Negative Acute Phase Reactant Research Articles

#704 Albumin, inflammation and nutrition in hemodialisis patients in Colombia: a cohort study

Abstract Background and Aims Hypoalbuminemia is a well-identified risk factor for mortality in chronic hemodialysis patients. As a negative acute phase reactant, albumin levels could be associated with several factors that affect the patient on hemodialysis (HD), such as alterations in the rate of hepatic synthesis, an increase in the rate of catabolism, or an increase in losses due to the dialysis process. The objective of the present study is to analyze serum albumin values in repeated measurements over time in two cohorts, one with expanded HD (HDx) enabled by the medium cut-off membrane (MCO) Theranova and the other with high flux (HF) HD and estimate the relationship with other relevant variables. Method Cohort study, one with HDx enabled by Theranova® and the other with HF HD, adult prevalent HD patients (> 90 days) at Baxter Renal Care Services Colombia starting between September 1, 2017, and November 30, 2017, with follow-up for up to 48 months. Sociodemographic and clinical characteristics were summarized descriptively, and a mixed linear model with repeated measures was performed to evaluate the association between dialysis membrane and albumin levels, controlling for confounding variables. Results We evaluated 1092 patients (62% male): 533 in HF-HD vs. 559 in HDx (Table 1); the median age was 61 years, 42% had a history of diabetes, and 19% had cardiovascular disease. We found no differences in albumin levels over time when comparing Theranova versus HF HD patients, p-value = 0.789 (see Fig. 1). No association between serum albumin levels and the Theranova dialyzer was found with the linear mixed model with repeated measures when controlling for confounding variables, p-value= 0.198. On the other hand, we found that serum albumin was associated with inflammatory and nutritional variables such as C reactive protein, Ratio platelets/lymphocytes, and Protein Energy Wasting (PEW) (Table 2). Conclusion Variables including nutritional status and inflammation, age, and hospitalization events are associated with serum albumin levels varying over time. Variation in serum albumin levels over time are not associated with type of dialyzer (Theranova® vs HF).

Which one predicts mortality better in acute ischemic stroke: negative vs positive acute-phase reactants

ABSTRACT Aim The aim of the study is to investigate the relationship between negative acute-phase reactants and positive acute-phase reactants with in-hospital mortality in patients diagnosed with acute ischemic stroke (AIS) in the emergency department (ED). Methods and Materials Patients aged 18 and older who presented to the ED of a tertiary hospital with AIS were included in the study. Demographic and clinical characteristics, laboratory parameters, acute-phase reactants, National Institutes of Health Stroke Scale (NIHSS), and outcome data of the included patients were recorded on a standard data form. Results A total of 588 patients were included in the study. When the in-hospital mortality of patients was examined, the mortality rate was 17.7%. In the analysis for predicting mortality, it was determined that albumin had the highest predictive power between the area under the curve (AUC) and the determined predictive values (AUC: 0.759, 95% CI 0.707–0.810, p < 0.001). The analyses of the study data revealed that albumin (<0.001) and TF (p = 0.049), which are negative acute-phase reactants, were independent predictors of mortality. According to our study data, in patients with AIS, for each unit decrease in albumin level at the time of ED admission, the risk of mortality increased by 0.868 times, and for each unit decrease in TF level, the risk of mortality increased by 0.593 times. Conclusion According to the study data, albumin and TF levels, which are negative acute-phase reactants, are independent determinants of in-hospital mortality in patients with acute ischemic stroke in the emergency department.

The relationship between albumin level and the development of acute kidney injury and mortality in critically COVID-19 patients

Aims: The impact of the Coronavirus Pandemic, which began in 2019, has considerably diminished; however, its effects still persist. While respiratory symptoms have been prominent during the pandemic, acute kidney disease has emerged as a significant contributor to morbidity and mortality. This study aims to demonstrate that serum albumin levels can serve as a predictor for acute kidney injury (AKI) and mortality, owing to their cost- effectiveness and feasibility for use across various healthcare centers. The goal is to contribute to the reduction of AKI development and mortality rates. Methods: The study was conducted by analyzing data from a total of 350 patients admitted to intensive care units of a training and research hospital due to COVID-19 between March 1, 2020, and April 30, 2021. Of these patients, 179 (51%) were male, and 171 (49%) were female. The data were examined retrospectively. Patients were categorized into two groups based on serum albumin levels: ?2.5 mg/dl (severe hypoalbuminemia) and 2.5-3.5 mg/dl (mild hypoalbuminemia). Subsequently, the patients were further categorized into groups based on the presence or absence of AKI, and these groups were statistically compared. Demographic data, clinical information, and laboratory values of the patients were assessed. The diagnosis of acute kidney injury (AKI) was made according to KDIGO criteria. Data were compared using the SPSS version 24 software. Results: Among the 350 patients included in the study, 115 had serum albumin levels ?2.5 mg/dl (severe hypoalbuminemia), and 235 had levels in the range of 2.5-3.5 mg/dl (mild hypoalbuminemia). Among those who developed AKI, the average albumin level was found to be 2.68 mg/dl, whereas in the group without AKI, the average albumin level was 2.76 mg/dl. Out of the total, 201 (57%) patients developed AKI, and 82% of them experienced mortality. In contrast, among the 149 (43%) patients who did not develop AKI, the mortality rate was 42%. Further subgroup analysis revealed the highest mortality rate of 88% among patients with severe hypoalbuminemia and AKI development. Conversely, the lowest mortality rate of 40% was observed in patients with mild hypoalbuminemia and no AKI. Conclusion: This study aims to establish that low serum albumin levels should be regarded not only as a negative acute-phase reactant but also as a predictive factor for complications including acute kidney disease development and mortality. Lower albumin values are correlated with higher complication rates and increased mortality. Additionally, due to its widespread availability and low cost, serum albumin is a cost-effective diagnostic tool that can be utilized in almost any healthcare setting.

Changes in serum prealbumin as a marker for nitrogen balance in surgical oncology patients.

Serum prealbumin has long been used as a marker of nutritional status. However, prealbumin is a negative acute phase reactant influenced by several non-nutritional-related factors including surgery, infection, and cancer. An increasing prealbumin has been correlated with a positive nitrogen balance in general surgery patients receiving parenteral nutrition (PN) with 88% specificity and 70% sensitivity. To date, no trial has evaluated the effect of concurrent cancer and surgery on the value of prealbumin in predicting nitrogen balance. This study is a concurrent retrospective design of post-operative patients (≥ 19years of age) identified by the nutrition support service who received PN for ≥ 5days, had a baseline and follow-up serum prealbumin and C-reactive Protein (CRP) measured, as well as a 24-h urinary urea nitrogen (UUN) performed between days 5-10 of PN. Exclusion criteria include anuric renal failure, Child-Pugh Class C liver failure, pregnancy, and corticosteroid use. Prealbumin was correlated to nitrogen balance, measuring sensitivity, specificity, and negative and positive predictive values. Information was collected regarding patient demographics and presence or absence of metastatic cancer. Thirty patients were identified and evaluated for this study from December 1st, 2010 to July 15th, 2011. Patients included in the study had a mean age of 57years old (range 20-82), 53% male, with a mean weight of 84kg (range 42-140) and body mass index (BMI) of 29kg/m2 (range 14.9-56.8). The mean daily caloric dose of PN per actual body weight was 21kcal/kg (range 10-34) and the mean daily protein dose was 1.4g/kg (range 1-2). Forty seven percent of patients were obese (BMI > 30kg/m2) and were prescribed high-protein hypocaloric PN. The most common indication for PN was post-operative ileus (23/30 patients). 24-h urine collection for UUN was performed on average of day 8 after PN initiation (range 5-10days). Nitrogen balance as calculated from 24-h UUN was positive in 17/30 patients. A positive prealbumin change of greater than 2.8 mg/dL was found to have a statistically significant association with positive nitrogen balance (p = 0.02). At the cut off level of positive 2.8 mg/dL, the likelihood of a positive nitrogen balance had a sensitivity of 82% (95% confidence interval (CI) 64-100%); specificity of 62% (95% CI 35-88%); positive predictive value of 74% (95% CI 54-93%); negative predictive value of 73% (95% CI 46-99%). No absolute value for prealbumin level (e.g., > 20 mg/dL) was found to be a significant predictor of positive nitrogen balance. CRP levels at initiation of PN were significantly elevated with a mean level of 147mg/dL. These results indicate a positive change in serum prealbumin (> 2.8mg/dL) has sufficient sensitivity (82%) to predict positive changes in nitrogen balance in the surgical oncology population. However, the low specificity (62%) makes it less useful in predicting a negative nitrogen balance. Absolute prealbumin levels were greatly affected by inflammation, as evidenced by CRP levels, and single values were not useful in predicting positive nitrogen balance. Positive changes in serum prealbumin levels have previously been associated with a positive nitrogen balance (NB) in surgical patients receiving parenteral nutrition (PN); however, it is unclear if this is true in oncologic surgery patients. This study highlights how changing levels of serum prealbumin and C-reactive protein correlates to NB for cancer patients in the post-operative period requiring PN. Changes in prealbumin levels from baseline showed sufficient sensitivity, but not specificity to utilize routinely for predicting NB in this population.

Serum Albumin Levels: A Biomarker to Be Repurposed in Different Disease Settings in Clinical Practice.

Serum albumin (ALB), one of the most important proteins in human physiology, has the main functions of maintaining plasma oncotic pressure and plasma volume, transporting hormones, vitamins, oligominerals and drugs, and exerting a powerful antioxidant-anti-inflammatory role. Its prognostic value in liver and malabsorption syndromes is well known. In this narrative review, an analysis of the most important studies evaluating the prognostic significance of low serum ALB levels in hospitalized patients was performed. Specifically, the risk in emergency medicine, cardiovascular diseases, Coronavirus Disease 19 (COVID-19) infection, nephrology, oncology, and autoimmune rheumatic diseases has been examined to fully explore its clinical value. ALB is a negative acute-phase reactant and the reduction in its serum levels represents a threatening parameter for long-term survival in several clinical settings, and a strong biomarker for a poor prognosis in most diseases. Therefore, clinicians should consider serum ALB as a valuable tool to assess the efficacy of specific therapies, both in hospitalized patients and in chronic follow-up.

Lipid Profile as a Predictive Marker for Organ Dysfunction after Thoracoabdominal Surgery: A Cross-sectional Study.

Plasma total cholesterol is considered a negative acute phase reactant. In various pathological conditions, such as trauma, sepsis, burns, and liver dysfunction, as well as post-surgery, serum cholesterol level decreases. This study aimed to investigate the role of lipid profiles in determining the probability of organ dysfunction after surgery. This cross-sectional study included patients who underwent thoracoabdominal surgery and were admitted to the intensive care unit of Imam Reza Hospital in Tabriz, Iran, between October 2016 and September 2018. During the first two days of admission, blood samples were taken, and serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), Low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and albumin were measured. The relation between the changes in these laboratory markers and six organ functions including cardiovascular, respiratory, renal, central nervous system, hepatic, and hematologic, length of stay in the hospital and intensive care unit, mechanical ventilation duration, and vasopressor use were investigated. The independent t test was used to compare continuous variables. The association between different variables and organ dysfunction and mortality was evaluated by using logistic regression. The serum TC increased the risk of mortality (OR=1.09, 95%CI=1.06-1.11, P<0.001), renal dysfunction (OR=1.09, 95%CI=1.06-1.12; P<0.001), liver dysfunction (OR=1.07, 95%CI=1.03-1.10; P<0.001), respiratory dysfunction (OR=1.08, 95%CI=1.05-1.13; P<0.001). Moreover, LDL, HDL, and TG were found to be inversely related to mortality, organ dysfunction, length of stay in the hospital and intensive care unit, mechanical ventilation duration, and vasopressor use. TC could be considered a risk factor for mortality, organ dysfunction, and clinical outcomes. On the other hand, LDL, HDL, and TG played a protective role in the patients' mortality, organ dysfunction, and clinical outcomes.

1631 ASSOCIATION BETWEEN ADMISSION INFLAMMATORY MARKERS AND 30-DAY MORTALITY IN PATIENTS WITH HIP FRACTURE

Abstract Introduction Risk prediction tools help guide prognostic conversations and benchmarking in hip fracture care. The Nottingham Hip Fracture Score (NHFS) shows only moderate predictive ability for 30-day mortality. We assessed whether routine markers of inflammation could improve the discriminant ability of the NHFS to predict 30-day mortality following hip fracture surgery. Methods We studied consecutive patients admitted with hip fractures at a large-volume trauma unit between 2015 and 2020. Baseline NHFS and postoperative outcome data were extracted from a local registry and linked to routine laboratory data from patients’ electronic clinical records. We selected measurements taken closest to admission pre-operatively. The biomarkers studied were albumin (negative acute-phase reactant), C-reactive protein (CRP), neutrophil count, and neutrophil-lymphocyte ratio (NLR). Univariate and multivariate logistic regression analyses were performed separately for each combination of NHFS and inflammatory marker. C-statistics were calculated to assess the discriminant ability of the NHFS with and without each inflammatory marker for 30-day mortality. Results We included 1710 patients, mean age 82.5 years (SD 8.2). 1199 (70.1%) were women. 104 (6.1%) patients died within 30 days of admission. In univariate analysis, admission NHFS, albumin, CRP and NLR were significantly different between those alive and dead at 30 days. Higher admission albumin was an independent predictor of 30-day mortality in multivariate analysis (OR=0.86 [95%CI 0.81-0.91], p≤0.001) as was higher CRP (OR=1.93 [95%CI 1.04-1.44], p=0.013). The addition of albumin significantly improved the discriminant ability of the NHFS for 30-day mortality (p≤0.001) (c-statistic 0.742 [95%CI 0.683-0.800] vs 0.681 [95%CI 0.617-0.745] for the NHFS alone). Other inflammatory biomarkers did not significantly improve discrimination of 30-day mortality when added to the NHFS. Conclusions Admission albumin improves the discrimination of 30-day mortality in patients undergoing hip fracture surgery when combined with the NHFS, whereas other markers of inflammation including CRP, neutrophil count and NLR did not.

A Very Rare Pathogen of Osteomyelitis: Alcaligenes faecalis.

To the Editors: Alcaligenes faecalis is a Gram-negative, rod-shaped, oxidase-positive, catalase-positive, obligate aerobic, motile and nonfermenting bacteria.1 It is commonly found in the environment (soil or water) and in the human gut.2A. faecalis has been associated with various infections such as bacteremia, meningitis, endophthalmitis, endocarditis, skin and soft tissue infections, urinary tract infections, peritonitis, otitis media and pneumonia.3 Here, we present 2 patients with osteomyelitis due to A. faecalis, a rarely reported clinical condition in the literature. Patient 1: An 18-year-old female with a medical history of operated for meningomyelocele and pes cavus was admitted with worsening pain in her right lower extremity. On admission, she was afebrile with normal vital signs there was a chronic ulcerated wound with seropurulent discharge on the right foot. On the laboratory evaluation, there was no leukocytosis, C-reactive protein, and procalcitonin were negative, erythrocyte sedimentation rate was 35 mm/h. Clindamycin 30 mg/kg/d and cefotaxime 200 mg/kg/d intravenously (IV) were administered empirically. The contrast-enhanced magnetic resonance imaging showed cellulitis in soft tissue and osteomyelitis in the bone at the level of the 5th finger metatarsal base and proximal shaft (Fig. 1). Wound debridement was performed by orthopedics. She developed emesis and rash on day 4 and the antibiotic was changed to IV ciprofloxacin (30 mg/kg/d). Intraoperative wound culture grew A. faecalis which was sensitive to ampicillin, cefotaxime and gentamicin. Due to clinical improvement, treatment with ciprofloxacin continued and she was discharged after 15 days of IV therapy. The total treatment is planned to be completed in 8 weeks.FIGURE 1.: MRI (T2 weighted) showing osteomyelitis of the right foot. MRI indicates magnetic resonance imaging.Patient 2: A 15-year-old girl presented with a chronic ulcerated wound on her right foot. She had been operated twice for meningomyelocele and had pes planovalgus. She was afebrile and there was a chronic wound without any discharge on her right foot on admission. Laboratory evaluation revealed negative acute phase reactants and erythrocyte sedimentation rate was 24 mm/h. The empirical treatment was administered as IV cefotaxime and clindamycin. The contrast-enhanced magnetic resonance imaging showed findings suggestive of active osteomyelitis on the right calcaneus (Fig. 1). Orthopedics performed wound debridement and inserted vacuum-assisted closure therapy system. A. faecalis growth was detected in the tissue culture which was sensitive to ceftazidime and meropenem but resistant to amikacin. Her treatment was changed to IV ceftazidime (150 mg/kg/d). After vacuum-assisted closure treatment, it was planned to perform tissue repair by plastic surgery and to continue antibiotherapy IV due to the resistance pattern of the microorganism. Opportunistic infections and antimicrobial resistance associated with A. faecalis have been reported but osteomyelitis due to A. faecalis was documented in a few patients with diabetic foot ulcers in the literature.4 It is usually sensitive to beta-lactam antibiotics and trimethoprim/sulfamethoxazole and resistant to aminoglycosides and tetracyclines.5 Most of the previously documented cases have been successfully treated with amoxicillin/clavulanic acid but antibiotic resistance is an emerging problem. In summary, we present 2 patients with osteomyelitis due to A. faecalis, a rare cause of osteomyelitis. In addition to surgery, medical treatment should be arranged based on the antibiotic susceptibility results for successful and appropriate treatment.

Could homocysteine represent a negative acute phase reactant in canine infections-a pilot study?

Homocysteine (Hcy) was investigated as the biomarker of cardiac, renal, and gastrointestinal disorders in dogs. Data about low Hcy concentrations in the systemic inflammatory response syndrome raised a hypothesis that Hcy in dogs is a negative acute-phase reactant. This survey compared Hcy concentrations, serum amyloid A (SAA), and the routine laboratory parameters between healthy (HD, N=6) and dogs with inflammation of different extent: mild ( dirofilariosis (DIR), N=31), moderate (babesiosis (BAB), N=12), and severe (pyometra (PYO), N=8). The BAB and PYO groups had lower Hcy er than HD. Also, the levels in the PYO group were below those in the DIRO group. SAA had the inverse pattern. Across the groups, Hcy and SAA levels correlated negatively (ρ = -0.502, P&lt;0.001). Hcy and SAA correlated with the erythrocyte count, hematocrit, hemoglobin and mean cellular hemoglobin concentrations, and neutrophil count, with correlations being positive for Hcy and negative for SAA. Among all dogs, hemoglobin was the only independent predictor of Hcy concentration. Hcy levels in canine infections, decreased as acute-phase reaction (APR) intensified. Also, they were related with the hematology changes accompanying the APR. Further studies will establish the clinical potential of these alterations.

Fasting Plasma Glucose May İnitially Behave as a Positive But Eventually Negative Acute Phase Reactant in The Body

Background: Smoking may cause a low-grade inflammation on vascular endothelium terminating with an accelerated atherosclerosis-induced end-organ insufficiencies. Plasma triglycerides may be positive acute phase reactants (APRs) whereas fasting plasma glucose (FPG) negative APR indicating the inflammatory effects of smoking. Method: Consecutive patients with irritable bowel syndrome (IBS) and age and sex-matched control cases were included. IBS was diagnosed according to Rome II criteria in the absence of red flag symptoms including pain, nocturnal diarrhea, weight loss, fever, or any abnormal finding of the physical examination.

Markers of inflammation in free-living African elephants (Loxodonta africana): Reference intervals and diagnostic performance of acute phase reactants.

Acute phase reactants (APRs) have not been investigated in free-living African elephants (Loxodonta africana), and there is little information about negative APRs albumin and serum iron in elephants. We aimed to generate reference intervals (RIs) for APRs for free-living African elephants, and to determine the diagnostic performance of APRs in apparently healthy elephants and elephants with inflammatory lesions. Stored serum samples from 49 apparently healthy and 16 injured free-living elephants were used. The following APRs and methods were included: albumin, bromocresol green; haptoglobin, colorimetric assay; serum amyloid A (SAA), multispecies immunoturbidometric assay, and serum iron with ferrozine method. Reference intervals were generated using the nonparametric method. Indices of diagnostic accuracy were determined by receiver-operator characteristic (ROC) curve analysis. Reference intervals were: albumin 41-55 g/L, haptoglobin 0.16-3.51 g/L, SAA < 10mg/L, and serum iron 8.60-16.99 μmol/L. Serum iron and albumin concentrations were lower and haptoglobin and SAA concentrations were higher in the injured group. Serum iron had the best ability to predict health or inflammation, followed by haptoglobin, SAA, and albumin, with the area under the ROC curve ranging from 0.88-0.93. SAA concentrations were lower in healthy African vs Asian elephants, and species-specific RIs should be used. Serum iron was determined to be a diagnostically useful negative APR which should be added to APR panels for elephants.

A snapshot of geriatric rehabilitation: one year experience.

Frailty is a common condition in older adults, characterized by multimorbidity, physical weakness and nutritional deficit. Frailty can be detected early and a prehabilitation treatment could reduce the incidence of disability. Two-hundred-fifteen elderly patients were admitted to the Rehabilitation and Physical Medicine Unit of Policlinico Gemelli for one year. Patients were clinically assessed by Charlson Comorbidity Index (CCI) and blood sample values. Numerical Pain Rating Scale (NRS) and Hand Grip Test were assessed before (T0) and after (T1) hospitalization. Number of drugs and number of infections were recorded. Patients were originally hospitalized in orthopaedic, neurology and medical ward. Most patients (68%) after discharge return home. Negative correlations between albumin and CCI and between total protein and CCI were recorded. Positive correlation between CCI cognitive subscore and number of drugs and a negative correlation between that subscore and Vitamin D were detected. An improvement in NRS and in the handgrip strength was recorded. At discharge an increase in the number of drugs and the number of infections was noted. The handgrip strength improvement increases quality of life. Pain management and NRS indicate a better recovery of activities of daily living. Malnutrition is a real problem; albumin is the principal negative acute-phase reactant and is related to a worse clinical condition and low vitamin D levels are associated with worse cognitive function. The goal of a Rehabilitation Unit is to create an effective multidisciplinary transitional care plan, involving the patient and caregivers, creating a continuity of care after discharge and a sustainable project.

POSITIVE AND NEGATIVE ACUTE PHASE REACTANTS IN SMOKERS

Background: We tried to understand whether or not there are some positive and negative acute phase reactants (APR) indicating the possible inflammatory effects of smoking on vascular endothelium. Method: Consecutive daily smokers at least with a history of one pack-year and age and sex-matched non-smokers were taken into the study. Cases with regular alcohol consumption (one drink a day) and patients with inflammatory, infectious, or devastating disorders, or heart failure were excluded. Results: The study included 247 smokers (173 males) and 167 non-smokers. Interestingly, the mean age of the smokers was 46.2 years, and 70.0% of them were males. Although the mean body weight, body mass index, systolic and diastolic blood pressures, and hematocrit values were similar in both groups, plasma triglycerides (163.1 versus 151.3 mg/dL, p&lt;0.05), low density lipoproteins (LDL) (123.8 versus 117.5 mg/dL, p&lt;0.05), erythrocyte sedimentation rate (ESR) (10.6 versus 9.3 mm/h, p&lt;0.05), and C-reactive protein (CRP) (2.3 versus 2.0 mg/L, p&lt;0.05) values were all higher in the smokers, significantly. On the other hand, high density lipoproteins (HDL) (40.9 versus 44.0 mg/dL, p&lt;0.05) and fasting plasma glucose (FPG) (102.3 versus 111.6 mg/dL, p= 0.007) values and prevalence of diabetes mellitus (8.9% versus 14.3%, p&lt;0.05) were all lower in the smokers, significantly. Conclusion: Smoking may cause a low-grade systemic inflammation on vascular endothelium terminating with an accelerated atherosclerotic process-induced end-organ insufficiencies all over the body. Plasma triglycerides, LDL, ESR, and CRP may be positive whereas HDL and FPG may be negative APR indicating such inflammatory effects in the body. Key words: Smoking, triglycerides, low density lipoproteins, erythrocyte sedimentation rate, C-reactive protein, high density lipoproteins, fasting plasma glucose

SMOKING CAUSES A LOW-GRADE SYSTEMIC INFLAMMATION IN THE HUMAN BODY

Background: There may be some positive and negative acute phase reactants (APR) indicating the possible inflammatory effects of smoking on vascular endothelium all over the body. Method: Consecutive daily smokers at least for a period of six months and age and sex-matched non-smokers were taken into the study. Cases with regular alcohol consumption (one drink a day) and patients with inflammatory, infectious, or devastating disorders including eating disorders, malignancies, acute or chronic renal failure, cirrhosis, chronic obstructive pulmonary disease, hyper- or hypothyroidism, or heart failure were excluded. Results: The study included 150 smokers (99 males) and 162 non-smokers. Interestingly, the mean age of the smokers was 45.9 years, and 66.0% of them were male. Although the mean weight, body mass index, systolic and diastolic blood pressures, and hematocrit values were similar in both groups, triglycerides (163.3 versus 151.8 mg/dL, p&lt;0.05), low density lipoproteins (LDL) (126.1 versus 117.4 mg/dL, p&lt;0.05), erythrocyte sedimentationrate (ESR) (10.8 versus 9.4 mm/h, p&lt;0.05), and C-reactive protein (CRP) (2.5 versus 2.1 mg/L, p&lt;0.05) values were all higher in the smokers, significantly. On the other hand, high density lipoproteins (HDL) (41.1 versus 44.0 mg/dL, p&lt;0.05) and fasting plasma glucose (FPG) (101.9 versus 111.9 mg/dL, p&lt;0.01) values were lower in the smokers, significantly. Conclusion: Smoking causes a low-grade systemic inflammation on vascular endothelium terminating with an accelerated atherosclerosis-induced end-organ insufficiencies in the body. Plasma triglycerides, LDL, ESR, and CRP may be positive whereas HDL and FPG negative APR indicating the inflammatory effects of smoking in the human body .Key words: Smoking, triglycerides, low density lipoproteins, erythrocyte sedimentation rate, C-reactive protein, high density lipoproteins, fasting plasma glucose

970 FRAILTY IS INVERSELY CORRELATED WITH SERUM ALBUMIN IN ACUTE HIP FRACTURE

Abstract Introduction Frailty and sarcopenia have been shown to significantly increase the risk of falls, traumatic hip fractures and all-cause mortality in the elderly. The assessment of frailty using a validated clinical frailty scale such as that proposed by Rockwood et al., therefore, continues to remain an important step in determining post-operative prognosis in patients undergoing hip fracture surgery. The purpose of this study was to examine the relationship between frailty and serum albumin—an independent biochemical predictor of survival in hip fracture patients (1). Method This retrospective cross-sectional study analysed 190 patients, aged above 60 years, admitted to Queen’s Hospital Burton (QHB) between the 1st January and 28th December 2019 with a newly diagnosed hip fracture. Pre-operative serum albumin levels (g/L) and Rockwood clinical frailty scores (rCFS) were recorded from electronic medical records (EMR). Using the SPSS 27 statistical package, Pearson’s correlation co-efficient and linear regression analysis were carried out using these variables. Results A total of 190 patients were included in the study (57 male, 133 female). Mean patient age was 82.2 ± 8.47 years. More than 50% of patients had a Rockwood CFS ≥5. Mean serum albumin (g/L) was 37.3 ± 6.56. A statistically significant inverse correlation was demonstrated between pre-operative serum albumin levels and Rockwood CFS (r = −0.243, p &amp;lt; 0.001). Conclusion This study showed how serum albumin, a negative acute phase reactant and marker of chronic malnutrition, is inversely associated with frailty in hip fracture patients and the important role of Rockwood CFS and pre-operative serum albumin levels in the prognostication of hip fractures in the elderly. References 1) Bohl D, Shen M, Hannon C, Fillingham Y, Darrith B, Della Valle C. Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture. Journal of Bone and Joint Surgery. 2017;99(24):2110–2,118.

Vitamin D Status and its Associations with Cytokines and Chemokines in Arab Adults Screened for COVID‐19

Observational studies have overwhelmingly demonstrated that vitamin D deficiency is a risk factor for coronavirus disease‐19 (COVID‐19) infection and severity. However, serum 25(OH)D may act as a negative acute phase reactant and therefore an unreliable marker for vitamin D status post‐inflammatory insult. This study evaluated the serum levels of 25(OH)D, 34 cytokines and chemokines in 220 participants (82 control and 138 SARS‐CoV‐2 patients). Serum 25(OH)D levels were significantly lower in the SARS‐CoV‐2 group than controls. Serum IP‐10, MCP‐1, CRP, IFNγ, IL‐10, IL‐13, IL‐17α, IL‐23, and IL‐6 were significantly higher in COVID‐19 patients compared to healthy control. Results showed that serum levels of VEGF, IFNγ, IL‐13, and IL‐5 were significantly higher in male patients compared to females. 25(OH)D was significantly correlated with EFG (R=0.39, p<0.05) and IL‐15 (R=0.39, p<0.05) in male patients, while inversely correlated with CRP (R=‐0.51, p<0.05) in female patients. In conclusion, we recommend 25(OH)D supplementation among high‐risk individuals and SARS‐CoV‐2‐infected individuals. Additionally, the upregulated cytokines might serve as therapeutic targets to modulate the heightened inflammation and disease severity, moreover, they could be helpful in the early screening of critical illness, diagnosis and treatment of SARS‐CoV‐2.

Hypoalbuminemia as an early predictor of severe COVID-19 infection

Objectives: Several unique characteristics have been found in severe COVID19, such as lymphopenia, old age, high CRP level, elevated D dimer levels and underlying comorbid diseases. Serum albumin, being a negative acute phase reactant has been found to be associated with inflammatory response and poor outcomes in infectious diseases. The aim of the study was to analyse whether the serum albumin levels on admission might reflect the severity of systemic inflammation in COVID 19 infection and thus serve as an early predictive factor for COVID 19 outcomes. Materials and Method: This retrospective observational study included 185 COVID-19 positive patients. Laboratory data was recorded from blood samples collected at admission and analyzed by standard methods in the laboratory. Hypoalbuminemia was defined as serum albumin levels &lt;3.5g/dl. p &lt; 0.05 was considered statistically significant. Results: In the 185 COVID 19 patients studied, average age was 51.29 (±15.68) years. The study population had a male predominance (68.11%). 85 (45.95%) individuals were found to have hypoalbuminemia on admission. 18 (9.73%) deaths were reported amongst the study population and a significant association was found between low serum albumin levels on admission and mortality.(p &lt; 0.001).

Positive and negative acute phase reactants in sickle cell diseases

Background: We tried to understand some positive and negative acute phase reactants (APR) in sickle cell diseases (SCD). Methods: Consecutive patients with the SCD and controls were studied. Results: The study included 193 patients (98 females) and 132 controls (67 females). Although the body weight and body mass index (BMI) were retarded in the SCD (58.9 versus 71.1 kg and 21.5 versus 26.8 kg/m2, respectively, p&lt;0.000 for both), the body heights were similar in both groups (164.8 versus 162.8 cm, p&gt;0.05). Parallel to the retarded body weight and BMI, fasting plasma glucose (FPG) (93.4 versus 102.4 mg/dL, p=0.025), low density lipoproteins (LDL) (70.4 versus 98.1 mg/dL, p&lt;0.000), high density lipoproteins (HDL) (24.2 versus 35.8 mg/dL, p&lt;0.000), and systolic (117.6 versus 127.9 mmHg, p=0.001) and diastolic blood pressures (BP) (77.3 versus 86.0 mmHg, p&lt;0.000) were all retarded in the SCD. On the other hand, total bilirubin (TB) and lactate dehydrogenase (LDH) were both increased (4.0 versus 0.7 mg/dL and 638.9 versus 268.4 U/L, respectively, p&lt;0.000 for both) in the SCD. Similarly, white blood cell (WBC) and platelet (PLT) counts (16.338 versus 7.407 /µL and 421.424 versus 268.612 /µL, respectively) and mean corpuscular volume (MCV) (90.3 versus 78.3 fL) were all increased whereas the hematocrit (Hct) level was decreased (23.2 versus 36.6%) in the SCD (p&lt;0.000 for all). Conclusion: Body weight, BMI, FPG, LDL, HDL, systolic and diastolic BP, and Hct may be some negative whereas TB, LDH, WBC and PLT counts, and MCV may be some positive APR in the body. Keywords: Sickle cell diseases, positive acute phase reactants, negative acute phase reactants, chronic endothelial damage, atherosclerosis, body weight, body mass index

Familial Mediterranean fever may actually be a persistent inflammatory process on vascular endothelium all over the body

Background: We tried to understand whether or not there is a persistent inflammatory process in Familial Mediterranean Fever (FMF). Methods: Consecutive patients with the FMF and controls were studied. Results: The study included 39 patients with the FMF (18 females) and 39 controls. Mean age of the FMF patients was 27.5 ± 11.9 (11-58) years. Although the body weight and body mass index (BMI) were retarded in the FMF patients (64.6 versus 71.7 kg and 24.1 versus 25.7 kg/m2, respectively), the differences were nonsignificant probably due to the small sample size of the study (p&gt;0.05). The mean body heights were similar in both groups (163.4 versus 166.8 cm, p&gt;0.05). As negative acute phase reactants (APR), low density lipoproteins (LDL) (99.0 versus 114.3 mg/dL) and high density lipoproteins (HDL) (37.5 versus 44.5 mg/dL) were suppressed whereas triglycerides (TG) increased (110.2 versus 105.1 mg/dL) as positive APR, but the differences were nonsignificant probably due to the small sample size of the study, again (p&gt;0.05). On the other hand, systolic blood pressures (BP) (115.0 versus 124.8 mmHg, p= 0.047) and diastolic BP (79.2 versus 88.9 mmHg, p= 0.001) were suppressed parallel to the suppressed body weight and BMI, significantly. Conclusion: Although the FMF is described as intermittent attacks of painful inflammation, probably there is a persistent vascular endothelial inflammation all over the body. The suppressed body weight, BMI, LDL, HDL, and systolic and diastolic BP and the increased TG levels probably play roles of positive and negative APR in the systemic inflammatory process. Key words: Familial Mediterranean fever, chronic endothelial damage, atherosclerosis, metabolic syndrome, acute phase reactants, triglycerides, blood pressure.

Prognostic Effect of Hypoalbuminaemia on Severity and Outcome in COVID-19: A Retrospective Cohort Study

Introduction: Severe Acute Respiratory Disease Coronavirus-2 (SARS-CoV-2) is a novel virus first detected in December 2019 causing the Coronavirus Disease-2019 (COVID-19) which has evolved into a pandemic rapidly. In patients who become symptomatic, 5% require oxygen and 15% develop severe disease ranging from respiratory failure to sepsis and septic shock. Severe COVID-19 infection is associated with high mortality. Hypoalbuminaemia is a negative acute phase reactant which has been associated with inflammatory response and poor outcome in infectious diseases. Hypoalbuminaemia is found in patients with severe COVID-19 disease. Aim: To assess the prognostic value of hypoalbuminaemia on severity and mortality of patients with COVID-19 infection. Materials and Methods: The present retrospective cohort study analysed data of 200 consecutive patients, with confirmed diagnosis of COVID-19 admitted, discharged or diseased between the period of April 2021 to June 2021. They were further classified as severe and non severe, survivors and non survivors based on oxygen saturation levels as per World Health Organisation (WHO) criteria and based on survival status of the patients. Hypoalbuminaemia was defined as serum albumin &lt;3.5 g/dL. Demographic characteristics, previous co-morbidities, clinical findings and laboratory findings were collected. Results: Hypoalbuminaemia was more frequent in patients with severe disease than in patients with non severe disease (28% vs 15%, chi square value 34.54, p&lt;0.001), also hypoalbuminaemia was more frequent in non survivors than survivors (23.5% vs 19.5%. Chi-square value 43.794, p&lt;0.001). A binary logistic regression analysis was performed to attribute the true association between hypoalbuminaemia and severity and survival status of the patients with 95% CI for OR and it was found statistically significant. Hence, hypoalbuminaemia was found to be an independent predictor of severity and mortality in the study subjects. Conclusion: Hypoalbuminaemia may serve as an independent prognostic marker and may be used to identify patients at risk of severity and death in COVID-19 patients.