Optimal Cut-off Values For C-reactive Protein Research Articles

Value of Serum C-Reactive Protein (CRP) Level in Early Detection of Anastomotic Leakage following Salvage Esophagectomy after Definitive Chemoradiation for Esophageal Squamous Cell Carcinoma

Background Definitive chemoradiation therapy is an alternative curative treatment for esophageal squamous cell carcinoma (ESCC). The prevalence of anastomotic leakage (AL) after salvage esophagectomy is significantly higher than planned esophagectomy after chemoradiation, which increases operative mortality. Minimizing AL-related mortality requires early detection. Several investigators have demonstrated the role of serum C-reactive protein (CRP) in early AL detection after esophagectomy for decades. However, its value in early AL detection after salvage esophagectomy is unknown. This study aims to evaluate the value of serial serum CRP levels for early AL detection in ESCC patients after salvage esophagectomy. Methods We retrospectively reviewed the medical record of 36 patients diagnosed with thoracic squamous cell esophageal carcinoma who underwent salvage esophagectomy at our hospital between December 2016 and May 2022. The CRP level was measured daily from postoperative day (POD) 1 to 5. Sensitivity, specificity, and receiver operating characteristic (ROC) curves were calculated to determine the optimal cutoff value. Results A total of 36 patients underwent salvage esophagectomy. Of these 36 patients, 3 patients (8.3%) were diagnosed with AL. The CRP level on POD 2 to 5 had been significantly associated with the presence of AL. The ROC curve showed the excellent diagnostic accuracy of CRP level on POD 2 to 5, with an area under the curve of 0.98, 0.98, 0.93, and 0.87, respectively. The optimal cutoff value of CRP on POD2 to 5 was 270, 250, 200, and 150 mg/L, respectively, with high sensitivity, specificity, and negative predictive value. Conclusion Postoperative serial CRP level after salvage esophagectomy is a reliable useful tool for early AL detection, similar to other settings of esophagectomy.

C-Reactive Protein as a Negative Predictive Marker for Anastomotic Leakage After Minimally Invasive Esophageal Surgery

BackgroundSerum C-reactive protein (CRP) is commonly used by surgeons to raise suspicion of anastomotic leakage and other infectious complications, but most studies on optimal cut-off values are retrospective with a small sample of patients. The aim of this study was to determine the accuracy and optimal cut-off value of CRP for anastomotic leakage in patients following esophagectomy for cancer.Materials and methodsConsecutive minimally invasive esophagectomy for esophageal cancer patients was included in this prospective study. Anastomotic leakage was confirmed if a defect or leakage of oral contrast was seen on a CT scan, by endoscopy or if saliva was draining from the neck incision. Diagnostic accuracy of CRP was assessed by receiver operator curve (ROC) analysis. Youden’s index was adopted to determine the cut-off value.ResultsA total of 200 patients were included between 2016 and 2018. Postoperative day 5 showed the highest area under the ROC (0.825) and optimal cut-off value of 120 mg/L. This resulted in a sensitivity of 75%, specificity of 82%, negative predicting value of 97%, and positive predicting value of 32%.ConclusionsCRP on postoperative day 5 can be used as a negative predictor for and can be used as a marker to raise suspicion of anastomotic leakage following esophagectomy for esophageal cancer. When CRP exceeds 120 mg/L on postoperative day 5, additional investigations should be considered.

Preoperative CRP(-)/CEA(-)/CA19-9(-)/non-T4 in Stage III Colorectal Cancer Is Favorable Risk for Recurrence.

We evaluated the prognostic impact of a novel C-reactive protein (CRP) cut-off value (0.6 mg/dl) and carcinoembryonic antigen (CEA)/carbohydrate antigen 19-9 (CA19-9) in stage II/III colorectal cancer. Four hundred ninety-eight patients with stage II (n = 275) or stage III (n = 223) colorectal cancer, surgically treated between January 2010 and December 2016, were analyzed. The optimal CRP cut-off value was fixed at 0.6 mg/dl to predict recurrence based on the receiver operating characteristic curve. Prognostic factors, including CRP/CEA/CA19-9 status, for relapse-free survival (RFS) were evaluated by multivariate analysis. Recurrent rates were 15% and 32% in stages II and III, respectively. In stage II, CRP, CEA, and CA19-9 were not significant prognostic factors for RFS. In stage III, the RFS of the low CRP group was significantly better than that of the high CRP group (p = 0.002). In stage III, the RFS of CRP(-)/CEA(-) or CRP(-)/CA19-9(-) was significantly better than the other group, as opposed to the RFS of the CEA(-)/CA19-9(-) group that was not. The CRP(-)/CEA(-)/CA19-9(-) group recurrence rate in stage III was significantly better than the CRP(+)/CEA(-)/CA19-9(-) group (20% vs. 50%, p = 0.006). Multivariate analysis revealed that CRP(-)/CEA(-)/CA19-9(-) (p = 0.04) and non-T4 (p < 0.001) were good independent prognostic factors in stage III. The CRP(-)/CEA(-)/CA19-9(-)/non-T4 group recurrence rate in stage III was 11% (8 out of 73). In stage III, the CRP(-)/CEA(-)/CA19-9(-)/non-T4 group is favorable risk for recurrence.

The Role of Pleural Fluid C-Reactive Protein in the Diagnosis of Exudative Pleural Effusions.

Background and objectivePleural effusion develops when there is disequilibrium between pleural fluid formation and absorption. Light's criteria are currently used to differentiate transudative from exudative effusion. If the pleural effusion is exudative, it requires extensive diagnostic workup to identify the local cause of the effusion. Pleural fluid cell count and differentials, glucose level, adenosine deaminase (ADA), fluid GeneXpert for Mycobacterium tuberculosis (MTb), fluid culture, and cytology are currently used for further evaluation of exudative pleural effusions. However, the sensitivity and specificity of the above tests are not dependable. The pleural fluid C-reactive protein (CRP) is likely to reflect serum CRP levels because the CRP in the pleural fluid may be caused by increased diffusion from the blood due to inflamed capillary leakage. In this study, we aimed to examine the role of pleural fluid CRP levels in the differential diagnosis of exudative effusion.Materials and methodsBased on Light's criteria, this study included 100 patients with exudative pleural effusion. Serum CRP and pleural fluid CRP were assessed with the CRP-Turbilatex-quantitative turbidometric immunoassay method based on the principle of an agglutination reaction. Receiver operating characteristic (ROC) curves were generated by plotting sensitivity against 1-specificity, and the area under the curve (AUC) with a 95% confidence interval (CI) was calculated. After data collection, statistical analysis was performed using SPSS Statistics v28.0 (IBM, Armonk, NY).ResultsOur study showed a significant difference in pleural fluid CRP levels (p<0.001). Pleural fluid CRP was significantly higher in the empyema and parapneumonic groups compared to tuberculous and malignant effusions. The optimal cut-off value of CRP ≥47.4 mg/dl yielded 87.5% sensitivity and 92.5% specificity in differentiating parapneumonic effusion from tuberculous effusion. Pleural fluid CRP proved to be an excellent marker for distinguishing parapneumonic effusion from malignancy (cut-off value ≥49.2 mg/dl, 75% sensitivity, and 85.7% specificity) and parapneumonic plus empyema from tuberculous effusion plus malignant effusion (cut-off value ≥47.4 mg/dl, 84.6% sensitivity, and 90.8% specificity).ConclusionPleural fluid CRP levels can be used as an additional tool in the differential diagnosis of exudative effusion. It significantly differentiates parapneumonic effusion and empyema from tuberculous and malignant effusions.

Systemic inflammatory markers differentiate between orbital cellulitis and non-specific orbital inflammation

ABSTRACT Purpose Bacterial orbital cellulitis (OC) and diffuse non-specific orbital inflammation (DNSOI) may be challenging to differentiate clinically. This study investigates the utility of systemic inflammatory markers, namely white cell count (WCC) and C-reactive protein (CRP), in differentiating between OC and DNSOI. Methods A single-centre retrospective study of patients diagnosed with OC or DNSOI, between 2003 to 2021, who had WCC and/or CRP obtained at presentation. The mean levels of these factors and the proportion of positivity were compared between OC and DNSOI. A receiver operating characteristic (ROC) analysis was conducted to calculate the specificity and sensitivity of WCC or CRP in each group. Results 49 patients were included in this study. The mean age was 56 ± 20 years, and 21 patients were females. 26 (53.1%) patients had OC, and 23 (46.9%) patients had DNSOI. Mean WCC for OC and DNSOI were 14.5 × 103/μL and 9.27 × 103/μL, respectively (P = 0.001). Mean CRP for OC and DNSOI were 104.4 mg/L and 10.0 mg/L, respectively (P < 0.001). The optimal CRP cut-off value of 20.2 mg/L demonstrated 90.9% sensitivity and 90.5% specificity (AUC = 0.946, P < 0.001) for differentiating between OC and DNSOI. CRP was more predictive of OC than WCC (P = 0.017). 7/26 (26.9%) OC patients with fever also had an elevated CRP, while 1/23 (4.3%) of DNSOI with fever had a normal CRP. Conclusions An elevated WCC is suggestive of OC. However, a normal WCC can neither exclude nor differentiate between OC and DNSOI. CRP may be a more accurate predictor of OC compared to WCC.

Evaluation and Correlation of Preoperative Serum C- Reactive Protein, Neutrophil-lymphocyte Ratio and Platelet-lymphocyte Ratio for Cervical Metastasis in Patients of Primary Oral Squamous Cell Carcinoma

Background: The influence of cervical metastasis on prognosis in a person who is suffering from oral squamous cell carcinoma (OSCC) has been notorious. C- reactive protein (CRP) is a prior biomarker for inflammation. Recent literature provide evidence of systemic inflammatory markers playing important role in determining survival rate on patient with OSCC. Hence, in current study the “utility of Neutrophil-lymphocyte ratio (NLR) ,Platelet-lymphocyte ratio (PLR), and serum CRP are evaluated and correlated for cervical metastasis”.&#x0D; Objectives: This study intends to evaluate and correlate preoperative serum CRP, NLR, and PLR for cervical metastasis in patients of primary oral squamous cell carcinoma.&#x0D; Methodology: The clinicopathological data, CRP and the preoperative complete blood investigation details were obtained from 40 primary OSCC patients who will undergo surgery. The optimal cut-off value of CRP, PLR and NLR was determined. The prognostic significance of markers will be determined by Univariate and multivariate analysis.&#x0D; Expected Results: The elevation of CRP, NLR, and PLR levels will significantly evaluate and correlate with cervical metastasis.&#x0D; Conclusion: Preoperative serum CRP, NLR, and PLR level will be a prognosticator in OSCC.

C-reactive protein adjusted for body mass index as a predictor of postoperative complications following laparoscopic gastrectomy for gastric cancer.

This study aimed to clarify the relationship between obesity and postoperative C-reactive protein (CRP) and assess the usefulness of obesity status-adjusted CRP levels for predicting early complications following laparoscopic gastrectomy for gastric cancer. This study retrospectively analyzed 527 patients who underwent laparoscopic gastrectomy for gastric cancer between January 2013 and March 2019. Patients were classified into three groups according to body mass index (BMI): BMI < 20; BMI ≥ 20 to < 25; and BMI ≥ 25. The correlation between BMI and perioperative CRP was investigated in 447 patients, excluding 80 with postoperative complications. The optimal CRP cutoff value of Clavien-Dindo (CD) grade ≥ 3 for predicting severe complications for each group was determined. BMI was significantly correlated with CRP on postoperative day (POD) 3 (p < 0.001) in 447 patients without complications. According to the receiver operating characteristic curve analysis, CRP cutoff values on POD 3 for predicting severe complications were 92.4, 111.1, and 171.9 in the BMI < 20, BMI ≥ 20 to < 25, and BMI ≥ 25 groups, respectively. In multivariate analysis for CD grade ≥ 3 complications, cardiac history and POD 3 CRP levels higher than the adjusted cutoff were identified as independent factors significantly associated with severe complications (p = 0.021 and 0.015, respectively). CRP cutoff values on POD 3 adjusted for BMI were useful for predicting severe complications in gastrectomy for gastric cancer.

The Diagnostic Performance of Interleukin-6 and C-Reactive Protein for Early Identification of Neonatal Sepsis.

Interleukin-6 (IL-6) and C-reactive protein (CRP) are being used for diagnosis of sepsis. However, studies have reported varying cut-off levels and diagnostic performance. This study aims to investigate the optimal cut-off levels and performance of IL-6 and CRP for the diagnosis of neonatal sepsis. The study was conducted at the University Hospital of Leipzig, Germany from November 2012 to June 2020. A total of 899 neonates: 104 culture proven sepsis, 160 clinical sepsis, and 625 controls were included. Blood culture was performed using BacT/ALERT 3D system. IL-6 and CRP were analyzed by electrochemiluminescent immunoassay and immunoturbidimetric assay, respectively. Data were analyzed using SPSS 20 statistical software. Among neonates with proven sepsis, the optimal cut-off value of IL-6 was 313.5 pg/mL. The optimal cut-off values for CRP in 5 days serial measurements (CRP1, CRP2, CRP3, CRP4, and CRP5) were 2.15 mg/L, 8.01 mg/L, 6.80 mg/L, 5.25 mg/L, and 3.72 mg/L, respectively. IL-6 showed 73.1% sensitivity, 80.2% specificity, 37.6% PPV, and 94.8% NPV. The highest performance of CRP was observed in the second day with 89.4% sensitivity, 97.3% specificity, 94.5% PPV, and 98.3% NPV. The combination of IL-6 and CRP showed increase in sensitivity with decrease in specificity. In conclusion, this study defines the optimal cut-off values for IL-6 and CRP. The combination of IL-6 and CRP demonstrated increased sensitivity. The CRP 2 at cut-off 8.01 mg/L showed the highest diagnostic performance for identification of culture negative clinical sepsis cases. We recommend the combination of IL-6 (≥313.5 pg/mL) and CRP1 (≥2.15 mg/L) or IL-6 (≥313.5 pg/mL) and CRP2 (≥8.01 mg/L) for early and accurate diagnosis of neonatal sepsis. The recommendation is based on increased sensitivity, that is, to minimize the risk of any missing cases of sepsis. The CRP2 alone at cut-off 8.01 mg/L might be used to identify clinical sepsis cases among culture negative sepsis suspected neonates in hospital settings.

Postoperative collections after liver surgery: predictors, and long-term outcomes

Introduction: Postoperative collection (PC) can occur after liver surgery (LS), but little is know on their impact on short and long-term outcomes. The aim of this study was to analyze factors predicting the occurrence of PC, the need of drainage and their impact on oncologic outcomes. Methods: . This prospective, single-center, cohort-study included all patients undergoing LS from 2008 to 2017. A systematic postoperative CT scan was realized on day7. The primary outcome was to determine variables associated with PC, defined as the presence of a fluid collection, and infected in case of positive bacterial culture. Secondary outcomes were to determine factors predicting drainage requirement, and the impact of infected PC on 5-y overall (OS) survival. Results: We included 254 patients: 45% (n=114) experienced PC. In the multivariate analysis, variables associated to PC occurrence were BMI (25-30=OR1.56(95%IC:0.78,3.13), 30-35=OR1.99(95%IC:0.67,5.89) p=0.002) and surgical resection (anatomic=reference, nonanatomic=OR1.22(95%IC:0.52,2.85), combined=OR2.09(95%IC:0.72,6.07), p=0.014). In the PC subgroup (n=114), variables predicting drainage requirement were antibiotic use OR14.01(95%CI:1.25,157 p= 0.015) and C-reactive protein (CRP) OR1.02(95%CI:1,1.05 p=0.043). The AUROC (0.71, 95%CI:0.59,0.83 p=0.002) found 152 mg/L as the optimal CRP cutoff value associated with PC drainage. In the malignant disease subgroup with PC (n=96), we observed lower 5-y OS among patients with infected vs non-infected PC (33% vs 56%, Log-Rank=0.03). Conclusions: In this cohort study we observed how nonanatomic or combined LS and BMI are associated to PC after LS, and those with CRP higher than 152 mg/L may require drainage. Moreover, the presence of an infected PC negatively impact 5-y OS.

Amalgamation of systemic inflammatory response syndrome score with C-reactive protein level in evaluating acute pancreatitis severity in children

Background and aim: Systemic inflammatory response syndrome (SIRS) has to do with how the body reacts to injury. Herein, we analyzed the clinical features of acute pancreatitis (AP) in children with SIRS complication and investigated the role of SIRS score combined with C-reactive protein (CRP) level in assessing AP severity in children.Methods: This retrospective cohort study involved 111 children hospitalized with AP at the Children's Hospital of Zhejiang University School of Medicine between January 2012 and August 2017. Presence of SIRS, demographic data, clinical information and laboratory test results on admission were statistically examined.Results: Out of the 111 AP cases, 45 were diagnosed with SIRS. Differences in CRP, interleukin-6 (IL-6), age, temperature, heart rate (HR), white blood cell (WBC), neutrophil count (NC), body mass index (BMI), duration of onset of disease symptoms as well as cases requiring intensive care unit (ICU) treatment were significantly higher in patients with SIRS than those without SIRS (p < .01 or p < .05). Logistic regression analyses evinced two independent risk factors for SIRS to be coexisted diseases (odds ratio (OR) = 4.871, p = .02) and fever (OR = 3.56, p = .007). SIRS was an independent predictor for AP severity (OR = 10.820, p = .005). The optimal cut-off value of CRP was 27.5 mg/L for severe AP classification according to receiver operating characteristic (ROC) (area under curve was 0.733).Conclusion: Amalgamation of SIRS criterion with CRP level potentially plays an important role in assessing AP severity in children.

Evaluation of the bedside Quikread go® CRP test in the management of febrile infants at the emergency department.

Recently C-reactive protein (CRP) point-of-care tests have been developed. We aimed to validate a bedside CRP test (QuikRead go® CRP), to compare it with the laboratory CRP (ARCHITECT c8000 Abbott, Germany) test in children with fever without source (FWS), and to evaluate the optimal CRP cut-off value to identify those patients at a high risk for serious bacterial infection (SBI). The CRP bedside test was prospectively performed in capillary blood samples concurrently with the laboratory CRP testing for 283 well-appearing infants aged 1 to 24months with FWS attending the emergency department (ED) between May 2013 and August 2015. The mean difference between the laboratory CRP and the QuikRead go CRP values was 0.71mg/L (p = 0.444). Pearson's correlation coefficient between the CRPs was r = 0.929 (p < 0.001). SBI was diagnosed in 34 patients (12.0%). The area under the receiver operating characteristics (ROC) curve obtained was 0.87 (95%CI: 0.82-0.90) for an optimal CRP cut-off value of > 10mg/L (sensitivity: 94.1%, specificity: 49.0%, positive predictive value: 20.1%, negative predictive value: 98.4%), as a predictor of SBI. Nearly 45% of the patients were at a low risk for SBI according to CRP value; thus, additional laboratory tests would have been hypothetically avoided. There was a very strong, positive correlation between the QuikRead go CRP test and laboratory CRP determination. The QuikRead go CRP test provides reliable results to rule out SBI. Its implementation at the ED would improve the management of infants with FWS.

Ability of Serum C-Reactive Protein Concentrations to Predict Complications After Laparoscopy-Assisted Gastrectomy: A Prospective Cohort Study.

Inflammatory markers, including C-reactive protein (CRP) and white blood cell (WBC), are widely available in clinical practice. However, their predictive roles for infectious complications following laparoscopy-assisted gastrectomy (LAG) have not been investigated. Our aim was to investigate the diagnostic accuracy of CRP concentrations and WBC counts for early detection of infectious complications following LAG and to construct a nomogram for clinical decision-making.The clinical data of consecutive patients who underwent LAG with curative intent between December 2013 and March 2015 were prospectively collected. Postoperative complications were recorded according to the Clavien–Dindo classification. The diagnostic value of CRP concentrations and WBC counts was evaluated by area under the curve of receiver-operating characteristic curves. Optimal cutoff values were determined by Youden index. Univariate and multivariate logistic regression analyses were performed to identify risk factors for complications, after which a nomogram was constructed.Twenty-nine of 278 patients (10.4%) who successfully underwent LAG developed major complications (grade ≥III). CRP concentration on postoperative day 3 (POD 3) and WBC count on POD 7 had the highest diagnostic accuracy for major complications with an area under the curve value of 0.86 (95% confidence interval [CI], 0.79–0.92] and 0.68 (95% CI, 0.56–0.79) respectively. An optimal cutoff value of 172.0 mg/L was identified for CRP, yielding a sensitivity of 0.79 (95% CI, 0.60–0.92) and specificity 0.74 (95% CI, 0.68–0.80). Multivariate analysis identified POD3 CRP concentrations ≥172.0 mg/L, Eastern Cooperative Oncology Group Performance Status ≥1, presence of preoperative comorbidity, and operation time ≥240 min as risk factors for major complications after LAG.The optimal cut-off value of CRP on POD3 to predict complications following LAG was 172.0 mg/L and a CRP-based nomogram may contribute to early detection of complications after LAG.

Elevated C-reactive protein values predict nodal metastasis in patients with penile cancer

BackgroundThe nodal status is a strong predictor for cancer specific death in patients with penile carcinoma, and the C-reactive protein (CRP) level at diagnosis has recently been shown to be associated with poor clinical outcome in various solid malignancies. Therefore, this retrospective study was performed to evaluate the association between preoperative CRP levels and the incidence of nodal metastasis in patients with squamous cell carcinoma (SCC) of the penis.MethodsThe analysis included 51 penile cancer patients who underwent either radical or partial penectomy for pT1-4 penile cancer between 1990 and 2010. The nodal status was correlated with patient and tumor specific characteristics.ResultsSixteen (31%) patients had lymph node metastasis at the time of penile cancer surgery. Nodal status was associated with tumor stage but did not correlate significantly with tumor grade. In contrast, high presurgical CRP levels were significantly associated with the diagnosis of nodal involvement (p = 0.04). The optimal CRP cut-off value to predict lymph node metastasis was set at 20 mg/l based on ROC analysis.ConclusionsSince a high preoperative serum CRP level was closely correlated with nodal disease, it could be used as an additional marker to help identify patients with penile cancer who may benefit from inguinal lymph node dissection.

The additional value of the CRP test in patients in whom the primary care physician excluded pulmonary embolism

Background: After excluding pulmonary embolism (PE) with an unlikely Wells-decision rule and a negative D-dimer test, the general practitioner still has to differentiate between clinically relevant and clinically non-relevant diseases accounting for the presented symptoms. A negative D-dimer test makes clinically relevant disease less likely. The C-reactive protein (CRP) test could be of additional value to make this differentiation.Objectives: To assess whether an unlikely Wells-decision rule in combination with a negative point of care D-dimer test not only can safely exclude PE but also, in combination with a negative CRP-test, any other clinically relevant disease.Methods: We used data of a prospective study including 598 primary care patients suspected of pulmonary embolism. We included all patients, referred to secondary care for reference testing, with an unlikely Wells-decision rule and a negative point of care D-dimer test. We included 191 patients and imputed the CRP-test results in 60 patients. Alternative diagnoses were divided in clinically relevant diseases and clinically non-relevant diseases. A ROC-curve was constructed to determine the optimal CRP-cut-off.Results: The optimal CRP cut-off value appeared to be 10 mg/l. A total of 116 patients had a CRP < 10 mg/l of whom 12 patients (10%) had a clinically relevant disease. Two patients (2%) needed hospital admission. A total of 75 patients had a CRP ≥ 10 mg/l of whom 32 patients (43%) had a clinically relevant disease. Fifteen patients (20%) were admitted to hospital.Conclusion: The CRP-test is enhancing diagnostic decision making in patients in whom the general practitioner excluded PE.

Use of preoperative C-reactive protein to improve predictive accuracy in clear cell renal cell carcinoma.

474 Background: White blood cell count (WBC) and C-reactive protein (CRP) are reliable biomarkers in clear cell renal cell carcinoma (ccRCC). Nevertheless, accepted cut-offs values for risk stratifications are missing. This study re-evaluated the prognostic and predictive significance of preoperatively WBC and CRP that independently predicts patient prognosis and to determine optimal cut-off values for CRP. Methods: 327 patients with surgery for ccRCC were retrospectively evaluated from 1996 to 2005. Cox-proportional hazard models were used, adjusted for the effects of tumor stage, tumor size, Fuhrman grade, and Karnofsky-Index; and to evaluate the prognostic significance of WBC and CRP; and to identify cut-off values. Identified cut-offs were correlated with clinico-pathological parameters and used to estimate cancer-specific survival (CSS). To prove any additional predictive accuracy of the identified cut-off it was compared to a clinico-pathological base model using Harrell c-index. Results: In univariable analyses WBC was a significant prognostic marker at a concentration of 9.5/µl (HR: 1.83) and 11.0/µl (HR: 2.09) and supported a CRP value of 0.25 mg/dL (HR: 6.47, p &lt; 0.001) and 0.5mg/dL (HR: 7.15, p &lt; 0.001) as potential cut-off values. If adjusted by the multivariable models WBC showed no clear breakpoint, but a CRP-value of 0.25mg/dL (HR: 2.80, p = 0.027) proved to be optimal. Reduced CSS was proven for CRP 0.25 mg/dL (median: 69.9 vs. 92.3 months). Median follow-up was 57.5 months with 72 (22%) tumor related deaths. The final model built by the addition of CRP 0.25mg/dL did not improve predictive accuracy (c-index = 0.877) than compared to the clinico-pathological base model (c-index =0.881) which included TNM-stage, grading and Karnofsky-Index. Conclusions: Multivariable analyses revealed an optimal breakpoint of CRP at a value of 0.25mg/dL best to stratify patients at risk of cancer-specific mortality, but CRP 0.25mg/dL added no additional information in the prediction model. Therefore we cannot recommend to measure CRP as the traditional parameters of TNM-stage, grading and Karnofsky-Index were already of high predictive accuracy.

Correlation analyses among Capsule Endoscopy Scroring Index, simplified Crohn Disease Activity Index and C-reactive protein in small bowel Crohn disease

Objective To investigate the correlation between any two of Capsule Endoscopy Scroring Index （Lewis score）, simplified Crohn Disease Activity Index （CDAI） and C-reactive protein （CRP） in small bowel Crohn disease （CD）. Methods A total of 58 consecutive patients with known small bowel CD were enrolled. We evaluated disease activity with Lewis score and simplified CDAI. Correlations among CRP, simplified CDAI and Lewis score were calculated with Spearman＇s rank order correlation coefficient. The optimal CRP cut-off value was calculated using the ROC curve. Results The Lewis score showed inac- tive, mild and moderate-severe patients were 13, 21 and 24, respectively. CRP of moderate-severe group was significantly higher than that in mild and inactive groups （P 〈 0.05）. The optimal CRP cut-off value that differentiated patients with moderate to severe disease from the others was 13.50 mg/L with sensitivity of 87. 5% and specificity of 82. 4%. The area under the ROC curve to analyze the cut-off was 0. 849. Lewis score was moderately correlated with CRP （ r = 0. 58, P 〈 0.01 ）, and weakly correlated with the simplified CDAI （ r = 0. 40, P 〈 0. 01 ）. Conclusion Serum CRP and the simplified CDAI cannot replace Lewis score for capsule endoscopy in the assessment of disease activity in small bowel CD. However, CRP may be considered as an inflammatory marker for evaluating the moderate to severe capsule endoscopic activity. Key words: C-reactive protein; Capsule endoscopy scoring index; The simplified Crohn disease activity index; Small bowel Crohn disease

Diagnostic Value of C-Reactive Protein for Predicting Activity Level of Crohn’s Disease

Measuring Crohn's disease (CD) activity is useful in clinical trials as well as in clinical practice, but each available instrument to measure such activity has some limitations. C-reactive protein (CRP) is a sensitive marker for inflammation and tissue injury. The aims of the study were: to assess the diagnostic value of low level of CRP for predicting a low CD activity, and to calculate optimal CRP cutoff value for selecting patients with moderate or high CD activity. One hundred fifty consecutive patients with active or nonactive CD were included in the study without any pre-selection criteria. CRP was measured, and CD activity was calculated by means of the van Hees index (VHI). The median VHI score was 154.4 (interquartile range, 126.0-193.4), and the median CRP was 19.1 mg/L (interquartile range, 6.1-50.1 mg/L; upper limit of normal [N], 4 mg/L). Forty-nine percent of our patients had CRP >20 mg/L. CRP was significantly correlated to VHI (P = .0001). The probability that VHI was <150 if CRP was below upper limit of normal was equal to 1 (confidence interval, 0.891-1.000). The diagnostic value for CRP predicting a VHI > or =150 was high; the area under the receiver operating characteristic curve was equal to 0.844 (confidence interval, 0.783-0.906; P = .0001) with an optimal cutoff value of 21.6 mg/L, about 5 x N. CRP appears useful to evaluate CD activity, especially to predict inactive or low activity CD.