Laboratory Parameters Of Inflammation Research Articles

Combined immunosuppression with cyclosporin A, mycophenolate mofetil (MMF) and dexamethasone for activity control of recurrent secondary hemophagocytic lymphohistiocytosis (sHLH) with underlying systemic lupus erythematosus (SLE)

A42-year-old female patient was admitted to hospital due to acute neurological symptoms (dysarthria, disorientation). After exclusion of cerebral ischemia and hemorrhage an autoimmune encephalitis was diagnosed. Shortly before as an outpatient the suspicion of the presence of systemic lupus erythematosus (SLE) was voiced. The patient showed a constellation of high levels of inflammatory laboratory parameters and within a few days developed a severe pancytopenia. In the presence of all diagnostic criteria a secondary hemophagocytic lymphohistiocytosis (sHLH) was diagnosed and confirmed by a kidney biopsy during the course of the underlying SLE. The immunosuppressive treatment with etoposide and high-dose dexamethasone according to the HLH-94 protocol only showed temporary success. After 3 weeks of treatment with a protocol-conform dose reduction, under running treatment a new exacerbation of symptoms was confirmed. A renewed dose escalation of the drugs used did not lead to control of the symptoms. The inflammatory activity could only be sustainably controlled by the use of cyclosporin A in combination with mycophenolate mofetil (MMF) and dexamethasone. After stabilization of the condition of the patient, an outpatient follow-up care was possible.

Relationship between inflammatory laboratory parameters and severity of adolescent idiopathic scoliosis: A pilot study.

Adolescent idiopathic scoliosis is a complex condition whose pathogenesis may include inflammation and signs of joint and bone degeneration. The main objective of this study is to evaluate the relationship between the severity of adolescent idiopathic scoliosis and inflammatory blood parameters. The study recruited patients with adolescent idiopathic scoliosis who attended the Rehabilitation Center of the Apostolo Foundation in Merate (LC). The scoliosis curve (Cobb's angle) was used as a severity index to compare with inflammatory blood parameters (white blood cells subpopulations, immunoglobulins, protein electrophoresis). In addition, the study used an overall severity grading called "Scoliosis Score" which includes all spine angles and Risser's score (bone development index). Thirty-four subjects were recruited (mean age 14years, 2months), 30females and 2males. A significant correlation was found between Cobb's angle and the percentage values of beta-2 globulins in a directly proportional manner (r= 0.42, p= 0.01), and gamma globulins in an inversely proportional manner (r=-0.366, p= 0.04). However, no significant correlation between Cobb's angle and the absolute values of white blood cells and percentage subpopulations was found (r= 0.0821 p= 0.655). A moderate, inverse correlation was found between the Scoliosis Score and the percentage of neutrophils (r=-0.385, p= 0.02), a direct correlation was found between the Scoliosis Score and the percentage of lymphocytes (r= 0.404, p= 0.02). In addition, there was a strong correlation of the Scoliosis Score with alpha-2 globulin (r= 0.564, p= 0.0012), beta-1 globulin (r= 0.478, p= 0.0074), and beta-2 globulin (r= 0.370, p= 0.044) and an inverse relationship with gamma globulin (r=-0.625, p= 0.0002). The main correlations were confirmed by regression analysis. The correlation between beta-2 globulins and gamma globulins with Cobb's angle and the Scoliosis Score suggests a link between spinal curvature and inflammation in scoliosis patients, This link may indicate the significance of these parameters for diagnosing, staging the disease, and monitoring therapies.

To study magnetic resonance imaging findings and inflammatory markers in inflammatory sacroiliitis

Objectives: The objectives of the study are to determine magnetic resonance imaging (MRI) findings in inflammatory sacroiliitis and assign scores and grades to it and to determine and correlate erythrocyte sedimentation rate, C-reactive protein (CRP), and human leukocyte antigen-B27 (HLA-B27) in various grades of sacroiliitis. Material and Methods: An observational cross-sectional study was conducted on 30 patients who clinically presented with features of sacroiliitis and underwent an MRI of sacroiliac joint (SIJ). Various inflammatory and structural findings on MRI were used to do Spondyloarthritis Research Consortium of Canada scoring and grading. Then inflammatory markers including erythrocyte sedimentation rate, CRP, and HLA-B27 were studied in various grades of sacroiliitis. Results: Inflammatory sacroiliitis affects commonly the age group of 21–40 years. Periarticular edema was the most common finding seen with the iliac aspect more commonly involved. The majority of the subjects were graded moderate (50%). Values of erythrocyte sedimentation rate and CRP levels were raised whereas HLA-B27 was positive in 9 patients (30%) of inflammatory sacroiliitis. Conclusion: Inflammatory sacroiliitis presents with a chief complaint of low back ache. MRI helps to grade it into mild, moderate, and severe. STIR is the most sensitive sequence for the detection of bone marrow edema with bilateral symmetrical involvement but the iliac bone of SIJ is more involved than the sacral side. Contrast-enhanced sequences and diffusion images add no significant statistical role in the diagnosis of bone marrow edema. Inflammatory laboratory parameters were increased in higher grades of sacroiliitis. HLA-B27, although not specific to inflammatory sacroiliitis, increases in higher grades of sacroiliitis.

Is there a connection between neurocognitive profile in treatment naïve non-cirrhotic HCV patients and level of systemic inflammation?

Hepatitis C virus (HCV) infection is a progressive, systemic disease which leads to the development of end-stage liver disease. In 70% of patients, HCV infection is followed by the development of extrahepatic manifestations (EHM). A common EHM is HCV associated neurocognitive disorder (HCV-AND), characterized by neuropsychological changes in attention, working memory, psychomotor speed, executive function, verbal learning, and recall. The aim of this study is to examine the correlation between the neurocognitive profile and routine, available laboratory parameters of inflammation, liver function tests, grade of liver fibrosis, and clinical and laboratory parameters of mixed cryoglobulinemia in treatment naïve non-cirrhotic HCV patients. This is a single-center exploratory study in which we examined 38 HCV + treatment naïve patients. The complete blood count and hematological parameters of systemic inflammation, liver function tests, biopsy confirmed grade of liver fibrosis, and clinical and laboratory parameters of mixed cryoglobulinemia caused by chronic HCV infection were observed. In the study, we used a battery of neuropsychological tests assessing multiple cognitive domains: executive functions, verbal fluency, delayed memory, working memory and learning, and one measure for visuo-constructive performance. Before the Bonferroni correction for multiple comparisons, the results show significant correlations between the scores in the neurocognitive variables and the single measures of inflammation, liver function parameters, and mixed cryoglobulinemia. It has not found a statistically significant correlation between systemic inflammation and neurocognitive variables. After the Bonferroni adjustment, no correlations remained significant. Certainly, the obtained results can be a recommendation for additional validation through future research.

E46 Viruses reactivating each other’s!

Abstract Introduction COVID-19 is known to cause an immunocompromised state. This condition was associated with reactivation of quiescent viruses. Objectives Describe a case of HHV-6 reactivation in a patient diagnosed with MIS-C syndrome. Methods The diagnosis of MIS-C syndrome associated to SARS-CoV-2 was done by following the criteria established by the World Health Organization (WHO). The reactivation of HHV6 was confirmed by positivity of RT-PCR in blood and presence of IgG in serology. Results A four years old girl, with no medical history who presented to emergency room with high fever associated with conjunctival injection, cheilitis, cervical adenopathy and rash since four days. She developed a generalized tonic-clonic seizure then a vasoplegic shock two days later. Thus, she was admitted in ICU. Clinical examination on admission showed polypnea, a low blood oxygen level, tachycardia, a low blood pressure (28/15mmhg), a hepatomegaly, a maculopapular rash in pelvic region and a bilateral eyelid swelling. Biology showed lymphopenia (660 109/l), hepatic cytolysis, low prothrombin test (19%), an acute renal failure, a biological inflammatory syndrome with an elevated C-reactive protein (274 mg/l), an elevated ferritin, increased d-dimers (1µg/ml) and fibrinogen level which suggest activation of the coagulation cascade with a prothrombotic state and elevated lactatemia (6.4 mmol/l). The chest X-ray was normal. She had a low ejection fraction (39%) showed on echocardiogram. A rapid SARS-CoV-2 test was negative but serology was positive. Since MIS-C syndrome was not known to give severe hepatitis, other diagnoses was proposed. RT-PCR in serum associated to RT-PCR in cutaneous lesion’s biopsy was positive for HHV6. The hepatitis A serology was negative. She has an anterior immunity to varicella-zoster (VZV). She was intubated. She received vasoactive medications, intravenous immunoglobulin (IVIG) and steroids. Course was marked by hemolytic anaemia, which was associated to immunoglobulin (IVIG). Our patient become rapidly afebrile. Vital signs and laboratory parameters of inflammation, CRP, lymphopenia, markers of cardiac injury, transaminases and renal function parameters all normalized. On day 28 of hospital stay, she was discharged with full dose of steroids and low dose of aspirin. Conclusion HHV6 reactivation needs a state of immunosuppression and was reported with acquired immunodeficiency syndrome (AIDS) and a variety of lymphoproliferative disorders. It leads to fever, cutaneous eruption as well as more serious complication such as hepatitis, which is the case with our patient. Ethics No conflicts of interest.

Dynamics of inflammatory markers, neutrophil lymphocyte ratio, platelet lymphocyte ratio in COVID-19 deaths

Introduction: Various inflammatory markers and laboratory parameters were identified as the predictors of severity and mortality in COVID -19 infection. However, the progression of inflammatory markers and their gender difference in COVID-19 deaths has not been extensively studied. The study aim was to analyze the progression of inflammatory markers, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) in COVID-19 deaths, and analyzed the correlation between NLR, PLR and inflammatory markers. Materials and methods: A retrospective observational study based on records was done on 104 patients who died due to COVID-19 infection. In addition to baseline investigations, NLR (Neutrophil Lymphocyte ratio), PLR (Platelet Lymphocyte Ratio), ferritin, D-dimer and CRP (C reactive protein) was collected for all patients on day one, day three and day five. Results: Out of 104 patients, 68 were males and 36 were females. Mean NLR was 5.7, 7.3 & 7.5 on day one, three and five respectively. Mean PLR was 145.9, 166.6 and 173.7 on day one, three and five respectively. Mean CRP was 37.6mg/l, 51mg/l & 57.2mg/l, mean ferritin was 780.9ng/ml, 852.5ng/ml &1033ng/ml and mean D-dimer was 2373ng/ml, 3149ng/ml & 3686ng/ml on day one, three and five respectively. There was a strong positive correlation of NLR with ferritin (0.598), CRP (0.663) and D-dimer (0.53) on day one and on day five, but only a weakly positive correlation observed on day three. There was a negative correlation between PLR and inflammatory markers. No significant difference in the inflammatory markers and their progression was noted between males and females. Conclusion: In this retrospective cohort study of 104 COVID-19 deaths, there was progressive increase of inflammatory markers. Serial measurements of inflammatory markers help in early identifications of patients who may deteriorate. Progression of NLR has strong correlation with inflammatory markers and could be used as a surrogate marker to prioritise treatment in resource limited settings.

Prediabetes Induces More Severe Acute COVID-19 Associated With IL-6 Production Without Worsening Long-Term Symptoms.

AimsPre-existing conditions, such as age, hypertension, obesity, and diabetes, constitute known risk factors for severe COVID-19. However, the impact of prediabetes mellitus (PDM) on COVID-19 severity is less clear. This study aimed to evaluate the influence of PDM in the acute and long-term phases of COVID-19.Materials and methodsWe compared inflammatory mediators, laboratory and clinical parameters and symptoms in COVID-19 patients with prediabetes (PDM) and without diabetes (NDM) during the acute phase of infection and at three months post-hospitalization.ResultsPatients with PDM had longer hospital stays and required intensive care unit admission more frequently than NDM. Upon hospitalization, PDM patients exhibited higher serum levels of interleukin 6 (IL-6), which is related to reduced partial pressure of oxygen (PaO2) in arterial blood, oxygen saturation (SpO2) and increased COVID-19 severity. However, at three months after discharge, those with PDM did not exhibit significant alterations in laboratory parameters or residual symptoms; however, PDM was observed to influence the profile of reported symptoms.ConclusionsPDM seems to be associated with increased risk of severe COVID-19, as well as higher serum levels of IL-6, which may constitute a potential biomarker of severe COVID-19 risk in affected patients. Furthermore, while PDM correlated with more severe acute-phase COVID-19, no long-term worsening of sequelae was observed.

C-reactive protein elevation predicts in-hospital deterioration after aneurysmal subarachnoid hemorrhage: a retrospective observational study

BackgroundThere is increasing evidence that inflammation plays a role in the pathogenesis of aneurysmal subarachnoid hemorrhage (aSAH) and in the development of delayed cerebral ischemia (DCI). However, the assessment and interpretation of classically defined inflammatory parameters is difficult in aSAH patients. The objective of this study was to investigate the relationship between easily assessable findings (hyperventilation, fever, white blood cell count (WBC), and C-reactive protein (CRP)) and the occurrence of DCI and unfavorable neurological outcome at discharge in aSAH patients.MethodsRetrospective analysis of prospectively collected data from a single center cohort. We evaluated the potential of clinical signs of inflammation (hyperventilation, fever) and simple inflammatory laboratory parameters CRP and WBC to predict unfavorable outcomes at discharge and DCI in a multivariate analysis. A cutoff value for CRP was calculated by Youden’s J statistic. Outcome was measured using the modified Rankin score at discharge, with an unfavorable outcome defined as modified Rankin scale (mRS) > 3.ResultsWe included 97 consecutive aSAH patients (63 females, 34 males, mean age 58 years) in the analysis. Twenty-one (22%) had major disability or died by the time of hospital discharge. Among inflammatory parameters, CRP over 100 mg/dl on day 2 was an independent predictor for worse neurological outcome at discharge. The average C-reactive protein level in the first 14 days was higher in patients with a worse neurological outcome (96.6, SD 48.3 vs 56.3 mg/dl, SD 28.6) in the first 14 days after aSAH. C-reactive protein on day 2 was an indicator of worse neurological outcome. No inflammatory parameter was an independent predictor of DCI. After multivariate adjustment, DCI, increased age, and more than 1 day of mechanical ventilation were significant predictors of worse neurological outcome.ConclusionsEarly elevated CRP levels were a significant predictor of worse neurological outcome at hospital discharge and may be a useful marker of later deterioration in aSAH.

Predictive ability of inflammatory markers and laboratory parameters in Legg-Calvé-Perthes disease: A single-center retrospective comparative study.

Legg-Calvé-Perthes disease (LCPD) presents with chronic nature of inflammation, characterized by prolonged synovitis. So far, no single blood marker has been identified to guide clinicians in estimating the severity and prognosis. Blood neutrophil to lymphocyte ratio (NLR) or systemic immune inflammation index (SII) is a simple indicator of subclinical inflammation. This study aims to examine the predictive ability of NLR, SII, and common laboratory parameters for estimating the severity of LCPD. The pre-operative laboratory findings at the time of osteotomy and implant removal in patients with unilateral LCPD who had been treated with the Salter innominate osteotomy and followed up until skeletal maturity as well as those of age-matched control patients with idiopathic noninflammatory conditions were analyzed. The datasets of 26 or 38 LCPD patients at the time of osteotomy or implant removal, respectively, and those of 20 control patients were available for analysis. At the time of osteotomy, compared to the control group, a significantly higher mean NLR or SII and a significantly lower mean alkaline phosphatase value were observed in the LCPD group. The alkaline phosphatase levels of patients with the modified lateral pillar (LP) group-A hips were significantly lower than those with the non-LP-A hips, whereas no significant differences were observed in any of the parameters between patients with favorable LP-A or -B hips and those with unfavorable LP-B|C border or -C hips. In agreement with the conventional opinion, it may be difficult to predict a meaningful prognosis of LCPD with the use of inflammatory markers or common laboratory parameters obtained in the initial stage of the disease.

Relationship between different methods of visualization of hip joint lesions in patients with axial spondyloarthritis during a two-year observational study

Almost half of the patients with axial spondyloarthritis (axSpA) in Russia have hip joint lesions (HJD), but the causes and rates of its progression have not been studied.Aim. To assess the relationship of X-ray progression with MRI data of hip joint examination in patients with axial spondyloarthritis during a two-year follow-up.Material and methods. We analyzed 77 patients (23 women and 54 men) with axSpA (ASAS criteria, 2009), followed for at least 2 years with clinical and/or instrumental signs of coxitis. After 2 years, the patients underwent a complete clinical, laboratory and instrumental examination (MRI and radiography of the hip joint) again. Their average age was 30.8±7.7 years, with an average disease duration of 74.0±90.3 months. 72 (94%) patients were HLA-B27 positive. In all patients, the BASRI-Hip index was assessed for each hip joint. The median values of laboratory parameters of inflammation – erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level – were initially high (20.0 mm/h and 14.5 mg/l respectively), but after 2 years the indicators decreased: ESR – down to 8.0 mm/h, and CRP – down to 5.0 mg/L (p<0.05). The median values of the BASDAI also decreased over 2 years of active observation from 4.5 to 2.2 (p<0.05). The value of the ASDAS-CRP index was high and corresponded to 3.1±1.1 and after 2 years also decreased down to 1.94±1.0 (p<0.05). Pain in the hip joint was detected in 66 out of 77 patients (86%) at the time of inclusion, and 2 years later – in 48 (62%) (p<0.05). As for other clinical manifestations of the disease at the time of inclusion in the study, among 77 patients, 75% had peripheral arthritis, and after 2 years – only about 39% (p<0.05). The patient’s functional index (BASFI) was initially 3.3, and after 2 years it decreased down to 1.3 (p<0.05).Results. At inclusion in the study, 59 patients had no radiological changes in the hip joint (BASRI-hip<2). 2 years after the start of follow-up, the number of patients with radiological changes in the hip joint was 48 (62%). Initially, according to MRI, synovitis was detected in 75 (97%), and osteitis – in 23 (30%), chronic changes were present in 2 (3%) patients. After 2 years, synovitis persisted in 46 (60%) (p<0.05), bone marrow edema – in 17 (22%) (p>0.005), and the number of chronic changes increased up to 29 (38%). In 25 (32%) MRI patients, signs of active inflammation were arrested, while only two (13.3%) of them showed the development of chronic changes. To assess the relationship between X-ray progression and MRI signs of inflammation of the disease, patients were divided into two groups according to the total stage of radiographic coxitis (ΔtsrC=0 and ΔtsrC>0). The group with ΔtsrC=0 included 33 patients (22 men and 11 women), and the group with ΔtsrC>0 included 44 patients (32 men and 12 women) (p>0.05). The groups did not differ in clinical parameters such as disease duration, patient age, BASDAI, ASDAS-CRP, BASFI, ESR and CRP (p>0.05). According to MRI, the signs of inflammation (osteitis, synovitis) of the groups also did not differ.Conclusion. The progression of coxitis did not depend on the activity of the disease, on the gender of the patients, and on MRI signs of inflammation in the hip joint.

Predominance of Staphylococcus Correlates with Wound Burden and Disease Activity in Dystrophic Epidermolysis Bullosa: A Prospective Case-Control Study

Recessive dystrophic epidermolysis bullosa is characterized by skin blistering and wounds. To uncover the changes in the skin and mucosal microbiome related to age and disease progression and microbiome impact on clinical and inflammatory laboratory parameters, swabs from wounded and unwounded skin, oral mucosa, and stool samples of 28 children with recessive dystrophic epidermolysis bullosa and 28 healthy controls were subjected to 16S-ribosomal RNA gene sequencing. Skin microbiome of patients with recessive dystrophic epidermolysis bullosa showed significantly reduced alpha diversity compared with that of healthy controls and showed significantly early, age-dependent predominance of Staphylococcus aureus, first in wounded skin and then in unwounded skin. These findings were more pronounced in the severe disease with higher abundances of S.aureus than in intermediate disease. S.aureus abundance correlated significantly with both acute and chronic wound burden. Changes in oral mucosal and gut microbiome were discrete, with no significant differences in alpha diversity. Our findings show that children with recessive dystrophic epidermolysis bullosa experience skin microbiome changes early in life. Longitudinal studies should confirm that dysbiosis starts in wounds and later extends to unwounded skin. The predominance of S.aureus significantly correlates with wound burden and disease activity and, to some extent, with systemic inflammation.

Mortality characteristics during the two waves of COVID-19 in India: A retrospective observational study

Objective: To evaluate patient demographic characteristics and risk factors for mortality during the first and the second wave among COVID-19 patients in a tertiary care hospital of India.Methods: Data were taken from the hospital’s electronic system for COVID-19 patients from August 2020 to December 2020, and the second from January 2021 to May 2021. The mortality rate, demographic and clinical characteristics, laboratory profile, and reasons for the death of the two waves were retrieved and compared, and the risk factors of the two waves were determined.Results: In the first wave, 1 177 COVID-19 cases visited the hospital and 96 (8.2%) died. In comparison, the death rate in the second wave was significantly higher (244/2 038, 12.0%) (P<0.001). No significant difference in age [60 (50-69) vs. 60.5 (53-70), P=0.11] or gender (P=0.34) was observed between the two waves. Compared to the first wave. there were significantly more cases with fever, cough, weakness, loss of taste and smell, and sore throat during the second wave (P<0.05), but significantly fewer cases with kidney disease (6.6% vs. 13.5%, P=0.038) and diabetes mellitus (35.7% vs. 50.0%, P=0.015). Besides, during the second wave, more patients had abnormal X-ray findings, higher levels of lymphocytes and serum ferritin (P<0.05). In addition, there were significant differences in the rate of death cases with acidosis, septic shock, acute kidney injury, diabetes mellitus, cardiovascular events, hypothyroidism (P<0.05). Multivariate regression showed that during the first wave, age (OR: 1.10; 95% CI: 1.02-1.21), diabetes mellitus (OR: 3.16; 95% CI: 2.08-3.53), and abnormal X-ray (2.67; 95% CI: 2.32-2.87) were significant independent risk factors of mortality; while in the second wave, age (OR: 1.13; 95% CI: 1.12-1.28), diabetes mellitus (OR: 8.98; 95% CI: 1.79-45.67), abnormal X-ray (OR: 12.83; 95% CI: 2.32-54.76), high D-dimer (OR: 10.89; 95% CI: 1.56-134.53), and high IL-6 (OR: 7.89; 95% CI: 1.18-47.82) were significant independent risk factors of mortality .Conclusion: Overall mortality and incidence of severe diseases are higher in the second wave than the first wave. Demographic characteristics, co-morbidities, and laboratory inflammatory parameters, especially D-dimer and IL-6, are significant risk facors of mortality during the COVID-19 pandemic.

Lung function and radiological findings 1 year after COVID-19: a prospective follow-up

BackgroundThe coronavirus disease (COVID-19) pandemic has already affected more than 400 million people, with increasing numbers of survivors. These data indicate that a myriad of people may be affected by pulmonary sequelae of the infection. The aim of this study was to evaluate pulmonary sequelae in patients with bilateral COVID-19 pneumonia according to severity 1 year after hospital discharge.MethodsCOVID-FIBROTIC is a multicenter prospective observational cohort study for admitted patients with bilateral COVID-19 pneumonia. Pulmonary functional outcomes and chest computed tomography sequelae were analyzed 12 months after hospital discharge and we classified patients into three groups according to severity. A post hoc analysis model was designed to establish how functional test changed between groups and over time. A multivariable logistic regression model was created to study prognostic factors for lung diffusion impairment and radiological fibrotic-like changes at 12 months.ResultsAmong 488 hospitalized patients with COVID-19 pneumonia, 284 patients had completed the entire evaluation at 12 months. Median age was 60.5 ± 11.9 and 55.3% were men. We found between-group differences in male sex, length of hospital stay, radiological involvement and inflammatory laboratory parameters. The functional evaluation of pulmonary sequelae showed that severe patients had statistically worse levels of lung diffusion at 2 months but no between group differences were found in subsequent controls. At 12-month follow up, however, we found impaired lung diffusion in 39.8% unrelated to severity. Radiological fibrotic-like changes at 12 months were reported in 22.7% of patients (102/448), only associated with radiological involvement at admission (OR: 1.55, 95% CI 1.06–2.38; p = 0.02) and LDH (OR: 0.99, 95% CI 0.98–0.99; p = 0.046).ConclusionOur data suggest that a significant percentage of individuals would develop pulmonary sequelae after COVID 19 pneumonia, regardless of severity of the acute process.Trial registration clinicaltrials.gov NCT04409275 (June 1, 2020)

Povezanost polimorfizma glutation transferaza omega sa laboratorijskim pokazateljima zapaljenja u KOVIDU-19

In a view of important functions of glutathione transferase omega (GSTO) class in redox homeostasis and innate immunity, it was proposed that interindividual differences in COVID-19 clinical manifestations might be affected by GSTO1 (rs4925) and GSTO2 (rs156697) polymorphisms. To assess the potential association of these polymorphisms with biochemical, coagulation and inflammatory laboratory parameters in the group of mild and severe COVID-19 patients. GSTO1 and GSTO2 single nucleotide polymorphisms were determined by qPCR in 251 samples of COVID-19 patients. Biochemical, coagulation and inflammatory laboratory parameters of COVID-19 participants were procured from routine laboratory practice on the day of admission. Polymorphisms of GSTO1 and GSTO2 affect laboratory biochemical profile of COVID-19 patients. GSTO1*C allele was associated with increased levels of C-reactive protein (CRP) (p=0.035), interleukin-6 (IL-6) (p=0.047), D-dimer (p=0.014) and lactate dehydrogenase LDH (p=0.002), whereas GSTO2*G allele was associated with CRP (p=0.033). COVID-19 patients homozygous for variant GSTO1*A allele and GSTO2*G had the highest levels of serum Fe (p=0.019, p=0.052, respectively). Our findings regarding the influence of GSTO1 and GSTO2 polymorphisms on inflammation and coagulation parameters might be of clinical importance. In future, these findings could aid in a more personalized approach for better recognition of patients prone to thrombosis and excessive immune response.

Polymyalgia rheumatica in 18-fluorodeoxyglucose-positron-emission-tomography/computed tomography : Improvement in diagnostic accuracy and differentiation from rheumatoid arthritis

The diagnosis of patients with polymyalgia rheumatica (PMR) has relied upon the clinical examination of symptoms and laboratory parameters of inflammation until now. Currently, the use of different imaging modalities is being explored, including ultrasound, MRI and PET. The aim was to evaluate the diagnostic value of 18-fluorodeoxyglucose-positron-emission-tomography/computed tomography (18F-FDG-PET/CT) for PMR, in order to improve the sensitivity and specificity of diagnosing PMR and to improve the differential diagnosis of rheumatoid arthritis (RA). Examinations using 18F-FDG-PET/CT of 284 rheumatological patients, including 97 patients with PMR, were retrospectively evaluated over a44-month period. Furthermore, 13regions changed by inflammation were analysed via athree-dimensional region of interest (ROI) measurement with determination of maximum standardized uptake values (SUVmax), followed by statistical analyses. Patients with PMR presented significantly elevated uptake in all regions examined (p < 0.001), compared with acontrol group treated for rheumatological diseases. The method with the highest diagnostic relevance was represented by the combination of four SUVmax values of both anterolateral hip capsules and both ischial tuberosities, reaching asensitivity of 91.3% and aspecificity of 97.6% with acut-off of 11.0 SUV at the initial diagnosis of PMR patients who had not yet received any immunosuppressive therapy. Patients with RA could be significantly distinguished from those with PMR at initial diagnosis in the same anatomical regions (p < 0.001).

Neisseria meningitidis-induced discitis at L5-S1 mimicking lumbar disc herniation

A 23-year-old man presented to his general practitioner with a 2-week history of increasing lumbar back pain and left-sided radiation at S1, with progressive motoric loss of function of S1 on the right side but with intact sensibility. On lumbar MRI, a medial L5-S1 disc herniation was identified (figure) and oral corticosteroid therapy (prednisolone 100 mg daily for 5 days) was initiated. Because the back pain and radiculopathy did not regress and a progressive functional motoric loss of function of S1 (M3) was present, he underwent microdiscectomy 2 weeks after initial presentation. At admission, the laboratory results showed moderately increased serum C-reactive protein (50 mg/L) and leukocyte count (12 × 109 cells per L). Preoperative antimicrobial prophylaxis with intravenous cefuroxime (1·5 g as a one-off injection) was administered. Intraoperatively, pus was detected in the epidural space and disc niche, hence lavage of the disc space and collection of two disc tissue biopsies followed. Antibiotic treatment with intravenous co-amoxiclav (2·2 g every 6 h for 7 days) was initiated postoperatively. Histopathological examination showed focal lymphoplasmacytic, partly granulocytic inflammation, which was consistent with discitis. Cultures of intraoperatively sampled tissue biopsies remained without bacterial growth, but broad-spectrum PCR identified Neisseria meningitidis (subgroup W135) in both disc tissue specimens. Antimicrobial treatment was subsequently changed to targeted therapy with intravenous ceftriaxone (2 g once daily for 14 days). On postoperative day 8, the patient had an exacerbation of pain. Despite debridement of the abscess at the first intervention, persistent epidural abscess collection was visible in the ensuing obtained lumbar MRI, which resulted in a second-look surgery with extensive lavage and abscess evacuation on the same day. Intraoperative tissue biopsies remained culture-negative; however, N meningitidis was identified by PCR again in three of six specimens (four disc tissue specimens and two abscess fluid specimens) taken during the second surgery. Subsequently, pain subsided substantially with extended oral analgesic treatment consisting of oral diclofenac (75 mg twice daily), oral metamizol (500 mg four times daily), oral tapentadol (150 mg prolonged-release tablet every 12 h), and oral pregabalin (50 mg three times daily), which was adminstered for 28 days. The patient was discharged on postoperative day 12 after index surgery still having increased inflammatory markers (C-reactive protein 47 mg/L, leukocyte count 9·7 × 109 cells per L). After 9 days of intravenous ceftriaxone (2 g once daily), oral ciprofloxacin (750 mg twice daily) was administered to complete the 6-week course of antimicrobial therapy for bacterial spondylodiscitis. The patient regained complete motor function at 6 weeks after the first surgery. Inflammatory laboratory parameters were completely resolved at 3 months of follow-up, and back and leg pain resolved at 6 months of follow-up.

Screening Protocol and Prevalence of Venous Thromboembolic Disease in Hospitalized Patients With COVID-19.

BackgroundSARS‐CoV‐2 disease (COVID‐19) induces endothelial damage and sustained hypoxia and facilitates immobilization as factors of hypercoagulability.ObjectivesThe objective of our study was to assess the prevalence of venous thromboembolic disease (VTD) in COVID‐19 patients and the usefulness of VTD screening based on age‐adjusted D‐dimer and point‐of‐care ultrasound (POCUS).Patients/MethodsWe conducted a single cohort, prospective observational study in 102 consecutive hospitalized patients.ResultsA total of 102 POCUS and 39 pulmonary computed tomography angiography (PCTA) were performed diagnosing 27 VTD (26.5%): 17 deep vein thrombosis (DVT) (16.6% positive POCUS) and 18 pulmonary embolism (PE) (46.2% positive PCTA). COVID‐19 patients with VTD were older (P < .030), had higher D‐dimer (P < .001), higher International Society on Thrombosis and Hemostasis score (P < .001), and higher mortality (P = .025). However, there were no differences in inflammatory laboratory parameters neither in the cytokine storm syndrome (CSS) development. The ROC curve for D‐dimer showed an AUC of 0.91. We have evidenced that patients with D‐dimer between 2000 and 6000 ng/mL could benefit from a screening strategy with POCUS given the high sensitivity and specificity of the test. Furthermore, patients with D‐dimer ≥6000 ng/mL should undergo POCUS and PCTA to rule out DVT and PE, respectively.ConclusionsIn our cohort, 26.5% of the patients presented VTD. Screening strategy based on age‐adjusted D‐dimer and POCUS proved high sensitivity and specificity. Future trials focused on screening strategies are necessary to early detect the presence of DVT and PE and determine thromboprophylaxis strategies in patients with COVID‐19.

“Impact of pentaglobin in severe COVID 19 pneumonia- a prospective study.”

BackgroundThe current COVID-19 pandemic has become a global public health crisis and presents a serious challenge in treatment of severe COVID pneumonia patients. With an imperative need for an effective treatment, we aimed to study the effectiveness of Pentaglobin, an intravenous immunoglobin in the treatment of severe Covid-19 pneumonia patients. MethodsThis is an open-label non-randomised controlled study. Patients in the study group (n = 17) received Pentaglobin in addition to standard therapy and the control group (n = 19) received only the standard of care treatment. Severity of illness were quantified by severity scores and inflammatory laboratory parameters were compared between the two groups. ResultsThe average length of hospital stay in pentaglobin group were 12.35 ± 6.98 days compared to 10.94 ± 4.62 days in standard treatment group with mean difference of 1.4 days (p value = 0.4). Pentaglobin did not provide an added advantage in terms of reducing the duration of hospital stay. There was no significant difference between both the groups in terms of requirement of invasive ventilation (p = 0.56) and mortality (p = 0.86). CT Severity score (OR = 1.39 95% CI = 1.09–1.77, P = 0.01), APACHE II score (OR = 1.16 95% CI = 0.99–1.35, P = 0.05) and the SOFA score (OR = 2.11 95% CI = 1.13–3.93, P = 0.02) were independent predictors of mortality. ConclusionThe administration of pentaglobin in COVID −19 patients has no significant effect in reducing the risk of mechanical ventilation or death, in disease worsening or in reduction of inflammation.

P121 The study of the hypercoagulable state in Crohn disease: Results of a prospective comparative study

Abstract Background The risk of thrombosis is increased in Crohn disease (CD). Abnormalities in hemostasis during CD have been evaluated in several studies but the results remain controversial. The thrombin generation assay (TGA) provides an overall assessment of hemostasis compared to traditional tests. The purpose of this work was to study the hypercoagulable state in patients with CD through TGA and to correlate it with the clinical and biological status of the disease. Methods This was a prospective comparative study, collating 50 patients diagnosed with CD and compared to 50 matched controls according with age and sex, between May 2016 and January 2020. TGA was effectuated in both groups. Data related to CD were collected. Parameters of lag time (min), time to peak (min), peak (nM), endogenous thrombin potential (ETP in nM.min) and velocity index (VI in nM/min) were analyzed. Laboratory parameters of inflammation, factor VIII and anti-coagulant factors were evaluated in patients. Results Median age of patients was 44.02 years (29 men and 21 women). The proportion of patients in remission was 66%. The mean levels of FVIII (285.1±175.2 vs 133.8±41.9; p=0.001), ProteinC (117±22.8 vs 103.2±13.6; p=0.003) and Antithrombin (97.1±16.9 vs 80.65±13.2; p=0.001) were significantly higher in patients with CD compared to controls. No significant difference was found for the rates of ProteinS. Thrombin generation was faster in patients with CD compared to controls (IV: 163.9±41.9 vs 138.2±67.4; p=0.04) and in cases of fistulizing or stenosing phenotype compared to the inflammatory phenotype. Thrombin generation was higher in patients: hospitalized compared to those seen as outpatients (ETP: 1515±406.6 vs 1248.2 + 380.8; p=0.05), treated with corticosteroids (ETP=1718.7 + 126.9) compared to the rest of the patients (p=0.03), with CRP&amp;gt; 6 mg/L compared to those with normal CRP (ETP= 1515 + 384.8 vs 1245 + 348.2) (p=0.02) and with hyperfibrinogenemia level compared to those with normal fibrinogen (Peak = 351.6±74.1 vs 294.9 ±64.4) (p= 0.03). A significant positive correlation was noted between the parameters of TGT, CRP and fibrinogen. ETP value was significantly correlated with CRP (r=0.45; p=0.001) and fibrinogen (r=0.35; p=0.02). This allowed us to determine two biological scores correlating ETP and CRP (ETP=1384 + 2.9 x CRP), as well as fibrinogen level (ETP=1060.7 + 130.5 x Fibrinogen) Conclusion Thrombin generation appears to be more accelerated in patients with CD than in controls. This hypercoagulability is associated with hospitalization, stenosing and fistulizing phenotypes, elevated CRP and fibrinogen and corticosteroid therapy. The determination of ETP from CRP and fibrinogen would be a valuable tool for assessing the state of coagulability in these patients.

Descending Necrotising Mediastinitis: the Choice of Drainage

Descending necrotising mediastinitis (DNM) is a rare, but very severe, septic condition, caused by the spread of infection from the neck to the mediastinum. Delay in diagnosis and inadequate surgical procedures may lead to a life-threatening situation. We retrospectively evaluated a group of patients who suffered from DNM and were treated in our department by mediastinal drainage in the last 10 years (2010 - 2019). All patients required one of the following methods of drainage: cervicomediastinal, mediastinothoracic or cervicomediastinothoracic "Rendevouz" drainage (MTC-D). In the group, we evaluated the source of infection, microbiologic findings, method of mediastinal drainage, length of hospitalisation, ventilation duration and inflammatory laboratory parameters. In total, we treated 22 patients with DNM, including 14 men and 8 women, aged 23 - 85 years, with a mean age of 54.1 years. After the spread of infection, in 8 cases the initial cervicomediastinal type of drainage had to be followed by one of the types of thoracic drainage. As the final method, in 8 patients we chose irrigation drainage from the cervical approach, from thoracotomy in 6 cases and in 8 cases irrigation CMT-D. The method of mediastinal drainage was chosen according to the initial CT findings, and further intervention was chosen according to CT signs during the treatment. Four patients died of DNM (mortality 18.2%). Pharyngeal focus was responsible for 15 cases of DNM; odontogenic infection caused 6 DNM cases; in 1 case the origin was unclear. Although we always chose the method individually and CMT-D for the most difficult cases, there were no statistically significant (p < 0.05) differences between the evaluated parameters. For CMT-D, there was even a shorter hospital stay (not significant) and ventilation duration. In cases of DNM with severe inflammation of caudal and distal compartments of the mediastinum we consider CMT-D as an ideal method of treatment. This appraoch is radical enough and in our group of patients, despite the severity of this illness, both the length of treatment and mortality were sufficient.