Mean Serum C-reactive Protein Concentration Research Articles

Comparison of Serum C-Reactive Protein (CRP) Level Between Non-Alcoholic Fatty Liver Disease (NAFLD) Cases and Healthy Adults: A Cross-sectional Analytical Study.

Background: Non-alcoholic fatty liver disease (NAFLD) encompasses the simple steatosis to more progressive steatosis with associated hepatitis, fibrosis and cirrhosis. Though accurate diagnosis of simple fatty liver (SFL) and non-alcoholic steatohepatitis (NASH) can be made by liver biopsy, it is not feasible to be done in all NAFLD patients. Relationship of C-reactive protein (CRP) with NAFLD was well documented in many populations, but comprehensive data is lacking in Bangladeshi people. Method: This case-control study was conducted at the Medicine, Gastroenterology and Hepatology departments in Dhaka Medical College Hospital from March to August 2018 involving 30 patients with NAFLD as case and apparently healthy 30 individuals as control. Abdominal ultrasound to detect fatty liver and serum CRP level estimation by nephelometry were performed for each subject to compare between two groups. Result: Majority of the NAFLD cases and healthy controls were female (70% and 60% respectively). Mean age was 47.53±9.69 year in NAFLD group and 46.03±8.44 year in healthy controls. NAFLD cases had significantly higher mean serum CRP concentration (6.27±1.80) mg/dl than that of healthy controls (3.94±2.16) mg/dl (p<0.001). Overweight/obesity and dyslipidaemia were found as significant risk factors for NAFLD compared to the healthy control group (p<0.05). Conclusion: NAFLD cases had significantly higher CRP than the control group. But, to find out the association of increasing CRP level with the severity of NAFLD and to establish it as a diagnostic tool, further extensive studies are recommended. J MEDICINE 2024; 25: 5-10

Clinical characteristics of and risk factors for poor outcomes in children with bacterial culture-negative septic arthritis of the hip

BackgroundSeptic arthritis of the hip is a serious infection in children. However, blood and joint fluid cultures are often negative, which makes the diagnosis and treatment challenging. We analyzed the clinical features of children with septic arthritis of the hip with negative bacterial cultures and identified the risk factors for poor outcomes. MethodsThe clinical data of children with septic arthritis of the hip with negative bacterial cultures who were treated at our hospital from January 2010 to December 2020 were retrospectively analyzed. The clinical characteristics and outcomes of the culture-negative cohort were compared with those of children with positive bacterial cultures treated during the same period. Culture-negative patients were divided into a group with good outcomes and a group with poor outcomes. The differences between the two groups were compared. ResultsThirty-nine children with culture-negative septic arthritis of the hip were compared with 37 children with culture-positive sepsis. Compared with the culture-positive group, the culture-negative group had a significantly younger mean age and a significantly lower mean serum C-reactive protein concentration. Logistic regression analysis of culture-negative patients with good versus poor outcomes revealed that the independent risk factors for poor outcomes were an increased serum C-reactive protein concentration and prolonged time from onset to surgery. The cut-off values for predicting a poor outcome in the culture-negative group were a time from onset to surgery of greater than 21 days and a C-reactive protein concentration of greater than 23 mg/L. ConclusionsCulture-negative septic arthritis of the hip has similar clinical features to culture-positive septic arthritis of the hip and can result in sequelae of varying severity. Therefore, active anti-infective and hip drainage therapy should be performed when children present with clinical symptoms, inflammatory marker concentrations, and imaging findings that are clinically diagnostic for septic arthritis of the hip. Level of evidenceLevel II, retrospective study.

C-Reactive Protein And Lipid Profile In Ischemic Heart Disease A Cross-Sectional Analytical Study

Inflammation plays a major role in the initiation, progression & destabilization of atheroma. C-reactive protein (CRP) is a sensitive marker of inflammation, and elevated levels have been associated with future risk of myocardial infarction (MI). Risk of coronary heart disease & other forms of atherosclerotic vascular disease rises with plasma cholesterol concentration & in particular the ratio of total cholesterol to high density lipoprotein (HDL-C) cholesterol. Measurement of C- reactive protein (CRP) adds to the predictive value of total cholesterol (TC) and HDL cholesterol (HDL-C) in determining subsequent risk of first myocardial infarction. Methods: This cross-sectional analytical study was undertaken to observe association between high sensitive CRP and lipid profile level with chronic ischaemic heart disease and was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka from July 2010 to June 2011. A total 50 cases were selected purposively according to the selection criteria from the patients admitted in the Department of Cardiology, Dhaka Medical College Hospital with chronic ischaemic heart disease (IHD). Diagnosed IHD patients were taken as cases; age- & sex- matched 50 healthy subjects were taken as controls. Serum hsCRP and serum TC, TAG, LDL-C & HDL-C were measured in all study subjects. Results: The mean serum CRP concentration in cases and controls were 11.22+/-7.64 mg/dl and 1.72+/-0.98 mg/dl respectively. Mean serum TC, TAG, HDL-C and LDL-C in cases groups were 314+/-74 mg/dl, 288+/-60 mg/dl, 36+/-4 mg/dl, and 178+/-22 mg/dl respectively and in controls groups were 175+/-19 mg/dl, 118+/-12 mg/dl, 43+/-2 mg/dl & 126+/-11 mg/dl respectively. Serum hsCRP, Total Cholesterol, TAG & LDL-C were significantly higher in cases than control subjects. Serum HDL-C was significantly lower in cases than control subjects. Conclusions: The present study reveals that the patients of chronic ischaemic heart disease have been found to have close association of increased level of hsCRP and lipid profile.

Association Between Serum Selenium and Serum C-Reactive Protein Concentrations in Persons Infected With Human Immunodeficiency Virus Infection

ObjectivesChronic inflammation and selenium deficiency are common in persons infected with the human immunodeficiency virus (HIV). Both C-reactive protein, a pro-inflammatory biomarker, and selenium deficiency have been associated with accelerated disease progression and poorer survival among persons infected with HIV-infection. However, research on the role of serum selenium levels in inflammation is limited. We assessed the association between serum selenium levels and C-reactive protein (CRP) concentrations in a cohort of persons infected with HIV. MethodsA cross-sectional survey was conducted among 233 HIV-infected persons (124 men and 109 women) aged 18–60 years who were residing in Kathmandu, Nepal. Regular serum CRP and selenium concentrations were measured by the latex agglutination turbidimetric and the atomic absorption method, respectively. Relationships were assessed using multiple linear regression analysis to adjust for potential confounding factors including sociodemographic, smoking, body mass index, chronic diseases, CD4+ T-cell count, and anti-retroviral therapy. ResultsThe geometric means of serum selenium and CRP concentrations were 9.65 μg/dL and 1.43 mg/L, respectively. Mean serum CRP concentration was significantly decreased with increasing serum selenium concentration across selenium tertiles (P for trend = 0.019), with mean serum CRP concentration in the highest tertile of serum selenium concentration was 40.8% lower than that in the lowest tertile. We found a significant inverse relation between log selenium and log CRP concentrations (beta for 1 unit change in log selenium; β = –1.01, p = 0.06). ConclusionsSerum selenium levels may be inversely associated with serum CRP concentrations in persons infected with HIV. Further prospective study to confirm the role of serum selenium levels in inflammation among persons infected with HIV is warranted. Funding SourcesUniversity of Massachusetts Amherst.

C-Reactive Protein Concentrations Among Crop and Dairy Farmers with Stable Chronic Obstructive Pulmonary Disease.

AIM:To assess the mean serum C-reactive protein concentrations among farmers and office controls, and further examined its relation to exposure duration, smoking habit, as well as presence or absence of COPD.METHODS:A cross-sectional survey was performed including examined group (EG), composed of agricultural workers (87 crop - EG1 and 83 dairy farmers - EG2), and control group (CG) composed by 80 office workers. Evaluation of subjects included a questionnaire on chronic respiratory symptoms, lung function tests, COPD diagnostics, and measurement of CRP serum concentrations.RESULTS:Serum CRP concentrations were raised in stable COPD patients independent of smoking habit or exposure duration. The mean CRP serum concentrations were higher in the subjects of EG1 and EG2 compared with those in CG, but without statistical significance. This count for mean CRP serum concentrations in subjects of EG1 and EG2 exposed more than 20 years and for those in smokers in all three groups as well. The mean CRP serum concentrations were significantly higher in subjects with COPD within EG1 (P=0.049) and EG2 (P=0.040), while those in CG were not.CONCLUSION:Data obtained suggest that systemic inflammation is present in farmers with COPD and CRP is an important biomarker in COPD in means of reflecting disease severity and prognosis of exposed farmers.

C-reactief proteïneconcentraties in het serum van honden met idiopathische epilepsie

Inflammatoire reacties bij honden zijn geassocieerd met systemische veranderingen in het serum, de acute fase respons genaamd. Deze gaat gepaard met veranderde concentraties acutefase-eiwitten in het serum. Het C-reactief proteïne (CRP) is een positief acutefase-eiwit en stijgt bijgevolg bij een ontsteking. Er bestaat veel onduidelijkheid over de relatie tussen epilepsie en ontsteking. Daarom werd in deze studie de rol van ontsteking onderzocht bij honden met idiopathische epilepsie (IE). Drie doelstellingen werden vooropgesteld: 1. het meten van serum-CRP-concentraties bij honden met IE en bij gezonde honden, 2. het meten van serum-CRP-concentraties bij honden met acute clusteraanvallen en bij honden met geïsoleerde aanvallen en 3. het opvolgen van de evolutie in serum-CRP-concentraties in de tijd na de laatste epilepsieaanval. In deze studie kon geen significant verschil in serum-CRPconcentratie tussen honden met IE en de honden van de controlegroep worden aangetoond. Verder waren de gemiddelde serum-CRP-concentraties hoger bij honden met clusteraanvallen (8,3 mg/l) dan bij honden met geïsoleerde aanvallen (7,8 mg/l). Deze resultaten waren echter statistisch niet significant (P = 0,077). Ten slotte werd een statistisch niet-significante daling in serum-CRP-concentraties gezien na de laatste epileptische aanval bij de honden met IE (P = 0,077).

Dietary B Vitamins and Serum C-Reactive Protein in Persons With Human Immunodeficiency Virus Infection: The Positive Living With HIV (POLH) Study.

B vitamins may have beneficial roles in reducing inflammation; however, research on the role of B vitamins in inflammation among HIV-infected persons is lacking. This study assessed the association between B vitamins and serum C-reactive protein (CRP) concentrations in HIV-infected persons. A cross-sectional survey was conducted among 314 HIV-infected persons (180 men and 134 women) aged 18 to 60 years residing in the Kathmandu, Nepal. High-sensitive and regular serum CRP concentrations were measured by the latex agglutination nephelometry and latex agglutination turbidimetric method, respectively. Dietary intake was assessed using 2 nonconsecutive 24-hour dietary recalls. The relationships between B vitamins and serum CRP concentrations were assessed using multiple regression analysis. The multivariate-adjusted geometric mean of serum CRP concentrations was significantly decreased with an increasing B vitamins intake across quartiles of niacin (P for trend = .007), pyridoxine (P for trend = .042), and cobalamin (P for trend = .037) in men. In men, the mean serum CRP concentrations in the highest quartiles of niacin, pyridoxine, and cobalamin were 63%, 38%, and 58%, respectively, lower than that in the lowest quartile. In women, the mean serum CRP concentrations in the highest quartiles of riboflavin (P for trend = .084) and pyridoxine (P for trend = .093) were 37% and 47%, respectively, lower than that in the lowest quartile. High intake of niacin, pyridoxine, or cobalamin was independently associated with decreased serum CRP concentrations among HIV-infected men. Further prospective studies are warranted to confirm the role of B vitamins in inflammation among HIV-infected persons.

Serum Zinc Concentration and C-Reactive Protein in Individuals with Human Immunodeficiency Virus Infection: the Positive Living with HIV (POLH) Study.

Low zinc levels and chronic inflammation are common in individuals infected with human immunodeficiency virus (HIV). Zinc deficiency may promote systemic inflammation, but research on the role of zinc in inflammation among HIV-positive individuals taking account of anti-retroviral therapy is lacking. We assessed the association between serum zinc and C-reactive protein (CRP) concentration in a cohort of HIV-positive individuals. A cross-sectional survey was conducted among 311 HIV-positive individuals (177 men and 134 women) aged 18-60 years residing in Kathmandu, Nepal. High-sensitive or regular serum CRP concentrations were measured by the latex agglutination nephelometry or turbidimetric method, and zinc concentrations were measured by the atomic absorption method. Relationships were assessed using multiple linear regression analysis. The geometric means of zinc in men and women were 73.83 and 71.93 ug/dL, respectively, and of CRP were 1.64 and 0.96 mg/L, respectively. Mean serum CRP concentration was significantly decreased with increasing serum zinc concentration across zinc tertiles (P for trend = 0.010), with mean serum CRP concentration in the highest tertile of serum zinc concentration was 44.2 % lower than that in the lowest tertile. The mean serum CRP concentrations in men and women in the highest tertile of serum zinc concentrations were 30 and 35.9 % lower, respectively, than that in the lowest tertile (P for trend = 0.263 and 0.162, respectively). We found a significant inverse relation between log zinc and log CRP concentrations (beta for 1 unit change in log zinc; β = -1.79, p = 0.0003). Serum zinc concentration may be inversely associated with serum CRP concentration in HIV-positive individuals.

Prognostic evaluation of preoperative serum C-reactive protein concentration in patients with epithelial ovarian cancer.

The aim of the present study was to evaluate correlations between preoperative C-reactive protein (CRP) serum concentration and the clinical-pathological parameters of epithelial ovarian cancer (EOC), as well as cancer antigen 125 (CA125) concentration, in patients with EOC. The preoperative serum CRP concentrations of 107 patients with EOC were compared with values of 44 control patients and defined as positive if values were >8 mg/l. Correlations between CRP expression and serum CA125 concentrations, International Federation of Gynecologists and Obstetricians (FIGO) staging, lymph node metastasis, ascites and size of postoperative residual lesions were evaluated for the EOC cases. A total of 69% (74/107) of the EOC cases were CRP-positive, with a mean serum CRP concentration of 14.32 mg/l (versus 2.18 mg/l in the control patients) (P<0.001). A rank correlation analysis showed a positive correlation between serum CRP and CA125 concentrations (P<0.001). The five-year survival rate of the CRP-positive patients with EOC was significant lower than that of the patients that were CRP-negative (33.3 vs. 75.8%, P<0.001). Non-parametric and multivariate analyses showed significant correlations between CRP concentrations and FIGO staging (P=0.001), lymph node metastasis (P=0.001) and ascites (P=0.033). In contrast to previous reports, the mean CRP serum concentration of the CRP-positive patients with EOC also correlated significantly with the CA125 values, and the increases in the CRP serum concentration in the Chinese patients were lower than those described for Caucasian EOC cases. In conclusion, the CRP serum concentration may be a useful clinical marker, solely or in combination with CA125, in patients with EOC.

In situ total aortic arch replacement for infected distal aortic arch aneurysms with penetrating atherosclerotic ulcer

We present a series of patients who underwent in situ total aortic arch replacement for infected distal aortic arch aneurysms. Between 2002 and 2013, 9 patients with infected distal aortic arch aneurysms underwent total aortic arch replacement using antegrade selective cerebral perfusion. There were 4 male and 5 female patients with a mean age of 72.7±9.0 years. All patients had penetrating atherosclerotic ulcer in the distal aortic arch, which formed saccular aneurysms. Four patients had preoperative hoarseness. Maximum preoperative white blood cell count was 10,211±4375/μL, and mean serum C-reactive protein concentration was 12.7±7.2 mg/dL. Causative microorganisms were identified by blood culture or aortic wall culture and were as follows: Candida albicans, Pseudomonas aeruginosa, Edwardsiella tarda, Streptococcus dysgalactiae, Listeria monocytogenes, Staphylococcus aureus (2 cases), and unknown (2 cases). Radical debridement with in situ total aortic arch replacement was performed in all patients, followed by the omental flap grafting in 7 patients. All surgery was performed on an urgent or emergency basis. Average cardiopulmonary bypass time and lower body circulatory arrest time were 199.7±50.7 minutes and 66.6±13.8 minutes, respectively. There was no in-hospital mortality, but 1 patient died of asphyxia 5 months after hospital discharge. Freedom from recurrence of infection was 100%. Surgical treatment with the combination of radical debridement with in situ total aortic arch replacement using antegrade selective cerebral perfusion and omental flap grafting was a reliable procedure for the treatment of infected distal aortic arch aneurysms.

Antioxidant intake from diet and supplements and elevated serum C-reactive protein and plasma homocysteine concentrations in US adults: a cross-sectional study

To investigate the association of antioxidant intakes from diet and supplements with elevated blood C-reactive protein (CRP) and homocysteine (Hcy) concentrations. A cross-sectional study. The main exposures were vitamins C and E, carotene, flavonoid and Se intakes from diet and supplements. Elevated blood CRP and Hcy concentrations were the outcome measures. The US population and its subgroups. We included 8335 US adults aged ≥19 years from the National Health and Nutrition Examination Survey 1999-2002. In this US population, the mean serum CRP concentration was 4·14 (95 % CI 3·91, 4·37) mg/l. Intakes of vitamins C and E and carotene were inversely associated with the probability of having serum CRP concentrations >3 mg/l in multivariate logistic regression models. Flavonoid and Se intakes were not associated with the odds of elevated serum CRP concentrations. The mean plasma Hcy concentration was 8·61 (95 % CI 8·48, 8·74) μmol/l. Intakes of vitamins C, E, carotenes and Se were inversely associated with the odds of plasma Hcy concentrations >13 μmol/l after adjusting for covariates. Flavonoid intake was not associated with the chance of elevated plasma Hcy concentrations. These results suggest that high antioxidant intake is associated with lower blood concentrations of CRP and Hcy. These inverse associations may be among the potential mechanisms for the beneficial effect of antioxidant intake on CVD risk mediators in observational studies.

Dietary intakes of α-linolenic and linoleic acids are inversely associated with serum C-reactive protein levels among Japanese men

Investigations suggest a protective role of n-3 polyunsaturated fatty acids (PUFA) but opposing roles of n-6 PUFA in inflammation, but the effects in vivo the human are not clear. We therefore tested the hypothesis that higher intakes of n-3 PUFA and n-6 PUFA are associated with lower levels of inflammation among a population consuming a diet high in PUFA. This study aimed to assess the association between PUFA intake and serum C-reactive protein (CRP) concentrations in a group of Japanese employees. The study subjects were 300 men and 211 women aged 21 to 67 years working in 2 municipal offices of Japan. We measured the serum high-sensitivity CRP concentrations by the latex agglutination nephelometry method and assessed dietary habits by a validated self-administered diet history questionnaire. We analyzed the data using multiple linear regression analysis with adjustment for potential confounding variables. Mean serum CRP concentrations tended to decrease as the intake of eicosapentaenoic acid, docosahexaenoic acid, or their combination increased in men and women, although none of these relationships was statistically significant. In men, there were statistically significant inverse relationships between dietary intake of n-3 or n-6 PUFA and serum CRP concentrations (P for trend = .03 and .008, respectively). Among specific PUFA, only alpha-linolenic acid and linoleic acid showed clear inverse relationships (P for trend = .001 and .003, respectively) in men. The results suggest that increased intake of not only alpha-linolenic acid (n-3 PUFA) but also linoleic acid (n-6 PUFA) has a beneficial effect on systemic inflammation in men.

Nitric Oxide Production is More Prominent in off-Pump than in On-Pump Coronary Artery Bypass Surgery

The aim of our study was to elucidate the extent to which cardiopulmonary bypass contributes to endogenous nitric oxide (NO) production in patients undergoing coronary artery bypass grafts (CABG). One-hundred-and-sixteen patients undergoing elective CABG with (on-pump, n=66) and without cardiopulmonary bypass (off-pump, n=50) were included. Urinary nitrite/nitrate (NOx) excretion was measured as an index of endogenous NO production during the first two postoperative days. Haemodynamic profiles, serum CK-MB and C-reactive protein (CRP) concentrations were measured after the operation. There was no significant difference in urinary NOx/creatinine (Cr) excretion on day one post CABG. The mean urinary NOx/Cr excretion ratio significantly (P < 0.01) decreased from days one to two in the on-pump group, but not in the off-pump group. The mean urinary NOx/Cr excretion ratio was significantly (P < 0.01) higher in the off-pump group (0.51 +/- 0.26 micromol/mg) than in the on-pump group (0.38 +/- 0.20 micromol/mg) on day two. The mean serum CRP concentration was also significantly (P < 0.01) higher in the off-pump group than in the on-pump group on day two. There was no significant difference in the mean cardiac index or the mean systemic vascular resistance index between the two groups after surgery. The mean serum CK-MB concentration was significantly (P < 0.05) lower in the off-pump group than in the on-pump group on days one and two. These findings suggest that endogenous NO production is stimulated by a surgical inflammatory response and that the cardiopulmonary bypass procedure per se is not the inciting stimulus for NO production in patients undergoing CABG.

Serum C-reactive protein concentrations in dogs with multicentric lymphoma undergoing chemotherapy

To determine whether serum C-reactive protein (CRP) concentration is high in dogs with multicentric lymphoma, whether CRP concentration changes in response to chemotherapy, and whether CRP concentration can be used as a marker for relapse in dogs with multicentric lymphoma. Cohort study. 20 dogs with multicentric lymphoma and 8 healthy control dogs undergoing chemotherapy with cyclophosphamide, vincristine, and prednisone (CVP) or with vincristine, cyclophosphamide, methotrexate, and L-asparaginase (VCMA) and 20 other healthy dogs. Serum CRP concentration was measured weekly during the first month of chemotherapy and then at 3-week intervals until relapse in dogs with multicentric lymphoma, weekly for 16 weeks in healthy dogs undergoing chemotherapy, and once in the healthy dogs not undergoing chemotherapy. For both groups of dogs with lymphoma, mean serum CRP concentration during week 1 (prior to treatment) was significantly higher than mean concentrations following induction of chemotherapy and at the time of relapse. Mean serum CRP concentration in the healthy dogs undergoing chemotherapy was not significantly different at any time from mean concentration for the healthy dogs not undergoing chemotherapy. No significant differences were observed between dogs treated with CVP and dogs treated with VCMA. Results suggest that serum CRP concentration is high in dogs with multicentric lymphoma but that serum CRP concentration is not a useful marker for relapse and that chemotherapy itself does not affect serum CRP concentration.

Value of serum C-reactive protein concentrations in febrile children without apparent focus.

We examined the value of serum C-reactive protein (CRP) in febrile children without an apparent focus of infection, (i) as a tool to differentiate bacteraemia and bacterial infection from a non-bacterial illness (NBI), and (ii) as an indicator of recovery or complications. Included in the study were 100 children up to the age of 3 years with a temperature of > or = 38.5 degrees C, without an apparent focus. The serum CRP concentration was measured on days 1, 3 and 5 of evaluation and correlated with the final diagnosis and outcome. The serum CRP was 40 mg/l and above in 95% of patients (18/19) with bacteraemia and also in seven of the eight with purulent meningitis, while it was < 40 mg/l in 84% of patients (52/62) with NBI (mean (SD) 22 (28.6) mg/l). The mean serum CRP concentration among six children with a culture-positive urinary tract infection (16.3 (8.3) mg/l) and five with otitis media (9 (5.7) mg/l) was similar to those with NBI. The sensitivity of serum CRP > or = 40 mg/l for diagnosis of bacteraemia was 95% and the positive predictive value 67%. On serial monitoring, a fall in the CRP concentration was a sensitive indicator of recovery from infection and provided the earliest clue to therapeutic response long before a fall in temperature.

Serum c-reactive protein in patients with serious trauma

Daily serum c-reactive protein (CRP) concentration was monitored in 98 patients (26 female) admitted to the Major Injuries Unit (MIU) at Birmingham Accident Hospital following serious trauma. The mean (SD) increase in CRP concentration for 79 survivors and 19 non-survivors between days 1 and 2 after trauma were 69.5 (74.6) and 111.8 (59.0) mg/l/24h, respectively (P = < 0.001). By day 4 after trauma the mean serum CRP concentrations for survivors and non-survivors were 150.9 (76.9) and 233.4 (100.8) mg/l (P < 0.001), respectively. Injury severity data were available for 50 patients. The mean (range) injury severity score was 25.2 (4–50), Glasgow coma scale 10.4 (3–15), revised trauma score 6.5 (3.39–7.8) and predicted survival 0.78 (0.02–0.99). Univariate regression analysis of serum CRP on days 1–5 after injury against revised trauma score and injury severity score, revealed an inverse correlation between day 1 serum CRP and Glasgow Coma Score (r = −0.306, P < 0.05), but no correlation with injury severity score or predicted survival on any of the study days. The lack of correlation between serum CRP and injury severity or predicted survival, and the strong association with actual survival, suggests that the acute inflammatory response to serious trauma and subsequent complications, is an important determinant of outcome.