Higher Serum C-reactive Protein Levels Research Articles

Genetic polymorphisms of regulatory T cell-related genes modulate systemic inflammation induced by viral hepatitis.

Viral hepatitis is a devastating disease with the risk for cirrhosis and carcinogenicity. Regulatory T cells (Tregs) play important roles in the disease course of viral hepatitis via maintaining the balance between overt-immune responses and viral replications. We hypothesized that genetic polymorphisms of Treg-related genes, such as interleukin-2, transforming growth factor-β 1 (TGF-β1), forkhead box P3 (FOXP3), and adenylyl cyclase type 9 modulate the hosts' immune regulation under circumstances of viral hepatitis. We examined the effect of five single nucleotide polymorphisms (SNPs) of Treg-related genes on the levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), alanine aminotransferase, and non-invasive hepatic fibrosis marker (Fibrosis-4 index) in a total of 138 participants with viral hepatitis. The rs1800469 (a TGF-β1 SNP) GG genotype is associated with higher serum CRP levels, and the rs3761547 (a FOXP3 SNP) C allele in the females is associated with higher ESR levels. Besides, female participants carrying the rs3761547 C allele had a significantly higher Fibrosis-4 (FIB-4) index than the females carrying the TT genotype, while the rs3761547 C allele had the opposite effect in males. With linear-regression moderation analysis, we found that sex moderated the impact of the FOXP3 SNP on the levels of FIB-4, whereas the FOXP3 SNP caused the opposite effect between males and females on the severity of hepatic fibrosis. These results provide evidence for the participation of TGF-β1 and FOXP3 in the inflammatory responses associated with viral hepatitis, where FOXP3 function may be moderated by sex.

Association between Serum C-reactive Protein and Pre-eclampsia

Among the common disorders of pregnancy, Pre-eclampsia is important one which causes significant maternal and perinatal morbidity and mortality. Its incidence is still high in the developing countries. The triad of high blood pressure, edema and albuminuria is neither specific nor sensitive enough; therefore, a reliable biochemical marker is needed to solve the problem. C-reactive protein(CRP), a marker of tissue damage and inflammation, is elevated in serum in overt preeclampsia. The present study is aimed to explore the association of high maternal serum C-reactive protein (CRP) level with preeclampsia and correlation with the severity of pre-eclamptic process. A total of 60 pregnant women constituting 30 pre-eclamptic (case) and 30 normal (control) pregnant women in the third trimester were enrolled in this study. Both the groups were matched for their age, parity and other baseline characteristics. More than three quarters (76.70%) of the case group exhibited raised serum CRP, which was 20% in control group (p=0.001). CRP was elevated about 13 fold higher than that in the normal pregnant women. The mean systolic and diastolic blood pressure were significantly higher in case group (154±12 mm of Hg) vs (107±7 mm of Hg) in control group (p<_0.001) and serum level of CRP bears linear relationship with both systolic and diastolic blood pressures. Preeclamptic women with higher serum CRP level were at a significantly (p<0.001) lower gestational age than control. Twenty two (73.30%) cases had gestational age <37 weeks (p=0.302) and 66.70% control group had gestational age > 37 weeks. The hypothesis of the study was supported by the study findings that maternal CRP concentration was higher in women with preeclampsia and was correlated with disease progression as evidenced by the investigative analysis. Faridpur Med. Coll. J. Jan 2020;15(2): 58-61

Correlation between serum levels of C-reactive protein and neonatal pneumonia: A protocol for systematic review and meta-analysis.

Background:Few studies have reported the correlation between serum levels of C-reactive protein (CRP) and neonatal pneumonia. The purpose of the present meta-analysis was to clarify whether an increased serum level of CRP accelerates the development of neonatal pneumonia.Methods:This protocol is conducted according to the preferred reporting items for systematic reviews and meta-analysis protocol (PRISMA-P) statement guidelines. Related articles were identified by searching PubMed, Embase, Cochrane Library, Web of Science, Science Direct, and CNKI databases. Two investigators extracted information according to the selection criteria and used a set of predefined criteria based on the Newcastle–Ottawa Scale (NOS) criteria to assess the studies. All calculations were carried out with Stata 12.0 (Stata Corp, College Station, TX).Results:The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.Conclusion:We hypothesized that a higher serum CRP level is closely correlated with the progression of neonatal pneumonia. CRP as a general systemic inflammation biomarker may help clinicians to make difficult therapeutic decisions for neonatal pneumonia.Open Science Framework registration number:10.17605/OSF.IO/RGBMX.

Serum C-Reactive Protein and Interleukin-6 Levels as Biomarkers for Disease Severity and Clinical Outcomes in Patients with Idiopathic Granulomatous Mastitis.

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease mimicking breast cancer. Limited research has been conducted on the application of serum biomarkers. This study aims to investigate the association of serum biomarkers with disease severity in patients with IGM. From November 2011 to March 2020, medical records of patients with IGM were reviewed. Serum cytokine levels were measured in patients and healthy controls between July 2018 and March 2020. A total of 41 patients with histologically proven IGM were found. Serum interleukin (IL)-6 level was significantly higher in patients with IGM (n = 11) than healthy controls (n = 7). Serum IL-6 and C-reactive protein (CRP) levels were significantly higher in patients with severe disease than mild and moderate disease. Serum IL-6 (Spearman’s ρ = 0.855; p < 0.001) and CRP (Spearman’s ρ = 0.838; p = 0.001) levels were associated with time to resolution. A higher serum CRP level was associated with a longer time to resolution (B = 0.322; p < 0.001) in multiple linear regression analysis. Serum IL-6 and CRP levels can be used as biomarkers for the evaluation of disease severity in IGM. IL-6 may play a crucial role in the immunopathology of IGM.

Giant Cell Arteritis

Giant cell arteritis (GCA), also referred to as temporal arteritis, is a variant of large-vessel vasculitis. GCA should be considered in the differential diagnosis in patients aged >50 years, who present with headache, abrupt onset of visual disturbances, unexplained fever, a high erythrocyte sedimentation rate, and high serum C-reactive protein levels. Diagnosis of GCA is based on accurate interpretation of laboratory data, temporal artery biopsy findings, and imaging study results. Imaging modalities used for GCA include positron emission tomography, computed tomography (CT), CT angiography, and conventional magnetic resonance angiography. Biopsy is the gold standard for diagnosis of GCA. Glucocorticoids (GCs) are used as standard treatment to induce remission and also for maintenance therapy. However, clinicians should be aware of the adverse effects of GC treatment, including hyperglycemia, an immunocompromised state, and delirium. If adverse effects outweigh the benefits of GC treatment, it is necessary to consider switching to or adding an immunosuppressant to the therapeutic regimen.

A High Postoperative Serum C-reactive Protein Level Has a Negative Impact on Long-term Survival, Regardless of Postoperative Infectious Complications, in Patients Who Undergo Laparoscopic Surgery for Colorectal Cancer.

We previously showed that an elevated postoperative serum C-reactive protein (CRP) level has a negative impact on long-term survival outcomes, regardless of the occurrence of infectious complications in colorectal cancer. However, the cause of postoperative inflammation could not be properly evaluated, because patient background factors, such as the surgical approach (open/laparoscopic), were not unified. A total of 277 patients who underwent laparoscopic surgery for stage II/III colorectal cancer were enrolled. The high-CRP group had lower relapse-free and overall survival rates in comparison to the low-CRP group. A high postoperative serum CRP level was significantly associated with a larger tumor diameter and longer operation time, and tended to be associated with a higher T stage and larger amount of bleeding. Larger tumor volume, longer operation time and larger amount of bleeding were associated with the promotion of postoperative inflammation, which worsened long-term survival outcomes in colorectal cancer.

High serum C-reactive protein levels predict survival in patients with treated advanced lung adenocarcinoma.

BackgroundThe prognosis of non-small cell lung cancer (NSCLC) varies greatly depending on whether or not it can receive molecular-targeted drug treatment including epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs). We investigated the clinical utility of C-reactive protein (CRP) levels measured at the time of diagnosis in EGFR-mutant and wild-type NSCLC patients who had undergone first-line therapy.MethodsSerum CRP levels were analyzed in 213 patients, of whom 89 patients had advanced EGFR-mutated NSCLC who underwent first-line EGFR-TKI treatment. We used Cox proportional hazards models to study the relationship between CRP and overall survival (OS). CRP cutoff values were obtained from the receiver operating characteristic curve.ResultsMean serum CRP level in treated NSCLC patients were not significantly different in patients with or without EGFR mutations. The optimal CRP cutoff values were 8.1 mg/L for EGFR-mutated NSCLC and 16.7 mg/L for EGFR-wild NSCLC. Based on multivariate analysis, high CRP level (EGFR-mutated, HR: 2.479, 95% CI: 1.331–4.619, P=0.004; EGFR-wild, HR: 3.625, 95% CI: 2.149–6.116, P<0.001) was a significant and independent negative prognostic factor for OS in patients with or without EGFR mutations.ConclusionsHigh CRP levels predicted a lack of response to treatment in patients with advanced lung adenocarcinoma with or without EGFR mutations. Thus, the CRP level is a good and easy to use prognostic factor and objective indicator for clinical practice.

Prediction of 72-hour mortality in patients with extremely high serum C-reactive protein levels using a novel weighted average of risk scores.

The risk factors associated with mortality in patients with extremely high serum C-reactive protein (CRP) levels are controversial. In this retrospective single-center cross-sectional study, the clinical and laboratory data of patients with CRP levels ≥40 mg/dL treated in Saitama Medical Center, Japan from 2004 to 2017 were retrieved from medical records. The primary outcome was defined as 72-hour mortality after the final CRP test. Forty-four mortal cases were identified from the 275 enrolled cases. Multivariate logistic regression analysis (MLRA) was performed to explore the parameters relevant for predicting mortality. As an alternative method of prediction, we devised a novel risk predictor, "weighted average of risk scores" (WARS). WARS features the following: (1) selection of candidate risk variables for 72-hour mortality by univariate analyses, (2) determination of C-statistics and cutoff value for each variable in predicting mortality, (3) 0-1 scoring of each risk variable at the cutoff value, and (4) calculation of WARS by weighted addition of the scores with weights assigned according to the C-statistic of each variable. MLRA revealed four risk variables associated with 72-hour mortality-age, albumin, inorganic phosphate, and cardiovascular disease-with a predictability of 0.829 in C-statistics. However, validation by repeated resampling of the 275 records showed that a set of predictive variables selected by MLRA fluctuated occasionally because of the presence of closely associated risk variables and missing data regarding some variables. WARS attained a comparable level of predictability (0.837) by combining the scores for 10 risk variables, including age, albumin, electrolytes, urea, lactate dehydrogenase, and fibrinogen. Several mutually related risk variables are relevant in predicting 72-hour mortality in patients with extremely high CRP levels. Compared to conventional MLRA, WARS exhibited a favorable performance with flexible coverage of many risk variables while allowing for missing data.

Initial Serum C-reactive Protein Level as a Predictor of Increasing Serum Vancomycin Concentration During Treatment.

Vancomycin has a narrow therapeutic window, and an increase in its serum concentration-to-dose ratio during treatment can cause renal toxicity. Therefore, this study was aimed at finding a marker to identify patients at risk of increasing serum vancomycin during treatment. This was a retrospective cohort study of patients treated with vancomycin at Kanazawa University Hospital, Japan, from April 2012 to May 2015. Spearman correlation coefficients were calculated to determine the correlations between changes in vancomycin concentration-to-dose ratio and initial values or changes in laboratory data and other parameters. In addition, a multiple regression analysis was conducted. One hundred ninety-nine patients for whom 2 or more points of data on therapeutic drug monitoring (TDM) of intravenous vancomycin treatment were available and did not undergo dialysis were included in the study. Changes in vancomycin concentration-to-dose ratio were associated with C-reactive protein (CRP) and sodium (Na) levels on the initial day of TDM and with changes in white blood cell count, Na, and estimated glomerular filtration rates (eGFRs). Multiple regression analysis helped identify CRP and Na levels on the initial day of TDM and change in eGFR as independent influencing variables. A high serum CRP level on the initial day of TDM is an independent predictor of increasing vancomycin concentration-to-dose ratio in patients receiving intravenous vancomycin treatment, even if eGFR remains unchanged.

Clinical impact of creatine phosphokinase and c-reactive protein as predictors of postgastrectomy complications in patients with gastric cancer

BackgroundPostoperative complications have been linked to the morbidity and mortality of several cancers. However, predicting whether complications will occur in the early period after surgery or not is challenging. Hence, this study aimed to examine the diagnostic accuracy of serum creatine phosphokinase (CPK) and c-reactive protein (CRP) in predicting the development of postgastrectomy complications.MethodsWe retrospectively analyzed 188 patients with gastric cancer (GC) who underwent gastrectomy. The diagnostic accuracy of serum CPK and CRP was investigated using the areas under the curves (AUC). The CPK ratio was defined as the CPK on postoperative day (POD) 1 to the CPK on a preoperative day.ResultsOut of 188 patients, 48 (25.5%) developed postoperative complications. The complications group had a greater operative time (p = 0.037), higher CPK ratio on POD1 (p < 0.0001), and a higher serum CRP level on POD3 (p = 0.001). The AUC for the CPK ratio was 0.772, with an optimal cutoff value of 7.05, whereas that for CRP was 0.659, with an optimal cutoff value of 11.4 mg/L. The CPK ratio on POD1 (p < 0.0001) and the CRP on POD3 (p = 0.007) were independent factors for predicting the development of postgastrectomy complications. The CPK ratio on POD1 and the CRP on POD3 predicted postgastrectomy complications in 41 patients (85.4%). According to combined value of both CPK ratio and CRP level, the positive predictive value and the negative predictive value was 0.70 and 0.829. And sensitivity and specificity were 0.438 and 0.936.ConclusionThe CPK ratio on POD1 and the CRP on POD3 after gastrectomy for GC were predictive factors for complication development and may be employed to prevent the development of such complications and improve the prognosis of patients with GC.

Interaction between apolipoprotein E genotyping, serum inflammatory biomarkers and cognitive functions in Egyptian elderly

There is evidence consistent with the hypothesis that genetic, inflammatory and immune mechanisms are involved in the pathogenesis of AD. The aim of this study is to assess the relationship between Apolipoprotein E (Apo E), serum levels of inflammatory markers, and cognitive functions among elderly patients with Alzheimer's disease (AD) and Mild cognitive impairment (MCI) compared to elderly with normal cognitive function. 88 participants (≥60 years) from Ain Shams University Hospital were enrolled. They were divided into 3 groups: Group A (32 elderly patients with AD), Group B (32 elderly patients with MCI) and Group C (24 controls with normal cognitive function). All participants were subjected to comprehensive geriatric assessment, Apo E genotyping, measurement of C-reactive protein (CRP) and Alpha-1-antichymotrypsin (ACT), by PCR-RFLP, ELIZA and semi-quantitative method respectively. The most common variant of Apo E gene was E3/E3 being more frequent in healthy control group (HC) than the other two groups and the least common variant was E4/E4 detected only in the AD group. ApoE4 allele was associated with 40.6% of AD patients (where 31.4% were heterozygous and 8.6 % homozygous) and 17.1% of MCI patients, whereas ApoE2 was more prevalent in the control group (P<0.05). A significant difference was observed when Mini mental status Examination (MMSE) score in different Apo E alleles was compared (P<0.01). The highest score was associated with (E2/E3) allele whereas, the lowest score was associated with (E4/E4) allele. Regarding inflammatory markers; CRP levels showed a statistically significant difference between the 3 groups and were higher in the AD group than the other 2 groups. (P<0.01). There was no statistically significant difference between the 3 groups as regard ACT level (P>0.05). Carriers of at least one E4 allele showed great risk to develop AD when combined with high CRP serum levels (OR = 36; CI: 11.4-113.7; P< 0.01). In conclusion, Apo E together with CRP may be a useful tool to predict Alzheimer's disease.

Serum Levels of CRP are Associated with Depression in a Middle-aged and Elderly Population with Diabetes Mellitus: A Diabetes Mellitus-Stratified Analysis in a Population-Based Study

BackgroundThe direct relationship between inflammation and depression in patients with diabetes is still unclear. We examined the association between serum C-reactive protein (CRP) levels and the high prevalence of depression in populations (aged ≥49 years) with and without type 2 diabetes. MethodsCross-sectional and longitudinal data from 3895 participants obtained from The Irish Longitudinal Study on Ageing (TILDA) were analyzed to determine the association between serum CRP levels and depression, accounting for relevant confounding factors. ResultsMultivariable analyses showed a positive association between serum CRP and depression score, independent of age and gender, BMI, marital status, education, smoking status, alcohol drinking status, systolic BP, diastolic BP, physical activity, self-reported CVDs and laboratory measurements in subjects with diabetes mellitus (coefficient = 0.179, P<0.001) but not in subjects without diabetes mellitus (coefficient = 0.011, P = 0.495). Higher serum CRP levels were associated with an increased risk of depressive symptoms in subjects with diabetes mellitus (OR = 1.301, 95% CI 1.012–1.799, P = 0.011) but not in subjects without diabetes mellitus (OR = 1.004, 95% CI 0.992–1.013, P = 0.344) after adjusting for these same confounding factors. After a follow-up of 4 years, higher serum CRP levels were significantly associated with a higher possibility of depression events in subjects with diabetes mellitus. LimitationsTime-varying confounding factors may interfere with our results. ConclusionWe observed a significant positive association between serum CRP levels and the prevalence of depressive symptoms in a middle-aged and elderly population with diabetes after adjustment for a range of lifestyle factors.

Serum C-Reactive Protein in Patients with Deficit Schizophrenia and the Relationship with Cognitive Function.

BackgroundSerum levels of C-reactive protein (CRP) were measured in patients with deficit schizophrenia (DS) to confirm the association between CRP level and cognitive performance and to determine whether CRP was a new biological indicator with the potential clinical applications in DS patients.MethodsThree independent samples [41 DS and 50 non-deficit schizophrenia (NDS) and 30 sex- and age-matched healthy controls (HCs)] were recruited in our study. Serum CRP levels were measured by immunofluorescence. The Positive and Negative Syndrome Scale (PANSS) and alternative forms of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were also assessed. And the relationships between serum CRP levels and both PANSS and RBANS scores were finally analyzed.ResultsThe results of serum CRP level were showed significantly different among the three groups and increased from the HCs to NDS patients to DS patients. There were also significant differences in the cognitive subdomain analyses among the three groups. Serum CRP levels were found positively correlated with total and negative PANSS scores, and showed negatively correlated with overall cognitive test scores in the DS samples.ConclusionSerum C-reactive protein levels and their association with cognitive performance were different between deficit schizophrenia and non-deficit schizophrenia samples, and higher serum CRP level was associated with worse cognitive performance in the DS patients. The results indicated that CRP could be a potential biomarker, and DS could be a distinct subset of schizophrenia.

Occult infection in pseudarthrosis revision after spinal fusion

Background ContextPseudarthrosis after attempted spinal fusion is yet not sufficiently understood and presents a surgical challenge. Occult infections are sometimes observed in patients with pseudarthrosis and no inflammatory signs of infection. The prevalence of such occult infection and its association with patient demographics and inflammatory markers are largely unknown. PurposeTo determine the prevalence of unexpected low-grade infection in spinal pseudarthrosis revision surgery, and to evaluate whether such infection is associated with patient demographics and inflammatory markers. Study DesignRetrospective observational study. Patient SampleOne-hundred-and-twenty-eight patients who underwent thoracolumbar revision surgery due to presumed aseptic pseudarthrosis after spinal instrumentation. Outcome MeasuresCulture-positive infections or noninfectious pseudarthrosis. MethodsSamples were routinely taken for microbiological examination from all adults (n=152) who underwent revision surgery for presumed aseptic thoracolumbar pseudarthrosis between 2014 and 2019. A full intraoperative microbiological workup (at least three intraoperative tissue samples) was done for 128 (84%) patients, and these patients were included in further analyses. Patient characteristics, medical history, inflammatory markers, and perioperative data were compared between those with and without microbiologically-confirmed infection based on samples obtained during pseudarthrosis revision. ResultsThe microbiological workup confirmed infection in 13 of 128 cases (10.2%). The predominant pathogen was Cutibacterium acnes (46.2%), followed by coagulase-negative staphylococci (38.5%). The presence of infection was associated with the body mass index (30.9±4.7 kg/m2 [infected] vs. 28.2±5.6 kg/m2 [controls], p=.049), surgery in the thoracolumbar region (46% vs. 18%, p=.019), and a slightly higher serum C-reactive protein level on admission (9.4±8.0 mg/L vs. 5.7±7.1 mg/L, p=.031). Occult infection was not associated with age, sex, prior lumbar surgeries, number of fused lumbar levels, American Society of Anesthesiologist score, Charlson Comorbidity Index, presence of diabetes mellitus, and smoking status. ConclusionsOccult infections were found in 10% of patients undergoing pseudarthrosis revision after spinal fusion, even without preoperative clinical suspicion. Occult infection was associated with higher body mass index, fusions including the thoracolumbar junction, and slightly higher C-reactive protein levels. Intraoperative microbiological samples should be routinely obtained to exclude or identify occult infection in all revision surgeries for symptomatic pseudarthrosis of the spine, as this information can be used to guide postoperative antibiotic treatment.

Prognostic Significance of Combined Platelet Distribution Width and C-Reactive Protein Score in Esophageal Cancer.

The platelet distribution width (PDW) and serum C-reactive protein (CRP) levels are known to be predictive of prognosis in various malignancies. Our aim was to determine whether combining PDW and serum CRP levels produces a prognostic indicator for esophageal cancer (EC) patients. A total of 168 EC patients who underwent neoadjuvant therapy prior to esophagectomy were included in this study. We defined a combined PDW and CRP (CPC) score as follows: patients with both low pretherapeutic PDW (≤12.4 fl) and high postoperative serum CRP levels (≥0.5 mg/dl) were assigned a score of 2, while patients with one or neither of those were assigned a score of 1 or 0. A multivariable analysis showed that the CPC score was a significant risk factor for overall (p=0.006) and recurrence-free (p=0.004) survival. The CPC score is a strong prognostic indicator in EC patients.

Physical Frailty among Urban-Living Community-Dwelling Older Adults in Malaysia.

Frailty is a multidimensional syndrome, which is a worldwide concern within the field of geriatrics due to the aggravating effect on the physical and mental functions of the elderly. This study aimed to determine the prevalence and risk factors of the frailty syndrome among urban-living community-dwelling elderly in Malaysia. A cross-sectional study was conducted among 301 community-dwelling elders. Frailty status was assessed using the Fried phenotype criteria. Depressive symptoms were assessed using the Geriatric Depression Scale (M-GDS-14), whereas the functional abilities and cognitive status were measured using the Lawton Instrumental Activities of Daily Living (Lawton IADL) scale and the Mini-Mental State Examination (MMSE-M), respectively. Malnutrition risk was observed through the abridged version (Short Form) of the Mini Nutritional Assessment (MNA-SF). Multinomial logistic regression analysis was employed to determine the significant predictors of the frailty syndrome. Three hundred and one elderly persons engaged in this study, with a mean age of 67.08 ± 5.536 ranging between 60 to 84 years old. The prevalence values of frailty and pre-frail were 15.9% and 72.8%, respectively, in which women appeared to be at a higher risk of frailty. The multivariate model revealed that frailty could be predicted from an increase in age, lower household income, being at risk of malnutrition, wasting (low skeletal muscle mass), and high serum C-reactive protein (CRP) level. A holistic approach is suggested for managing the frailty syndrome as it involves a decline in the multiple components of the geriatric syndrome.

Clinical, radiological, and laboratory characteristics and risk factors for severity and mortality of 289 hospitalized COVID-19 patients.

BackgroundThe coronavirus disease 2019 (COVID‐19) has become a global pandemic, with 10%‐20% of severe cases and over 508 000 deaths worldwide.ObjectiveThis study aims to address the risk factors associated with the severity of COVID‐19 patients and the mortality of severe patients.Methods289 hospitalized laboratory‐confirmed COVID‐19 patients were included in this study. Electronic medical records, including patient demographics, clinical manifestation, comorbidities, laboratory tests results, and radiological materials, were collected and analyzed. According to the severity and outcomes of the patients, they were divided into three groups: nonsurvived (n = 49), survived severe (n = 78), and nonsevere (n = 162) groups. Clinical, laboratory, and radiological data were compared among these groups. Principal component analysis (PCA) was applied to reduce the dimensionality and visualize the patients on a low‐dimensional space. Correlations between clinical, radiological, and laboratory parameters were investigated. Univariate and multivariate logistic regression methods were used to determine the risk factors associated with mortality in severe patients. Longitudinal changes of laboratory findings of survived severe cases and nonsurvived cases during hospital stay were also collected.ResultsOf the 289 patients, the median age was 57 years (range, 22‐88) and 155 (53.4%) patients were male. As of the final follow‐up date of this study, 240 (83.0%) patients were discharged from the hospital and 49 (17.0%) patients died. Elder age, underlying comorbidities, and increased laboratory variables, such as leukocyte count, neutrophil count, neutrophil‐to‐lymphocyte ratio (NLR), C‐reactive protein (CRP), procalcitonin (PCT), D‐dimer, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and blood urea nitrogen (BUN) on admission, were found in survived severe cases compared to nonsevere cases. According to the multivariate logistic regression analysis, elder age, a higher number of affected lobes, elevated CRP levels on admission, increased prevalence of chest tightness/dyspnea, and smoking history were independent risk factors for death of severe patients. A trajectory in PCA was observed from "nonsevere" toward "nonsurvived" via "severe and survived" patients. Strong correlations between the age of patients, the affected lobe numbers, and laboratory variables were identified. Dynamic changes of laboratory findings of survived severe cases and nonsurvived cases during hospital stay showed that continuing increase of leukocytes and neutrophil count, sustained lymphopenia and eosinopenia, progressing decrease in platelet count, as well as high levels of NLR, CRP, PCT, AST, BUN, and serum creatinine were associated with in‐hospital death.ConclusionsSurvived severe and nonsurvived COVID‐19 patients had distinct clinical and laboratory characteristics, which were separated by principle component analysis. Elder age, increased number of affected lobes, higher levels of serum CRP, chest tightness/dyspnea, and smoking history were risk factors for mortality of severe COVID‐19 patients. Longitudinal changes of laboratory findings may be helpful in predicting disease progression and clinical outcome of severe patients.

Clinical significance of peripheral blood CD11b+/CD33+/HLA-DR- myeloid cells in infants and children with infectious diseases and increased CRP.

Background: At early ages, recurrent or persistent infections are associated with increased serum C-reactive protein (CRP). Inflammatory mediators release inhibitory cells named myeloid-derived suppressor cell (MDSC) into circulating and tumor tissues. In the present study, we assayed the percentage and count of whole blood CD11b+/CD33+/HLA-DR- MDSCs or myeloid cells at early ages with infectious diseases and increased CRP. Methods: In this study, the clinical significance of CD11b+/CD33+/HLA-DR- MDSCs or myeloid cells was evaluated in whole blood samples from 40 patients with infectious disease and 20 healthy controls by flow cytometry analysis. Subsequently, the Pearson correlation between the percentage and absolute count of MDSCs with clinical parameters were obtained by SPSS analysis. A p value of < 0.05 was considered statistically significant. Results: We found a significantly higher level of MDSCs in infants and children with infectious diseases and increased CRP as compared to healthy controls (P=0.003). However, the results of analysis showed no correlation between MDSC percentage and count with grouped age and sex in patient groups. Conclusion: Our findings showed a significant correlation between the high level of serum CRP and peripheral blood CD11b+/CD33+/HLA-DR- MDSCs at early ages. This study could be a roadmap for future studies to use increased CRP as a potential prognostic biomarker to target MDSCs in children with recurrent or persistent infections.

Use of saliva sample to detect C-reactive protein in children with pneumonia.

Serum C-reactive protein (CRP) is a sensitive biomarker for inflammation and is broadly used to clinically diagnose infectious diseases, including pneumonia. However, blood sampling is fraught with technical difficulties in children. The salivary analysis may be a potential diagnostic tool, as it is noninvasive, patient-friendly, and easy to perform in children. This study aimed to evaluate the use of salivary CRP as a biomarker for children with pneumonia. A prospective study was conducted in patients aged 2 to 17 years, admitted to the hospital with pneumonia. Saliva and serum samples for CRP and chemokine determination were collected at the initial admission and during a follow-up from pediatric patients with pneumonia. Salivary samples were also collected from healthy subjects used as controls. A total of 60 healthy children and 106 pediatric patients with pneumonia were enrolled in this study. The salivary CRP level was much higher in pediatric patients with pneumonia than in healthy children (48.77 ± 5.52 ng/mL vs 14.78 ± 3.92 ng/mL; P < .001). Salivary CRP level was highly correlated with serum CRP level in pediatric patients with pneumonia (r = .679; P < .001). Salivary CRP level (≥40.307 ng/mL) can be used to predict high serum CRP levels (≥80 mg/L) with an area under the curve of 0.810 (95% confidence interval, 0.740-0.881). As pneumonia improved, both salivary and serum CRP levels decreased during follow-up. Salivary CRP could be an alternative biomarker for serum CRP in pediatric patients with pneumonia. This is especially beneficial for pediatric patients, as saliva collection is simple, noninvasive, and patient-friendly.

ANCA-associated nephritis without crescent formation has atypical clinicopathological features: a multicenter retrospective study

Although crescentic glomerulonephritis is a hallmark of ANCA-associated nephritis, the clinicopathological features of ANCA-associated nephritis without crescent formation remain to be elucidated. We enrolled 146 Japanese ANCA-associated vasculitis (AAV) patients subjected to renal biopsy in 16 hospitals from 2001 to 2018, and compared those with and without crescent formation (C + and C- groups). The primary endpoint was end-stage renal disease (ESRD) and/or death. C- group comprised 25 (17.1%) subjects. They had better renal function at the time of renal biopsy [estimated glomerular filtration rate (eGFR); median 41.7 vs 27.5ml/min/1.73m2, p < 0.01] with minor urinary abnormalities but had a higher serum C-reactive protein level (8.8 vs 5.4mg/dl, p = 0.01) and frequency of extra-renal lesions of AAV (76.0% vs 48.8%, p = 0.02) than C + group. Pathologically, C- group had a higher frequency of arteritis (40.0% vs 16.5%, p < 0.01). Kaplan-Meier method with log-rank tests showed no significant difference in renal and life prognosis combined, regardless of crescent formation. Multivariate Cox regression analysis revealed baseline eGFR, sclerotic class, and extra-renal lesions to be risk factors of ESRD and death combined. Competing risk analysis showed baseline eGFR and sclerotic class to be associated with ESRD, whereas baseline eGFR and extra-renal lesions were associated with death. ANCA-associated nephritis without crescent formation had different clinicopathological features from those with crescent formation, suggesting an atypical subtype of ANCA-associated nephritis. Despite the better renal function at the time of renal biopsy, these results suggest that this subtype requires especially careful attention, especially in the presence of extra-renal involvement.