Median C-reactive Protein Values Research Articles

Anastomotic leakage after resection for rectal cancer and recurrence-free survival in relation to postoperative C-reactive protein levels

BackgroundAnastomotic leakage after rectal cancer surgery is linked to reduced survival and higher recurrence rates. While an aggravated inflammatory response may worsen outcomes, few studies have explored the combined effects of leakage and inflammation.MethodsThis is a retrospective multicenter cohort study including patients operated with anterior resection for rectal cancer in Sweden during 2014–2018. Anastomotic leakage within 12 months was exposure and primary outcome was recurrence-free survival. Mediation analysis was performed to evaluate the potential effect of systemic inflammatory response, as measured by the highest postoperative C-reactive protein (CRP) level within 14 days of surgery. Confounders were chosen using a causal diagram.ResultsSome 1036 patients were eligible for analysis, of whom 218 (21%) experienced an anastomotic leakage. At the end of follow-up at a median of 61 months after surgery, recurrence-free survival amounted to 82.6% and 77.8% in the group with and without leakage, respectively. The median highest postoperative CRP value after surgery was higher in the leakage group (219 mg/l), compared with the group without leakage (108 mg/l). Leakage did not lead to worse recurrence-free survival (HR 0.66; 95% CI 0.43–0.94), and there was no apparent effect through postoperative highest CRP (HR 1.12; 95% CI 0.93–1.29).ConclusionsIn conclusion, anastomotic leakage, with its accompanying CRP increase, was not found to be associated with recurrence-free survival after anterior resection for rectal cancer in this patient cohort. Larger, even more detailed studies are needed to further investigate this topic.

Predicting complicated acute diverticulitis with the HALP score: A retrospective study

ObjectiveHALP score is a scoring system consisting of hemoglobin, albumin, lymphocyte and platelet. It is different from other prognostic markers because it provides information about both inflammation and immunonutrition status. This study aims to evaluate the severity of the disease and the level of prognosis in patients diagnosed with acute diverticulitis. Material methods190 patients diagnosed with acute diverticulitis between January 2017 and June 2023 were included in the study. The patients were divided into two separate groups according to the Hinchey classification. The prognostic effect of inflammatory markers and HALP score was examined. ResultThe median values of C-reactive protein, white blood cell count, neutrophil count, HALP score, and hospitalization duration were significantly higher in patients diagnosed with complicated diverticulitis than in those diagnosed with uncomplicated diverticulitis. (p < 0.001, p = 0.045, p = 0.004, p < 0.001 and p < 0.001, respectively). The distinguishing feature of the HALP score in predicting the complexity of the diagnosis of diverticulitis was evaluated using ROC analysis. Area Under Curve (AUC) value was found to be 0.723 (p < 0.001). According to the ROC curve, the sensitivity and specificity for the cut-off value of HALP score ≤44.1 were 66.7 % and 75.0 %, respectively. ConclusionHALP score is an inexpensive parameter that can be used safely to determine the severity and prognosis of acute diverticulitis.

C-reactive protein and high-sensitivity C-reactive protein levels in asymptomatic intestinal parasite carriers from urban and rural areas of Gabon.

Chronic carriage of intestinal parasitic infections (IPIs) can induce chronic inflammation and dysbiosis, which are risk factors for non-communicable diseases. The objective of this study was to determine the relationship between IPI carriage and inflammation in a population of volunteers living in Gabon. A cross-sectional study was conducted from September 2020 to November 2021 in asymptomatic volunteers aged 18 years old and over, residing in different areas of Gabon: Libreville (urban area) and Koula-Moutou and Bitam (rural areas). The detection of IPIs was carried out using four common microscopic techniques. C-reactive protein (CRP), and high-sensitivity C-reactive protein (hsCRP) were measured and levels were compared according to the presence or absence of IPI. Overall, 518 participants were included, 64.5% (n = 334) of whom resided in urban area and 35.5% (n = 184) in rural areas. The median age was 35 years (27; 46). The prevalence of asymptomatic IPIs was 29.9% (n = 155), with a significantly higher frequency in rural areas than in urban area (adjusted OR 6.6 (CI 3.2-13.8), p < 0.01). Protozoa were more frequent than soil-transmitted helminths (STHs) in both areas: 81.6% (n = 40) in urban area and 69.8% (n = 74) in rural areas. STHs were predominant in rural areas (48.1% vs 22.4% in urban area. In case of IPI, the median values of CRP (15 (13-15) mg/L vs 13.0 (11.1-14.9) mg/L) and hsCRP (4.2 (1.4-13.0) mg/L vs 2.2(0.4-6.1) mg/L) were higher (p<0.01). Elevated hsCRP and CRP were significantly more frequent in parasitized individuals (for hsCRP: 22.6%, n = 35; for CRP: 52.9%, n = 82); in particular among STH carriers (for hsCRP: 65.9%, n = 27, for CRP: 36.6%, n = 15) (p < 0.01). This first study showed that asymptomatic IPIs, particularly STH carriage are associated with high CRP and hsCRP levels. Further larger and longitudinal studies are needed to elucidate the global and specie-specific enteropathogens link with chronic inflammation.

Role of doxycycline in the treatment of dengue infection: An open-label, randomized, controlled, pilot trial

Objective: To measure the effect of doxycycline on inflammatory marker [IL-6, TNF-α, ferritin and C reactive protein (CRP)] levels in patients with dengue infection. Methods: A single-centre, open-label, parallel-group randomized controlled trial was done in PGIMER Chandigarh from June 2021 to October 2022. Patients were randomized using a simple randomization process into two groups: the doxycycline treatment group (n=35) and the control group (n=34). Patients in the treatment group were given oral doxycycline 100 mg twice daily for five days along with standard treatment, whereas patients in the control group received only standard treatment. The objective was to measure the effect of doxycycline on inflammatory markers in dengue infection. Results: On comparative analysis at day 5, there was a statistically significant reduction in the median values of ferritin and CRP in cases compared to the control group (ferritin: P=0.006 and CRP: P=0.006). No significant reduction was noted in the levels of IL-6 and TNF-α. Conclusions: Doxycycline treatment led to a reduction of inflammatory markers in dengue infection.

Role of Calprotectin, IL-6, and CRP in Distinguishing Between Inflammatory Bowel Disease and Diarrhea Predominant Irritable Bowel Syndrome.

The early establishment of prophylaxis and immediate administration of anticoagulant therapy upon the diagnosis of venous thromboembolism should be the treatment objectives in these patients. The study aimed to determine the optimal cut-off point of Calprotectin, IL-6 (interleukin-6), CRP (C reactive protein) to differentiate UC, IBS-D. A cross-sectional descriptive study of 335 individuals ≥15 years old was performed, including 31 healthy controls, 215 with IBS-D, 71 diagnosed with UC, and 18 diagnosed with CD. Receiver Operating Characteristics (ROC), sensitivity, specificity, and area under curve (AUC) were computed. The results showed that the median value of calprotectin (IQR) in healthy participants was 20.0 (6.0 - 34.0) µg/g; 17,7 (8,7-38,9) µg/g in IBS-D group; 1710.0 (588 - 4260,0) µg/g in UC group; and 560.5 (177.8 - 1210.0) µg/g in CD group. Calprotectin concentration in IBD group including UC and CD was higher than IBS-D with p<0.05. The median value of CRP (range IQR) was 1,3 (0,9 - 2,3) mg/L in IBS-D group; 7.0 (2.4 -16.6) mg/L in UC group; and 10.1 (2.2 - 42.5) mg/L in CD group. CRP concentration in IBD group including UC and CD was higher than IBS-D with p<0.05. The median value of IL-6 (range IQR) was 2.3 (1.6 - 5.7) pg/mL in IBS-D group; 16.8 (9.4 - 47.0) pg/mL in UC group; and 9.4 (7.9 - 11.0) pg/mL in CD group. Calprotectin concentration in IBD group including UC and CD was higher than IBS-D with p<0.05. The optimal cut-off point of calprotectin that differentiated IBS-D from IBD was 110.5 µg/g, with sensitivity and specificity of 93.3% and 91.4%, respectively; of IL-6 was 7.2 pg/mL with sensitivity and specificity of 92.0% and 78.0%, respectively; of CRP of 2.4 mg/L had specific sensitivities of 83.3% and 86.0%, respectively. The Calprotectin immunoassay has the best value in discriminating between IBD and IBS-D.

Gamma-glutamyl transpeptidase and indirect bilirubin may participate in systemic inflammation of patients with psoriatic arthritis

BackgroundPrevious studies have suggested that systemic metabolic abnormalities are closely related to psoriatic arthritis (PsA). Gamma-glutamyl transpeptidase (GGT) and indirect bilirubin (IBIL), two essential active substances in hepatic metabolism that have been demonstrated as an oxidative and anti-oxidative factor respectively, have been proved to be involved in oxidative stress damage and inflammation in several human diseases. However, their role in PsA remains unclear.MethodsIn this retrospective comparative cohort study, a case group of 68 PsA patients and a control group of 73 healthy volunteers from the Third Hospital of Hebei Medical University were enrolled. Serum GGT, IBIL, GGT/IBIL ratio and C-reactive protein (CRP), a well applied bio-marker of systemic inflammatory in PsA, were compared between the two groups. Furthermore, the relationship of GGT, IBIL and GGT/IBIL with CRP were explored in PsA patients. Finally, the patients were divided into high inflammation group and low inflammation group according to the median value of CRP. Multivariate logistic regression analyses were used for the association of systemic inflammation level with GGT, IBIL and GGT/IBIL.ResultsCompared with healthy controls, PsA patients exhibited significantly higher serum GGT, GGT/IBIL, and CRP levels and lower IBIL levels. Serum GGT and GGT/IBIL were positively correlated with CRP, whereas IBIL were negatively correlated with CRP. Binary logistic regression analysis revealed that serum GGT was a risk factor for high CRP in PsA, whereas IBIL was a protective factor. Furthermore, GGT/IBIL was a better indicator of high CRP condition in PsA patients than either GGT or IBIL alone, as determined by the receiver operating characteristic curves.ConclusionGGT and IBIL may participate in the pathogenesis of PsA. Additionally, GGT, IBIL and the balance of the two may reflect systemic inflammation mediated by oxidative stress events related to metabolic abnormalities to a certain extent.

Comparison of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and C-reactive protein in predicting osteomyelitis in patients with diabetic foot ulcer.

Neutrophil/lymphocyte ratio (NLR) and platelet/ lymphocyte ratio (PLR) are readily available and inexpensive biomarkers that have received great attention for diagnosing type 2 diabetes(T2DM) complications. The objective of the present cross-sectional study was to compare diagnostic values of these biomarkers with C-reactive protein(CRP) in detecting diabetic foot ulcer (DFU) and osteomyelitis (OS) and discriminating between the degree of DFU according to Wagner's classification. A total of 217 individuals (42 healthy controls, 40 T2DM patients without DFU, and 135 patients with DFU) were enrolled. The DFU patients were classified according to Wagner's classification into grade 1, grade 2, and grade 3. Blood samples were obtained and various biochemical and hematological parameters including creatine, CRP, HbA1c, NLR, and PLR were measured. The levels of CRP, PLR, and NLR were significantly higher in the patients with DFU and OS compared to healthy controls and T2DM patients without DFU. The median values of CRP were correlated with the severity of DFU and increased with DFU grades. The highest values of CRP, NLR, and PLR were observed in the DFU patients with OS which were significantly higher than those of DFU patients with grades 1 and 2 as well as T2DM patients without DFU. The PLR and NLR had no significant performance in diagnosing DFU patients with grades 1 and 2 from the patients without DFU. NLR and PLR could be useful for diagnosing OS but cannot be used for detecting lower grades of DFU. CRP showed higher performance in detecting OS compared to PLR and NLR. The online version contains supplementary material available at 10.1007/s40200-023-01327-w.

The Role of C-reactive Protein and Procalcitonin in Predicting the Occurrence of Pancreatic Fistula in Patients who Underwent Laparoscopic Pancreaticoduodenectomy: a Retrospective Study.

The occurrence of postoperative pancreatic fistula following laparoscopic pancreaticoduodenectomy (LPD) is a significant concern, yet there is currently a lack of consensus on reliable predictive methods for this complication. Therefore, the aim of this study was to assess the clinical significance of C-reactive protein (CRP) and procalcitonin (PCT) values and their reliability in early predicting the development of clinically relevant pancreatic fistula (CRPF) following LPD.A retrospective analysis was conducted using data from 120 patients who had LPD between September 2019 and December 2021. Preoperative assessment data, standard patients' demographic and clinicopathological characteristics, intra- and postoperative evaluation, as well as postoperative laboratory values on postoperative days (PODs) 1, 3, and 7, including white blood cells (WBCs), CRP, and PCT, were prospectively recorded on a dedicated database. Two clinicians separately collected and cross-checked all of the data.Among 120 patients [77 men (64%), 43 women (36%], CRPF occurred in 15 patients (11 grade B and 4 grade C fistulas). The incidence rate of CRPF was 12.3%. A comparison of the median values of WBCs, PCT, and CRP across the two groups revealed that the CRPF group had higher values on most PODs than the non-CRPF group. Receiver operating characteristic (ROC) analysis was used to calculate the area under the curve (AUC) and cutoff values. It was discovered that POD 3 has the most accurate and significant values for WBCs, CRP, and PCT. According to the ROC plots, the AUC for WBCs was 0.842, whereas the AUC for PCT was 0.909. As for CRP, the AUC was 0.941 (95% CI 0.899-0.983, p<0.01) with a cutoff value of 203.45, indicating a sensitivity of 93.3% and specificity of 91.4%.Both CRP and PCT can be used to predict the early onset of CRPF following LPD, with CRP being slightly superior on POD 3.

Prognostic value of fibrosis-5 index combined with C-reactive protein in patients with acute decompensated heart failure

BackgroundFibrosis-5 (FIB-5) index is a marker of liver fibrosis and has been shown to have a good prognostic value for patients with acute heart failure (AHF), and C-reactive protein (CRP) has inflammatory properties and predicts adverse prognosis in patients with HF. However, the long-term prognostic value of FIB-5 index combined with CRP in patients with acute decompensated HF (ADHF) is yet unclear.MethodsThis retrospective study included 1153 patients with ADHF hospitalized from January 2018 to May 2022.The FIB-5 index was calculated as (albumin [g/L]×0.3 + PLT count [109/L]×0.05)−(ALP [U/L]×0.014 + AST to ALT ratio×6 + 14). Patients were stratified into the following four groups according to the median value of FIB-5 index (=-2.11) and CRP (= 4.5): Group 1 had a high FIB-5 index (FIB-5 index >-2.11) and a low CRP (CRP ≤ 4.5); Group 2 had both low FIB-5 index and low CRP; Group 3 had both high FIB-5 index and high CRP; Group 4 had a low FIB-5 index (FIB-5 index ≤-2.11) and a high CRP (CRP > 4.5). The endpoint was major adverse cardiac and cerebral events (MACCEs). Multivariate Cox analysis was used to evaluate the association of the combination with the development of MACCEs. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analysis were used to compare the accuracy of the combination with a single prognostic factor for predicting the risk of MACCEs.ResultsDuring the mean follow-up period of 584 ± 12 days, 488 (42.3%) patients had MACCEs. Kaplan–Meier analysis revealed that the incidence of MACCEs was different in the four groups (P < 0.001). After adjusting for the confounding factors, the hazard ratio (HR) for MACCEs in Group 4 (low FIB-5 index + high CRP) was the highest (Model 1, HR = 2.04, 95%CI 1.58–2.65, P < 0.001; Model 2, HR = 1.67, 95%CI 1.28–2.18, P < 0.001; Model 3, HR = 1.66, 95%CI: 1.27–2.17, P < 0.001). Additionally, the combination of FIB-5 index and CRP enabled more accurate prediction of MACCEs than FIB-5 index alone (NRI, 0.314,95%CI 0.199–0.429; P < 0.001; IDI, 0.023; 95% CI 0.015–0.032; P < 0.001).ConclusionsIn patients with ADHF, the combination of the FIB-5 index and CRP may be useful in risk stratification in the future.

Efficacy of olokizumab in patients with mild or moderate COVID-19 and risk factors of progression

The COronaVIrus Disease 2019 (COVID-19) is a common infectious disease characterized by hyperactivation of the immune response and the development of a “cytokine storm” upon progression. The aim of this study was to obtain additional information about the efficacy of the drug olokizumab in comparison with the Janus kinase inhibitor upadacitinib in real clinical practice in patients with mild to moderate COVID-19 and combined risk factors for disease progression. Methods. A single-center, non-interventional, prospective study was conducted in specialized day hospital patients (n = 125) who received therapy with olokizumab (n = 62) (64 mg once intravenously) and the Janus kinase inhibitor upadacitinib (n = 63) (orally, according to selected dosing regimen). The primary endpoint was the frequency of hospitalizations in the 24-hour hospital over the entire observation period. We also analyzed the frequencies of intensive care unit (ICU) transfer, prescription of respyratory therapy, use of “rescue” therapy (monoclonal antibodies/therapeutic proteins acting on interleukins (IL) and their receptors: IL-6 receptor inhibitors and Janus kinase inhibitors (baricitinib, tofacitinib, upadacitinib, etc.)), mortality, dynamics of laboratory and instrumental parameters, as well as frequency of negative and positive changes according to the clinical progression scale of the World Health Organization. Results. All study subjects showed rapid clinical improvement and recovery. Patients in both groups did not experience any negative clinical events, such as admission to a 24-hour hospital, prescription of respyratory therapy, use of “rescue” therapy, etc. Thus, the hyperinflammatory reaction and adverse clinical outcomes are effectively prevented by the timely use of both drugs. Those who received olokizumab had slightly higher levels of C-reactive protein (CRP) at baseline than those who received upadacitinib (p &lt; 0.001). The median CRP value returned to normal on the 4th day in both groups. Patients treated with olokizumab showed a more pronounced change in CRP levels relative to baseline values. A similar trend was also established in body temperature. Conclusion. The study confirmed that early administration of olokizumab in patients with mild to moderate COVID-19 with several risk factors for the severe course is as effective a method of preemptive anti-inflammatory therapy as the use of Janus kinase inhibitors but more stronger suppression of markers and symptoms of intoxication.

Assessment of Oxidant and Antioxidant Status in Prepubertal Children following Vegetarian and Omnivorous Diets

Oxidant-antioxidant balance is crucial for maintaining one's health, and the diet is possibly one of the most important factors affecting this balance. Therefore, the aim of this study was to determine the oxidant-antioxidant balance in children on a lacto-ovo-vegetarian diet. The study was conducted between January 2020 and December 2021. The concentrations of total oxidant capacity (TOC), total antioxidant capacity (TAC), reduced (GSH), and oxidized (GSSG) glutathione, as well as C-reactive protein (CRP) and calprotectin were measured in serum samples of 72 healthy prepubertal children (32 vegetarians and 40 omnivores). The oxidative stress index (OSI) and the GSH/GSSG ratio (R-index) were calculated. Children on a vegetarian diet had significantly lower median values of TOC, GSH, and GSSG, and higher TAC compared with the omnivores. OSI was significantly lower in vegetarians, while R-index, as well as median values of CRP and calprotectin did not differ between both groups of children. Significant negative correlations were observed between TOC and TAC levels in the whole group of children and in vegetarians. GSH and GSSG levels correlated positively in the groups of vegetarians, omnivores, and in all the children. There were significant positive correlations between TOC and GSH, as well as GSSG levels in all the studied groups of children. Our study results suggest that the vegetarian model of nutrition allows to maintain the oxidant-antioxidant balance in the serum of prepubertal children.

The role of serum and urinary markers in predicting obstructing ureteral stones and reducing unjustified non-contrast computerized tomographic scans in emergency departments.

The reported yield of non-contrast computed tomography (NCCT) in assessing flank pain and obstructive urolithiasis (OU) in emergency departments (EDs) is only ~ 50%. We investigated the potential capability of serum and urinary markers to predict OU and improve the yield of NCCT in EDs. All consecutive ED patients with acute flank pain suggestive of OU and assessed by NCCT between December 2019 and February 2020 were enrolled. Serum white blood cells (WBC), C-reactive protein (CRP) and creatinine (Cr) levels, and urine dipstick results were analyzed for association with OU, and unjustified NCCT scan rates were calculated. NCCTs diagnosed OU in 108 of the 200 study patients (54%). The median WBC, CRP, and Cr values were 9,100/µL, 4.3mg/L, and 1mg/dL, respectively. Using ROC curves, WBC = 10,000/µL and Cr = 0.95mg/dl were the most accurate thresholds to predict OU. Only WBC ≥ 10,000/µL (OR = 3.7, 95% CI 1.6-8.3, p = 0.002) and Cr ≥ 0.95mg/dl (OR = 5, 95% CI 2.3-11, p < 0.001) were associated with OU. Positive predictive value and specificity for detecting OU among patients with combined WBC ≥ 10,000 and Cr ≥ 0.95 were 83% and 89%, respectively. Patients negative to the serum markers criteria underwent significantly more unjustified NCCTs (p = 0.03). The negative predictive value of the serum criteria for justified NCCT scanning was 81%. WBC and Cr may be valuable serum markers in predicting OU among patients presenting to EDs with acute flank pain. They may potentially reduce the number of unjustified NCCT scans in the ED setting.

Pretreatment Serum Lactate Dehydrogenase and Metastases Numbers as Potential Determinants of Anti-PD-1 Therapy Outcome in Nasopharyngeal Carcinoma.

We aimed to investigate the determinant factors of anti-PD-1 therapy outcome in nasopharyngeal carcinoma (NPC). In this retrospective study, we included 64 patients with recurrent/metastatic NPC. The association of patients' characteristics, C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR), and lactate dehydrogenase (LDH) with survival benefit of anti-PD-1 therapy were analyzed using Cox regression models and Kaplan-Meier analyses. Patients were divided based on the median value of CRP, NLR or LDH into different subgroups. At a median follow-up time of 11.4months (range: 1-28months), median progression-free survival (PFS) and overall survival (OS) were 1.9months (95% CI, .18-3.6) and 15months (95% CI, 10.9-19.1) months, respectively. Pretreatment metastases numbers was significant predictor of PFS (HR = 1.99; 95% CI 1.10-3.63; P = .024) and OS (HR = 2.77; 95% CI 1.36-5.61; P = .005). Baseline LDH level was independent predictor of OS (HR = 7.01; 95% CI 3.09-15.88; P < .001). Patients with LDH level >435U/L at the baseline had significantly shorter PFS and OS compared to patients with LDH level ≤435U/L (median PFS: 1.7 vs 3.5months, P = .040; median OS: 3.7 vs 18.5months, P < .001). Patients with non-durable clinical benefit (NDB) had significantly higher LDH level at the baseline compared to patients who achieved durable clinical benefit (DCB) (P = .025). Post-treatment levels of CRP, LDH, and NLR were decreased compared to baseline in patients with DCB (P = .030, P = .088, and P = .066, respectively), whereas, there was a significant increase in post-treatment level of LDH compared with baseline in patients with NDB (P = .024). LDH level at the baseline was an independent predictor of OS and pretreatment metastases numbers was a significant predictor of PFS and OS.

Comparative study of the clinicoepidemiological profile of COVID-19 patients of first wave and second wave admitted in a tertiary care teaching hospital in Nadiad, Gujarat, India

Background: According to other studies, second wave was different as compared to the first wave in clinical outcomes and laboratory parameters. Aims and Objectives: We aimed to compare the clinicoepidemiological features and their effect on mortality in coronavirus disease-2019 (COVID-19) patients of first wave versus second wave. Materials and Methods: We carried out cross-sectional, observational, and retrospective study among two groups of COVID-19 patients of first and second wave. Each group contains a 135 patients of COVID-19 admitted at our hospital. We analyzed the demographic profile, clinical features, comorbidities, and inflammatory markers. Results: In our study, majority patients were male (67%). Majority number of the patients were between 18 and 60 years of age in both the groups. Presenting complaint of shortness of breath was significantly higher in second wave and sore throat was significantly higher in first wave. SpO2 on admission was significantly lower in second wave (93% vs. 98%). Median value of C-reactive protein (6.865 vs. 2.805), neutrophil-leucocyte ratio (4.647 vs. 2.917), and D-dimer (679.5 vs. 450) were significantly higher in second wave. Second wave had significantly higher mortality as compared to first wave (18.5% vs. 4.4%). However, level of D-dimer was found significantly higher in patients who died during first wave (6820 vs. 848). Higher mortality was seen in male patients of second wave. Conclusion: Overall higher mortality was seen during the second wave which was supported by increased in the inflammatory markers. Delta variant, late admission, increased demand of oxygen support, and intensive care unit beds may have led to higher mortality.

CORRELATION OF CT STAGING AND BIOCHEMICAL PARAMETERS IN ASSESSING DISEASE SEVERITY AND MORTALITY OF COVID -19 PATIENTS

Abstract: Background CT chest has become the front-line investigation even for a Real-time polymerase chain reaction (RT-PCR) negative patient due to low viral load. Many grading systems were formulated to assess the severity of lung involvement and combined with inflammatory markers like ferritin (Fr) and C reactive protein (CRP) to provide a guide for diagnosing and managing COVID patients. Methods After being tested with RT-PCR, Severe acute respiratory syndrome coronavirus -2(SARS-CoV-2) patients who were referred for CT were included in our study. A non-contrast CT scan of the chest was obtained with 16 slice -Toshiba with 1mm collimation. Findings documented included the presence and extent of ground glass opacities; consolidation whether round, linear, patchy, lobar, or diffuse; septal thickening; and other features of pre-existing diseases like cavity, bronchiectasis, pleural effusion, and cardiomegaly. CT staging was done based on the progress of the disease and compared with biochemical parameters. Results 571 patients; between the ages of 19 and 88 suspected to have Coronavirus pneumonia were included in the study. CT stages were compared with the median value of LDH, Fr, TGL, AND CRP All biochemical parameters LDH 692 (438.5 -771 ) (p-value 0.0001), Fr 1.27 (0.64 -1.89) (p-value 0.0001), and CRP (113.4 (95.5 2-207.7 ) (p-value 0.0001), were elevated in higher CT stages. Both elevated biochemical parameters and higher CT stages were associated with the severity and mortality of the disease. No significant p-value was noted with TGL. Conclusions Covid 19 pneumonia starts as a respiratory infection but spreads to become a systemic disease. The inflammation is associated with an increase in biochemical parameters which correlate with the staging of the lung by CT and in dead patients.

Predictors of Severity and Mortality among Hospitalised COVID-19 Patients during First Three Waves- A Retrospective Study

Introduction: Coronavirus disease 2019 (COVID-19) was was a global pandemic outbreak that emerged in three waves of varying severity. The inflammatory markers can be used to identify the transition of severity of the disease from a mild to severe or critical illness and also to predict the mortality. To improve clinical outcomes, continuous monitoring of these biomarkers in hospitalised patients is essential. Aim: To compare the serum C-Reactive Protein (CRP), Lactate Dehydrogenase (LDH), serum ferritin and D-Dimer as a predictor of severity and mortality in hospitalised patients in different clinical categories during three waves of COVID-19 . Materials and Methods: This retrospective study was conducted at Vydehi Institute of Medical Sciences and Research Centre, Karnataka. A total of 6189 patient’s data were retrieved from medical record section with confirmed cases of COVID-19 admitted during the three waves of COVID-19. The results of four inflammatory marker on the day of admission were analysed in mild, moderate, severe and critically ill patients and compared with disease severity, survival and death and also assessed the difference between first, second, and third wave of COVID-19 for sensitivity and specificity. Data was analysed by Chi-square test, Mann Whitney U test, ANOVA (Analysis of Variance), and Kruskal Wallis test and Receiver Operating Curve (ROC). Results: The median age of patients in the mild category was found to be younger in all three waves compared to those in the severe and critically ill categories. In terms of gender distribution, males were more prevalent than females. Inflammatory markers were significantly increased in all three waves in the severe and critically ill categories. The median CRP (mg/dL) values were significantly increased in the critically ill in wave three compared to waves one and two. The median values of LDH IU/L significantly increased in critically ill patients in the second wave. The median values of ferritin increased significantly in wave one. The D-dimer values significantly increased in the critically ill category in wave three. Conclusion: Before proceeding on to a specific diagnosis by RT-PCR, a combination of standard laboratory markers (CRP, LDH, and Ferritin D-Dimer) could accurately and reliably predict the diagnosis of COVID-19 with established sensitivity and specificity.

Serum Calcium, Magnesium and Creactive protein levels in female Metabolic Syndrome patients

Background: Metabolic syndrome (Mets) is a risk factor for cardiovascular, chronic lung, liver and kidney diseases. Hypercalcaemia, hypomagnesaemia and elevated C-reactive protein (CRP) produce various complications such as cardiac arrythmia, renal stones, atherosclerosis, Diabetes Mellitus, Obesity etc. Some researchers suggested that hypercalcaemia, hypomagnesaemia and elevated CRP occur in Metabolic syndrome patients. Objectives: To measure serum calcium, magnesium and CRP levels in Metabolic syndrome patients. Methods: This cross sectional study was conducted from March 2019 to July 2020 in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University(BSMMU), Shahbag, Dhaka. For this study, 30 female metabolic syndrome patients aged 25 to 45 year, from the Outpatient department of Endocrinology of BSMMU were selected. For comparison, 30 age and gender matched apparently healthy female subjects were control. Serum calcium and magnesium were measured by Colorimetric method and serum CRP was measured by Immunoturbidimetric method. Independent sample‘t’ test was performed for serum calcium and Mann-Whitney U test was performed for serum magnesium and CRP. Results: Mean serum calcium (p £0.05 and median value of serum CRP (p £0.01) were significantly higher, median value of serum magnesium was lower (p&gt;0.05) but not significant in Metabolic syndrome patients than that of control. Conclusion: This study may conclude that elevated serum calcium and CRP levels are associated with metabolic syndrome patients. J Bangladesh Soc Physiol. 2022, June; 17(1): 14-20

Neutralizing antibody responses in asymptomatic close contacts of COVID-19 patients and in asymptomatic healthcare workers

The identification of novel antibodies that could neutralize SARS-CoV-2 is one of the novel approaches to use in combating COVID-19. This study aimed to explore the level of neutralizing antibodies (NAbs) in asymptomatic close contacts of COVID-19 patients and asymptomatic healthcare workers. In vitro qualitative detection of serum antibodies of participants from both populations was done using an anti-SARS-CoV-2 immunoassay. The study included 107 participants, of which 59.8% were healthcare workers and 40.2% were family contacts of confirmed COVID-19 cases. Their median age was 22 years. The percentage of positivity and median titer for NAbs were significantly higher among family contacts than mong healthcare workers (P = 0.013 and < 0.001, respectively). We also measured C-reactive protein (CRP) levels and the median value of CRP was significantly higher in the family members who had been in contact with COVID-19 patients than in healthcare workers (P < 0.001). In the family contact group, there was a significant negative correlation between the absolute lymphocyte count and CRP (r = -0.409, P = 0.034). There was no significant correlation between neutralizing antibody titers and either CRP or absolute lymphocyte count (P > 0.05 for both). In conclusion, the indication of elevated NAb titers in asymptomatic family contacts could help lay the groundwork for further studies to explore the potential utility of these antibodies to provide future immunity from infection within a family as well as for potential use in general during passive antibody therapies for COVID-19 patients.

Recent Antibiotic Treatment Impacts Serum and Synovial Laboratory Values in Early Periprosthetic Joint Infection Workup.

Accurately detecting early postoperative periprosthetic joint infection (PJI) following total hip arthroplasty (THA) and total knee arthroplasty (TKA) remains challenging. The purpose of our study was to determine the impact of antibiotics given prior to laboratory evaluation on the reliability of serologic and synovial fluid tests to identify PJI in the early postoperative period. We identified 49,861 primary total hip arthroplasties and total knee arthroplasties performed between 2000 and 2019. Among these patients, 21 hips and 28 knees that underwent arthrocentesis within 12 weeks of their arthroplasty were identified as infected. Patients who had received antibiotics within 2 weeks prior to laboratory evaluation were compared to those who had not. Median values of C-reactive protein, erythrocyte sedimentation rate, synovial white blood cell (WBC) count, synovial neutrophil percentage, and synovial absolute neutrophil count were compared between groups. The false negative rate for detecting PJI using laboratory values was compared using published cutoffs for PJI in the early postoperative period. Median values of C-reactive protein (105 vs 22 mg/L; P= .006), synovial WBC count (57,591 vs 4,473 cells/μL; P= .003), synovial neutrophil percentage (94% vs 76%; P= .004), and synovial absolute neutrophil count (50,748 vs 2,804 cells/μL; P < .001) were significantly lower in patients who received antibiotics compared to those who did not. False negative rates for detecting PJI were significantly higher for synovial WBC and synovial neutrophil percentage in patients treated with antibiotics compared to untreated patients. False negative rates for detecting early PJI when using published cutoffs were markedly higher in antibiotic-treated patients compared to untreated patients for synovial WBC count and synovial neutrophil percentage. Level IV retrospective review.

C-Reactive Protein Levels in Male and Female Blood Donors at Kenyatta National Hospital, Kenya

Background: C-reactive protein is an inflammatory marker and has found a wide clinical application in monitoring disease progress, effectiveness of treatment and post-operative complications. Determination of gender – based reference intervals of this protein would be of great value in eliminating any biases in results interpretation. It was in this endeavor that this cross-section study was conducted at Kenyatta National Hospital, blood donor unit, between 2018 and 2019. Objectives: To determine gender-based means, medians and 2.5 th and 97.5 th interquartile ranges of C-reactive protein (CRP) in suitable blood donors attended to at the blood donor unit of Kenyatta National Hospital, Kenya. Methods: A total of 108 (53.5%) female and 94 (46.5%) male volunteer blood donors aged between 18 and 60 years were recruited consecutively as they consented. Their social demographic characteristics were captured using a questionnaire form. Immediately after blood donation five milliliters of blood samples for CRP determination were drawn from the pilot tube of the blood bag by injecting the cap of an Ethylene dopamine tetra acetic acid (EDTA) vacutainer with the donation needle. Extracted plasma samples were stored frozen at -70 0 C till analysis. Analysis was done using standard laboratory methods. Statistical analyses were done using SPSS version 21. Bootstrap methods were used to calculate means, medians and confidence intervals. The fit of the observed data distribution was determined using Shapiro – Wilk tests with P &gt; 0.05 indicating Gaussian distribution. Means, medians and 2.5 th and 97.5 th interquartiles were determined. Gender – based comparison of the medians were done using Wilcoxon rank-sum test with, p&lt; 0.05, considered significant. Results: The male enrollees had a mean age of 31.91 years, while females’ mean age was 31.85 years. C-reactive protein demonstrated non-parametric distribution. Females’ medians were higher than males’ (11.7 mg/l vs. 4.4 mg/l, p&lt; 0.01) Conclusion: The females have significantly higher CRP median values than males in health.