Normalization Of C-reactive Protein Levels Research Articles

Prognostic model using postoperative normalization of C-reactive protein levels in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy.

To improve the prediction of outcomes in patients who will undergo radical nephroureterectomy (RN U) for upper tract urothelial carcinoma (UTUC), we investigated the preoperative prognostic factors and developed a risk classification model. A total of 144 patients who underwent RNU with history of neither neoadjuvant nor adjuvant chemotherapy between 2008 and 2022 were retrospectively reviewed. Associations between perioperative/clinicopathologic factors and outcomes, including cancer-specific survival (CSS), were assessed. We specifically focused on preoperative serum C-reactive protein (CRP) and its postoperative normalization. Non-normalization of postoperative serum CRP level and pathologic T3 stage were identified as independent predictive factors of shorter CSS in univariate and multivariate analysis (p=0.0150 and 0.0037, hazard ratio: 3.628 and 4.470, respectively). We classified the patients into three groups using these factors and found that five-year CSS was 88%, 42.5%, and 0% in the low-risk group (zero factors), intermediate-risk group (one factor), and high-risk group (two factors), respectively (p<0.0001). Non-normalization of postoperative serum CRP level and pathologic T stage were identified as independent postoperative prognostic factors in patients with UTUC who underwent RNU. These factors can stratify three prognostic groups and may help urologists in clinical decision-making for adjuvant therapy.

Effectiveness of Toothbrushing Technique for Biofilm Removal and Postoperative Infection Control after Spinal Fusion Surgery: A Retrospective Study.

This retrospective study was designed to investigate the effectiveness of using a toothbrush, which is commonly used in our daily life, for biofilm removal and infection control in the treatment of spinal infections occurring after spinal fusion surgery. Currently, a biofilm is thought to form on the surface of the metal inserted during spine fusion surgery. We aim to determine the differences in clinical outcomes between using and not using a toothbrush to remove biofilm while performing conventional drainage, curettage, and debridement. A total of 1081 patients who underwent anterior or posterior spinal fusion surgery between November 2018 and October 2022 were screened. The study included 60 patients who developed surgical site infection and underwent incision and drainage surgery either with a toothbrush (n = 20) or without a toothbrush (n = 40). Failure of infection control that requires revision surgery occurred in 2 patients (10%) in the Toothbrush group and in 14 patients (35%) in the No-Toothbrush group (p = 0.039). Thus, the rate of additional surgery was significantly lower in the Toothbrush group. Additionally, normalization of c-reactive protein levels occurred significantly faster in the Toothbrush group (p = 0.044). Therefore, using a toothbrush to treat spinal infections following spinal fusion surgery appears to have beneficial mechanical debridement effects, resulting in improved clinical results, which were also confirmed based on the electron microscopic images.

Рівень С-реактивного білка в плазмі крові молодих дорослих із соматотропною недостатністю, що виникла в дитинстві

У статті наведені дані щодо вмісту високочутливого С-реактивного білка в плазмі крові молодих дорослих із соматотропною недостатністю, що виникла в дитинстві та збереглася в дорослому віці. Встановлено, що тривалий дефіцит ендогенного гормона росту асоціюється з вірогідним підвищенням рівня С-реактивного білка в плазмі крові пацієнтів. Це може значно підсилювати ризик розвитку раннього атеросклерозу та серцево-судинних захворювань у хворих на соматотропну недостатність вже в молодому віці. Терапія препаратами рекомбінантного гормона росту призводить до нормалізації показників С-реактивного білка вже через 3–6 місяців після початку/поновлення терапії.

Normalization of C-reactive protein levels following cytoreductive nephrectomy in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors is associated with improved overall survival

Introduction and objectivesPretreated C-reactive protein (CRP) has been suggested as one of the most important prognostic factors for metastatic renal cell carcinoma (mRCC). The aim of this study was to investigate the prognostic impact of the change in CRP level before and after cytoreductive nephrectomy (CN) in patients with mRCC treated with tyrosine kinase inhibitor. Materials and methodsThe CRP in 60 patients undergoing molecular targeted therapy for mRCC was measured before and after CN. The cutoff value of CRP was determined to be 0.5mg/dl.; thus, all patients were classified into lower CRP groups and higher ones according to their CRP before CN. The higher CRP group was further classified into 2 groups based on the kinetics after CN, “normalized CRP group” and “nonnormalized CRP group,” respectively. The overall survival (OS) of these groups was compared. ResultsThe median of the observation period was 21.6 months. The OS of patients in the lower CRP, normalized CRP, and nonnormalized CRP groups were 28.6, 23.1, and 12.3 months, respectively (nonnormalized CRP group vs. others, P<0.0001). Multivariate analysis revealed that the postoperative CRP level (≥0.5mg/dl) (hazard ratio = 0.218; 95% CI: 0.091–0.522; P = 0.0006) was an independent predictive factor of OS. ConclusionThe CRP level after CN can be a predictive factor for OS in patients with mRCC treated with tyrosine kinase inhibitor.

Predictors of conservative treatment for pyogenic spondylitis.

Introduction Although initial treatments for pyogenic spondylitis include conservative approaches such as rest and antibiotics, some cases are refractory to conservative therapy. The objective of this study was to clarify the predictors for achievement of C-reactive protein (CRP) normalization in pyogenic spondylitis by conservative therapy. Methods In the present study, we enrolled 83 patients (51 men and 32 women) with conservatively treated pyogenic spondylitis from 2006 to 2015. Multiple logistic regression analysis was used to examine the association of achievement of CRP normalization with the number of infected vertebrae, bacterial strain, blood data, and the expansion of abscess to the epidural space by using functional magnetic resonance imaging. Results We found significant differences in the subjects with and without achievement of CRP normalization with respect to age, the number of affected vertebrae, ratio of resistant pathogenic bacteria, ratio of expansion of abscess to the epidural space, and blood data such as Hb, ALB, eGFR, Cr, and ALP levels. After adjustment for age and sex, the number of infected vertebral bodies, resistant bacteria, expansion of abscess to the epidural space, and Hb level showed significant associations with the normalization of CRP. In addition, we used multiple logistic regression analysis with age, sex, number of infected vertebral bodies, resistant bacteria, expansion of abscess to the epidural space, and serum Hb level as explanatory variables. We found that expansion of the abscess to the epidural and paravertebral spaces was significantly associated with the normalization of CRP level. Conclusions The number of infected vertebral bodies, resistant strains of pathogenic bacteria, expansion of abscess to the epidural and paravertebral spaces, and serum Hb level predicts the prognosis of patients with pyogenic spondylitis. Particularly, expansion of abscess to the epidural and paravertebral spaces was strongly associated with the achievement of CRP normalization.

THU0124 Importance of monitoring of C-reactive protein level to predict achievement of better clinical outcome during treatment with tocilizumab in patients with rheumatoid arthritis

BackgroundBiologics have molecular target such as cytokine and its receptor. It should be critical for maximizing its clinical response how biologics completely inhibit signalling of the target cytokines. However, it...

Polymorphonuclear Cell Count on Frozen Section Is Not an Absolute Index of Reimplantation in Infected Total Knee Arthroplasty

We evaluated the outcomes in 15 patients with infected total knee arthroplasty (TKA) who underwent reimplantation following excision arthroplasty in the presence of five to twenty polymorphonuclear cells per high power field (hpf) on intraoperative frozen section. At a minimum of two years of follow-up, we achieved 100% infection eradication rate with normalization of C-reactive protein levels, no radiolucency on plain radiographs and no clinical evidence of recurred infection. Successful reimplantation for infected TKA is possible despite of the presence of five to twenty polymorphonuclear cells per hpf in intraoperative frozen section with clear appearance of the tissues in the operative field. Clinical and serological confirmations of infection eradication before reimplantation as well as healthy operative findings are equally important factors for a successful reimplantation.

Clinical pharmacology of tocilizumab for the treatment of systemic juvenile idiopathic arthritis

Tocilizumab is a humanized anti-IL-6 receptor monoclonal antibody approved for the treatment of rheumatoid arthritis and systemic juvenile idiopathic arthritis. Biweekly doses of 8 mg/kg for patients who weigh ≥30 kg and 12 mg/kg for patients who weigh <30 kg produce adequate blockade of IL-6 receptors and normalization of C-reactive protein levels. The mean area under the curve during a 2-week dosing interval, maximum and minimum serum concentrations for both doses were 1341 ± 415 µg·day/ml, 245 ± 57.2 and 57.5 ± 23.3 µg/ml, respectively. Tocilizumab pharmacokinetic exposure parameters and clinical end points were comparable between these two dose groups. Proportions of patients achieving clinical end points were comparable across exposure quartiles, suggesting that pharmacokinetic exposures are within the plateau of the exposure–response curve.

Intravenous immune globulin plus corticosteroids in refractory Kawasaki disease

The aim of the present study was to investigate the efficacy of i.v. immune globulin (IVIG) therapy combined with corticosteroids for additional treatment of acute Kawasaki disease (KD) unresponsive to initial IVIG treatment. In 50 prospective KD patients, six IVIG non-responders without clinical improvement within 24-48 h after completion of initial IVIG, received 2 g/kg IVIG concurrently with 2 mg/kg i.v. prednisolone sodium succinate (PSL) until normalization of C-reactive protein level. Treatment was then changed to oral PSL, which was tapered over time. Clinical and coronary artery lesion (CAL) outcomes were compared with those of 13 IVIG non-responders who received additional heterogeneous therapies in 125 retrospective KD patients. In addition, the scoring system of Kobayashi et al. for prediction of non-responsiveness to initial IVIG treatment was retrospectively verified in 175 KD subjects, consisting of 50 prospective and 125 retrospective patients in order to evaluate the efficacy of the re-treatment regimen. Incidence of CAL in the study patients was lower than in the control patients, although differences were not significant both in the acute stage (within 1 month: 1/6, 16.7% vs 7/13, 53.8%; P= 0.177) and in the convalescent stage (after 1 month: 0/6, 0.0% vs 4/13, 30.8%; P= 0.255). According to the non-responder prediction system, the scores of six study and 13 control patients before initial IVIG treatment were similar (7.2 ± 1.9 vs 5.3 ± 3.1; P= 0.200). No serious adverse effects related to each treatment were noted in patients of either group. Additional IVIG combined with concurrent PSL appears to be safe and worth evaluation for the treatment of acute KD unresponsive to initial IVIG treatment.

CRP evolution pattern in CPAP-treated obstructive sleep apnea patients. Does gender play a role?

C-reactive protein (CRP) is directly implicated in atherogenesis and associated cardiovascular morbidity in patients with obstructive sleep apnea (OSA). Effective continuous positive airway pressure (CPAP) treatment has been shown to gradually decrease CRP levels and thus consequently improve disease-related cardiovascular morbidity. However, the influence of gender on the CRP evolution pattern has never been assessed before. The aim of our study was to investigate possible gender differences in CRP evolution in OSA patients 3 and 6 months after the start of effective CPAP treatment. The study population consisted of 436 patients (252 males/184 females) with newly diagnosed moderate to severe OSA and good CPAP compliance assessed by a thorough follow up. High-sensitivity C-reactive protein (hs-CRP) was assessed before CPAP initiation and at the third and sixth month of the follow-up period. C-reactive protein values showed a statistically significant decrease at the third and sixth month of CPAP therapy [initial values 0.79 ± 0.65 mg/dL versus 0.70 ± 0.52 mg/dL (p < 0.05) after 3 months and 0.30 ± 0.33 mg/dL (p < 0.001) after 6 months of CPAP therapy]. When patients were divided into males and females, the above evolution pattern was changed. At the third month time point, the CRP values showed a statistically significant decrease only in males (from 0.74 ± 0.53 mg/dL to 0.61 ± 0.5 mg/dL, p < 0.01) while females showed only minimal and insignificant changes (from 0.87 ± 0.79 mg/dL to 0.83 ± 0.51 mg/dL, p > 0.05). After 6 months' treatment, CRP decreased significantly in both genders (males from 0.74 ± 0.53 mg/dL to 0.28 ± 0.32 mg/dL, p < 0.001 and females from 0.87 ± 0.79 mg/dL to 0.34 ± 0.36 mg/dL, p < 0.001). Our results suggest a delay in the normalization of CRP levels in females despite effective CPAP treatment. A time period of at least 6 months appeared to be required in women in order to reduce CRP levels and consequent cardiovascular risk. In contrast, CPAP's protective role in males is achieved at an earlier time point. Gender-related hormonal and genetic factors may influence the above CRP evolution pattern.

Clinical pharmacology of tocilizumab for the treatment of patients with rheumatoid arthritis

Tocilizumab is a humanized anti-IL-6 receptor (IL-6R) monoclonal antibody for the treatment of rheumatoid arthritis (RA). A dose of 8 mg/kg produces adequate blockade of IL-6 receptors throughout a dosing interval, as confirmed by sustained high levels of tocilizumab-bound soluble IL6-R complex and normalization of C-reactive protein levels. Studies have confirmed 8 mg/kg every 4 weeks as the optimal dose and 4 mg/kg as the starting dose for the treatment of RA, with favorable efficacy and acceptable safety profiles. After 8 mg/kg, steady-state peak and trough concentrations were 183 ± 86 and 9.7 ± 11 µg/ml, respectively. Tocilizumab serum exposures increased more than proportionally to the dose increase from 2–10 mg/kg. Total clearance is concentration dependent, with non-linear receptor-mediated clearance dominant at low concentrations (<25 µg/ml). Tocilizumab exposures are not affected by common concomitant medications in RA patients, but decreased IL-6 activity resulted in increased CYP3A4 activity and hence decreased exposures of CYP3A4 substrates.

Minocycline-induced vasculitis fulfilling the criteria of polyarteritis nodosa

A 47-year-old man who had been taking minocycline for palmoplantar pustulosis developed fever, myalgias, polyneuropathy, and testicular pain, with elevated C-reactive protein (CRP). Neither myeloperoxidase- nor proteinase-3-antineutrophil cytoplasmic antibody was positive. These manifestations met the American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Stopping minocycline led to amelioration of symptoms and normalization of CRP level. To our knowledge, this is the second case of minocycline-induced vasculitis satisfying the criteria. Differential diagnosis for drug-induced disease is invaluable even for patients with classical polyarteritis nodosa.

Transient hypophosphataemia associated with acute infectious disease in paediatric patients.

The aim of this study was to investigate the prevalence of hypophosphataemia in children with acute infection and the relationship between serum phosphate and C-reactive protein (CRP) concentration. Serum phosphate and CRP levels were measured on admission in 238 patients (aged 1 month to 14 y) with: pneumonia (n = 51), upper respiratory tract-related bacterial infection (n = 70), urinary tract infection (n = 50) and viral infection (n = 67). Patients were classified according to CRP value (0-50, 51-100, 101-150, > or = 151 mg/l) and type of infection. The prevalence of hypophosphataemia was calculated for each group. 30 children with hypophosphataemia on admission had serial measurements of serum phosphate and CRP levels. A significant negative correlation between serum phosphate and CRP levels was found (r = -0.41, p < 0.0001). Patients with CRP > or = 151 mg/l on admission had a lower mean serum phosphate value than those with CRP < or = 50 mg/l (1.17 vs 1.50 mmol/l, p < 0.0001). The overall prevalence of hypophosphataemia for patients with pneumonia, upper respiratory tract bacterial infection, urinary tract and viral infections was 45%, 35.7%, 18% and 4.4%, respectively. Hypophosphataemia occurred during the phase of rising of CRP level and resolved soon after CRP reached a plateau. In conclusion, hypophosphataemia is a relatively frequent but transient phenomenon in children with acute infectious disease. It is associated with an increase in CRP concentration and resolves before the normalization of CRP levels.

Surgical Treatment of Active Native Valve Endocarditis

A report is presented of 24 patients (23 male), mean age 38 years, who underwent surgery for active native valve endocarditis of the left heart in 1975-1988. The aortic valve was affected in all patients, and also the mitral valve in five. Pre-existing aortic valve disorder was present in 17 cases (13 congenitally bicuspid 4 rheumatic affection). There were five hospital deaths (20.8%). Staphylococci as causal organism and extensive infection predicted the highest mortality and morbidity. The mean follow-up time was 39.7 (range 2-114) months. Two reoperations because of prosthetic valve dehiscence revealed endocarditis of the implanted valve. Strong correlation was found between favourable postoperative course and rapid normalization of C-reactive protein levels, which did not fall in patients with persistent infection. Early surgery is recommended if the course of bacterial endocarditis is severely complicated.