Serial C-reactive Protein Measurements Research Articles

Extracorporeal Photopheresis with 5-Aminolevulinic Acid in Crohn's Disease-A First-in-Human Phase I/II Study.

Background/Objectives: With the increasing prevalence of Crohn's disease (CD), treatment options for patients who fail conventional and advanced therapy are highly needed. Therefore, we explored the safety and efficacy of extracorporeal photopheresis (ECP) using 5-aminolevulinic acid (ALA) and blue light (405 nm). Methods: Patients with active CD who failed or were intolerant to biological therapy were eligible. Mononuclear cells (90 mL) were collected from each patient using a Spectra Optia® apheresis system and diluted with 100 mL of 0.9% sodium chloride in a collection bag. The cells were incubated with ALA at a concentration of 3 millimolar (mM) for 60 min ex vivo and illumination with an LED blue light (405 nm) source (BLUE-PIT®) before reinfusion to the patient. Recording of vital signs and adverse events were regularly performed. At week 13, we assessed the patients with colonoscopy, the Harvey Bradshaw Index (HBI), the Inflammatory Bowel disease Health Related Quality of Life Questionnaire, and the measurement of serum C-reactive protein and fecal calprotectin (FC) levels. Biopsies of the intestines were taken for immunohistochemistry. Results: Seven patients were included. Four patients completed the treatments, with a total of 24 treatments. Three of the four patients achieved a favorable response, including a lower HBI, lower FC levels, and/or endoscopic improvement. No significant adverse events were observed. The remaining three patients received only one, three, or five treatments due to technical difficulties, medical reasons, or the withdrawal of informed consent. Conclusions: ALA-based ECP appears safe and seems to give some clinical improvement for the patients with active CD who failed to respond to conventional and advanced therapies.

Drug-induced acute tubulointerstitial nephritis: Serial C-reactive protein measurements might predict the course of acute kidney injury.

Elevated C-reactive protein (CRP) was proposed as a biomarker instead of renal biopsy in drug-induced acute tubulointerstitial nephritis (D-ATIN) in adults. However, there is no study in which patients were followed up with serial CRP without kidney biopsy. We evaluated the significance of CRP levels in predicting the clinical course of D-ATIN in children. Children with a clinical diagnosis of D-ATIN were evaluated for sex, age, symptoms, offending drug(s), latent period after exposure, blood pressure, urine output, urinalysis, eosinophiluria, urine albumin/total protein, serum creatinine, and CRP at presentation. In addition, serial CRP and creatinine levels were recorded daily until discharge and thereafter. Correlations of CRP with creatinine and of peak CRP with creatinine normalization time were evaluated. There were 13 patients (8 female, median age 15 years). None had oliguria or hypertension. Median CRP and creatinine at presentation were 36 mg/L and 1.6 mg/dL, respectively. Median times to peak CRP and creatinine were 6 and 7 days after drug exposure, respectively. The decrease in CRP preceded the fall in creatinine. Median CRP and creatinine normalization times after their peaks were 5 and 14 days, respectively. None required renal biopsy or corticosteroid treatment. CRP was correlated with creatinine throughout the study period. However, peak CRP was not correlated with creatinine normalization time. CRP was increased at presentation and decreasing CRP predicted favorable outcome. Renal biopsy and corticosteroid treatment could be postponed safely in these children.

Hypochloremia: A Potential Indicator of Poor Outcomes in COVID-19.

Background: Coronavirus Disease-2019 (COVID-19) has posed formidable challenges to healthcare systems. Exploring novel biomarkers that can provide valuable prognostic insights, particularly in critically ill patients, has a significant importance. Against this backdrop, our study aims to elucidate the associations between serum chloride levels and clinical outcomes. Methods: A total of 499 patients were enrolled into the study. The serum chloride levels of patients upon hospital admission were recorded and then categorized into three groups (hypochloremia, normochloremia, and hyperchloremia) for the evaluation of clinical outcomes. Additionally, serum C-reactive protein, procalcitonin, and D-dimer measurements were recorded for further evaluation. Results: A total of 390 (78.1%) patients tested positive for COVID-19 via polymerase chain reaction testing. Non-contrast thorax computed tomography scans were indicative of COVID-19 compatibility for all patients. A total of 210 (42%) patients were female and 289 (58%) were male. A total of 214 (42.8%) patients necessitated tocilizumab intervention; 250 (50.1%) were at an intensive care unit (ICU), with 166 (66.4%) of them receiving tocilizumab. A total of 65 (13%) patients died, 40 (61.5%) of whom received tocilizumab; 41 (63%) were in the ICU. Serum chloride levels upon admission were markedly lower and elevated D-dimer levels were apparent in tocilizumab users, patients requiring ICU care, and patients who died. Conclusions: our findings provide robust evidence supporting the value of serum chloride levels as a prognostic biomarker in critically ill COVID-19 patients.

The Kinetics of Inflammation-Related Proteins and Cytokines in Children Undergoing CAR-T Cell Therapy-Are They Biomarkers of Therapy-Related Toxicities?

CD19-targeted CAR-T cell therapy has revolutionized the treatment of relapsed/refractory (r/r) pre-B acute lymphoblastic leukemia (ALL). However, it can be associated with acute toxicities related to immune activation, particularly cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Cytokines released from activated immune cells play a key role in their pathophysiology. This study was a prospective analysis of proinflammatory proteins and cytokines in children treated with tisagenlecleucel. Serial measurements of C-reactive protein, fibrinogen, ferritin, IL-6, IL-8, IL-10, IFNγ, and TNFα were taken before treatment and on consecutive days after infusion. The incidence of CRS was 77.8%, and the incidence of ICANS was 11.1%. No CRS of grade ≥ 3 was observed. All complications occurred within 14 days following infusion. Higher biomarker concentrations were found in children with CRS grade ≥ 2. Their levels were correlated with disease burden and CAR-T cell dose. While cytokine release syndrome was common, most cases were mild, primarily due to low disease burden before lymphodepleting chemotherapy (LDC). ICANS occurred less frequently but exhibited various clinical courses. None of the toxicities were fatal. All of the analyzed biomarkers rose within 14 days after CAR-T infusion, with most reaching their maximum around the third day following the procedure.

Campylobacteriosis: genotypic characteristics of the pathogen and immunological status of patients

Introduction. Campylobacteriosis is among the leading causes of acute gastrointestinal infections. The severity of campylobacteriosis and the development of long-term complications may be influenced by the genotype of the pathogen, whose biological properties can affect immune response parameters. The aim of the study was to identify common genotypes of epidemic clones of Campylobacter pathogens and to investigate characteristics of the immune response and severity of the disease. Materials and methods. The study included 203 patients aged from 1 month to 17 years with campylobacteriosis who underwent treatment at the clinic of the Federal State Budgetary Institution "DNKCIB FMBA" in 2019–2021. The diagnosis was confirmed using polymerase chain reaction method. Patient samples were also analyzed using culture-based methods. Total DNA was extracted using the QIAamp DNA Mini Kit. Genetic determinants encoding virulence factors and MLST typing were performed using the ResFinder program. The immune status of patients was assessed on days 1 and 7 of the illness. Immunological investigation included measurement of serum immunoglobulin concentrations (IgA, IgM, IgG), C-reactive protein, and cytokines (IL-1β, IL-1, IL-2, IL-4, IL-5, IL-6, IL- 7, IL-8, IL-10, TNF-α, and IFN-γ). Results. When analyzing the frequency of detection of Campylobacter sequence types in children with clinical intestinal infections, it was found that the profile of isolated isolates is most similar to those from countries of North America (USA and Canada), Northern Europe (Great Britain, Holland ) and Scandinavia (Denmark, Sweden, Finland). Identification of a pathogen with the flgE+, cdtA+, cdtC+ genotype was accompanied by a statistically significant increase in the level of IL-8 and a decrease in the content of IgA in the peripheral blood serum, which reflected the low efficiency of the immune response during infection with Campylobacter and predetermined the severe course of the infectious process during the disease.

The Diagnostic Accuracy of Procalcitonin and Its Combination with Other Biomarkers for Candidemia in Critically Ill Patients.

Background: The aim of this study was to investigate the usefulness of serum procalcitonin (PCT), C-reactive protein (CRP), neutrophil to lymphocyte count ratio (NLR), and their combination, in distinguishing candidemia from bacteremia in intensive care unit (ICU) patients. Methods: This is a retrospective study in ICU patients with documented bloodstream infections (BSIs) and with both serum PCT and CRP measurements on the day of the positive blood sample. Illness severity was assessed by sequential organ failure assessment (SOFA) score on both admission and BSI day. Demographic, clinical, and laboratory data, including PCT and CRP levels and NLR on the day of the BSI, were recorded. Results: A total of 63 patients were included in the analysis, of whom 32 had bacteremia and 31 had candidemia. PCT, CRP, and NLR values were all significantly lower in candidemia compared with bacteremia (0.29 (0.14-0.69) vs. 1.73 (0.5-6.9) ng/mL, p < 0.001, 6.3 (2.4-11.8) vs. 19 (10.7-24.8) mg/dl, p < 0.001 and 6 (3.7-8.6) vs. 9.8 (5.3-16.3), p = 0.001, respectively). PCT was an independent risk factor for candidemia diagnosis (OR 0.153, 95%CI: 0.04-0.58, p = 0.006). A multivariable model consisting of the above three variables had better predictive ability (AUC-ROC = 0.88, p < 0.001), for candidemia diagnosis, as compared to that of PCT, CRP, and NLR, whose AUC-ROCs were all lower (0.81, p < 0.001, 0.78, p < 0.001, and 0.68, p = 0.015, respectively). Conclusions: A combination of routinely available laboratory tests, such as PCT, CRP, and NLR, could prove useful for the early identification of ICU patients with candidemia.

The CRP troponin test (CTT) stratifies mortality risk in patients with non-ST elevation myocardial infarction (NSTEMI).

The C-reactive protein (CRP)-troponin-test (CTT) comprises simultaneous serial measurements of CRP and cardiac troponin and might reflect the systemic inflammatory response in patients with acute coronary syndrome. We sought to test its ability to stratify the short- and long-term mortality risk in patients with non-ST elevation myocardial infarction (NSTEMI). We examined 1,675 patients diagnosed with NSTEMI on discharge who had at least two successive measurements of combined CRP and cardiac troponin within 48 h of admission. A tree classifier model determined which measurements and cutoffs could be used to best predict mortality during a median follow-up of 3 years [IQR 1.8-4.3]. Patients with high CRP levels ( > 90th percentile, >54 mg/L) had a higher 30-day mortality rate regardless of their troponin test findings (16.7% vs. 2.9%, p < 0.01). However, among patients with "normal" CRP levels ( < 54 mg/L), those who had high troponin levels ( > 80th percentile, 4,918 ng/L) had a higher 30-day mortality rate than patients with normal CRP and troponin concentrations (7% vs. 2%, p < 0.01). The CTT test result was an independent predictor for overall mortality even after adjusting for age, sex, and comorbidities (HR = 2.28 [95% CI 1.56-3.37], p < 0.01 for patients with high troponin and high CRP levels). Early serial CTT results may stratify mortality risk in patients with NSTEMI, especially those with "normal" CRP levels. The CTT could potentially assess the impact of inflammation during myocardial necrosis on the outcomes of patients with NSTEMI and identify patients who could benefit from novel anti-inflammatory therapies.

B-001 Method Development of C-Reactive Protein in the Serum of Non-Human Primates

Abstract Objective The objective of this study is to validate C-Reactive Protein (CRP) measurement in Non-Human Primate (NHP) serum using the ADVIA 1800 analyzer. Methods CRP was validated in NHP serum using the ADVIA 1800 analyzer. Validation testing included intra-assay precision, inter-assay precision, accuracy, linearity of dilution, limit of quantitation (LOQ), limit of detection (LOD), reference interval, carry-over, correlation, and stability. Samples were collected into tubes containing no anti-coagulant. Intra-assay precision was determined by analyzing two biological samples and the two quality control levels of Bio-Rad Lyphochek Immunology Plus Control 10 consecutive times (in duplicate) within a single run. Inter-assay precision was determined by analyzing two biological samples and the two quality control levels of Bio-Rad Lyphochek Immunology Plus Control six times for six days over a 10-day period. Accuracy was calculated using the data obtained from the inter-assay precision testing. For linearity of dilution, calibrator material and diluted specimen samples were analyzed in duplicate. The LOQ was determined by diluting the low-level calibrator material to produce a value at the low end of the reportable range. Diluted material was tested six times within the same run. The LOD was determined by assaying the appropriate blank 10 times within the same run. The reference interval was determined by analyzing 21 serum samples. Correlation between the two ADVIA 1800 analyzers was determined by assaying 10 samples on both analyzers once. The carry-over of the assay was determined by analyzing the high-level quality control material followed by the low-level quality control material. Stability of serum samples was tested at room temperature, refrigerated, and frozen (at -20°C) for various durations of storage. Results Results show that measurement of CRP in NHP serum met the acceptance criteria for intra-assay precision, inter-assay precision, accuracy, linearity of dilution, limit of quantitation, carry-over, and stability. For intra-assay precision in specimen and control material, the %CV was within ±20%. The inter-assay precision for specimen and control material %CV was within ±20%. The total error observed (TEobs) was within ±20% for accuracy in control material and the obtained mean was within the acceptable range specified by the manufacturer. For linearity of dilution, the coefficient of determination was ≥0.9000 and TEobs for each dilution and calibrator level was lower than 20%. The LOQ was set at the lowest concentration for which the TEobs was within ±20%. The LOD was calculated by adding the mean concentration obtained and three times the standard deviation. The reference interval was set to the 2.5th to 97.5th percentile interval using Excel software. The carry-over was acceptable as it was ≤2%. Correlation between the two ADVIA 1800 analyzers was determined to describe any bias in result interpretation. Stability at all storage conditions was found to be acceptable with a mean %difference within ±20%. Conclusion CRP in NHP serum met the acceptance criteria for all required validation parameters. The ADVIA 1800 analyzer can be used for preclinical studies to test CRP in NHP serum.

Early postoperative CRP predicts major complications following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is associated with significant postoperative complications. Early detection of at-risk patients may lead to improved outcomes. The role of C-reactive protein (CRP) in predicting postoperative complications has only been recently investigated. Postoperative complications were categorized according to Clavien-Dindo classification and further divided into minor (Grade <3) and major complications (Grade≥3A). Absolute CRP counts (mg/L) on postoperative days (POD) 1-7, and proportional change in CRP was compared and the area under (AUC) receiver operating characteristics (ROC) curve was calculated. Univariate and multivariate analysis was performed. Significant findings were externally validated. Twenty-five percent of patients experienced one or more major complications. A CRP level of≥106 mg/L on POD 2 and 65.5 mg/L on POD 4 were significantly associated with an increased risk of major complications with an AUC of 0.658 and 0.672, respectively. The proportional increase in CRP between POD 1 and 4 (ΔCRP POD 1/4) at a cut-off of 30 % had the best AUC of 0.744 and was the only independent risk factor for major complications (p<0.0001) on multivariate analysis. ∆CRP had an AUC of 0.716 (p=0.002) when validated in an independent database. CRP can be used in a variety of ways to predict major complications after CRS and HIPEC. However, the ∆CRP POD 1/4>30 % is the best indicator of major complications. Serial CRP measurements in the early postoperative period may lead to early detection of patients at risk of major complications allowing for alternative management strategies to improve outcomes.

Utility of neutrophil to lymphocyte ratio to predict acute respiratory distress syndrome in COVID-19: short communication.

A retrospective cohort study was conducted in hospitalized COVID-19 patients. Serial measurements of NLR and C-reactive protein were recorded and patients were followed for development of ARDS. Out of 388 patients admitted with COVID-19, 43 patients developed ARDS compared with 345 patients who did not develop ARDS. The median NLR at presentation was significantly higher in patients who developed ARDS (8.89 vs. 4.25) compared with those who did not develop ARDS (P<0.001). Moreover, serial measurement of NLR at presentation, day 3, day 5 and day 7 was significantly associated with development of ARDS (P<0.001). In multivariable analysis, age of greater than or equal to 50 years (adsjusted odds ratio=3.28; 95% CI=1.40-7.69) and unit increase in NLR at presentation (adsjusted odds ratio=1.07; 95% CI=1.03-1.11) were independently associated with development of ARDS. Serial measurement of NLR can predict patients who are at a greater risk for developing ARDS in COVID-19.

The relationship between thoracic CT findings and C-reactive protein and ferritin levels in COVID-19 patients

Aim: In this study, we aimed to establish the relationship between thoracic computed tomography (CT) findings at initial presentation and CRP and ferritin levels in 232 patients diagnosed with COVID-19. &#x0D; Material and Method: 232 patients who were diagnosed with COVID-19 and underwent a thoracic CT examination at our hospital between Apr 2020 and Aug 2021 were enrolled in this study. The study group was selected from among individuals aged 18-45 years without any chronic diseases and comorbidities. The patients' complaints, RT-PCR test results and blood biochemistry values from the medical records system, and CT imaging from the PACS system were reviewed retrospectively. Parenchymal lesions, ground-glass area, consolidation and combination of ground-glass area and consolidation observed on thoracic CT were considered typical findings. Blood samples were analyzed in the laboratory using standard methods. Routine blood tests were performed to measure serum C-reactive protein and ferritin levels. &#x0D; Results: Out of the 232 patients infected with COVID-19, 118 were female and 114 were male. While the mean age of all patients was 34.9, the mean ages of men and women were 34.9 and 35.2, respectively. No significant differences were observed between the ages of patients with and without lung involvement (32.9, 37.9, p=0.903, respectively). CT scan showed typical parenchymal findings in 140 patients out of whom 65 were male and 75 were female. With regard to the morphologic features observed on CT, ground-glass density was the most common (74 patients), followed by a combination of ground-glass density and consolidation (34 patients) and finally consolidation (32 patients). In statistical analysis, no significant differences were found in CRP values between patients with and without lung involvement, whereas a significant difference was noted in ferritin values (p=0.196 and p

Serial measurements of lymphocytes, D-dimer, LDH, and CRP do not improve the ability to predict COVID-19 adverse outcomes

We evaluated the discriminatory ability of variations in lymphocyte, D-dimer, C-reactive protein (CRP), and lactate dehydrogenase (LDH) serum levels at 48 to 72 hours of hospitalization compared with baseline measurements to predict unfavorable clinical outcomes in patients with COVID-19. We analyzed diagnostic test results based on a retrospective cohort to determine the ability of variations (gradients or ratios) in patients' lymphocyte, D-dimer, CRP, and LDH serum levels taken 48 to 72 hours after hospital admission to predict adverse outcomes such as death, mechanical ventilation, or intensive care unit (ICU) admission developing. Among 810 patients (56.1% men, age 61.6 ± 16.2 years), 37.5% had at least one adverse outcome; 28.2% required ICU admission, 26.5% required mechanical ventilation, and 19.4% died during hospitalization. In comparing baseline measurements with measurements at 48 to 72 hours, D-dimer, lymphocyte delta, LDH, and CRP had similar discriminatory ability (area under the receiver operating characteristic curve [AUC] 0.57 vs. 0.56, 0.53 vs. 0.57, 0.64 vs. 0.66, and 0.62 vs. 0.65, respectively). Measuring serum risk markers upon hospital admission can be used to evaluate risk of adverse outcomes in hospitalized patients with COVID-19. Repeating these measurements at 48 to 72 hours does not improve discriminatory ability.

Effect of iron-enriched bean-based diet on body weight, exercise performance and iron biomarkers in young adult BALB/c mice

Iron deficiency contributes to the global burden of disease, affecting children, premenopausal women, and population from low-income and middle-income countries. To manage the deficit of iron on diet, biofortified crops can be obtained from conventionally plant-based foods. BIO102 bean is a biofortified crop with higher iron and protein content when compared to conventional beans. Therefore, this study aimed to determine the effect of BIO102 food on body weight, exercise performance, and iron biomarkers in young adult BALB/c mice. To achieve this, 24 BALC/c mice were randomly assigned to each of the following groups (n=6 per group): Control diet (conventional diet 5010 Diet; CTRL), bean-based biofortified diet (BIO102), bean-based non-biofortified diet (NB), and corn-based diet (CD). The following parameters were assessed weekly from baseline to 8 weeks: body weight, food intake, endurance capacity, and limbs strength. Baseline blood glucose and hemoglobin measurements were made at the first, three, and eighth weeks of tail blood, and serum ferritin, hepcidin, C-reactive protein, and testosterone measurements were made at the end of 8 weeks of whole blood.During the initial week of housing (acclimatization), there were no differences among groups on neither food intake nor body weight ( p&gt;0.05) (Figure 1). A significant difference in body weight from the second week of feeding with the natural diets was found (Figure 1). Due to signs of stress after three weeks of feeding, all the groups that took the natural diets, received 1 g of 5010Diet food as supplementation up to the end of the experiment. Both CTRL and BIO102 groups showed higher body weight gain when compared to NB and CD groups. Regarding exercise performance, no significant differences were found among groups (Figure 2). As for the iron biomarkers, no differences were determined for hemoglobin concentration and blood glucose in acclimatization (Figure 3). Interestingly, at three weeks, bean-based diet groups were significant different from CTRL group for Blood glucose concentration ( p&lt;0.05) (Figure 3). Moreover, at 8 weeks, only CD group showed a statically significant increase in ferritin (Table 1). In summary, our results suggest that bean-based biofortified diet (BIO102) has a higher nutritional value than common crops such as conventional beans and corn, when compared with a control diet. This suggestion is because the mice feed with BIO102 diet kept body weight gain like those in CTRL group. In addition, BIO102 reduced fasting blood glucose, maintaining both endurance capacity and strength, as well as biomarkers of iron regulation. This work was funded by the following: Pontificia Universidad Javeriana Cali-Colombia, El Centro Internacional de Agricultura Tropical (CIAT) y la Fundación Banco de la República. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Association of Initial and Longitudinal Changes in C-reactive Protein With the Risk of Cardiovascular Disease, Cancer, and Mortality

ObjectiveTo evaluate the value of serial C-reactive protein (CRP) measurements in predicting the risk of cardiovascular disease (CVD), cancer, and mortality. MethodsThe analysis was performed using data from two prospective, population-based observational cohorts: the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study and the Framingham Heart Study (FHS). A total of 9253 participants had CRP measurements available at two examinations (PREVEND: 1997-1998 and 2001-2002; FHS Offspring cohort: 1995-1998 and 1998-2001). All CRP measurements were natural log-transformed before analyses. Cardiovascular disease included fatal and nonfatal cardiovascular, cerebrovascular and peripheral vascular events, and heart failure. Cancer included all malignancies except nonmelanoma skin cancers. ResultsThe mean age of the study population at baseline was 52.4±12.1 years and 51.2% (n=4733) were women. Advanced age, female sex, smoking, body mass index, and total cholesterol were associated with greater increases in CRP levels over time (Pall<.001 in the multivariable model). Baseline CRP, as well as increase in CRP over time (ΔCRP), were associated with incident CVD (hazard ratio [HR]: 1.29 per 1-SD increase; 95% confidence interval [CI]: 1.29 to 1.47, and HR per 1-SD increase: 1.19; 95% CI: 1.09 to 1.29 respectively). Similar findings were observed for incident cancer (baseline CRP, HR: 1.17; 95% CI: 1.09 to 1.26; ΔCRP, HR: 1.08; 95% CI: 1.01 to 1.15) and mortality (baseline CRP, HR: 1.29; 95% CI: 1.21 to 1.37; ΔCRP, HR: 1.10; 95% CI: 1.05 to 1.16). ConclusionInitial as well as subsequent increases in CRP levels predict future CVD, cancer, and mortality in the general population.

A77 THE ASSOCIATIONS OF OBJECTIVELY ASSESSED SEDENTARY TIME AND STEP COUNT ON ULCERATIVE COLITIS OUTCOMES

Abstract Background Physical activity has been associated with positive health outcomes in those with Ulcerative Colitis (UC). The extent to which other more prominent behaviours occurring throughout the 24-hour day (i.e., sitting, standing, lying down, and stepping) are associated with UC outcomes is unknown. Purpose The purpose of this study was to explore whether objectively measured time spent sitting, lying down, standing, and stepping were associated with Total Mayo score (TMS), fecal calprotectin (FCP), and C-reactive protein (CRP) in patients with UC. Method Patients were recruited from the Foothills Medical Center in Calgary, Alberta and were given activPALTM accelerometers (PAL Technologies Limited, Glasgow, UK) to wear on their thigh for 7 days. Step count, sitting time, standing time, and time lying down (excluding sleep) were recorded for a minimum of 4 days, including at least one day on the weekend. TMS was used to determine disease activity and patients were categorized into normal/mild (TMS score &amp;lt;6) or moderate/severe (TMS score 6). FCP, a marker of gut inflammation, was measured using stool samples. Blood samples were collected to measure serum CRP, a marker of systemic inflammation. Univariate analysis of covariance (ANCOVA) was used to evaluate associations between the activPALTM daily activity variables, TMS, FCP (&amp;lt; or &amp;gt;250ug/g) and CRP (&amp;lt; or &amp;gt; 5 mg/L). Analyses were controlled for age, sex, body mass index (BMI), and antibiotic use. Result(s) Patients (N=29; 15 male, 14 female) were on average 38 years of age (SD=12.1). The average BMI was 26.2 kg/m2 (SD=3.2). Based on TMS, 14 had moderate/severe disease activity and 16 had normal/mild disease activity. Average CRP was 2.16 mg/L (SD=2.49) while the mean FCP was 954.5 ug/g (SD=1427.7). Patients recorded an average of 8,137 steps (SD=3,051) per day. Average standing time was 240 minutes (SD=84) per day, sitting time was 503 minutes (SD=131) per day, and time spent lying down was 527 minutes (SD=111) per day. FCP was negatively associated with step count (D=-2,134 steps, 95% CI: -4,360 to 93, p=0.06). Patients with lower FCP values (&amp;lt;250mg/g) spent 60 fewer minutes sitting (p=.25), and 52 more minutes standing (p=.12) during the day compared to patients with higher FCP values (&amp;gt;250mg/g). Patients with normal/mild disease severity (TMS &amp;lt;6) spent 83 fewer minutes per day sitting compared to those with moderate/severe disease severity (TMS &amp;gt;6, p=.12). CRP was not associated with any behavioural outcomes. Conclusion(s) In our study, daily steps appeared to be most strongly associated with FCP. While not statistically significant, patients with lower FCP reported less sitting and more standing compared to those with higher FCP. Future studies with larger sample sizes should continue to explore these activity behaviours and their potential associations with UC disease outcomes. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; Alberta's Collaboration of Excellence for Nutrition in Digestive Diseases (ASCEND) Disclosure of Interest B. Chiew: None Declared, K. Lyden Consultant of: PAL Technologies, the company that manufactures the activPAL device., A. Schick: None Declared, C. Ohland: None Declared, K. McCoy: None Declared, S. Kaur: None Declared, M. Yousuf: None Declared, L. Taylor: None Declared, M. Raman Shareholder of: LyfeMD – Director, Shareholder, Grant / Research support from: Pfizer, Takeda, Speakers bureau of: Fresenius Kabi, Pfizer, Mckesson, Takeda, Lupin, J. Vallance Grant / Research support from: Canada Research Chairs Program

Role of salivary c reactive protein and mean platelet volume in diagnosis of late onset neonatal pneumonia

Background: Late onset neonatal pneumonia (LONP) must be diagnosed accurately and promptly if we are to accurately assess the disease&#39;s prevalence, create better strategies for preventing and treating it, and ultimately find a cure. The combined measurement of C- reactive protein (CRP) and mean platelet volume (MPV) could be useful in determining if a patient has bacterial or viral infection and in estimating the likelihood of complications from either. The purpose of this research is to evaluate the usefulness of CRP in saliva (sCRP) and MPV in the identification of LONP. Methods: This prospective case control research was carried out on 60 full‐term neonates. The neonates were classified into 2 equal groups: Group a: included 30 neonates with LONP. Group b: included 30 healthy control neonates. All patients were subjected to thorough medical history taking and physical examination as well as measurement of salivary and serum CRP and complete blood picture for assessment of MPV. Results: MPV, sCRP, serum CRP and serum CRP / MPV are statistically significant predictors of LONP cases. SCRP at a cutoff value >3.2 is a statistically significant predictor of serum CRP> 6 in patient groups. A stastistically notable positive link between salivary and serum CRP concentrations (r = 0.476, p≤ 0.05), the research also showed significant link between serum CRP and MPV (r = 0.547, P = 0.002). There was a statistically evident link between sCRP and MPV concentrations in the pneumonic group (r =0.507, p≤ 0.05) in diagnosis of LONP. CRP/MPV ratio as predictor for diagnosis of LONP cases, was a statistically significant predictor at a cutoff value >0.6. Conclusions: Late-onset neonatal pneumonia may be diagnosed non-invasively with CRP and MPV in the saliva. The ratio of C-reactive protein to mean platelet volume (MPV) is easy to compute and has the potential to serve as a straightforward and reliable biomarker for the identification of late-onset neonatal sepsis.

Comparison of nutritional risk screening with NRS2002 and the GLIM diagnostic criteria for malnutrition in hospitalized patients

Nutritional risk screening, to identify patients at risk of malnutrition, is the first step in the prevention and treatment of malnutrition in hospitalized patients, and should be followed by a thorough nutritional assessment resulting in a diagnosis of malnutrition and subsequent treatment. In 2019, a consensus on criteria has been suggested for the diagnosis of malnutrition by the Global Leadership Initiative for Malnutrition (GLIM). This study investigates the diagnosis of malnutrition in hospitalized patients using nutritional risk screening and the diagnostic assessment suggested by GLIM. Hospitalized patients (excluding cancer, intensive care, and transmissible infections) who underwent nutritional risk screening (by NRS2002) were included. Nutritional risk screening was followed by anthropometric measurements including measurement of muscle mass, assessment of dietary intake and measurement of serum C-reactive protein (CRP) for inflammation in all patients. Malnutrition was diagnosed according to the GLIM-criteria. In total, 328 patients (median age 71 years, 47% women, median length of stay 7 days) were included. Nutritional risk screening identified 143 patients as at risk of malnutrition, while GLIM criteria led to a diagnosis of malnutrition in 114 patients. Of these 114 patients, 77 were also identified as at risk of malnutrition by NRS2002, while 37 patients were not identified by NRS2002. Malnutrition was evident in fewer patients than at risk of malnutrition, as expected. However, a number of patients were malnourished who were not identified by the screening procedure. More studies should investigate the importance of inflammation and reduced muscle mass, which is the main difference between nutritional risk screening and GLIM diagnostic assessment.

Prognostic implication of residual inflammatory risk according to disease status in patients treated with percutaneous coronary intervention

Abstract Background Compared with stable angina, acute myocardial infarction (AMI) phenotype is related with the elevated inflammatory activity. However, time-dependent change of inflammatory level and its prognostic implication has not been fully understood according to the disease entity. Methods We enrolled total 4,263 patients who underwent percutaneous coronary intervention (PCI) with serial measurement of high-sensitivity C-reactive protein (hsCRP) at on-admission and 1-month post-PCI. The risks of MACE (a composite of death, MI or stroke), and major bleeding were evaluated up to 4 years after procedure. Results Compared with the non-AMI group (n=1,887), the AMI group (n=2,376) showed the significant decrease of hs-CRP during 1 month (∇0.5 vs. ∇0.1 mg/L; P&amp;lt;0.001). However, 1-month hs-CRP value still was higher in the AMI group than in the non-AMI group (median: 1.0 vs. 0.9 mg/L; P=0.001). During 1-month follow-up, high vs. low inflammatory risk (upper vs. lower tertile of hs-CRP) was significantly associated with increased rate of MACE in the AMI group (HR: 7.66; 95% CI: 2.29–25.59; P&amp;lt;0.001), but not in the non-AMI group (HR: 0.74; 95% CI: 0.12–4.40; P=0.736). From 1-month to 4-years, patients with high inflammatory risk showed the greater rate of MACE compared to those with low inflammatory risk, in both the AMI (HR: 2.40; 95% CI: 1.73–3.45; P&amp;lt;0.001) and non-AMI (HR: 2.67; 95% CI: 1.80–3.94; P&amp;lt;0.001) groups. Conclusion In PCI-treated patients, patients presented with AMI showed the greater values of inflammatory activity and its prognostic implication during the early phase, but combined inflammatory risk appeared similar across the disease entity during the late phase. This result may support that clinical benefit of post-PCI anti-inflammatory treatment would be constant regardless of the disease entity during the stabilized phase. Funding Acknowledgement Type of funding sources: None.

Early detection of inflammation-prone STEMI patients using the CRP Troponin Test (CTT)

Abstract Background Elevated concentrations of C-reactive protein (CRP) early after acute coronary syndrome (ACS) may reflect the magnitude of the inflammatory response to myocardial damage and are associated with worse outcome. However, the routine measurement of both CRP and cardiac troponin simultaneously in the setting of ST segment myocardial infarction (STEMI) is not used broadly. Here, we sought to identify and characterize individuals who are prone to an elevated inflammatory response following STEMI using the CRP Troponin test (CTT) and determine their short- and long-term outcome. Material and methods We retrospectively examined 1,186 patients with the diagnosis of acute STEMI, who had at least two successive measurements of combined CRP and cardiac troponin (up to 6 hours apart), all within the first 48 hours of admission. We used Chi-Square Automatic Interaction Detector (CHAID) tree analysis to determine which parameters, timing (baseline vs. serial measurements), and cut-offs should be used to predict mortality. Results Patients with high CRP concentrations (above 90th percentile, &amp;gt;33mg/L) had higher 30 day- and all-cause mortality rates regardless of their troponin test status (above or below 118,000 ng/L); 14.4% vs 2.7%, p&amp;lt;0.01. Furthermore, patients with both high CRP and high Troponin levels on their second measurement had the highest 30-day mortality rates compared to the rest of the cohort; 21.4% vs. 3.7%, p&amp;lt;0.01. These patients also had the highest all-cause mortality rates after a median follow up of 4.5 years compared to the rest of the cohort; 42.9% vs 12.7%, p&amp;lt;0.01 (Figure 1). Conclusions In conclusion, serial measurements of both CRP and cardiac troponin might detect patients at increased risk for short-and long-term mortality following STEMI. We suggest the future use of the combined CRP Troponin-test (CTT) as a potential early marker for inflammatory-prone patients with worse outcomes following ACS. This sub-type of patients might benefit from early anti-inflammatory therapy such as colchicine and anti-IL-1β agents. Funding Acknowledgement Type of funding sources: None.

Evaluation of CRP, D-Dimer of clinical significance in Iraqi patients with COVID-19 and associated comorbidities

Background: The pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused an unprecedented global social and economic impact, and high numbers of deaths. Many risk factors have been identified in the progression of COVID-19 into a severe and critical stage, underlying comorbidities such as hypertension, diabetes, obesity, chronic lung diseases, heart, liver and kidney diseases. Aims and Methods: This study was designed to investigate Measurement of serum C-reactive protein( CRP) level, plasma D-dimer level and evaluate the levels of each one of the studied parameters between patients infected by coronavirus COVID-19 and no associated comorbidities and patients infected by coronavirus COVID-19 with associated comorbidity (Diabetes , Hypertension). Results: The mean of CRP was 19.31 ± 8.205 in control, , 96.80 ± 18.33 in HTN, 51.08 ± 16.56 in DM group, while mean of D-dimer was 560.45 ± 155.13 in control group, , 1178.86 ± 379.12 in HTN group, 1529.51 ± 530.20 in DM group of patients.