zinc ions.Materials and methods The studies were performed on 12 male rabbits, who underwent implantation of an original implant into the tibial stump. After implantation, a compression device was installed on the bone, maintaining a load of 3.5 N for 5 weeks. Duration of observation was 26 weeks. The animals were divided into two groups: a control group (n = 6) with an implant without coating and an experimental group (n = 6) with a zinc-substituted calcium-phosphate coated implant.Results The implant fell out in one case in animals from the control group; no cases of implant loss were noted in the experimental group. It was revealed that the weight concentration of Ca and P in all zones of the bone-implant block of the animals in the experimental group significantly exceeded similar indicators in the control group. In the control group, long-term persistence of high levels of C-reactive protein was noted, which was not observed in the experimental group.Discussion This series of studies has shown that an implant with a zinc-modified calcium-phosphate coating exhibited a more effective integration, in contrast to an uncoated product. The absence of serious adverse reactions to the tested products indicates acceptable tolerability and safety of its use.Conclusion The implants with a zinc-modified calcium-phosphate coating showed signs of more effective osseointegration compared to the product without additional coating.

High levels of serum hypersensitive C-reactive protein are associated with non-alcoholic fatty liver disease in non-obese people: a cross-sectional study

IntroductionNon-alcoholic fatty liver disease (NAFLD) and obesity have become one of the most common chronic diseases, and the global prevalence is increasing year by year. Both are accompanied by hypersensitive C-reactive protein (hs-CRP). At present, there are many predictors of NAFLD. Exploring the relationship between hs-CRP and nonalcoholic fatty liver disease in non-obese people will be helpful for risk prediction and clinical screening in high-risk populations.ObjectiveTo explore the relationship between levels of serum hs-CRP and the presence of NAFLD in non-obese people.MethodsA total of 6558 participants who underwent physical examination from March 2017 to November 2017. Multivariate logistic regression was utilized to analyze the risk factors associated with NAFLD.ResultsThis study including 4240 males and 2318 females ranging from 20 to 94 years. In 1396 patients with NAFLD, the prevalence rate was 21.3%, among which 1056 (24.9%) males and 340 (14.7%) females had NAFLD. The prevalence of NAFLD was much higher in males compared to females (χ2 = 93.748, P < 0.001). In the nonalcoholic fatty liver group, various factors including hs-CRP, age, WC, BMI, systolic blood pressure and blood pressure diastolic blood pressure were significantly higher than those in the control group. Logistic regression analysis confirmed that hs-CRP was an independent risk factor for NAFLD, even after adjusting for relevant variables.ConclusionsThe prevalence of NAFLD increases with the level of hs-CRP in both men and women who are non-obese. Hs-CRP levels are an important risk factor for nonalcoholic fatty liver disease in non-obese individuals.

Myocarditis: Differences in Clinical Expression between Patients with ST-Segment Elevation in Electrocardiogram vs. Patients without ST-Segment Elevation.

In cases of myocarditis, electrocardiograms (ECGs) may suggest a pattern of ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI). NSTEMI patterns are less frequent in myocarditis cases, but it remains unclear if the presence of ST-segment elevation in myocarditis cases is related to a more severe condition and more damage in the myocardium. This is a retrospective study involving 38 patients admitted to hospital with myocarditis. Patients were divided into two groups: patients with ST-segment elevation (STE) patterns in the ECG (25), and patients without ST-segment elevation (non-STE) patterns (13). The data compared included results from epidemiological, laboratory, and instrumental tests. Data were analysed using IBM SPSS Statistics v26.0. A p value of <0.05 was established as the threshold for statistical significance. C-reactive protein (CRP) levels were higher in the STE group (103.40 ± 82.04 mg/L vs. 43.54 ± 61.93 mg/L, p = 0.017). The left ventricle ejection fraction (LVEF) was significantly higher in the non-STE pattern group (49.71 ± 4.14 vs. 56.58 ± 3.99, p < 0.001). A lower LVEF correlates with higher TnI levels (r= -0.353, p = 0.032) and higher CRP levels (r = -0.554, p < 0.001). Lower left ventricle (LV) strain correlates with higher levels of Troponin I (TnI) (r = -0.641, p = 0.013). LVEFs in the STE group were lower compared to those in the non-STE pattern group. STE pattern was associated with higher CRP levels. Higher TnI levels in cases of myocarditis were associated with lower LV strain and lower LVEF; higher CRP levels also correlated with lower LVEF. Based on a 6-month echocardiographic follow-up, the prognosis of myocarditis was favourable.

From evidence to practice: real-world insights into outpatient management of acute uncomplicated diverticulitis.

Diverticulitis is experiencing a significant increase in prevalence and its widespread in-hospital management results in a high burden on healthcare systems worldwide. This study compared inpatient and outpatient approach of acute non-complicated diverticulitis using a non-selected population in a real-world setting. This observational retrospective study included all consecutive patients from two Portuguese institutions diagnosed between January 2017 and December 2021 with non-complicated diverticulitis according to the modified Hinchey Classification. The primary endpoints were to identify criteria for inpatient treatment and compare the outcomes on the basis of the treatment regimen. The secondary endpoints were to determine the predictive factors for clinical outcomes, focusing on treatment failure, pain recurrence, and the need for elective surgery following the initial episode. A total of 688 patients were included in this study, 437 treated as outpatients and 251 hospitalized. Inpatient management was significantly associated with higher preadmission American society of anesthesiologists (ASA) score (p = 0.004), fever (p = 0.030), leukocytosis (p < 0.001), and elevated C-reactive protein (CRP) (p < 0.001). No significant association was found between failure of conservative treatment and patient's age, ASA score, baseline CRP, presence of systemic inflammatory response syndrome (SIRS), and inpatient or outpatient treatment regimen. Pain recurrence was significantly associated with higher CRP levels (p = 0.049), inpatient treatment regime (p = 0.009) and post index episode mesalazine prescription (p = 0.006). Moreover, the need for elective surgery was significantly associated with the presence of previous episodes (p = 0.004) and pain recurrence (p < 0.001). The majority of patients with uncomplicated diverticulitis of the left colon experience successful conservative approach and can be safely managed in an ambulatory setting. Neither treatment failure, recurrence of pain, or need for posterior elective surgery are associated with outpatient treatment regimen.

Evaluation of the Association Between Coffee Consumption, Including Type (Instant, Ground), and Addition of Milk or Sweeteners and New-Onset Hypertension and Potential Modifiers

BackgroundThe association between coffee consumption and incident hypertension remained inconsistent. ObjectiveThis study aimed to examine the association of consumption of coffee, including different types (instant and ground) and with different additives, with new-onset hypertension, and evaluate whether genetic variation in caffeine metabolism and inflammation may modify the association. DesignThis study utilized a prospective cohort design. Participants/settingA total of 98 765 participants free of hypertension enrolled in the UK Biobank between 2006 and 2010 were included. Dietary coffee consumption was collected using 24-hour dietary recall questionnaires. Main outcome measuresThe study outcome was new-onset hypertension, ascertained by self-reported medical conditions, hospital inpatient records, death registers, and primary care records. Statistical analyses performedCox proportional hazards models were used to estimate hazard ratio and 95% CI. Potential modifying effects were assessed by likelihood ratio testing. ResultsDuring a median follow-up of 12.1 years, 7090 (7.2%) new-onset cases of hypertension were documented. Overall, regardless of coffee type (instant or ground) and whether adding milk to coffee, there was a U-shaped association between unsweetened coffee consumption and new-onset hypertension, with a 14% to 18% reduction of hypertension risk at >1 to ≤4 drinks per day, whereas a null association was observed between sweetened coffee consumption and the risk of new-onset hypertension. Relative to coffee nonconsumers, the adjusted hazard ratio (95% CI) of new-onset hypertension for participants who drinking unsweetened coffee 1 or fewer, >1 to 2, >2 to 3, >3 to 4, and >4 drinks/day were 0.92 (95% CI 0.85 to 1.00), 0.82 (95% CI 0.76 to 0.89), 0.86 (95% CI 0.79 to 0.96), 0.86 (95% CI 0.77 to 0.96), and 0.88 (95% CI 0.78 to 0.99), respectively. Moreover, a stronger inverse association between moderate consumption of unsweetened coffee and new-onset hypertension was found in participants with higher C-reactive protein levels (P for interaction =.012), whereas an individual’s genetic variation in caffeine metabolism did not significantly modify the association (P for interaction = .453). ConclusionsRegardless of the type of coffee (instant or ground) or the addition of milk to coffee, moderate consumption of unsweetened coffee (>1 to ≤4 drinks/day), but not sweetened coffee, was associated with a lower risk of new-onset hypertension.

Asymptomatic Elevated Inflammatory Markers: Is There a Risk for Infection or Revision in Primary Total Knee Arthroplasty?

BackgroundTotal knee arthroplasty (TKA) is the treatment of choice for advanced knee osteoarthritis. Long-term studies report high patient satisfaction, while complications such as periprosthetic joint infection (PJI) can be devastating. Knowledge regarding risk factors for PJI is critical to minimize and ideally avoid complications. The purpose of this study was to investigate the risk of PJI and revision in patients who had preoperative asymptomatic high C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels in primary TKAs. MethodsPatients undergoing primary TKA between 2010 and 2022 were eligible. Inclusion criteria were patients who had preoperative complete biochemical parameters and a minimum follow-up of 12 months. Patients who died during the first year, and those who had a history of inflammatory arthritis, autoimmune disease, renal pathologies or septic arthritis, were excluded. Patients who had elevated blood CRP and ESR levels taken within 48 hours before surgery underwent a thorough medical examination with a focus on infection symptoms. After screening and consultation, residual elevated CRP and ESR levels were classified as asymptomatic. After exclusions, 1,528 patients were included. The mean age was 66 years (range, 35 to 92) and the mean follow-up time was 6.4 years (range, 1.6 to 12.3). ResultsThe rate of revision within one year after surgery was 1.6%, whereas the rate of revision in the first five years was 3.8%. The PJI rates for the 1st and 5th postoperative years were 1.7 and 2.9% respectively. Regression analysis did not show any of the potential variables to be a risk factor for revision or PJI. ConclusionAsymptomatic elevated acute-phase reactants are not a risk factor for periprosthetic joint infection or aseptic revision. At a mean follow-up of 6.4 years, overall survival was 96.7%, with only 2.2% of patients revised due to a PJI.