Higher High-sensitivity C-reactive Protein Levels Research Articles

HS-CRP Modifies the Prognostic Value of Platelet Count for Clinical Outcomes After Ischemic Stroke.

Background We examined whether the relationship between baseline platelet count and clinical outcomes is modulated by HS-CRP (high-sensitivity C-reactive protein) in patients with ischemic stroke. Methods and Results A total of 3267 patients with ischemic stroke were included in the analysis. The primary outcome was a combination of death and major disability at 1 year after ischemic stroke. Secondary outcomes included major disability, death, vascular events, composite outcome of vascular events or death, and an ordered 7-level categorical score of the modified Rankin Scale at 1 year. Multivariate logistic regression and Cox proportional hazards regression models were used to assess the association between the baseline platelet count and clinical outcomes stratified by HS-CRP levels when appropriate. There was an interaction effect of platelet count and HS-CRP on the adverse clinical outcomes after ischemic stroke (all Pinteraction<0.05). The elevated platelet count was significantly associated with the primary outcome (odds ratio [OR], 3.14 [95% CI, 1.77-5.58]), major disability (OR, 2.07 [95% CI, 1.15-3.71]), death (hazard ratio [HR], 2.75 [95% CI, 1.31-5.79]), and composite outcome of vascular events or death (HR, 2.57 [95% CI, 1.38-4.87]) among patients with high HS-CRP levels (all Ptrend<0.05). Conclusions The HS-CRP levels had a modifying effect on the association between platelet count and clinical outcomes in patients with ischemic stroke. Elevated platelet count was significantly associated with adverse clinical outcomes in patients with ischemic stroke with high HS-CRP levels, but not in those with low HS-CRP levels. These findings suggest that strategies for anti-inflammatory and antiplatelet therapy should be developed according to the results of both platelet and HS-CRP testing.

Peripheral Markers of Suicidal Behavior: Current Findings and Clinical Implications.

Biomarkers of suicidal behavior (SB), particularly peripheral biomarkers, may aid in the development of preventive and intervention strategies. The peripheral biomarkers of SB should be easily accessible, cost-effective, and minimally invasive. To identify peripheral biomarkers of SB, we summarized the current knowledge related to SB biomarkers with a focus on suicidal outcomes (suicidal ideation [SI], suicide risk [SR], suicide attempt [SA], and suicide death [SD]), measured site (center or periphery), and study design (cross-sectional or longitudinal). We also evaluated the central findings to validate the findings of peripheral biomarkers of SB. We found reduced peripheral interleukin (IL)-2 levels in individuals with a recent SA, higher cerebrospinal fluid (CSF) IL-6 levels in patients with a current SR and future SD, higher CSF tumor necrosis factor-α levels for current and future SRs, higher high-sensitivity C-reactive protein levels and lower peripheral total cholesterol levels for recent SAs, lower peripheral 5-HT levels for present SR, and a lower folate level for future SR and SA within 1 year. Previous studies have shown inconsistent associations of low peripheral leptin levels with SR and recent SA; therefore, further study is required. Given the multiple determinants of SB and weak associations with single biological markers, combinations of potential biological markers rather than single markers may improve the screening, diagnosis, and prediction of SB.

High visceral fat attenuation and long-term mortality in a health check-up population.

The prognostic role of increased visceral fat attenuation (VFA) remains underexplored. We investigated the long-term prognostic implications of computed tomography (CT)-derived VFA in a health check-up population. This study included consecutive individuals who had positron-emission tomography/CT scans for health check-ups between January 2004 and December 2010. The primary outcome was overall survival (OS), and the secondary outcomes were cancer-specific survival (CSS) and non-cancer-specific survival (NCS). Commercially available body composition analysis software was used to obtain abdominal waist VFA, visceral fat volume index (VFI) and skeletal muscle index (SMI) at the L3 level. Sarcopenia was determined using sex-specific SMI references. VFA and VFI were dichotomized using the thresholds for the highest quartiles. The relationship between CT-derived body composition parameters and body mass index (BMI) was evaluated with Pearson correlation coefficients. The prognostic implications of VFA and sarcopenic obesity (SO) defined by VFA were assessed by multivariable Cox regression analysis and Kaplan-Meier plots with log-rank tests. A total of 2720 individuals (1530 men [56.3%] and 1190 women [43.7%]; median age: 53years, inter-quartile range: 47-60years) were included. During the median follow-up of 138months, 128 individuals (5%) died (cancer mortality: 2%; non-cancer mortality: 3%), with 0.2% (5 of 2720) and 1.1% (30 of 2720) of 1- and 5-year mortality rates. VFA was negatively correlated with BMI (r=-0.62; P<0.001) and VFI (r=-0.69; P<0.001). After adjusting for clinical variables, sarcopenia and VFI, high VFA was a negative prognostic factor for OS (hazard ratio [HR]: 1.05 per Hounsfield unit; 95% confidence interval [CI]: 1.02, 1.08; P=0.001), CSS (HR: 1.07 per Hounsfield unit; 95% CI: 1.02, 1.12; P=0.006) and NCS (HR: 1.03 per Hounsfield unit; 95% CI: 1.01, 1.06; P=0.009). Individuals with high VFA had higher high-sensitivity C-reactive protein levels than those with low VFA (0.11 vs. 0.03mg/dL; P<0.001). Individuals with SO defined by VFA had worse OS (9% vs. 4%; P<0.001), CSS (3% vs. 2%; P=0.02) and NCS (6% vs. 3%; P<0.001) than those without SO, even in the same BMI (underweight-to-normal BMI, OS: 8% vs. 4%; overweight-to-obese BMI, OS: 38% vs. 4%; P<0.001 in both) or VFI category (high VFI, OS: 43% vs. 6%; low VFI, OS: 8% vs. 3%; P<0.001 in both). High VFA was associated with long-term mortality and low-grade inflammation. VFA can further stratify the current SO by BMI or VFI, and SO defined by VFA can identify individuals who are most vulnerable to long-term mortality.

Factors Associating with Non-Dipping Pattern of Nocturnal Blood Pressure in Patients with Essential Hypertension.

Background: In patients with essential hypertension, a non-dipping blood pressure pattern is a strong risk factor for cardiovascular diseases. However, background factors associating with such a blood pressure pattern remain unknown. Methods: Untreated essential hypertensive patients without chronic kidney diseases who were admitted to our outpatient clinic were included. Blood sampling and 24 h ambulatory blood pressure monitoring were mandatorily performed. Non-dipper status was defined as a maximum decrease in nocturnal systolic blood pressure within 10%. Clinical factors associating with non-dipper status were investigated. Results: A total of 154 patients (56 ± 12 years old, 86 men) were included. Among baseline characteristics, a higher serum uric acid level was independently associated with non-dipper status (odds ratio 1.03, 95% confidence interval 1.00−1.05, p < 0.05). Among those with non-dipper status, a higher high-sensitivity C-reactive protein level tended to be associated with incremental nighttime systolic blood pressure levels (p = 0.065). Conclusions: Hyperuricemia and micro-inflammation might be associated with attenuated nocturnal blood pressure dipping and incremental nighttime systolic blood pressure levels.

Association between 19 dietary fatty acids intake and rheumatoid arthritis: Results of a nationwide survey

BackgroundThe relationship between dietary fatty acid intakes and rheumatoid arthritis (RA) is unclear and the available studies have focused on only a few fatty acids. This study investigated the association between the intake of 19 dietary fatty acids and RA in U.S. adults. MethodsThis cross-sectional study using nationally representative data from the 2010-2020 National Health and Nutrition Examination Survey (NHANES). Multivariate linear regression model, multivariate logic regression models, smoothing curve fitting, and two-segment linear regression model were used to explore the relationships between 19 dietary fatty acids intakes with high-sensitivity C-reactive protein (Hs-CRP) and RA risk. ResultsA total of 16,530 participants were included (1053 participants with RA). Intake of hexadecanoic acid and octadecanoic acid were significantly associated with higher Hs-CRP levels, intake of hexadecenoic acid was significantly associated with higher RA risk, and intake of docosahexaenoic acid was significantly associated with lower RA risk. In addition, there was an inverted U-shaped relationship between total monounsaturated fatty acids (MUFAs) intake and RA risk, with the inflection point reached at 15.77% . ConclusionsAmong the 19 dietary fatty acids, only 4 subclasses were significantly associated with Hs-CRP or RA risk. The inverted U-shaped relationship between MUFAs and RA risk may provide insights to find potential prevention strategies for RA.

Association of leukocyte mitochondrial DNA copy number with longitudinal C-reactive protein levels and survival in older adults: a cohort study.

Systemic chronic inflammation occurs with age. The association of the leukocyte mitochondrial DNA copy number, a measure of mitochondrial function in aging, with the temporal profile of serum high-sensitivity C-reactive protein and mortality risk remains uncertain. The objectives of this study were to examine the association of the leukocyte mitochondrial DNA copy number with longitudinal high-sensitivity C-reactive protein levels and the association of the longitudinal high-sensitivity C-reactive protein levels with mortality risk. This prospective cohort study included 3928 adults aged ≥ 55years without systemic inflammation in the baseline examination of the Healthy Aging Longitudinal Study in Taiwan, which started in 2009. Each participant received leukocyte mitochondrial DNA copy number measurement using a fluorescence-based quantitative polymerase chain reaction at baseline, serum high-sensitivity C-reactive protein measurements at baseline and the follow-up examination five years later, and the ascertainment of all-cause death (until November 30, 2021). The relationships among the leukocyte mitochondrial DNA copy number, longitudinal serum high-sensitivity C-reactive protein levels, and time to all-cause mortality were examined using the joint longitudinal and survival modeling analysis. Of the 3928 participants (mean age: 69years; 2060 [52%] were women), 837 (21%) died during follow-up. In the adjusted analysis, one standard deviation lower natural log-transformed baseline leukocyte mitochondrial DNA copy number was associated with an increase of 0.05 (95% confidence interval [CI], 0.02 to 0.08) standard deviation in serum high-sensitivity C-reactive protein in subsequent years. An increase of 1 standard deviation in instantaneous high-sensitivity C-reactive protein levels was associated with a hazard ratio (HR) for all-cause mortality of 1.22 (95% CI, 1.14 to 1.30). Similar results were obtained after further adjusting for baseline high-sensitivity C-reactive protein levels (HR [95% CI], 1.27 [1.16 to 1.38]) and after excluding those with serum high-sensitivity C-reactive protein above 10mg/L (HR [95% CI], 1.21[1.11 to 1.31]) or 3mg/L (HR [95% CI], 1.19 [1.06 to 1.31]) during follow-up. A lower leukocyte mitochondrial DNA copy number was associated with persistently higher high-sensitivity C-reactive protein levels. Moreover, these higher time-varying high-sensitivity C-reactive protein levels were instantaneously associated with a higher risk of death.

Association of urinary albumin:creatinine ratio with incident frailty in older populations.

ABSTRACTBackgroundThe longitudinal relationship of albuminuria with incident frailty remains unknown. Therefore we aimed to evaluate the relation of albuminuria with the risk of incident frailty in older adults.MethodsA total of 1115 participants ≥65 years of age (average age 80.3 years) who were free of frailty in the Chinese Longitudinal Healthy Longevity Survey were included. The outcome was incident frailty, defined as a frailty index ≥0.25 during follow-up. Cox proportional hazards models were used to assess the association of the urinary albumin:creatinine ratio (UACR) with frailty.ResultsDuring a median follow-up duration of 5.3 years, 295 (26.5%) participants developed incident frailty. Overall, the UACR was significantly positively associated with the risk of incident frailty (P for trend = 0.005), with a significantly higher risk of incident frailty in participants in the quartile 4 of UACR {≥13.43 mg/g; hazard ratio [HR] 1.64 [95% confidence interval (CI) 1.13–2.37]} compared with those in quartile 1 (<0.73 mg/g). Consistently, when UACRs were assessed as clinical categories, compared with participants with UACR <10 mg/g, those with UACR ≥30 mg/g had a higher HR of incident frailty [HR 1.61 (95% CI 1.17–2.20)]. Accounting for the competing risk of death also did not substantially change the results. In addition, a stronger positive association between UACR and incident frailty was found in those with a higher high-sensitivity C-reactive protein level (hs-CRP) (P for interaction = 0.045).ConclusionAlbuminuria was positively associated with the risk of incident frailty, particularly in those with higher hs-CRP, emphasizing the importance of managing both albuminuria and inflammation for primary prevention of frailty.

Perinatal factors and high-sensitive C-reactive protein levels during adolescence

Objective To examine whether perinatal factors are associated with low-grade inflammation measured by high-sensitivity C-reactive protein levels during adolescence. Methods Nested case-control study of 125 teenagers who were born by Cesarean delivery and had high-sensitivity C-reactive protein levels determined at 15–17 years. Data on obstetric and perinatal factors were recorded prospectively at the time of their birth. Results Median values of high-sensitivity C-reactive protein were significantly higher in teenagers, who were born as large for gestational age or with maternal diabetes compared to others (2.54 vs 0.34 mg/L; p &lt; 0.024), and born during spring or summer compared to those born during winter or autumn (0.48 vs 0.27 mg/L; p &lt; 0.023). No other perinatal associations were detected (for ex. such as electivity of operation, onset of labor, rupture of fetal membranes, cervical dilatation at delivery, gestational age, Apgar scores at 5 min, umbilical blood pH value, administration of neonatal antibiotics or need of neonatal intensive care treatment) in CRP levels. Further, teenagers with current body mass index in the highest tertile, regular medication for chronic disease and girls using oral contraceptives had significantly higher high-sensitivity C-reactive protein levels than others. Conclusion Prenatal exposures such as maternal metabolic environment and seasonality may have longterm effects on the low-grade inflammation and later cardiometabolic risks. Seasonality might be partly explained by maternal vitamin D levels during pregnancy, and thus future efforts are warranted to ensure sufficient vitamin D availability during pregnancy. Surprisingly, no other significant associations were detected between perinatal characteristics and high-sensitivity C-reactive protein levels.

Higher Levels of High-Sensitivity C-Reactive Protein Is Positively Associated with the Incidence of Hyperuricemia in Chinese Population: A Report from the China Health and Retirement Longitudinal Study.

Purpose The aim of the present cohort study was to explore the longitudinal association between high-sensitivity C-reactive protein (CRP) and hyperuricemia in Chinese population. Furthermore, we conducted subgroup analyses to explore this association according to age, sex, and body mass index. Methods A total of 5,419 healthy participants were enrolled in the final cohort analysis. The high-sensitivity CRP level was measured by immunoturbidimetric assay. Hyperuricemia was defined as serum uric acid ≥7.0 mg/dL (416 μmol/L) in men and ≥6.0 mg/dL (357 μmol/L) in women. Multivariate logistic regression was used to analyze the association. Results During the 4 years follow-up, 474 participants developed hyperuricemia. Compared with participants in the lowest tertile of high-sensitivity CRP, the multivariate-adjusted odds ratio (OR) (95% confidence interval [CI]) for incident hyperuricemia in the highest tertile was 1.36 (1.02, 1.82). In the subgroup analyses, high-sensitivity CRP was positively associated with the incidence of hyperuricemia after multivariate adjustments (P for trend = 0.04) in women. Compared with the women in the lowest tertile of high-sensitivity CRP, the multivariate-adjusted OR (95% CI) in the highest tertile was 1.69 (1.10, 2.66). No statistically significant association was found in other subgroups. Conclusions The findings of this prospective cohort study suggest that higher level of high-sensitivity CRP is an independent risk factor for hyperuricemia in Chinese, especially in women.

High fructose consumption may be associated with slow coronary flow.

The precise pathophysiology of slow coronary flow (SCF) has not yet been clarified; however, many studies have shown that significant fructose consumption is associated with oxidative stress and inflammation, which may play a role in the pathophysiology of SCF. The aim of this study was to investigate the association between fructose consumption and isolated SCF. Patients with stable angina pectoris who underwent coronary angiography between December 2018 and April 2019 were evaluated for this study. In all, 45 patients with isolated SCF were selected as the patient group (SCF group) and 50 patients with a normal coronary flow pattern were enrolled as a control group. Participants used a dietary record to provide details of nutrient consumption and all of the data from the 2 groups were compared. The high-sensitivity C-reactive protein (Hs-CRP) level (p=0.024), white blood cell count (p=0.038), and smoking rate (p=0.012) were higher in the SCF group. Total energy (p=0.029), carbohydrate (p=0.047), and fructose consumption (p<0.001) were also higher in the SCF group. Multivariable logistic regression analysis demonstrated that a higher level of Hs-CRP, fructose consumption, and smoking were independently associated with SCF. The SCF group demonstrated a higher level of fructose consumption. Excessive fructose consumption may play a role in SCF pathophysiology.

Plasma Levels of IL-6, IL-8, IL-10, ICAM-1, VCAM-1, IFNγ, and TNFα are not Associated with Delayed Cerebral Ischemia, Cerebral Vasospasm, or Clinical Outcome in Patients with Subarachnoid Hemorrhage

Delayed cerebral ischemia (DCI) is a serious and frequent complication following subarachnoid hemorrhage (SAH). The pathophysiology behind DCI remains poorly understood, but inflammation has been proposed to play a significant role. This study investigated the relationship between plasma levels of some of the most important inflammatory markers and DCI, cerebral vasospasm, and functional outcome in patients with SAH. In 90 patients with SAH, interleukin-6, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, high sensitivity C-reactive protein (HsCRP), interleukin-8, interleukin-10, interferon gamma, and tumor necrosis factor alpha were measured in peripheral blood day 3 and day 8 after SAH. Any occurrence of DCI or infection was recorded, and computed tomography angiography was performed on day 8. Clinical outcome was assessed after 3 months. HsCRP on day 3 was higher in patients with angiographic vasospasm (P= 0.003), and HsCRP on day 8 was higher in patients with poor outcome (P= 0.014). No association with DCI, vasospasm, or outcome was found for any of the remaining analyzed substances. High plasma levels of HsCRP were significantly associated with angiographic vasospasm and clinical outcome. Plasma levels of interleukin-6, vascular cell adhesion molecule-1, intercellular adhesion molecule-1, interleukin-8, interleukin-10, interferon gamma, and tumor necrosis factor alpha were not associated with DCI, angiographic vasospasm, or clinical outcome at 3 months.

Predictors of Coronary Slow Flow Phenomenon: A Retrospective Study

Abstract Aim This study aimed to analyze laboratory predictors, angiographic profile, clinical profile, and risk factors for coronary slow flow (CSF) phenomenon without coronary obstructive lesion in patients who came for a coronary angiogram. Materials and Methods The case-control study consisted of patients who underwent coronary angiography and were divided into two groups: patients with coronary slow flow (case group, n = 100) and patients with the normal coronary flow (control group, n = 100). Coronary flow was studied using corrected thrombolysis in myocardial infarction frame count (CTFC). The slow flow was defined as CTFC beyond 2 standard deviations from the normal published range. Risk factors including age, sex, diabetes mellitus (DM), hypertension, dyslipidemia, smoking, body mass index (BMI), hematological and biochemical parameters (complete blood picture, platelet count, total and differential leucocyte count, platelet-to-lymphocyte ratio [PLR], neutrophil-to-lymphocyte ratio [NLR] and lipid profile) were assessed. In both groups, clinical information was collected, and laboratory parameters were measured and compared. Results Patients with CSF were more likely to be male and active smokers. Total cholesterol, triglyceride, BMI, and DM were more commonly seen in the CSF group compared with the control group. Inflammatory markers like uric acid (p = 0.03) and high-sensitivity C-reactive protein (Hs-CRP) (p = 0.000) were found to be statistically significant. Hematocrit (p = 0.023), NLR (p = 0.001), total cholesterol (p = 0.000), triglycerides (p = 0.000), and BMI (p = 0.000) were statistically significant. PLR has the tendency of statistically significance (p = 0.059) BMI, total cholesterol, triglycerides, and Hs-CRP were strong predictors for CSF. Conclusion CSF was common in males, smokers, DM patients, and it was associated with high NLR, uric acid, and Hs-CRP levels. The independent predictor of CSF was BMI, total cholesterol, triglycerides, and Hs-CRP levels. These findings provide an impetus for additional studies to confirm the role of other inflammatory markers in CSF patients and treatment strategies depending on that.

Sub-clinic atherosclerosis in patients with postprandial reactive hypoglycemia

Aim: Hypoglycemia is associated with excessive cardiovascular mortality because of the pro-inflammatory and pro-atherothrombotic pathway stimulation. Hypoglycemia is known to affect the development of sub-clinic atherosclerosis. This study aims to determine the development of sub-clinic atherosclerosis in patients with postprandial reactive hypoglycemia by investigating thickness of carotid intima media and epicardial fat, and high-sensitivity C-reactive protein values and their relationships with each other.Material and Methods: 51 patients in total were included in the project, including 28 patients (37.50±10.82 years) who had hypoglycemia symptoms and who had hypoglycemia during prolonged oral glucose tolerance test and 23 healthy adult volunteers (35.01±10.92 years) as a control group. Subjects underwent echocardiographic examination including EFT and IMT measurement using transthoracic echocardiography.Results: Postprandial Reactive Hypoglycemia group were marked with higher high-sensitivity C-reactive protein levels (1.67±0.67 vs. 1.20±0.52; p= 0.007), carotid intima media thickness (0.65±0.10 vs. 0.50±0.10; p0.001) and epicardial fat thickness (0.57±0.07 vs. 0.48±0.08; p= 0.001) values as compared to the control group.Conclusion: Patients with postprandial reactive hypoglycemia had impaired epicardial fat thickness and increased thickness of carotid intima media, and carotid intima media thickness linked with significantly with high-sensitivity C-reactive protein. These observations support the importance of chronic inflammation mechanism for the development of sub-clinic atherosclerotic disease in postprandial reactive hypoglycemia.

Association of Musculoskeletal Disorders and Inflammation Markers in Workers Exposed to Lead (Pb) from Pb-battery Manufacturing plant.

Background:Lead (Pb) deposits in the skeletal system on chronic exposure and releases to circulation over a period. The musculoskeletal disorders (MSDs) are associated with enhanced expression of inflammation. The combination of Pb-exposure and MSDs induced inflammation was not attempted.Objective:This study was conducted to examine the association between MSDs and inflammatory markers in workers exposed to Pb from Pb-battery plant.Material and Methods:In a case-control study design, the study enrolled 176 male Pb-exposed workers as study subjects and 80 healthy workers with no occupational exposure to Pb as control subjects. The Nordic musculoskeletal questionnaire was used to assess the MSDs. From the blood sample, blood lead level (BLL) and High Sensitivity C-reactive protein (Hs-CRP) were estimated as markers of Pb-exposure and Inflammatory marker respectively. The BLL was estimated by flame atomic absorption spectrometric method and the Hs-CRP by using a diagnostic kit method.Results:Significantly high proportions of MSDs were noted in study subjects as compared to controls. The MSDs identified in the study subjects were at low back (33%) followed by knee (26%), shoulders (16%), neck (14%), ankle/foot (11%), wrist/hand (10%), elbows (8%), upper back (7%), and hips/thighs (5%). The significant association between Pb-exposure and MSDs among study subjects was mainly noted in low back and ankle/foot. Also, significantly high serum Hs-CRP levels were noted among study subjects with ankle/foot MSDs.Conclusion:Pb-exposure and inflammatory markers were significantly associated with lower limbs of MSDs.

The role of high high-sensitivity C-reactive protein levels at admission on poor prognosis after acute ischemic stroke

Objective: Plasma high hypersensitive C-reactive protein (hs-CRP) levels are associated with risk and prognosis of vascular diseases. The clinical implications of markedly elevated hs-CRP levels are more discovered in the onset and development of stroke. The aim of this study is to determine the association of plasma hs-CRP levels on the prognosis in patients with acute ischemic stroke.Methods: Retrospective analysis of a single-center database of consecutive cases for acute cerebral infarction (ACI) from January 1 2012 to December 30 2016 was performed. Significant predictors of the dependent variable variance were identified by standard linear, univariate and multivariate, or binary logistic regression modeling. Multivariate regression analysis was introduced to investigate the relationship between plasma hs-CRP levels at admission and change in National Institutes of Health Stroke Scale (NIHSS) score at discharge.Results: The percentages of hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, body mass index (BMI) and chronic kidney disease were raised with the increase of hs-CRP plasma concentration at admission among all patients (p < 0.05). ACI patients with large-artery atherosclerosis had an increasing percentage with the increase of hs-CRP mean value (p < 0.05). The initial NIHSS scores, the acute infection rate and age advance also increased with the increase of hs-CRP plasma concentration at admission (p < 0.05). The ratio of neurological improvement increased with the decrease of plasma hs-CRP concentration (p < 0.05). The neurological deterioration and poor prognosis increased with the increase of plasma hs-CRP concentration (p < 0.05).Conclusion: High plasma hs-CRP levels are associated with worse outcomes in the ACI patients. Monitoring plasma hs-CRP levels and cutting down the elevated plasma hs-CRP levels will be beneficial in screening and treatment decisions for the prognosis of acute ischemic stroke.

The value of time-averaged serum high-sensitivity C-reactive protein in prediction of mortality and dropout in peritoneal dialysis patients.

PurposeC-reactive protein (CRP) is a useful biomarker for prediction of long-term outcomes in patients undergoing chronic dialysis. This observational cohort study evaluated whether the time-averaged serum high-sensitivity CRP (HS-CRP) level was a better predictor of clinical outcomes than a single HS-CRP level in patients undergoing peritoneal dialysis (PD).Patients and methodsWe classified 335 patients into three tertiles according to the time-averaged serum HS-CRP level and followed up regularly from January 2010 to December 2014. Clinical outcomes such as cardiovascular events, infection episodes, newly developed malignancy, encapsulating peritoneal sclerosis (EPS), dropout (death plus conversion to hemodialysis), and mortality were assessed.ResultsDuring a 5-year follow-up, 164 patients (49.0%) ceased PD; this included 52 patient deaths (15.5%), 100 patients (29.9%) who converted to hemodialysis, and 12 patients (3.6%) who received a kidney transplantation. The Kaplan–Meier survival analysis and log-rank test revealed a significantly worse survival accumulation in patients with high time-average HS-CRP levels. A multivariate Cox regression analysis revealed that a higher time-averaged serum HS-CRP level, older age, and the occurrence of cardiovascular events were independent mortality predictors. A higher time-averaged serum HS-CRP level, the occurrence of cardiovascular events, infection episodes, and EPS were important predictors of dropout. The receiver operating characteristic analysis verified that the value of the time-average HS-CRP level in predicting the 5-year mortality and dropout was superior to a single serum baseline HS-CRP level.ConclusionThis study shows that the time-averaged serum HS-CRP level is a better marker than a single baseline measurement in predicting the 5-year mortality and dropout in PD patients.

The role of very high high-sensitivity C-reactive protein levels on mortality after stroke

High-sensitivity C-reaction protein (hsCRP) levels are correlated with risk of vascular disease. The clinical implications of markedly elevated hsCRP levels in the setting of acute stroke are less understood. ObjectiveTo determine the association of very high admission hsCRP levels (≥10mg/L) on all-cause mortality in patients with acute stroke. MethodsA retrospective cohort study of 1176 patients hospitalized with acute stroke between 2005 and 2012 who had a hsCRP assay drawn within seven days of admission. Mortality data was obtained using Ohio Death Index. Cox proportional analysis was used to determine hazard ratios of death among patients with hsCRP values >10mg/L after adjusting for age, sex, race and relevant co-morbid conditions. NIHSS was also adjusted in a subset of patients in whom it was available (n=378). ResultsPatients with hsCRP >10mg/L had 2.65 (95% CI: 1.99, 3.53) increased hazard of all-cause mortality compared to stroke patients with hsCRP ≤10mg/L. Association of hsCRP with mortality was greater for patients with low NIHSS and declined in patients with increasing NIHSS scores. A higher proportion of patients with hsCRP >10 died from nonvascular causes than patients with hsCRP ≤10mg/L. ConclusionVery high levels of hsCRP may be a useful marker to identify stroke patients at increased risk for death, especially those with stroke of mild severity. More research is needed to determine how this information can be used to improve patient care, especially in patients with mild stroke.

Effect of chronic inflammation on coronary arteries in renal amyloidosis: More than renal dysfunction

Effect of chronic inflammation on coronary arteries in renal amyloidosis: More than renal dysfunction

Cardiovascular Risk Factors and Markers of Atherosclerosis in Stable Kidney Transplant Recipients

BackgroundThere is limited evidence regarding the risk factors influencing vascular injury in kidney transplant recipients, except for accelerated vasculopathy and endothelial dysfunction in the pre-transplantation period of end-stage renal failure. Therefore, we performed a cross-sectional study to evaluate the role of traditional and novel or potential nontraditional risk factors in vascular and endothelial dysfunction in a cohort of stable kidney transplant recipients. MethodsOne hundred forty-two kidney transplant recipients at 8.4 ± 1.8 years after transplantation were enrolled into the study. Different markers of vascular injury, such as carotid intima-media thickness (IMT), pulse wave velocity (PWV), and peripheral arterial tonometry (PAT), were assessed. Inflammatory markers, oxidative stress and endothelial function surrogate markers, adhesion molecules, and parathormone and osteoprotegerin levels were measured. ResultsAmong traditional risk factors, only age, pre-transplantation diabetes, left ventricular hypertrophy (LVH) and cardiovascular disease (CVD) were related to increased IMT and PWV, whereas PAT values were significantly decreased only in diabetics and patients with CVD and were similar in patients with and without LVH. In multivariate regression analysis, IMT was explained by age, previous CVD episodes, and higher high-sensitivity C-reactive protein levels, and PWV by age and pre-transplantation diabetes. The regression analysis failed to find any significant explanatory variables for PAT. Conclusions1. In stable kidney transplant recipients, age, pre-transplantation diabetes, previous cardiovascular episode, and systemic microinflammation were predictors of vascular injury. 2. PAT is poorly associated with traditional CV risk factors and does not correspond with levels of biochemical markers of endothelial dysfunction in those patients.

Clinical significance of interleukin-6, tumor necrosis factor-α and high-sensitivity C-reactive protein in neonates with hypoxic-ischemic encephalopathy.

The present study aimed to investigate the potential roles of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (Hs-CRP) in the progression and prognosis of neonatal hypoxic-ischemic encephalopathy (HIE). The observation group comprised 74 neonates with HIE and the control group comprised 74 healthy neonates. The serum levels of IL-6, TNF-α and Hs-CRP were measured in the patients with HIE and the normal control infants. The correlations between the variances in the levels of these inflammatory cytokines and the different clinical gradings and prognoses of the disease were analyzed. The data revealed significant upregulation of the serum levels of IL-6, TNF-α and Hs-CRP in patients with HIE. The increase in the levels of these inflammatory mediators correlated with the severity of the disease and also had a positive correlation with the prognosis of the disease. In conclusion, high levels of IL-6, TNF-α and Hs-CRP were observed in neonatal patients with HIE. Thus, these inflammatory mediators may play a role in the progression and prognosis of the disease.