Mean C-reactive Protein Levels Research Articles

Diagnostic value of lymphocyte-to-monocyte ratio in Crohn’s disease: a cross-sectional study

Background: Investigating non-invasive laboratory biomarkers for detecting and classifying Crohn’s disease (CD) activity remains challenging. Here, we aimed to evaluate the diagnostic efficacy of immunological biomarkers in identifying disease activity in newly diagnosed CD patients. Methods: This cross-sectional study was performed from October 2022 to July 2023 and included 20 healthy participants and 46 confirmed newly diagnosed CD patients in a Teaching Hospital for Gastroenterology and Hepatology, Sulaimani, Iraq. The patients were categorized according to the disease activity assessed according to the Harvey-Bradshaw Index and divided into remission and active CD. Results: A statistically higher serum C-reactive protein and erythrocyte sedimentation rate was found among the remission CD group (p = 0.005 and p = 0.0002, respectively) and active CD group (p<0.0001 and p<0.0001, respectively) compared to the healthy controls. Moreover, the mean C-reactive protein and erythrocyte sedimentation rate levels among active CD were also considerably higher than those of remission CD (P = 0.018 and 0.005, respectively). The lymphocyte-to-monocyte ratio was significantly lower in patients with active disease (3.01 ± 1.36) than in remission patients (6.77 ± 2.17) (cutoff<4.42, area under receiver operating characteristic curve = 0.807, 95% CI, 77.35-98.73%, 93% sensitivity, and 78% specificity). Although the neutrophil-to-lymphocyte ratio was significantly elevated in active patients (3.64 ± 2.004) compared to healthy controls (1.91 ± 0.48; p = 0.0001), it is not usable for disease activity or severity as the area under the receiver operating characteristic curve was 0.68 (95% CI, 52.22%-85.08%, sensitivity = 79%, specificity = 62%). Conclusion: Lymphocyte-to-monocyte ratio can be an affordable, easily accessible test that shows promise for determining disease activity in newly diagnosed CD patients.

Predictive Value of Quantitative CRP Levels as a Marker of Nosocomial Neonatal Sepsis: Outcome of an Observational Study From a Tertiary Care Hospital.

Nosocomial infection (NI) is a serious health concern primarily for premature neonates and for term babies with illnesses requiring continued hospitalisation. Early diagnosis of NI using biomarkers is central to decreased neonatal mortality and morbidity. We aimed to evaluate the predictive value of C-reactive protein (CRP) as a marker of NI. Sixty-four neonates, suspected of sepsis, admitted to the Department of Paediatrics and Neonatology with a negative workup for sepsis on their first day of admission were investigated for various haematological parameters, blood culture positivity, and CRP levels. The patients were then stratified into culture-positive and culture-negative groups. All the parameters analysed were compared between these 2 groups, and ROC curve analysis was performed to determine the value of CRP in predicting positive blood culture in NI. NI was seen in a total of 70.31% (n=45) neonates based on blood culture-positive status. Compared to females, a greater number of male neonates were culture-positive (60% vs 40%). The mean birth-weight of the culture-positive group was significantly lower than the negative group (P =0.03). The mean CRP levels were elevated in the positive group (98.5±47.8) when compared to the negative group (32.2±24.1; P < .001). Using the ROC curve,a cut-off value (45.05 mg/L) of CRP had sensitivity and specificity of 80.0% and 73.7% respectively in predicting blood culture-positive NI. Serum CRP is a sensitive marker to diagnose NI in admitted neonates. CRP levels can aid in the diagnosis of clinical deterioration, and a treating physician can modify the regimen based on elevated CRP levels.

Serum cardiac and inflammatory biomarker levels following chemotherapy among female patients with breast cancer attending at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

BackgroundChemotherapy is a well-established therapeutic approach for several malignancies, including breast cancer (BCa). However, the clinical efficacy of this drug is limited by cardiotoxicity. Assessing multiple cardiac biomarkers can help identify patients at risk of adverse outcomes from chemotherapy.ObjectiveTo evaluate changes in serum cardiac and inflammatory biomarker levels following chemotherapy among female patients with BCa attending at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.MethodsAn experimental study design was used. Forty patients with breast cancer were selected using a convenience sampling method. After obtaining informed consent, 40 paired samples (40 samples before chemotherapy and 40 matched samples after three cycles of chemotherapy) were collected between May 2018 and March 2019. An Elecsys 2010 Troponin-T immunoassay analyzer was used to measure serum levels of cardiac troponin T (cTnT), creatinine kinase-myocardial band (CK-MB), C-reactive protein (CRP), and R and D systemic luminex performance assays were used to measure serum Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF- α). Data were analyzed using the SPSS version 23 package, and a p-value < 0.05 was considered statistically significant.ResultsAmong female patients with BCa receiving chemotherapy, 20%, 15%, and 35% of patients had elevated cTnT, CK-MB, and CRP levels, respectively, after three cycles of chemotherapy. In contrast, 15% of patients had baseline elevated CRP levels compared with their respective cutoff values. The mean serum cTnT, CK-MB, CRP, and TNF-α levels significantly increased (p < 0.05) compared with their respective baseline values. However, the IL-6 levels at baseline and after chemotherapy were not significantly different.ConclusionThis study revealed significant increases in cardiac and inflammatory biomarkers following chemotherapy among female patients with breast cancer in the study area. Therefore, cardiac biomarkers and echocardiography findings were used to assess functional abnormalities and treatment outcomes.

Diagnostic Biochemical Changes Identified in a Cohort of Patients with Coronavirus-19 (COVID-19) Disease

Backgroun: SARS-CoV-2 infection was associated with inflammatory, metabolic, haematological, and immunological changes, which contributed to the increase in morbidity and mortality. Objective: To illustrate changes in some biomarkers (ESR, ferritin, CRP, D. dimer, ALT, AST, creatinine, and urea) during COVID-19 and their predictive value in the diagnosis of SARS-CoV-2 infection, especially in rural and urban areas in which sophisticated tests were not available. Materials and Methods: The study includes 154 COVID-19 patients with positive RT-PCR. Sixty age and sex-matched individuals were included as controls. The study was conducted during the period from 23rd July 2021 to the end of December 2021. The subjects with a history of liver diseases, pregnant women, an age of less than 18, and chronic renal failure were excluded. The informed consent was taken from each individual before their enrolment in the study. The study was performed in compliance with the World Medical Association Declaration of Helsinki. Venous blood samples were collected from both groups and tested for determination of creatinine, urea, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), D dimer, ferritin, and C-reactive protein (CRP) using a Mindray BS 240 chemical auto-analyzer. Results: The mean serum values were significantly higher (P= 0.01 – 0.001) in COVID-19 patients as compared to matched controls for creatinine, blood urea, ALT, AST, ESR, LDH, D- dimer, ferritin, and CRP. In addition, the mean serum levels of ALT, AST, ESR, LDH, D-dimer, ferritin, and CRP were higher than the values of normal ranges. Although, creatinine and urea mean serum values were significantly higher in COVID-19 patients, their mean values were within the normal range values. ESR was highly significantly (p &lt; 0.001) correlated with ALT, AST, LDH, urea, ferritin, and CRP. While LDH was highly significantly correlated with creatinine, urea, ESR, ferritin, and CRP. Also, D. dimer was significantly highly correlated with ferritin, and CRP. Serum ferritin was highly significantly correlated with creatinine, urea, ESR, LDH, D. dimer, and CRP. While CRP was highly significantly correlated with creatinine, urea, ESR, LDH, D. dimer, and ferritin. Conclusion: ESR, CRP, Ferritin, D. dimer, LDH, AST, ALT, urea, and Creatinine levels in venous blood were significantly elevated in COVID-19 patients compared with controls. Sex- influenced serum levels of C-reactive protein, creatinine, and urea in this study cohort. Serum levels of tested biomarkers may be useful in the diagnosis of COVID-19 in primary healthcare centres, especially in rural areas in developing countries.

P1357 Association between stool infection and C - reactive protein levels in Ulcerative Colitis: A retrospective analysis in Albania

Abstract Background Stool infections complicate the management of Ulcerative Colitis (UC), worsening symptoms and treatment outcomes. This study aimed to explore the relationship between stool infections and C-reactive protein (CRP) levels, a marker of inflammation, in UC patients. Methods A retrospective study was conducted at the IBD Unit, Clinic of Gastroenterology, Tirana, Albania, between April and October 2024. A total of 25 active (mean total Mayo score 5.72 ±1.67) UC patients (15 females, 10 males, mean age 41.96 ± 13.99 years, disease duration 9.26 ± 11.59 years) were included. Stool samples were tested for pathogens, and CRP levels were measured. Demographic data, and treatment history (including corticosteroids, immunosuppressants, and antibiotics) were recorded. The relationship between CRP levels, stool infection status, and clinical variables was analyzed using Pearson correlation and logistic regression models. ANOVA was used to compare CRP levels between UC patients with and without stool infection. Results Stool infections were present in 10 of 25 patients (40%), with 6 (60%) having multiple infections. Identified pathogens included Clostridium difficile (3), Enteropathogenic E. Coli (4), Enterohemorrhagic E. Coli (1), Dientamoeba fragilis (2), Aeromonas species (2), Norovirus (2), Shiga toxin-producing bacteria (2), Salmonella (1), and Blastocystis species (1). Of the infected patients, 4 (40%) were on multiple drugs, (corticosteroid and immunosuppressant), and 1 (10%) had recent antibiotic use. The mean CRP level was significantly higher in the stool infection group (13.09 ± 13.73 mg/L vs 4.41 ± 4.75 mg/L (F = 5.163, p = 0.033). A significant correlation was seen between CRP levels and stool infection (r =0.420, p = 0.041). Logistic regression suggested that each 1-unit increase in CRP was associated with an increase of 11.5% in the odds of stool infection {Exp (B) = 1.115}, though this trend was not statistically significant (p = 0.076). Conclusion Stool infection is associated with higher CRP levels in UC patients, suggesting increased inflammation in the presence of infection. Although CRP levels correlate with infection status, they do not reliably predict stool infection risk in this cohort. This study highlights the common occurrence of stool infections among UC patients and the potential role of infection in disease activity, though further research is needed to clarify the predictive value of CRP and other biomarkers in UC management.

P1124 Disease Clearence after Acute Severe Ulcerative Colitis episode: is it possible ?

Abstract Background Acute severe ulcerative colitis (ASUC) is a critical and potentially life-threatening condition necessitating prompt and effective intervention. Long-term follow-up of these patients is vital for understanding the disease trajectory, therapeutic outcomes, and overall patient management. The concept of disease clearance has been proposed as a potential target in ulcerative colitis (UC). This study aims to report one-year follow up data after patients experienced ASUC. Methods We performed a retrospective analysis of patients diagnosed with ASUC at our Referral IBD center from 2014 to 2024. Inclusion criteria were based on established clinical parameters in accordance with ASUC. Data collected included patient demographics, disease severity, treatment modalities, surgical interventions, and one-year outcome (disease clearance, mucosal healing, colectomy). Treatment comprised intravenous corticosteroids, followed by immunomodulator (Cyclosporine and biologics) in non-responders. Results The study included 109 patients diagnosed with ASUC. The average age at the time of initial presentation with ASUC was 42.1 years, and 47% of the participants (44 out of 109) were male. The mean C-reactive protein (CRP) level recorded was 77.65 mg/L. Among the patients, 36.7% (40 out of 109) were treated with Infliximab, while 14.6% (16 out of 109) received Cyclosporine as rescue therapy. Colectomy was necessary for 12% (14 out of 109) of the patients due to either refractory disease or complications within the first year. The rest of the patients, 44.9 % (49 out of 109) achieved remission on intravenous steroids, and consecutively received either Infliximab (33/49), Vedolizumab (11/49) or Tofacitinib (5/49). Additionally, 7.3% (8 out of 109) achieved clinical remission using intravenous steroids in combination with aminosalycilates. After one year of follow-up, 55% (57 out of 109) of the patients achieved mucosal healing, and disease clearance was observed in 27.5% (30 out of 109) of the cases. 67.5% (27 out of 40) achieving mucosal healing and 45% (18 out of 40) experiencing disease clearance. Conclusion Definition of disease clearance was proposed to provide practical recommendations for its implementation as a therapeutic target in UC. Almost one third of our patients achieved DC after ASUC, majority in Infliximab group with colectomy rate of 12 % in first year.

Posttraumatic Spinal Cord Tethering and Syringomyelia: A Retrospective Investigation of Patients With Progressive Disease and Surgical Revisions.

Spinal cord tethering and syringomyelia after trauma are well-known pathologies in patients suffering from spinal cord injury (SCI). In symptomatic cases, various surgical options are available, but untethering and expansion duraplasty is the currently preferred treatment strategy. However, patient outcomes are usually limited by rather high rates of surgical revisions. The aim of the present study was to identify risk factors in SCI patients who underwent multiple surgeries for symptomatic spinal cord tethering and syringomyelia. We retrospectively investigated 25 patients who received at least 2 untethering surgeries of the spinal cord. All patients were treated by untethering and expansion duraplasty and/or clinically followed between 2012 and 2022 at the Swiss Paraplegic Center. A higher location of SCI correlates with a more rapid development of symptomatic spinal cord retethering in need of surgical revision (r = 0.406 and P = 0.044). Interestingly, the extent of spinal cord tethering is lower in those patients who underwent an early surgical intervention (r = 0.462 and P = 0.030), which points toward an increased vulnerability of the spinal cord at higher levels. Ninety-two percent of the patients displayed a potentially chronic inflammatory condition with a mean level of C-reactive protein of 28.4 ± 4.1 mg/L, while the white blood cell count was identified as an independent predictor for surgical interventions in symptomatic cases. Revision surgery in posttraumatic spinal cord tethering and syringomyelia patients is associated with the location of SCI and the extent of spinal cord tethering. It appears that chronic inflammatory conditions might play an important role in promoting spinal cord retethering and thus warrant further investigation. SCI patients with chronic inflammatory conditions and SCI at upper levels should be clinically monitored more carefully as they appear to be more susceptible to progressive forms of posttraumatic spinal cord tethering and syringomyelia.

Correlation Between Levels of C-Reactive Protein, D-Dimer, and Ferritin in Covid-19 Patients Infected with Different Bacterial Species

Introduction: The fast dissemination of SARS-CoV-2 occurred swiftly across Iraq and various nations globally, leading to a widespread viral pandemic. C-reactive protein, Ferritin, and Ddimer have emerged as pivotal molecules within the immune system, playing a central role in coordinating cellular defense mechanisms against inflammation. This study aimed to correlate the role of CRP, ferritin- and D-dimer parameters in patients of coronavirus disease - 2019 (COVID-19) associated bacterial co-infection. Methods: Sputum and blood samples were collected from patients who diagnosed a COVID-19 by an internal medicine specialist and positive PCR test. The collected samples of sputum were inoculated on selective culture media, the isolated colonies were further subjected to subculture and identified using cultural and biochemical tests. Antibiogram testing was performed with selected antibiotics. An automated VITEK-2 compact system using AST-N222 cards and - chroma11 TM D-Dimer kits was used to determine the levels or titers of these parameters using ELISA and fluorescence Immunoassay (FIA) for the quantitative determination in human whole blood/serum /plasma according to manufacturing instructions. Results: the results revealed a significant rise in ferritin levels among individuals with moderate and severe diseases in comparison to those with mild cases. Among severe patients, ferritin levels were significantly higher than in non-severe cases (P=0.02). The mean C-Reactive protein levels were 92.54±68.94, 97.66±65.70, and 123.83±65.80 in Covid19 patients infected with M. catarrhalis, P. aeruginosa, and K. pneumonia, respectively. The study showed levels of ferritin non-significant increase in patients infected with COVID-19 and K. pneumoniae when compared with other groups was none. Conclusion: In this study, the results proved the presence of an association between the elevated levels of tested biomarkers (CRP, Ferritin, D-dimer) in co-infection by bacteria of COVID-19 patients.

The Impact of COVID-19 on White Blood Cell Subpopulations and Inflammatory Markers

Background: COVID-19 is a disease of the zoonosis class and much has come to light since the onset of the pandemic in December 2019. Understanding COVID-19 pathophysiology is crucial for its effective treatment. The present study is conducted to observe the haematological changes associated with COVID-19 infection among a cohort of Iraqi patients. Methods and Design: A retrospective cohort study involving confirmed (60) COVID-19 patients and (20) individuals in the control group admitted to Al Karama Teaching Hospital in Al-Kut Wasit Province, Iraq. Data captured included complete blood counts (CBC), C-reactive protein (CRP), and D-dimer levels. The statistical analysis covered t-tests for between-group comparison and multiple linear regression to ascertain the associations between the haematological parameters. Results: The COVID-19 patients had a significantly higher total white blood cell count, with a mean of 17.1575 than the control groups of 8.7005 (p &gt; 0.001). COVID-19 patients also had significantly greater mean lymphocyte counts (mean 55.365) compared to controls (mean 29.79; p &gt; 0.001), suggesting the presence of lymphocytosis. The COVID-19 patients also showed significantly higher mean neutrophil count (mean 82.9205) than the control group (mean 60.369; p &gt; 0. The mean levels of CRP were 75.74667 in COVID-19 patients, which is significantly higher compared to 3.11 as observed in the control group (p &gt; 0.001). Similarly, the mean D-dimer levels were higher in COVID-19 patients at 2319.7 compared to 336.65 in the control group (p &gt; 0.001). The correlation analysis shows a high negative correlation between WBCs and neutrophils and a moderate positive correlation between CRP and D-dimer, which reflects the complex interplay between inflammatory and coagulation processes. Conclusion: This study highlights striking haematological changes in COVID-19, characterized by lymphocytosis, neutrophilia, and activation of inflammatory and coagulation markers. It underlines the importance of monitoring these parameters for better patient management. More research is needed to explore therapeutic interventions targeting these specific immune and coagulation responses in COVID-19.

The role of vitamin D in treated and refractory ulcerative colitis patients: a case-control study

BackgroundUlcerative colitis is a form of chronic inflammatory bowel disease (IBD) marked by ongoing inflammation of the mucosal lining that extends from the rectum to the upper part of the colon. Vitamin D regulates immune responses in several autoimmune and inflammatory diseases, including ulcerative colitis. Therefore, the study aims to investigate the role of vitamin D in the pathogenesis and treatment of ulcerative colitis.MethodsThis case-control study included 94 participants who were divided into four groups. Group 1: people with ulcerative colitis who responded to treatment (n = 24). Group 2: family members of patients who responded to treatment and did not have the disease (n = 24). Group 3: People with ulcerative colitis who are resistant to treatment (n = 23). Group 4: family members of treatment-resistant patients who does not have the disease (n = 23). Groups 1 and 3 were considered as patient groups (n = 47) and groups 2 and 4 as control groups (n = 47). Blood samples were taken and analyzed for complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum vitamin D levels.ResultsThe mean age of treatment-responsive patients (group 1) was 45.88 ± 18.51 years, while treatment-resistant patients (group 3) averaged 41.30 ± 13.01 (P = 0.33) years. Serum Vitamin D levels were 24.96 ± 9.66 ng/mL in group 1 and 27.70 ± 12.28 ng/mL in group 3, showing no significant correlation with ulcerative colitis (P = 0.41). All groups had a BMI within the normal range, and mean CRP levels varied significantly across groups. Hemoglobin was significantly lower in group 3 compared to group 1 (P = 0.029), but ESR results showed no significant relationship with ulcerative colitis. Vitamin D levels were highest in patients with lower BMI, and no significant relationships were found between Vitamin D and other risk factors, although extensive colitis was associated with higher Vitamin D levels compared to distal colitis.ConclusionIn this study, there was no significant association between ulcerative colitis and serum levels of vitamin D. However, the small number of patients may limit the conclusions that can be drawn regarding the role of vitamin D in the treatment of ulcerative colitis. Future studies should aim for larger cohorts to provide more definitive insights into this important issue.

Clinicopathological Factors and Interleukin-6 Levels Associated With Low Relative Dose Intensity in Women With Breast Cancer Receiving First-Line Chemotherapy.

Chemotherapy has a substantial role in decreasing the risk of recurrence and mortality in breast cancer (BC) in a dose-dependent manner where a low relative dose intensity (RDI) is associated with unfavorable outcomes. Several baseline clinicopathological factors, including pro-inflammatory biomarkers, were found to be significant determinants of low RDI. This study aimed to explore the occurrence of low RDI and its influencing factors in women with BC. This cross-sectional study recruited 172 women with stage I-IV BC who received first-line chemotherapy. We collected patients' clinical, pathological, and treatment data and analyzed the pre-chemotherapy C-reactive protein (CRP) and interleukin (IL)-6 levels using a quantitative enzyme-linked immunosorbent assay (ELISA). We calculated the RDI based on the actual and planned delivered chemotherapy dose (mg/m2) and duration (weeks). RDI less than 85% was defined as "low". Multivariate analysis with logistic regression was conducted to determine the association between pre-chemotherapy parameters and RDI < 85%. The mean CRP level was 10.82 ± 19.17 mg/L (0.00 - 151.73 mg/L) and the mean IL-6 level was 1.12 ± 3.41 pg/mL (0.00 - 27.67 pg/mL). The average RDI for all patients was 93±8.19%. An RDI < 85% occurred in 23 patients (13.4%). The presence of diabetes mellitus (odds ratio (OR): 4.78, 95% confidence interval (CI): 1.03 - 22.27, P = 0.046), triple-negative tumors (OR: 6.45, 95% CI: 1.39 - 29.83, P = 0.017), and IL-6 levels > 0.5 pg/mL (OR: 3.45, 95% CI: 1.01 - 11.79, P = 0.049) was associated with an increased low RDI risk. The proportion of BC patients receiving a low chemotherapy RDI in our study was comparable to published literature and drove close monitoring of patients at risk to provide adequate management.

The effects of spondylodiscitis on the inflammation burden in infective endocarditis.

This study investigates the effects of spondylodiscitis on the inflammation burden in infective endocarditis patients. Aprospective, observational study was conducted between September 2018 and October 2022 in anon-surgical teaching hospital. Patients with adefinite or possible and treated as infective endocarditis were recruited from the Alkmaar Endocarditis Team meetings. Spondylodiscitis was diagnosed based on symptoms and radiological findings. The inflammation burden was defined as the area under the C‑reactive protein (CRP) curve. 174 consecutive patients with infective endocarditis were included (mean age73years, 34.5% female). Concomitant spondylodiscitis was present in 32patients (18%), frequently associated with Streptococcus species (38%). At admission, the mean level of CRP was significantly higher in patients with concomitant spondylodiscitis (p = 0.004). The median CRP area under the curve was significantly higher in spondylodiscitis patients (4.2 × 106 min.mg/l [1.2 × 105 - 1.6 × 107 min.mg/l] vs 2.0 × 106 min.mg/l [8.7 × 104 - 1.6 × 107 min.mg/l], p < 0.001). This difference remained during the whole treatment period. At 6months of follow-up, rates of mortality and relapse of infective endocarditis were not significantly different. The prevalence of spondylodiscitis in non-referred patients with infective endocarditis was 18%. Endocarditis patients with spondylodiscitis had an increased inflammation burden at and during admission. This difference in normalisation of CRP levels was particularly apparent in the final phase of antibiotic treatment but not related to infectious complications. Despite an augmented inflammation burden, spondylodiscitis was not associated with mortality, cardiac surgery or infectious relapse.

Effect of saline irrigation temperature difference on postoperative acute pain and hypothermia during biportal endoscopic spine surgery.

Recently, enhanced recovery after surgery (ERAS) protocols have attracted attention; they emphasize on avoiding intraoperative hypothermia while performing lumbar fusion surgery. However, none of the studies have reported the protocol for determining the temperature of saline irrigation during biportal endoscopic spine surgery (BESS) procedure. This study evaluated the effectiveness of warm saline irrigation during BESS in acute postoperative pain and inflammatory reactions. Fifty-five patients who underwent BESS procedure were retrospectively analyzed for the incidence of perioperative hypothermia (< 36oC), postoperative inflammatory factors (white blood cells (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6), serum amyloid A (SAA)), and clinical outcomes (back visual analog scale (VAS) score, postoperative shivering). The patients were divided into the warm and cold saline irrigation groups. Hemoglobin, WBC, ESR, creatine kinase, and creatine kinase-muscle brain levels did not significantly differ between the warm and cold saline groups. The mean CRP, IL-6, and SAA levels were significantly higher in the cold saline group than in the warm saline group (p = 0.0058, 0.0028, and 0.0246, respectively); back VAS scores were also higher with a statistically significant difference until two days postoperatively (p < 0.001). During the entire procedure, the body temperature was significantly lower in the cold saline irrigation group, but the hypothermia incidence rate significantly differed 30min after the operation was started. Using warm saline irrigation during BESS is beneficial for early recovery after surgery, as it is associated with reduced postoperative pain and complication rates.

CD64 Expression on Neutrophils (nCD64) as a Biomarker in Adult Patients With Sepsis: A Cross-Sectional Study.

Introduction Neutrophils that are at rest exhibit very low expression of CD64, the high-affinity immunoglobulin fragment crystallizable γ receptor I, which is also found in monocytes. Neutrophils that have been exposed to endotoxins or are infected express more CD64. Objectives The aim of this study was to assess the CD64 biomarker expression on neutrophils using the flow cytometry method and its comparison with total leukocyte count, C-reactive protein (CRP) level, and blood culture sensitivity test in the diagnosis of sepsis in adults. Materials and methods Using the quick Sequential Organ Failure Assessment (qSOFA) scoring criteria, 94 blood samples from individuals with clinical indications of sepsis were included in this investigation. Samples were collected in K2 EDTA (ethylenediaminetetraacetic acid) vacutainers and analyzed for neutrophil CD64 (nCD64) levels using BD FACSLyricTM flow cytometer (BD, Franklin Lakes, NJ) within 24 hours of collection. Total leukocyte count, CRP levels, and blood culture sensitivity tests were also assessed simultaneously. Results Majority of the patients, i.e., 29 (30.9%), belonged to the age group of 19 to 35 years, with a female preponderance. The mean total leukocyte count was 19.49 ± 8.12 x 103/µL, mean CRP level was 81.19 ± 56.33 mg/dL, and the mean nCD64 expression - median fluorescence intensity was 197.26 ± 79.56. A positive blood culture was found in 59 (62.8%) cases. Neutrophils showed bright expression of nCD64 in 39 (41.5%) patients, dim expression in 35 (37.2%) patients, and moderate expression in 20 (21.3%) patients in the present study. The correlation between nCD64 expression with CRP, total leukocyte count, and blood culture sensitivity test was statistically significant (p=0.001). nCD64 expression showed a sensitivity of 93.2% and specificity of 91.4% for diagnosing sepsis, with an area under the curve (AUC) of 0.973. This proves nCD64 to be a highly effective biomarker compared to conventional methods. Conclusion nCD64 has a higher sensitivity and specificity as compared to total leukocyte count, CRP levels, and blood culture sensitivity test in the diagnosis of sepsis. It is an effective and rapid test that can enhance sepsis diagnostic accuracy, when combined with other biomarkers. Multicentric research needs to be conducted to validate these findings.

Predicting Survival Status in COVID-19 Patients: Machine Learning Models Development with Ventilator-Related and Biochemical Parameters from Early Stages: A Pilot Study.

Objective: Coronavirus disease 2019 (COVID-19) can cause intubation and ventilatory support due to respiratory failure, and extubation failure increases mortality risk. This study, therefore, aimed to explore the feasibility of using specific biochemical and ventilator parameters to predict survival status among COVID-19 patients by using machine learning. Methods: This study included COVID-19 patients from Taipei Medical University-affiliated hospitals from May 2021 to May 2022. Sequential data on specific biochemical and ventilator parameters from days 0-2, 3-5, and 6-7 were analyzed to explore differences between the surviving (successfully weaned off the ventilator) and non-surviving groups. These data were further used to establish separate survival prediction models using random forest (RF). Results: The surviving group exhibited significantly lower mean C-reactive protein (CRP) levels and mean potential of hydrogen ions levels (pH) levels on days 0-2 compared to the non-surviving group (CRP: non-surviving group: 13.16 ± 5.15 ng/mL, surviving group: 10.23 ± 5.15 ng/mL; pH: non-surviving group: 7.32 ± 0.07, survival group: 7.37 ± 0.07). Regarding the survival prediction performanace, the RF model trained solely with data from days 0-2 outperformed models trained with data from days 3-5 and 6-7. Subsequently, CRP, the partial pressure of carbon dioxide in arterial blood (PaCO2), pH, and the arterial oxygen partial pressure to fractional inspired oxygen (P/F) ratio served as primary indicators in survival prediction in the day 0-2 model. Conclusions: The present developed models confirmed that early biochemical and ventilatory parameters-specifically, CRP levels, pH, PaCO2, and P/F ratio-were key predictors of survival for COVID-19 patients. Assessed during the initial two days, these indicators effectively predicted the likelihood of successful weaning of from ventilators, emphasizing their importance in early management and improved outcomes in COVID-19-related respiratory failure.

C-reactive Protein Levels After Anterior Cruciate Ligament Reconstruction.

Introduction Understanding standard changes in C-reactive protein (CRP) after Anterior cruciate ligament reconstruction (ACLR) is important for early detection of septic arthritis. Methods We conducted a prospective two-center comparative study to clarify changes in postoperative CRP levels after ACLR, as well as factors that influence the changes, in a large sample of Asian patients. A total of 439 ACLR cases were included in this study. CRP tests were performed before and one, seven, and 14 days after ACLR. Results The mean CRP level was 0.06 ± 0.19 mg/dl (range: 0-2.69) preoperatively, increased to 0.54 ± 0.58 (range: 0-4.38) mg/dl at one day postoperatively and 0.92 ± 1.22 (range: 0-11.48) mg/dl at seven days postoperatively, and decreased to 0.23 ± 0.35 (range: 0-3.11) mg/dl at 14 days postoperatively. Multivariate multiple regression analysis revealed that sex, BMI, and which facility the surgery was performed significantly affect CRP levels after one day postoperatively, and sex, BMI, and age significantly affect CRP levels after seven days postoperatively. Only sex was found to significantly affect CRP levels at 14 days postoperatively. Conclusion The present study provides a standard change in CRP after ACLR in a sufficient number of patients without postoperative complications, which would be helpful to rule out the complications. Moreover, the multivariate analysis revealed that sex, age, BMI, and facility are factors that significantly affect CRP levels after ACLR.

Impact of enhanced recovery after surgery on postoperative blood management following primary total knee arthroplasty: a propensity score-matched analysis.

To evaluate the efficacy of blood management in patients underwent unilateral Total Knee Arthroplasty (TKA)under an enhanced recovery after surgery (ERAS) program. Patients underwent unilateral TKA from January 2019 to October 2023 in a university hospital were retrospectively studied. A total of 200 cases were selected in the analysis. After matching with propensity scoring, 51 patients in each group were included. The postoperative Haemoglobin (Hb), albumin (Alb), C-reactive protein (CRP), total length of stay (LOS), and estimated blood loss after operation were compared between the two groups. Clinical outcomes including Western Ontario and McMaster Universities Arthritis Index (WOMAC), SF-12, and Oxford Knee Score (OKS) were also compared atsixweek and threemonth follow-up. The results showed that the Hb of the ERAS group was significantly higher than those of the non-ERAS group (P < 0.05) on the third postoperative. The mean CRP level was lower, LOS was shorter, and Alb level was higher in the ERAS group compared to that in the non-ERAS group (P < 0.05). The clinical outcomes such as WOMAC and OKS, SF-12 scores were higher in the ERAS group at both follow-up. ERAS protocol effectively minimizes perioperative blood loss and supports optimal nutrient levels in patients. ERAS management significantly contributes to the postoperative recovery of knee function in patients undergoing primary total knee arthroplasty.

Early warning model to detect anastomotic leakage following colon surgery: a clinical observational study.

We aimed to develop a predictive tool for anastomotic leakage (AL) following colon cancer surgery by combining a clinical early warning score (EWS) with the C-reactive protein (CRP) level. The records of 1,855 patients who underwent colon cancer surgery at the Oxford University Hospitals NHS Foundation Trust between January 2013 and December 2018, with or without AL, were retrospectively reviewed. EWS and CRP levels were assessed daily from the first postoperative day until discharge. AL was defined as an anastomotic defect observed at reoperation, the presence of feculent fluid in a pelvic drain, or evidence of AL on computed tomography. The tool incorporated postoperative EWS and CRP levels for the accurate early detection of AL. From postoperative days 3 to 7, the mean CRP level exceeded 200 mg/L in patients with AL and was under 200 mg/L in those without AL (P<0.05). From postoperative days 1 to 5, the mean EWS among patients with leakage exceeded 2, while scores were below 2 among those without leakage (P<0.05). Receiver operating characteristic curve analysis identified postoperative day 3 as the most predictive of early leakage, with cutoff values of 2.4 for EWS and 180 mg/L for CRP; this yielded an area under the curve of 0.87 (sensitivity, 90%; specificity, 70%). We propose using an EWS of 2.4 and a CRP level of 180 mg/L on postoperative day 3 following colon surgery with anastomosis as threshold values to prompt investigation and treatment of AL.

Impact of COVID-19 on Psychiatric Patients: The Role of Vaccination, Comorbidities, and Biomarkers in Clinical Outcomes

Background/Objectives: The COVID-19 pandemic has posed significant challenges, particularly for individuals residing in psychiatric facilities. This study aims to investigate the impact of COVID-19 on psychiatric patients, focusing on factors such as their vaccination status, comorbidities, medication regimens, and biomarkers like C-reactive protein (CRP) and ferritin. Methods: This retrospective study analyzed 100 patients with confirmed SARS-CoV-2 infections admitted to the private psychiatric clinic “Asclepius of Upper Volos” from March 2020 to March 2023. The data collected included sociodemographic characteristics, vaccination status, symptom severity, medication regimens, and levels of CRP and ferritin. Statistical analyses using IBM SPSS Statistics version 29 included Pearson’s chi-square tests, Student’s t-tests, and a survival time analysis via the log-rank test to assess associations between clinical characteristics and outcomes. Results: Among the participants, 64% were female and 74% received two doses of the COVID-19 vaccine. The majority experienced mild symptoms, with a survival rate of 74%. Statistically significant findings include a higher survival rate among vaccinated individuals (98.6%) versus unvaccinated individuals (1.4%, p &lt; 0.001). Comorbidities like chronic obstructive pulmonary disease (COPD), coronary artery disease, and renal failure were associated with severe symptoms and higher mortality rates. Higher ferritin levels were significantly associated with poorer outcomes, with survivors having a mean ferritin level of 246.2 (SD = 150.3) compared to the 416.9 (SD = 215.9) seen in non-survivors (p &lt; 0.001). Similarly, mean CRP levels were lower in survivors (1.58, SD = 1.96) than in non-survivors (3.46, SD = 2.92), with a p-value of 0.002. Conclusions: The findings underscore the importance of tailored health protocols and continued support for this vulnerable population. Enhanced strategies for managing comorbidities and utilizing biomarkers can aid in better predicting and improving psychiatric patient outcomes.

The Prospective Analysis of Biomarkers in Sepsis: Correlation With Clinical Outcomes.

Background Sepsis is a medical emergency and necessitates immediate diagnosis and treatment to prevent the progression to severe sepsis, septic shock, and potentially mortality. Aim This study aims to study the diagnostic significance of conventional and new markers, interleukin-10 (IL-10), in predicting the severity of sepsis. Methodology A prospective observational study was conducted in the department of surgery in a tertiary care hospital in Pune, India. The study included 100 patients diagnosed with a quick Sequential Organ Failure Assessment (qSOFA) score of ≥2. Serum C-reactive protein (CRP), procalcitonin (PCT), and interleukin-10 (IL-10) levels were measured. Receiver operating characteristic (ROC) curves were plotted to assess the diagnostic performance of these biomarkers. Results The mean serum CRP level on day 7 was significantly higher than the baseline, day 1, and day 3 groups (p=0.0001). On analysis by repeated measure, the ANOVA test revealed that the mean CRP levels on day 7were significantly higher. The mean PCT levels on day 7, day 3, and day 1 groups were significantly lower than those on day 1, day 2, and day 2, respectively (p=0.0001). The mean p-value of 3.3 g/L CRP was significantly lower on day 1 than that on day 3. IL-10 levels showed a significant upward trend, rising from 5.21 pg/mL at baseline to 7.57 pg/mL by day 7, with a p-value of <0.0001. Our cohort population showed elevated IL-10 values on the day of admission in a total of 15 patients. In our study, we observed that 11 patients with elevated IL-10 levels progressed towardmultiple organ dysfunction syndrome (MODS) and four mortalities. IL-10 is a crucial marker for identifying patients with worsening surgical sepsis. Conclusion IL-10, CRP, and PCT have potential as prognostic markers in assessing and predicting disease severity.The dynamic changes in these biomarkers correlate strongly with clinical outcomes, suggesting their role in guiding treatment decisions.