Higher CRP Levels Research Articles

Liver Enzyme Correlated with C-Reactive Protein as a Biomarker of Metabolic Syndrome in Elderly Patients

Metabolic syndrome is a multifactorial disease with various risk factors that arise from insulin resistance associated with obesity, diabetes, hypertension, and dyslipidemias. Objective: To investigate the association between C-Reactive Protein and various risk factors related to CVS and metabolic health in elderly adults. Increased levels of various liver enzymes were found to be indicative of the progression of metabolic syndrome. Methods: In this study, total of 150 individuals with diagnosed metabolic syndrome were included, and they were compared to an equal number of control cases. The participants were selected from individuals visiting the Pathology and Molecular Biology Laboratories in Karachi for lab investigations. before collecting blood samples, basic vital signs, blood pressure, height, and waist circumference measurements were recorded to determine the participants' body mass index. The blood samples were then taken to assess liver enzyme levels and CRP. Results: The study examined and compared the levels of inflammatory marker and liver enzymes in both cases of metabolic syndrome (MetS) and the control group. The findings revealed a significant association (p-value of 0.001) between metabolic syndrome and elevated levels of liver enzymes and CRP. Specifically, the suspected cases of metabolic syndrome showed strong correlations with alanine aminotransferase, gamma-glutamyl transferase, and aspartate aminotransferase. However, alkaline phosphatase did not show substantial differences between the two groups. Conclusions: Our research revealed correlation between metabolic syndrome, liver enzymes and CRP. These findings indicate that high levels of liver enzymes and CRP can be indicative of cardiovascular functional abnormalities in elderly patients with metabolic syndrome.

Temporary trends of cardiac device related infective endocarditis in a tertiary referral center between 2006 and 2022

Abstract Funding Acknowledgements Type of funding sources: None. Background Infective endocarditis (IE) is a rare, but life-threatening complication of cardiac device implantation. Despite recent preventive strategies and advances in antimicrobial and surgical treatment, morbidity and mortality rates are still high. Aims The objective of our study was to assess the epidemiological characteristics, temporal trends and mortality rates of cardiac device related IE (CDRIE) in our high-volume, tertiary referral center. Methods retrospective data collection was performed between January 1, 2006 and March 31, 2022. Median follow-up was 3.8 yrs (IQR: 0.6 – 9.2 yrs). Patients admitted between 2006 and 2013 (group 1) and between 2014 and 2022 (group 2) were compared to assess temporal trends. Thirty-day, 6-month and 1-year mortality rates were estimated. Results During the observed 17 years 82 patients were admitted with CDRIE (61 males [74%]), mean age: 57.3 ±18 yrs; 6 VVI, 7 VDD, 17 VVI-ICD, 24 DDD, 10 DDD-ICD and 18 CRT devices [4 CRT-P, 14 CRT-D]); median time since first implantation was 3.8 yrs [IQR: 1.1 – 6.6 yrs]). Staphylococci were the most prevalent infective agents (62%), S. aureus (SA) infection was found in 37 cases (out of whom 13 were MRSA [16%]), coagulase negative Staphylococcus in 14 cases (17%), Enterococcus faecalis in 9 cases (11%), streptococci in 4 cases (5%), blood culture was negative in 13 cases (15%), and in 5 cases other pathogens were the underlying microorganism. Patients in Group 1 (n=42) did not differ from patients in Group 2 (n=40) in terms of age, male gender or ejection fraction. Patients in Group 2 had higher CRP level at admission (42,9 [IQR:34-55] mmol/l vs 90 [IQR:25-60] mmol/l, p=0.02). ICD lead (29% vs 67%, p<0.001) and E. faecalis infection (2% vs 20%, p=0.03) and percutan extraction (55% vs 75%, p=0.05) were more prevalent in Group 2. The 30-day and 6-month mortality rates were worse in Group 2 than in Group 1 (2% vs 17.5% p=0.03; and 16% vs 35% p=0.04 resp.) while the 1-year mortality did not differ (24% vs 40%). The all-cause mortality was 10% at 30 days, 26% at 6 month and 32% at 1 year. Univariate regression showed that age (HR: 1.03 [1.01-1.07] p<0.05), ejection fraction (HR: 0.96 [0.93-0.98] p<0.005), ICD lead (HR: 4.89 [1.82-14.40] p<0.005) and the time since first implantation (HR: 0.88 [0.77-0.98] p<0.05) were the predictors of 1-year mortality. However, in Cox multiple regression model only age (HR: 1.05 [1.004-1.1] p<0.05) and ICD lead (HR: 1.16 [1.16-17.38] p<0.05) remains independent predictors of outcome at 1 year. Conclusions In the past 17 years the most prevalent underlying microorganism were staphylococcal species, although Enterococcus faecalis infection increased over time. Patients with CDRIE had poor prognosis, every third patient died at 1 year after diagnosis. The short-term prognosis is even worse in the past few years than before, which may be a negative consequence of limited accessibility of healthcare due to COVID 19 pandemic.

Effect of Early Versus Delayed Laparoscopic Cholecystectomy on Postoperative Morbidity and Difficult Cholecystectomy in Patients With Grade II Cholecystitis According to Tokyo 2018 Guidelines: A Prospective Study.

The timing of the cholecystectomy in patients with acute cholecystitis is still controversial. In our study, we aimed to investigate the effect of early and delayed cholecystectomy on difficult cholecystectomy, morbidity and mortality in patients diagnosed with Grade II acute cholecystitis according to Tokyo 2018 guidelines. Patients who presented to the emergency department and diagnosed with Grade II acute cholecystitis between December 2019 and June 2021 were included in this study. Cholecystectomy was performed within 7days and 6weeks after symptom onset. The effect of early and delayed cholecystectomy was observed. A total of 92 patients were included in the study. The timing of cholecystectomy was not a risk factor for mortality, morbidity and difficult cholecystectomy. The conversion rate was higher in delayed group (P = .007). The bleeding was significantly higher in early group (P = .033). Total hospital stay was higher in delayed group (P < .001). CRP was a predictive parameter for increased Parkland score in early group (P < .001). Delayed cholecystectomy does not facilitate cholecystectomy in patients with Grade II acute cholecystitis. Early cholecystectomy can be performed safely and high CRP levels can be used to determine difficult cholecystectomy in early period.

PCR-confirmed malaria among children presenting with a decreased level of consciousness in Angola: a prospective, observational study

BackgroundIn malaria-endemic areas, children presenting to hospitals with a decreased level of consciousness remain a diagnostic dilemma. The definition of cerebral malaria in a comatose child demands exclusion of other possible reasons, which requires in-depth investigations that are not easily available. The aim of this study was to investigate the frequency and clinical characteristics of PCR-confirmed malaria in a cohort of children with a decreased level of consciousness, look for potential features that would aid in differentiating children with malaria from those without, and assess the performance of traditional thick film microscopy against the cytb-qPCR-method.MethodsA total of 345 children aged 30 days–15 years old, presenting to Hospital Pediátrico David Bernardino in Luanda, Angola, with a decreased level of consciousness (Glasgow coma scale score < 15) were prospectively enrolled during 2014–2017. Malaria was defined as a positive cytb-qPCR result on any occasion in hospital. The clinical course and laboratory parameters were compared between children with malaria and those without. The performance of thick film microscopy was analysed against the PCR method.Results161 of 345 children (46.7%) had a positive malaria PCR test result. All cases were Plasmodium falciparum species, and 82.6% (133/161) fulfilled the WHO criteria for severe malaria. Overall, children with malaria presented to hospital with a shorter duration of symptoms and less convulsions pre-admission compared to those without malaria. The median GCS score on admission was 8, which did not differ between children with or without malaria. Clinical findings on admission were mostly similar across the whole cohort, but an infection focus outside the central nervous system was more common in malaria-negative children. Moreover, severe anaemia, thrombocytopenia, and high CRP levels occurred more frequently in children with malaria. The case fatality ratio was 28.5% (91/319) and did not differ between parasitaemic children and those without malaria, although parasitaemic children died sooner after hospital admission. When neurological sequelae were also considered, a positive malaria test was associated with a better outcome. The performance of thick film microscopy against PCR yielded a sensitivity of 96.8% and a specificity of 82.7%.ConclusionsIn this cohort of children with a decreased consciousness, the frequent presence of a malarial infection could not be judged from the clinical findings on admission, but the combination of profound aneamia, thrombocytopenia, and a high CRP level increased the odds of a positive malaria test result. Mortality remained high regardless of etiology, but malaria infection associated with fewer neurological deficits at discharge. Thick film microscopy performed well compared to the cytb-qPCR method.

The effectiveness of CRP and leukocyte examinations as a detection of risk factors for pre-eclampsia in pregnant women

Introduction: Preeclampsia is an important problem in obstetrics because it is a pregnancy complication often found and results in high morbidity and mortality in both mother and baby. Preeclampsia is one of the complications of pregnancy that needs to be detected or monitored for symptoms, because in addition to being risky for the mother, it will also have an impact on the occurrence of preterm birth and even further impact, namely fetal death in the womb. This study aimed to determine the effectiveness of CRP and leukocyte examination to detect preeclampsia. Method: This research was conducted at the Jagir Health Center Surabaya in March-July 2022. The research used case control with 30 pregnant women as samples divided into 15 as a control group of normal pregnant women and 15 pregnant women with preeclampsia. Result: The results showed that of the 15 respondents who had preeclampsia more than half (60%) had high leukocyte and CRP levels, the remaining less than half (40%) had normal CRP and leukocyte levels. While in the control group more than half (67%) had normal CRP and leukocyte levels and less than half (33%) had normal CRP and leukocyte levels. The results of data analysis showed p value 0.001 (&lt;0.005), which means there is a relationship between the CRP and leukocytes on the incidence of preeclampsia. Conclusion: Examination of CRP levels and leukocyte count proved effective for detecting the incidence of preeclampsia in pregnant women. It is expected that pregnant women carry out routine pregnancy checks and health workers are expected to routinely carry out early detection to prevent pregnancy complications such as preeclampsia

C-reactive Protein, Glomerular Filtration Rate, and Echocardiographic Parameters in Individuals With Different Cardiovascular Risk Categories

Despite the emergence of modern biomarkers, innovative methods of examination and treatment, the problems of cardiovascular risk in clinical medicine are still quite relevant. Widespread cardiovascular risk factors and high mortality from diseases of the circulatory system are observed in all countries of the world, including the Kyrgyz Republic thicknesses, relative LV wall thickness, LV myocardial mass, LV myocardial mass index, r. Aim of the study. To study the clinical and functional values of CRP and its relationship with cardiovascular risk factors in patients with chronic non-communicable diseases. Material and methods. The single-center open study included 290 people with different categories of cardiovascular risk, of which 150 men (51.7%), women - 140 (48.3%). All participants were analyzed hemodynamic parameters, indicators of clinical and biochemical parameters. The excretory function of the kidneys was assessed by the level of serum cystatin C. The glomerular filtration rate (GFR) was calculated according to the method of F. Hoek. The size of the left atrium (LA), the linear dimensions of the left ventricle (LV) were taken into account with an assessment of the structural modification of the myocardium. Depending on the concentration of CRP, two groups were formed: 1A and 1B. Results. In patients with high CRP levels, mean age, body mass index, heart rate, platelet, leukocyte, glucose, and cystatin C blood levels were significantly higher, and mean HDL cholesterol and GFR were significantly lower. Left atrial size, LV end-diastolic size, ventricular septal and posterior wall right ventricular E/A ratio, DT (deceleration time) LV, DT (deceleration time) of the right ventricle were significantly higher in the group of individuals with high levels of blood CRP. In patients with normal (1A) and elevated (1B) levels of CRP in the structure of changes in LV geometry, an eccentric variant of LV hypertrophy was significantly more often detected (74.9% and 66.0%, respectively). The blood CRP concentration was positively associated with the size of the left atrium and LV wall thickness, and negatively with the rate of GFR. Conclusion. In individuals with high and very high cardiovascular risk, elevated CRP levels are associated with more pronounced cardiovascular risk factors. In the group of patients with a high level of CRP, structural modification of the myocardium is represented significantly more often by an eccentric variant of LV hypertrophy.

Peritoneal metastasis of advanced epithelial ovarian carcinoma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: A retrospective international multicentric data analysis

IntroductionThe purpose of our study was to evaluate outcome data after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal metastasis originating from advanced epithelial ovarian carcinoma (PMOC). Patients and methodsA retrospective international multi-institutional registry was established through collaborative efforts of participating units affiliated with the Peritoneal Surface Oncology Group. ResultsOne thousand four hundred and ninety-one patients from 11 specialized units underwent CRS and HIPEC that of those 326 (21.9%) upfront surgeries, 504 (33.8%) interval surgery, and 661(44.3%) recurrent cases. Complete Cytoreduction(CC0/1) was achieved in 1213 patients (81.3%). Treatment -related mortality was 0.8%, major operative complications (Grades 3–5) was 25.1%. Factors associated with major operative complications include prior surgical score (PSS for recurrent cases; RC) PSS>2,p = 0.000), PCI(≤15, >15 cut-off level; p ≤ 0.000), completeness of cytoreduction (CC, p=0.000), high CA125 levels (>25 mg/dl), presence of ascites, high CRP (>5 mg/dl) levels and low albumin levels (below to 2.5 mg/dl) (p ≤ 0.05).The median survival was 58 months in upfront surgery(UFS), 60 months in interval surgery(IS), and 42 months in RC. The overall survival for five years was 45% for UFS, 37% for IS, 28% for RC cases. CCscore (p = 0.000), CA125, CRP and albumin levels (p ≤ 0.05) were predictors for progression free survival. PCI(p ≤ 0.000), major postoperative complications (p = 0.004), incomplete CRS(CC2/3)(p < 0.001), prior chemotherapy (hazard ratio [HR], 3–8; p < 0.001) and PSS>2 for RC were independent predictors of poor overall survival. ConclusionThe combined treatment strategy for PMOC may be performed safely with acceptable morbidity and mortality in the specialized units.

Elevated Soluble Suppressor of Tumorigenicity 2 Predict Hospital Admissions Due to Major Adverse Cardiovascular Events (MACE).

The role of soluble suppression of tumorigenicity (sST2) as a biomarker in predicting clinical outcomes in patients with cardiovascular diseases (CVD) has not been fully elucidated. In this study, we sought to determine the relationship between sST2 levels and any unplanned hospital readmissions due to a major adverse cardiovascular event (MACE) within 1 year of first admission. Patients (n = 250) admitted to the cardiology unit at John Hunter Hospital were recruited. Occurrences of MACE, defined as the composite of total death, myocardial infarction (MI), stroke, readmissions for heart failure (HF), or coronary revascularization, were recorded after 30, 90, 180, and 365 days of first admission. On univariate analysis, patients with atrial fibrillation (AF) and HF had significantly higher sST2 levels vs. those who did not. Increasing levels of sST2 by quartiles were significantly associated with AF, HF, older age, low hemoglobin, low eGFR, and high CRP levels. On multivariate analysis: high sST2 levels and diabetes remained as risk predictors of any MACE occurrence; an sST2 level in the highest quartile (Q4: >28.4 ng/mL) was independently associated with older age, use of beta-blockers, and number of MACE events within a 1 year period. In this patient cohort, elevated sST2 levels are associated with unplanned hospital admission due to MACE within 1 year, independent of the nature of the index cardiovascular admission.

Hematological and Biochemical Parameters at Admission as Predictors for Mortality in Patients with Moderate to Severe COVID-19.

Timely diagnosis and effective use of available resources are urgent to avoid the loss of time, medical, and technological resources, particularly in COVID-19 pandemic. This study aimed to identify the most dominant predicting factor for mortality in moderate-severe COVID-19 patients. This retrospective cohort study included a total of 253 patients diagnosed with moderate-severe COVID-19. The primary outcome measure was mortality during hospitalization. The receiver operating characteristic (ROC) curve was used to determine cut-off points. The data were categorized according to the cut-off points in ROC curve and analyzed using Chi-square and by binary logistic regression test to identify the independent predictors associated with mortality. The mean number of leukocytes (/µL), neutrophils (%), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), C-reactive protein (CRP, mg/L), and D-dimer (mg/L) in the non-survived group was significantly higher than those of the survived group. Meanwhile, the mean number of platelet count/µL, absolute lymphocyte count (ALC), in the non-survived group was significantly lower than those of the survived group. CRP level predicted mortality with a cut-off point of ≥8.41 mg/L, sensitivity of 98.1%, and specificity of 72.0% (P = .000). High leukocyte count, low platelet count, high NLR, high CRP level, and high D-dimer on admission predicted mortality of COVID-19 patients. In addition, CRP was found to be the most dominant predicting factor of mortality in moderate-severe COVID-19 patients.

Диагностические маркеры поражения сердца у пациентов со среднетяжелой формой новой коронавирусной инфекции

The results of numerous randomized clinical trials indicate the relationship of a new coronavirus infection (NCI) with the development of acute myocardial injury (AMI). Of great importance in the defeat of the heart belongs to the change in the cytokine and chemokine status, which determines the inflammatory potential. The aim of this work was a comprehensive assessment of clinical and laboratory indicators of the state of the heart in a new coronavirus infection and the determination of immunopathogenetic mechanisms of myocardial damage. 180 patients hospitalized with a diagnosis of «coronavirus infection COVID-19, virus identified (U07.1), moderate form» were examined. Risk factors, levels of cytokines and chemokines (IFN-α, IL-6, IL-17, MIP-1b), markers of cardiac damage/dysfunction (troponin I and FAFA, NTproBNP), and antimyocardial IgG antibodies were assessed. Statistical processing was carried out using the Microsoft Office package (Microsoft Excel), as well as the statistical package STATISTICA 9.0. The Shapiro-Wilk W test was used to check the normality of the distribution. Differences were considered significant at p ≤ 0.05, unreliable at p ≥ 0.05. It has been established that in the acute period, 45% of patients have an increase in troponin I values. They also have significantly higher levels of IL-6, IL-17 and MIP-1b against the background of inhibition of IFN-α production. In the acute period, a third of patients have antimyocardial antibodies, which are detected significantly more often and in higher titers in patients with AMI. The presence of a direct correlation between the level of antimyocardial antibodies and an increase in the amount of CRP, MIP-1b and IL-17 was established. The most significant risk factors for the development of myocardial damage in NCI are the presence of a burdened history of cardiovascular diseases, an increased body mass index, and diabetes mellitus. Thus, high levels of CRP, MIP-1b IL-17, antimyocardial antibodies, with a continuing deficiency without a tendency to restore the level of IFN-α, in the presence of the above risk factors, are diagnostically significant markers of AMI in patients with moderate NCI.

Clinical determinants and impact of hemorrhagic lesions on intestinal pathology in preterm infants with surgical necrotizing enterocolitis.

We sought to determine the clinical and histopathological factors associated with intestinal hemorrhage and its correlation with clinical outcomes in neonates with surgical necrotizing enterocolitis (NEC). A retrospective study compared clinical and histopathology information in neonates following surgical NEC with severe hemorrhage and those with mild/moderate hemorrhagic lesions seen on resected intestine pathology. The infants with severe hemorrhage (Grade 3-4, 81/148, 54.7%) had significantly lower exposure to antenatal steroids (52.5 % vs 76.9 %; p = 0.004), had higher gestational age (28.5 weeks [7.14] vs. 26.58 [2.90]; p = 0.034), lost more bowel length (p = 0.045), had higher CRP levels at 2 weeks (p = 0.035), and had less intestinal failure ([30.3 % vs 52.5 %]; p = 0.014) than mild/moderate (Grade 0-2, 67/148, 45.2%) hemorrhage group. Those with severe hemorrhage had significantly higher mean inflammation score (2.67 [0.94] vs. 1.63 [0.92]; p = <0.001), higher necrosis scores (1.95 [1.28] vs. 1.49 [1.35]; p = 0.037), higher neovascularization (p = 0.01), higher fibroblasts (p = 0.023) and higher lymphocyte percentages up to 48 hours (p < 0.05) following NEC than mild/ moderate hemorrhage group.On multivariable regression, less exposure to antenatal steroids (OR 0.18 [95% CI 0.05-0.58]; p = 0.005), higher inflammation (OR 3.7 [95% CI 2.09-7.32]; p = 0.001), and lymphocyte count on the day of onset/24 hours following NEC (OR 1.06 [95% CI 1.02-1.11]; p = 0.005) were independently associated with a higher odd of severe intestinal hemorrhage. The surgical NEC infants with intestinal hemorrhage were less likely to have antenatal steroid exposure but had higher inflammation grade and lymphocyte counts following NEC onset on multivariable regression modeling.

Antibiotic Overprescribing among Neonates and Children Hospitalized with COVID-19 in Pakistan and the Implications.

There are concerns with excessive antibiotic prescribing among patients admitted to hospital with COVID-19, increasing antimicrobial resistance (AMR). Most studies have been conducted in adults with limited data on neonates and children, including in Pakistan. A retrospective study was conducted among four referral/tertiary care hospitals, including the clinical manifestations, laboratory findings, the prevalence of bacterial co-infections or secondary bacterial infections and antibiotics prescribed among neonates and children hospitalized due to COVID-19. Among 1237 neonates and children, 511 were admitted to the COVID-19 wards and 433 were finally included in the study. The majority of admitted children were COVID-19-positive (85.9%) with severe COVID-19 (38.2%), and 37.4% were admitted to the ICU. The prevalence of bacterial co-infections or secondary bacterial infections was 3.7%; however, 85.5% were prescribed antibiotics during their hospital stay (average 1.70 ± 0.98 antibiotics per patient). Further, 54.3% were prescribed two antibiotics via the parenteral route (75.5%) for ≤5 days (57.5), with most being 'Watch' antibiotics (80.4%). Increased antibiotic prescribing was reported among patients requiring mechanical ventilation and high WBCs, CRP, D-dimer and ferritin levels (p < 0.001). Increased COVID-19 severity, length of stay and hospital setting were significantly associated with antibiotic prescribing (p < 0.001). Excessive antibiotic prescribing among hospitalized neonates and children, despite very low bacterial co-infections or secondary bacterial infections, requires urgent attention to reduce AMR.

Elevated C-Reactive Protein Levels Modify the Effect of Magnesium on Depressive Symptoms: A Population-Based Study

Depression is a profound public health concern, yet its etiology remains unclear. A body's magnesium status and low-grade systemic inflammation are associated with depression. However, the interaction of magnesium status and inflammation on depression/depressive symptoms is unknown. We assessed the association between serum magnesium levels and depressive symptoms by analyzing data from the Nutrition and Health Survey in Taiwan 2005-2008. In total, 2196 participants aged ≥20 years were included. Depressive symptoms were assessed using the 5-item Brief-Symptom Rating Scale. We performed logistic regression and multiple linear regression analyses to examine the association. A dose-response analysis was performed using restricted cubic spline models, and stratification by chronic inflammation was also performed. We found that higher serum magnesium levels were associated with lower depression scores and a lower risk of depression. In the subgroup analysis, serum magnesium levels were inversely associated with depressive symptoms more prominently among people with higher CRP levels, with a threshold at 5 mg/L (≥5 vs. <5) showing a greater difference than at 3 mg/L (≥3 vs. <3). Conclusions: Serum magnesium levels were inversely associated with depressive symptoms. This inverse association was affected by inflammation level. A dose-response relationship was also observed.

Demographic Characteristics, Laboratory Findings, Radiological Features, and Outcomes of Patients with COVID-19: A Single-center Descriptive Study

The coronavirus disease 2019 (COVID-19) has resulted in a global crisis, affecting hundreds of millions of individuals, with Indonesia reporting a significant increase in cases in July 2021. Therefore, this study aims to describe the clinical, laboratory findings, radiological features, and outcomes of hospitalized patients with COVID-19. This retrospective study was carried out using 606 hospitalized COVID-19 patients who were admitted to the isolation ward in a Hospital in South Jakarta, Indonesia, from January 1 to April 30, 2021. The median age of the patients was 45 years, 55.6% were male, and 85.5% had non-severe diseases, with the most common presenting symptoms being fever, cough, and gastrointestinal symptoms. Patients with severe disease were significantly older (P&lt;0.001), more likely to have hypertension (P&lt;0.05) and diabetes (P&lt;0.001), have an increased CRP (P&lt;0.001), high ferritin (P&lt;0.001), and increased d-dimer (P&lt;0.001). Compared to patients who survived, patients who had died were older (P&lt;0.001), had hypertension (P=0.013), increased CRP (P&lt;0.001), high ferritin (P=0.002), and increased d-dimer (P=0.006). These results showed that older age, comorbidities, and a higher level of CRP, ferritin, and d-dimer increased the risk of severe disease and poor clinical outcomes in hospitalized COVID-19 patients.

Low HDL-c levels at admission are associated with greater severity and worse clinical outcomes in patients with COVID-19 disease

Background and aimsHDL particles may act to buffer host cells from excessive inflammatory mediators. The aim of this study is to investigate if the lipid profile provides a prognostic biomarker for COVID-19 outcomes. MethodsThis was a prospective study of the characteristics of 125 adult COVID-19 patients with a lipid profile performed on the day of admission analyzed with regard to clinical outcomes. ResultsSeventy-seven patients (61.2%) were men, with a mean age of 66.3 (15.6) years. 54.1% had bilateral pneumonia. The all-cause mortality rate during hospitalization was 20.8%. We found a direct association between more severe disease assessed by the WHO classification, admission to the ICU and death with more pronounced lymphopenia, higher levels of CRP, ferritin (p < 0.001), D-dímer and lactate dehydrogenase (LDH) all statistically significant. Lower leves of HDL-c and LDL-c were also associated with a worse WHO classification, ICU admission, and death,. HDL-c levels were inversely correlated with inflammatory markers CRP (r = −0.333; p < 0.001), ferritin (r = −0.354; p < 0.001), D-dímer (r = −0.214; p < 0.001), LDH (r = −0.209; p < 0.001. LDL-c levels were significantly associated with CRP (r = −0.320; p < 0.001) and LDH (r = −0.269; p < 0.001). ROC curves showed that HDL [AUC = 0.737(0.586–0.887), p = 0.005] and lymphocytes [AUC = 0.672(0.497–0.847], p < 0.043] had the best prognostic accuracy to predict death. In a multivariate analysis, HDL-c (β = −0.146(0.770–0.971), p = 0.014) and urea (β = 0.029(1.003–1.057), p = 0.027) predicted mortality. ConclusionHypolipidemia including HDL levels at admission identifies patients with a higher risk of death and worse clinical manifestations who may require more intensive care.

Importance of hematological markers in familial Mediterranean fever in terms of disease severity and amyloidosis.

There are limited follow-up parameters for familial Mediterranean fever (FMF) related to disease severity and amyloidosis. Some hematological markers are emerging to assess inflammation. In this study, we hypothesized that some hematological parameters could be used to determine disease severity and amyloidosis in FMF. We included 274 adult FMF patients, and evaluated the relationship between neutrophil lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR) and platelet-lymphocyte ratio (PLR), platelet counts and leukocyte counts, mean erythrocyte haemoglobin concentration (MCHC) and mean erythrocyte haemoglobin (MCH) with disease severity and amyloidosis. First, we classified patients according to disease severity and presence of amyloidosis. We then compared the parameters within the groups. In addition, we determined predictive cut-off values with ROC analysis. Finally, we correlated the change in ISSF scores with the change in hematological parameters of 52 patients with follow-up hematological indices after six months. The patients with severe-moderate group had higher CRP levels (p < 0.001), white blood cell (p = 0.002) and neutrophil counts (p = 0.004) and, conversely, lower MCHC levels (p = 0.001) than patients with mild disease severity. FMF patients with amyloidosis had higher neutrophil (p = 0.04) and monocyte count (p = 0.02), increased NLR (p = 0.01) and lower MLR (p = 0.02) levels than those without. In addition, MCHC levels were also lower in the severe-moderate group in the follow-up analyses after sixth months (p = 0.03). MCHC, neutrophil and monocyte counts, NLR, MLR may be associated with poor prognosis in FMF patients. These parameters can be used in conjunction with acute phase reactant and clinical features to assess disease status.

Assessment of serum high mobility group box 1 protein (HMGB1) levels and its change with treatment in patients with manic episode of bipolar disorder

IntroductionThere has been an increasing evidence in recent years that inflammation plays a role in the pathophysiology of bipolar disorder (BD). In addition to central inflammation, systemic immune response is thought to be associated with disease stages and course. HMGB1 protein is a member of damage-associated molecular pattern which plays a role in the regulation of cytokine release and is important for innate immunity. It has been revealed that HMGB1 levels change in many autoimmun and inflammatory diseasesObjectivesOur study was designed to compare serum HMGB1 levels of inpatients with mania and healthy controls as well as analyzing its relationship with other inflammatory markers and disease severity. Another aim of our study is to determine the changes in serum HMGB1 levels before and after treatment in manic patients.MethodsOur study included 35 patients who were hospitalized in our hospital between November 2020 and April 2021, diagnosed with bipolar disorder, manic episode according to DSM-5 criteria, and 35 healthy controls who matched to the patient group in terms of age and gender. The sociodemographic and clinical characteristics data forms of the participants were filled in, and the patients were evaluated with the Young-Mania Rating Scale (YMRS) and the Hamilton Depression Scale (HAM-D). Serum HMGB1, CRP levels and complete blood count values were measured in healthy controls and patients before and after the treatment.ResultsThe main finding of our study is that HMGB1 levels did not show a statistically significant difference in the patient and healthy control groups (p&gt;0.05). In addition, there was no significant change in serum HMGB1 levels of the patients after treatment compared to the level before treatment (p&gt;0.05). Our study has also revealed that manic patients had a higher level of CRP than the ones in control group at a statistically significant level. The platelet/lymphocyte and neutrophil/lymphocyte rates of the patients increased after the treatment compared to the pre-treatment period (respectively p=0,026, p=0,003).ConclusionsThe higher CRP levels in manic patients support the hypothesis of low-grade chronic inflammation, which is thought to be involved in the etiology of BD. The most important finding of this study is that there is no statistically significant difference of serum HMGB1 levels between the two groups. This can be explained by the fact that HMBG1 is one of the late mediators of inflammation and does not rise immediately during the acute period. However, since the inflammation process includes complex mechanisms involving many systems, it makes it difficult to comment on this issue.Disclosure of InterestNone Declared

Misdiagnosis of multisystem inflammatory syndrome in children: A diagnostic challenge.

Asthe COVID-19 pandemic continues, multisystem inflammatory syndrome in children (MIS-C) maintains its importance in the differential diagnosis of common febrile diseases. MIS-C should be promptly diagnosed because corticosteroid and/or intravenous immunoglobulin treatment can prevent severe clinical outcomes. In this study, we aimed to evaluate clinical presentation, diagnostic parameters and management of MIS-C and compare its clinical features to those of common febrile disease. This study was conducted at a tertiary-level university hospital between December 2020 and October 2022. One hundred and six children who were initially considered to have MIS-C disease were included in the study. During the follow-up period in the hospital, when the clinical and laboratory findings were re-evaluated, 38 out of 106 children were diagnosed differently. The clinical and laboratory findings of 68 children followed up with the diagnosis of MIS-C and 38 children who were initially misdiagnosed as MIS-C but with different final diagnoses were retrospectively compared. We identified 68 patients with MIS-C and 38 patients misdiagnosed as MIS-C during the study period. Infectious causes (71%), predominantly bacterial origin, were the most frequently confused conditions with MIS-C. Patients with MIS-C were older and had a more severe clinical course with high rates of respiratory distress, shock, and paediatric intensive care unit admission. While rash and conjunctivitis were more common among patients with MIS-C, cough, abdominal pain and diarrhoea were observed more frequently in patients misdiagnosed as MIS-C. Lower absolute lymphocyte counts, platelet counts and higher C-reactive protein and fibrinogen levels, pathological findings on echocardiography were the distinctive laboratory parameters for MIS-C. Multivariate analysis showed that older age, presence of conjunctivitis, high level of serum CRP and lower platelets were the most discriminative predictors for the diagnosis of MIS-C. There are still no specific findings to diagnose MIS-C,which therefore can be confused with different clinical conditions. Further data are needed to assist the clinician in the differential diagnosis of MIS-C and the diagnostic criteria should be updated over time.

Assessment of factors affecting mortality in patients with percutaneous endoscopic gastrostomy tube placement in the intensive care unit

Aim: It was aimed to evaluate the clinical outcomes, complications, and factors affecting mortality of percutaneous endoscopic gastrostomy (PEG) applied to patients in the intensive care unit (ICU).Material and Method: PEG procedures which were performed in the ICU between January 2016 and January 2021 and patients' age, gender, comorbidities, trauma history, serum CRP, albumin levels, CRP albumin ratios (CAR), and PEG-related complications were reviewed. Patients were divided into two groups, patients without mortality (Group 1) and patients with mortality (Group 2), and a comparison between groups was made.Results: Of all patients, 49 (39.2%) patients had mortality. The mean age of the patients in group 2 was 69.57±16.78 years, which was higher than the other group (p&amp;lt;0.001). Nephrological diseases and diabetes were significantly more common in Group 2, whereas neurologic diseases were less common (p=0.005, p=0.005, 0.044, respectively). The median length of stay (LOS) of the patients in Group 1 was 50 days, while the median LOS of the patients in Group 2 was found to be significantly higher, with 81 days (&amp;lt;0.001). The mean CRP of Group 2 was 81.63±54.06, which was higher than the other group, while the mean of albumin was found to be 2.29±0.5 and was lower than Group 1 (p&amp;lt;0.001, p&amp;lt;0.001). The mean CAR of Group 1 was 15.96±16.81, which was significantly lower than that of Group 2 (p&amp;lt;0.001). The optimal CAR cut-off value for mortality discrimination was found to be 20,216 with a sensitivity of 73.5%, a specificity of 78.9%, a positive predictive value of 69.2%, a negative predictive value of 82.2%, and 76.8% test accuracy. A CAR value of ≥ 20.216 increased the odds of death 9.3-fold (OR 10.385, CI 95% 4.481-24.065, p&amp;lt;0.001). Conclusion: We suggest that CAR ratio, low albumin, and high CRP levels could be predictors of early mortality. Considering that PEG is an elective procedure, we believe that it can be a safe and effective procedure when nutritional support is provided by alternative means and appropriate conditions are met.

Determinants of patient and physician global assessments of disease activity in anti-neutrophil cytoplasmic antibody-associated vasculitis.

To compare physician and patient assessments of global disease activity in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and to identify associated factors. Global disease activity scores (0-10 points) were retrospectively analyzed from physicians and patients with AAV at each outpatient visit from 2010 to 2020. We compared the scores and performed a linear regression with a random effects to identify associated factors. Patients (n = 143, 1,291 pairs, 52% female) had a mean 64 (±15) years of age and a mean disease duration of 9 (±7) years. Patients and physicians global disease activity assessments showed a moderate correlation (Pearson R 0.31, CI [0.23-0.52], p < 0.001). Linear regression showed a strong association between the physician-documented disease activity scores and serum CRP levels (β = 0.22, CI [0.18, 0.28]), disease duration (β = -0.022, CI [-0.04,-0.01]) and patients' assessment of disease activity (β = 0.08, CI [0.04, 0.12]). By contrast, patient assessments were strongly associated with the degree of pain (β = 0.30, CI [0.25, 0.35]), functional limitations in daily living (HAQ, β = 0.49, CI [0.21, 0.78]) and the global physical well-being (NRS, β = 0.39, CI [0.32, 0.46]). Patients' and physicians' assessments of disease activity correlated. High CRP levels and disease duration were associated with physician-assessed disease activity scores, while subjective limitations were associated with higher patient-assessed disease activity scores. These findings highlight and support the need to develop and evaluate patient-reported outcomes to assess disease activity in patients diagnosed with AAV.