Non-elevated C-reactive Protein Research Articles

Retrospective Study to Examine Prognostic Value of C-Reactive Protein in Patients With Surgically Resectable Non-Small-Cell Lung Cancer

BackgroundThis study evaluated the association between elevated C-reactive protein (CRP) and clinical outcomes among adults treated with surgery for non-small cell lung cancer (NSCLC) in the US. Materials and MethodsAdults with NSCLC who underwent lung cancer surgery and had ≥1 CRP measurement prior to, or >1 month following, index surgery were identified in the Optum Clinformatics claims database. The association between elevated CRP (>10 mg/L) and risk of NSCLC recurrence/death was assessed separately during the 6 months before surgery (pre surgery cohort) and 2 years following surgery (post-surgery cohort) using multivariate regressions and Kaplan-Meier analysis. ResultsAfter adjusting for baseline demographic and clinical characteristics among patients in the pre surgery cohort with index surgery between 2016 to 2020 (n = 104), the incidence rate ratio (IRR) for NSCLC recurrence between elevated vs. non-elevated CRP was 2.17 (95% confidence interval [CI]=1.03-4.60; P = .04). In the post surgery cohort (n = 264), the adjusted IRR for disease recurrence (elevated vs. non-elevated CRP) was 2.22 (95% CI=1.05-4.70; P = .04). In the pre surgery cohort, the odds of death were nearly two-fold (odds ratio [OR]=1.91; 95% CI=1.06-3.42; P = .03) among patients with elevated CRP. In the post surgery cohort, the OR was 1.62 (95% CI=0.88-2.97; P = .12). Among those with persistently elevated CRP prior to surgery, there was a significant overall trend of increased CRP over the 5-year period. ConclusionThese results support the association between elevated CRP and a higher risk of NSCLC recurrence/death in pre- and postsurgery cohorts. This study may shed lights on inflammation-suppressing treatments in patients with NSCLC.

Retrospective study to examine prognostic value of c-reactive protein (CRP) in patients with surgically resected non-small-cell lung cancer (NSCLC).

e20569 Background: This study evaluated the association between baseline elevated CRP and lung cancer outcomes among adults with NSCLC who underwent surgery in the US. Methods: Optum Clinformatics Data Mart in the US (01/2007-09/2020) was used to identify adults with NSCLC who underwent lung cancer surgery and had at least 1 CRP measurement prior to or > 1 month following the index surgery. Baseline CRP levels were defined as the CRP closest to the index surgery in the pre-surgery cohort, and the CRP at least 1-month after in the post-surgery cohort. The association between elevated CRP (> 10 mg/L) and rate of NSCLC recurrence/risk of death was assessed separately for pre-surgery and post-surgery cohorts using multivariate regressions. The overall trend in CRP measurements over a 5-year period was examined using trend tests among those with persistently elevated CRP. Results: For adults in the pre-surgery cohort who had index lung cancer surgery between 2016-2020 (N = 104), after adjusting for age, sex, National Cancer Institute comorbidity, autoimmune disease, peripheral vascular disease, and smoking status, the adjusted-incidence rate ratio (IRR) for NSCLC recurrence was 2.17 (95% confidence interval [CI]: 1.03, 4.60; p < 0.05) among patients with elevated CRP compared with non-elevated CRP. A similar IRR (2.22 [95% CI: 1.05, 4.70]; p < 0.05) was observed among the 264 patients in the post-surgery cohort. Among the 234 patients in the pre-surgery cohort, there was a near two-fold increase in the risk of all-cause death associated with the elevated than the non-elevated CRP groups (odds ratio [OR]: 1.91 [95% CI: 1.06, 3.42]; p < 0.05), and there was a numerically increased risk associated with elevated baseline CRP for the post-surgery cohort (OR: 1.62 [95% CI: 0.88, 2.97]; p = 0.12). Among those with persistently elevated CRP prior to surgery, we observed a significant overall trend of increased CRP levels over the 5-year period. Conclusions: Using real world data in the US, results suggest that an elevated CRP at baseline is associated with a higher risk of NSCLC recurrence and mortality, for both pre- and post-surgery cohorts. An increasing trend of CRP level within 5 years prior to lung cancer surgery indicates the correlation of CRP (as a marker of inflammation) with tumor development. This study adds to a growing body of literature and may shed light into oncology treatments aimed at suppressing tumor-promoting inflammation.

MP45-05 IMPACT OF ELEVATED C-REACTIVE PROTEIN ON SURVIVAL OUTCOMES IN SMALL RENAL MASSES: ANALYSIS OF THE INMARC REGISTRY

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance I (MP45)1 Sep 2021MP45-05 IMPACT OF ELEVATED C-REACTIVE PROTEIN ON SURVIVAL OUTCOMES IN SMALL RENAL MASSES: ANALYSIS OF THE INMARC REGISTRY Margaret Meagher, Dattatraya Patil, Kazutaka Saito, Devin Patel, Juan Javier-Desloges, Fady Ghali, Kevin Hakimi, Shady Soliman, Julia Yuan, Fang Wan, Yasuhisa Fujii, Viraj Master, and Ithaar Derweesh Margaret MeagherMargaret Meagher More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Devin PatelDevin Patel More articles by this author , Juan Javier-DeslogesJuan Javier-Desloges More articles by this author , Fady GhaliFady Ghali More articles by this author , Kevin HakimiKevin Hakimi More articles by this author , Shady SolimanShady Soliman More articles by this author , Julia YuanJulia Yuan More articles by this author , Fang WanFang Wan More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , Viraj MasterViraj Master More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002066.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of small renal masses (SRM) represents a therapeutic quandary given the low oncologic risk of most tumors and increasing incidental detection. We investigated the impact of elevated C-reactive protein (CRP) on survival outcomes and competing sources of mortality in a cohort of patients with renal cell carcinoma (RCC) and clinical tumor size ≤3 cm. METHODS: Multi-institutional retrospective analysis the International Marker Consortium for Renal Cancer (INMARC) of patients with SRM (clinical tumor size ≤3cm) managed by surgery. The cohort was divided into elevated CRP (≥0.5 ng/dL) vs. non-elevated CRP (<0.5 0.5 ng/dL) for descriptive analyses. Primary outcome was non-cancer mortality (NCM). Secondary outcomes included All Cause Mortality (ACM) and progression. Cox-regression analysis was used to elucidate predictive factors for NCM, ACM, and progression. Kaplan Meier Analysis (KMA) was performed to analyze 5 year Overall Survival (OS), Non-Cancer Survival (NCS), Cancer-Specific Survival (CSS), and Progression-Free Survival (PFS). RESULTS: 1014 patients were analyzed (586 non-elevated CRP, 428 elevated CRP). Elevated CRP patients were younger (57.0 vs. 59.5 years, p=0.001) with more diabetes (28.5% vs. 10.4%, p<0.001). Cox-regression revealed increasing age (HR=1.1, p=0.001) and elevated CRP (HR=10.2, <0.001) as independent risk factors for ACM. Increasing age (HR=1.04, p=0.001) and elevated CRP (HR=10.3, p<0.001) were also independently associated with worsened NCM, while high tumor grade (HR=2.4, p=0.012) but not elevated CRP (p=0.275) was an independent risk factor for progression. For elevated CRP, KMA revealed 5 year OS, NCS and CSS of 83%, 86%, and 95%, respectively. For non elevated CRP, KMA revealed 5 year OS, NCS and CSS of 98%, 98%, and 100%. CONCLUSIONS: Elevated CRP was an independent predictor of ACM and NCM, but not progression in patients with SRM. Patients with elevated CRP had lower OS and NCS compared to CSS. In such patients, oncologic risk stratification through biopsy should be considered prior to offering treatment and indolent or low-grade neoplasms should be strongly considered for non-surgical management. Patients with non elevated CRP had similar OS, NCS and CSS, and as such, primary surgical intervention may be considered from a more favorable risk benefit standpoint. Further investigation is requisite. Source of Funding: Stephen Weissman Kidney Cancer Research Fund © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e804-e804 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Margaret Meagher More articles by this author Dattatraya Patil More articles by this author Kazutaka Saito More articles by this author Devin Patel More articles by this author Juan Javier-Desloges More articles by this author Fady Ghali More articles by this author Kevin Hakimi More articles by this author Shady Soliman More articles by this author Julia Yuan More articles by this author Fang Wan More articles by this author Yasuhisa Fujii More articles by this author Viraj Master More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Loading ...

Less severe but prolonged inflammation causes very disabling preterm brain injury in the long run

There has been increasing interest in classifying inflammatory phenotypes of depression. Most investigations into inflammatory phenotypes only have tested whether elevated inflammation is associated with elevated levels of depression symptoms, or risk for a diagnosis. This study expanded the definition of phenotype to include the structure of depression symptoms as a function of inflammation.Network models of depression symptoms were estimated in a sample of 4157 adults (mean age = 47.6, 51% female) from the 2015–2016 National Health and Nutrition Examination Survey (NHANES). Analyses included comparisons of networks between those with elevated (C-reactive protein (CRP) values ≥ 3.0 mg/L; N = 1696) and non-elevated CRP (N = 2841) as well as moderated network models with CRP group status and raw CRP values moderating the associations between depression symptoms.Differences emerged at all levels of analysis (global, symptom-specific, symptom—symptom associations). Specifically, the elevated CRP group had greater symptom connectivity (stronger total associations between symptoms). Further, difficulty concentrating and psychomotor difficulties had higher expected influence (concordance with other symptoms) in the elevated CRP group. Finally, there was evidence that several symptom—symptom associations were moderated by CRP. Conclusions: This study provides consistent evidence that the structure of depression symptoms varies as a function of CRP levels. Greater symptom connectivity might contribute to why elevated CRP is associated with treatment-resistant depression. Additionally, differences in symptom structure might highlight different maintenance mechanisms and treatment targets for individuals with compared to those without elevated CRP. Finally, differences in symptom structure as a function of CRP highlight a potential misalignment of standard depression measures (the structure of which are evaluated on groups unselected for CRP levels) and the presentation of depression symptoms in those with elevated CRP.

Inflammatory phenotype of depression symptom structure: A network perspective

BackgroundThere has been increasing interest in classifying inflammatory phenotypes of depression. Most investigations into inflammatory phenotypes only have tested whether elevated inflammation is associated with elevated levels of depression symptoms, or risk for a diagnosis. This study expanded the definition of phenotype to include the structure of depression symptoms as a function of inflammation. MethodsNetwork models of depression symptoms were estimated in a sample of 4157 adults (mean age = 47.6, 51% female) from the 2015–2016 National Health and Nutrition Examination Survey (NHANES). Analyses included comparisons of networks between those with elevated (C-reactive protein (CRP) values ≥ 3.0 mg/L; N = 1696) and non-elevated CRP (N = 2841) as well as moderated network models with CRP group status and raw CRP values moderating the associations between depression symptoms. ResultsDifferences emerged at all levels of analysis (global, symptom-specific, symptom—symptom associations). Specifically, the elevated CRP group had greater symptom connectivity (stronger total associations between symptoms). Further, difficulty concentrating and psychomotor difficulties had higher expected influence (concordance with other symptoms) in the elevated CRP group. Finally, there was evidence that several symptom—symptom associations were moderated by CRP. Conclusions: This study provides consistent evidence that the structure of depression symptoms varies as a function of CRP levels. Greater symptom connectivity might contribute to why elevated CRP is associated with treatment-resistant depression. Additionally, differences in symptom structure might highlight different maintenance mechanisms and treatment targets for individuals with compared to those without elevated CRP. Finally, differences in symptom structure as a function of CRP highlight a potential misalignment of standard depression measures (the structure of which are evaluated on groups unselected for CRP levels) and the presentation of depression symptoms in those with elevated CRP.

Temporal Value of C-Reactive Protein and Erythrocyte Sedimentation Rate after Total Knee Arthroplasty in Patients with Elevated Preoperative C-Reactive Protein: A Matched-Pair Analysis.

Background:We aimed to determine whether temporal values of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) after total knee arthroplasty (TKA) differ between patients with and without elevated preoperative CRP. We hypothesized that temporal pattern of CRP and ESR change would differ between the two groups.Materials and Methods:This retrospective study included 30 TKAs with a diagnosis of osteoarthritis with elevated preoperative CRP (>1 mg/dl) without clinical signs and symptoms of infection before surgery (elevated CRP group). Patients without elevated preoperative CRP were matched in a 1:10 fashion according to age, sex, number of comorbidities and whether TKA was unilateral or bilateral (nonelevated CRP group). The temporal values of CRP and ESR after TKA were compared between the two groups until 2 months after surgery.Results:The mean peak values of CRP and ESR after surgery were similar between the two groups in both unilateral and bilateral TKAs. In the unilateral TKA, mean values of CRP and ESR and the proportions of the knees with normal CRP and ESR at 2 months after surgery were similar in the two groups. However, in the bilateral TKA, mean values of CRP and ESR were higher and the proportions of the knees with normal CRP and ESR at 2 months after surgery were lower in the elevated CRP group compared to the nonelevated CRP group.Conclusions:When performing TKA in patients with elevated preoperative CRP, the fact that the levels of CRP and ESR may not be normalized until 2 months after surgery should be considered during followup.

Prognostic value of serum C-reactive protein level prior to second-line treatment in intermediate risk metastatic renal cell carcinoma patients.

e16065 Background: The later-line treatment of metastatic renal cell carcinoma (mRCC) has been drastically changing by the development of immune-oncology drugs and molecular targeted treatment in recent years. Although the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model is useful for second-line setting, this model has the problem that over 50% patients are classified as intermediate risk group. The aim of this study is to evaluate whether the serum C-reactive protein (CRP) levels prior to second-line treatment could divide intermediate risk group patients. Methods: We retrospectively reviewed 150 mRCC patients received second-line molecular targeted therapy. We assessed the prognostic impact of serum CRP levels prior to second-line treatment initiation to predict overall survival (OS) especially in intermediate risk group. Results: The median OS from second-line treatment of whole cohort and intermediate risk group were 24.6 (95%confidence interval, 95%CI:18.2-31.0) and 23.6 (95%CI:15.1-32.1) months. Thirty-three out of 82 (40%) intermediate risk patients demonstrated elevated baseline CRP levels. The median OS of elevated and non-elevated CRP group were 13.4 (95%CI:5.9-20.8) and 29.4 (95%CI:25.5-33.5) months, respectively (p = 0.001). The serum CRP elevation could predict prognosis in intermediate risk patients treated with second-line treatment (HR 2.5,95%CI:1.4-4.2, p = 0.001). Conclusions: The serum CRP levels at second-line treatment initiation could divide intermediate risk mRCC patients into two prognostic subgroups.

Prognostic impact of pretreatment C-reactive protein for patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors

C-reactive protein (CRP) was an independent prognostic factor for metastatic renal cell carcinoma in the cytokine era. However, the impact of CRP on the survival of metastatic renal cell carcinoma patients treated with tyrosine kinase inhibitors has not yet been investigated. Therefore, we further evaluated the prognostic impact of CRP for patients with metastatic renal cell carcinoma treated with molecular-targeted agents of tyrosine kinase inhibitors. Fifty-two patients were treated with tyrosine kinase inhibitors for metastatic renal cell carcinoma at our institution. Overall, 31 and 21 patients were administered sunitinib and sorafenib, respectively. The prognostic value of all variables, including CRP, for overall survival was assessed using the Cox proportional hazards model. The median baseline CRP level was 4.9 mg/l. In multivariate analysis, CRP was an independent predictor for overall survival as both continuous and categorical variable. The median overall survival times of patients with non-elevated CRP concentration (<8 mg/l) were not reached, compared with those of patients with elevated CRP concentration (8 mg/l or greater) of 15.9 months. There was a significant difference in overall survival rates between the two groups, with 1- and 3-year overall survival rates of 92.8 and 69.3% versus 50.2 and 22.9% for the non-elevated CRP group and the elevated CRP group (p = 0.003), respectively. CRP has a significant impact on overall survival of patients with metastatic renal cell carcinoma carcinoma treated with tyrosine kinase inhibitors.

Impact of pretreatment C-reactive protein on overall survival for patients with metastatic renal cell carcinoma treated with sunitinib.

436 Background: C-reactive protein (CRP) has been shown to be a significant prognostic factor for metastatic renal cell carcinoma (mRCC) in cytokine era. We further evaluated the prognostic impact of CRP for mRCC treated with sunitinib. Methods: Consecutive 37 patients were treated with sunitinib for mRCC from April 2008 to January 2011 at our institution. Seven patients were excluded because they received prior other tyrosine kinase inhibitors, sorafenib. Among eligible 30 patients, 9 patients (30%) had prior immunotherapy and 16 patients (55.5%) had prior nephrectomy. All clinical charts of the patients were reviewed for variables. Overall survival were estimated using the Kaplan-Meier method. Variables including hemoglobin, albumin, calcium, lactate dehydrogenase (LDH), thrombocytosis, number of the metastatic sites, ECOG performance status (PS), prior immunotherapy, prior nephrectomy, and pretreatment CRP concentration were evaluated. The cut-off point of pretreatment CRP concentration was set at 8mg/l. Multivariate analysis was carried out by Cox proportional hazard model. For all analysis the difference was considered significant when p &lt; 0.05. Results: Median follow up period was 9 months (range; 1 to 25 months). The 1-year overall and progression free survival rates for the entire cohort were 68.9% and 45.8%. During follow up, 6 patients (20 %) died of disease. In univariate analysis, pretreatment CRP was a significant factor for overall survival as well as thrombocytosis. Multivariate analysis showed pretreatment CRP was solely an independent prognostic factor for overall survival. The elevations of pretreatment CRP concentrations were found in 14 patients (46.7%). The median overall survival length of patients with nonelevated CRP concentrationswas not reached compared with that of patients with elevated CRP concentration of 9.9 months. The 1-year overall survival rates of the patients with preoperative CRP elevation (35.7%) were significantly worse than those of patients without CRP elevation (91.7%) (p = 0.012). Conclusions: CRP had also prognostic impact on overall survival for patients with mRCC treated with sunitinib.

A Point-of-Care Platelet Function Assay and C-Reactive Protein for Prediction of Major Cardiovascular Events After Drug-Eluting Stent Implantation

This study sought to investigate clinical utility of on-site platelet function test and C-reactive protein (CRP) in patients undergoing percutaneous coronary intervention (PCI). Data on long-term prognostic value of high on-treatment platelet reactivity (HTPR) on clopidogrel after PCI are limited. As a distinct biological pathway, CRP has been suggested to be associated with post-PCI atherothrombotic events. We evaluated 2,849 patients who received drug-eluting stents (DES) and had post-PCI VerifyNow P2Y12 assays (Accumetrics, San Diego, California) performed. Among them, baseline CRP measurement was available in 2,546 patients. The primary endpoint was a composite of all-cause death, nonfatal myocardial infarction, stent thrombosis, and stroke. During follow-up (median, 2.2 years), the occurrence of the primary endpoint did not significantly differ among patients with and without HTPR (2.8% vs. 2.4% at 2 years; hazard ratio [HR]: 1.33, 95% confidence interval [CI]: 0.88 to 2.01; p = 0.18). By contrast, patients with elevated CRP levels were at significantly higher risk for the primary endpoint, as compared with those with nonelevated CRP levels (5.6% vs. 1.7% at 2 years; HR: 2.81, 95% CI:, 1.83 to 4.31; p < 0.001). The VerifyNow test had no incremental usefulness to classify long-term risk. However, the incorporation of CRP into a model with conventional clinical and procedural risk factors significantly improved the C-statistic for the prediction of the primary endpoint (0.729 to 0.759; p = 0.03). We failed to identify that HTPR measured by VerifyNow P2Y12 assay was significantly associated with long-term atherothrombotic risks in patients receiving DES. However, elevated CRP levels were significantly associated with worse outcomes and had incremental predictive values over conventional risk factors.

Use of C-reactive protein to predict perinephric or renal sinus fat invasion in patients with clinical T1N0M0 renal cell carcinoma.

385 Background: Indication of nephron sparing surgery (NSS) for renal cell carcinoma (RCC) has been extending, as NSS can be considered for not only cT1a but also cT1b tumors. However, some cT1 diseases have pathological perinephric or renal sinus fat invasion. It is useful to know the probability of the presence of fat invasion before surgery, but diagnostic ability of imaging studies such as CT for predicting pT3a disease is limited. Therefore, estimation of the risk for pT3a disease in cT1 RCC patients could be helpful. C-reactive protein (CRP) has been shown to be a strong prognostic factor in RCC patients, reflecting tumor aggressiveness. We evaluated the predictive ability of preoperative CRP for pT3a disease in cT1N0M0 RCC patients. Methods: Of consecutive 386 patients treated with radical nephrectomy for cT1a-bN0M0 RCC, 82 were excluded due to hemodialysis, inflammatory disease, bilateral synchronous renal tumors, synchronous other malignant disease or loss of each data. The remaining 304 patients constituted the current study cohort. Cut off point of CRP was 3 mg/L. Associations were analyzed between pT3a and preoperative factors including age, sex, BMI, laterality, tumor size, CRP, hemoglobin, platelet, LDH, ALP, calcium and albumin. We developed a multivariate model for predicting pT3a disease in cT1 RCC. Results: Of the 304 patients, 28 (9%) had pT3a disease. Of 43 patients with elevated CRP level, 10 (23%) had pT3a disease. In contrast, of the remaining 261 patients with non-elevated CRP level, 18 (7%) had (p=0.002). Univariate and then multivariate analyses identified age (p=0.021), tumor size (p=0.007), and CRP (p=0.024) as independent and significant predictors for pT3a disease. Incorporating these three factors, we developed a predictive model for pT3a disease with predictive accuracy of area under the ROC curve of 0.772. Conclusions: Preoperative CRP is an independent predictor for pT3a disease in cT1 RCC along with age and tumor size. The model could be useful to estimate the risk of the probability of fat invasion before surgery, especially NSS. No significant financial relationships to disclose.