Predictive Value Of C-reactive Protein Research Articles

C-reactive protein during the first 6 postoperative days after total hip arthroplasty cannot predict early periprosthetic infection

IntroductionPeriprosthetic joint infection (PJI) after total hip arthroplasty (THA) remains a serious complication in orthopaedic surgery. C-reactive protein (CRP) is widely used as a marker to screen for inflammatory complications. The early postoperative course is well known, but knowledge about the predictive value of CRP in the first 6 postoperative days for detecting an acute postoperative PJI is lacking.MethodsWe retrospectively analyzed the inpatient course of CRP of all primary THA and THA with acute PJI within 28 days in our hospital from 2013 to 2021. A receiver-operating curve (ROC) analysis was performed and the best CRP threshold for detecting an acute PJI based on Youden’s-index was calculated and an area-under-the curve (AUC) analysis of the threshold was performed.Results33 of 7042 patients included had an acute PJI within 28 days. Patients with acute PJI were older, had a higher BMI and longer operation time and suffered more often from diabetes mellitus. A preoperatively elevated CRP was a risk factor for PJI. CRP was significantly higher in the PJI group on postoperative days 3 and 5. Threshold values were calculated to be 152 mg/l on day 3 and 73 mg/l on day 5. However, these values had a low sensitivity (75%, 76%) and specificity (67%, 61%).ConclusionEspecially considering the decreasing length of stay after THA, the question of the usefulness of regular inpatient CRP checks arises. AUC analysis of the ROC showed a poor diagnostic accuracy in almost all cases. Only the dynamic analysis of the maximum CRP value to the lowest CRP value with a decrease of 102.7 mg/l showed a fair accuracy. This calls into question the clinical relevance of CRP in the first postoperative week for detection of acute postoperative PJI.

The Diagnostic Value of Various Inflammatory Biomarkers for Diagnosing Periprosthetic Joint Infection is Gender-Specific.

ObjectivePrevious studies have suggested that the diagnostic biomarkers of periprosthetic joint infection (PJI) are largely influenced by gender. In the present study, we aimed to evaluate the diagnostic value of traditional inflammatory biomarkers, fibrinolytic biomarkers (fibrinogen and D-dimer), and C-reactive protein (CRP)/albumin for PJI in different genders.MethodsA single-center retrospective analysis was performed on revision total hip or knee arthroplasty between June 2013 to June 2021, and the study included 80 patients in the PJI group and 136 patients in the non-PJI group. PJI was diagnosed based on the International Consensus Meeting (ICM) in 2018. The levels of CRP, fibrinogen, erythrocyte sedimentation rate (ESR), D-dimer, and albumin count were determined. Receiver operating characteristic (ROC) curves and Youden’s index were used to evaluate the diagnostic ability of various biomarkers.ResultsThe levels of CRP, fibrinogen, D-dimer, ESR, and CRP/albumin were significantly higher in the PJI group (P < 0.001). In PJI of females, the predictive value of CRP was the highest among the five biomarkers, with the area under the curve (AUC) of 0.98. The optimal predictive cut-off for CRP was 8.86 mg/L, with a sensitivity and specificity of 90.2% and 95.7%, respectively. When combined with the other four biomarkers, the AUC of CRP was 0.98, 0.99, 0.98, and 0.99, respectively. In PJI of males, the predictive value of ESR was the highest among the five biomarkers, with an AUC of 0.92. The optimal predictive cut-off for ESR was 14.50 mm/h, with a sensitivity and specificity of 84.6% and 86.6%, respectively. When combined with the other four biomarkers, the AUC of ESR was 0.95, 0.94, 0.93, and 0.97, respectively.ConclusionCRP and ESR were excellent biomarkers for diagnosing PJI in female and male patients, respectively, and their combined use with CPR/albumin could provide higher diagnostic value in different genders.

MP12-04 PREDICTIVE IMPACT OF EARLY CHANGES IN SERUM C-REACTIVE PROTEIN LEVELS IN NIVOLUMAB PLUS IPILIMUMAB THERAPY FOR METASTATIC RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 May 2022MP12-04 PREDICTIVE IMPACT OF EARLY CHANGES IN SERUM C-REACTIVE PROTEIN LEVELS IN NIVOLUMAB PLUS IPILIMUMAB THERAPY FOR METASTATIC RENAL CELL CARCINOMA Hidekazu Tachibana, Yuki Nemoto, Hiroki Ishihara, Hironori Fukuda, Kazuhiko Yoshida, Junpei Iizuka, Yasunobu Hashimoto, Tsunenori Kondo, Kazunari Tanabe, and Toshio Takagi Hidekazu TachibanaHidekazu Tachibana More articles by this author , Yuki NemotoYuki Nemoto More articles by this author , Hiroki IshiharaHiroki Ishihara More articles by this author , Hironori FukudaHironori Fukuda More articles by this author , Kazuhiko YoshidaKazuhiko Yoshida More articles by this author , Junpei IizukaJunpei Iizuka More articles by this author , Yasunobu HashimotoYasunobu Hashimoto More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , Kazunari TanabeKazunari Tanabe More articles by this author , and Toshio TakagiToshio Takagi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002534.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Serum C-reactive protein (CRP) is reportedly associated with metastatic renal cell carcinoma (mRCC) activity. However, in the era of immune checkpoint inhibitors, the predictive value of CRP is unclear. In this study, we investigated the predictive impact of pretreatment CRP levels and early changes in CRP levels for the treatment of mRCC with nivolumab plus ipilimumab (NIVO-IPI) therapy. METHODS: Forty-eight patients with mRCC treated with NIVO-IPI as a first-line therapy were retrospectively analyzed. First, patients were divided into 2 groups: initial CRP ≥1.0 mg/dL and <1.0 mg/dL. Progression-free survival (PFS) was compared between the 2 groups. Second, based on the CRP change within the first three months of NIVO-IPI, patients were placed in the normal group (CRP remains <1.0 mg/dL), normalized group (CRP decreased <1.0 mg/dL), and non-normalized group (CRP remained or increased to ≥1.0 mg/dL). The predictive association between CRP change and PFS was evaluated. RESULTS: PFS was significantly lower in the high initial CRP group (n=24, 50%) compared to the normal CRP group (n=24, 50%) (median: 4.3 vs. 28.1 months, P=0.03). As for the early CRP change, the normal (2.7 vs. 28.1, P=0.0002) and normalized (2.7 vs. 11.0, P=0.0094) groups showed significantly higher PFS, compared to the non-normalized group. Meanwhile, there was no significant difference between normal and normalized groups (P=0.51). The objective response rate was higher in the normal (57.1% vs. 18.7%, P=0.015) and normalized (81.8 vs. 18.7%, P=0.0008) groups, compared to the non-normalized group. Multivariate Cox regression analysis showed that normal [Hazard ratio (HR)=0.15, 95% Confidence interval (CI)=0.02-0.70, P=0.026] and normalized (HR 0.21, 95% CI=0.05-0.73, P=0.015) CRP showed significant association with PFS. CONCLUSIONS: In the NIVO-IPI therapy for mRCC, early changes in CRP could predict PFS. This data may be useful for the early detection of ineffective NIVO-IPI therapy and conversion to subsequent therapies. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e166 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hidekazu Tachibana More articles by this author Yuki Nemoto More articles by this author Hiroki Ishihara More articles by this author Hironori Fukuda More articles by this author Kazuhiko Yoshida More articles by this author Junpei Iizuka More articles by this author Yasunobu Hashimoto More articles by this author Tsunenori Kondo More articles by this author Kazunari Tanabe More articles by this author Toshio Takagi More articles by this author Expand All Advertisement PDF DownloadLoading ...

BIOCHEMICAL PROFILE, BACTERIAL PROFILE, AND ANTIBIOTIC SUSCEPTIBILITY PATTERN OF THE ISOLATES OF NEONATAL SEPTICEMIA IN TERTIARY CARE HOSPITAL, VISAKHAPATNAM

Objectives: The objective of the study was to determine sensitivity, specificity, and predictive values of C-reactive protein (CRP), leukocyte count, platelet count, and blood culture as indicators of neonatal sepsis. Methods: This prospective study was conducted in the Department of Paediatrics, GITAM Institute of Medical sciences and Research, Visakhapatnam during January 2019 to December 2019. The institutional ethics committee had approved the study. Eighty clinically suspected cases of neonatal sepsis constituted material of study. All neonates who were clinically suspected sepsis, categorized into 0–72 h (early onset) or late onset (&gt;3 days) sepsis based on day of presentation. Detailed history and clinical findings were recorded in the pro forma and screened with CRP and various hematological tests with predetermined cutoff values and at the same time blood culture was sent. Concerning a clinical scenario CSF, urine analysis, chest X-ray, and infective focus swabs were all taken. The length of treatment and time spent in the hospital were recorded. The death rate was calculated, and numerous risk variables were evaluated. Results: Intrapartum risk factors such as a prolonged rupture of membrane &gt;24 h, a long labor, several filthy vaginal examinations (&gt;3) before birth, and foul-smelling liquid were all linked to culture-proven newborn sepsis. Any of the two risk factors listed above was a good predictor of sepsis with a positive culture. Neonatal sepsis impacted a higher percentage of low birth weight and preterm babies. The sensitivity and negative predictive value of the I/T ratio and CRP were both high. The most prevalent isolates were Klebsiella species, followed by Staphylococcus aureus and Escherichia coli. While S. aureus was 80% sensitive to Cefotaxime and Amikacin, Klebsiella species and E. coli were only 20% sensitive. All were sensitive to Ofloxacin in range of 75-100%. Septicemia with multiorgan dysfunction was the most common mode of death with 100% risk of mortality. Conclusion: Intraparum risk factors are significantly with culture proven sepsis. All sepsis screening parameters used were statistically significantly associated with culture proven sepsis. I/T ratio and CRP were more sensitivity and had high negative predictive value. CRP can be used as an early and predictable screening test for diagnosing neonatal sepsis.

Predictive Impact of Early Changes in Serum C-Reactive Protein Levels in Nivolumab Plus Ipilimumab Therapy for Metastatic Renal Cell Carcinoma.

Serum C-reactive protein (CRP) is reportedly associated with metastatic renal cell carcinoma (mRCC) activity. However, in the era of immune checkpoint inhibitors, the predictive value of CRP is unclear. In this study, we investigated the predictive impact of pretreatment CRP levels and early changes in CRP levels for the treatment of mRCC with nivolumab plus ipilimumab (NIVO-IPI) therapy. Forty-eight patients with mRCC treated with NIVO-IPI as a first-line therapy were retrospectively analyzed. First, patients were divided into 2 groups: initial CRP ≥ 1.0 mg/dL and < 1.0 mg/dL. Progression-free survival (PFS) was compared between the 2 groups. Second, based on the CRP change within the first 3 months of NIVO-IPI, patients were placed in the normal group (CRP remains < 1.0 mg/dL), normalized group (CRP decreased < 1.0 mg/dL), and non-normalized group (CRP remained or increased to ≥ 1.0 mg/dL). The predictive association between CRP change and PFS was evaluated. PFS was significantly lower in the high initial CRP group (n=24, 50%) compared to the normal CRP group (n=24, 50%) (median: 4.3 vs. 28.1 months, P=.03). As for the early CRP change, the normal (2.7 vs. 28.1, P=.0002) and normalized (2.7 vs. 11.0, P=.0094) groups showed significantly higher PFS, compared to the non-normalized group. Meanwhile, there was no significant difference between normal, and normalized groups (P=.51). The objective response rate was higher in the normal (57.1% vs. 18.7%, P=.015) and normalized (81.8 vs. 18.7%, P=.0008) groups, compared to the non-normalized group. Multivariate Cox regression analysis showed that normal [Hazard ratio (HR)=0.15, 95% Confidence interval (CI)=0.02-0.70, P=.026] and normalized (HR 0.21, 95% CI=0.05-0.73, P=.015) CRP showed significant association with PFS. In the NIVO-IPI therapy for mRCC, early changes in CRP could predict PFS. This data may be useful for the early detection of ineffective NIVO-IPI therapy and conversion to subsequent therapies.

Role Of C-Reactive Protein in Diagnosis of Acute Appendicitis

Background: Appendicitis is a common surgical emergency and diagnostic dilemma. Making the correct diagnosis is often difficult as the clinical presentation varies according to the age of the patient and the position of appendix. The objective of this study was to identify clinical applicability of C- reactive protein, as a diagnostic test for appendicitis.&#x0D; Methods: This prospective study was carried out in Federal government Polyclinic hospital, Islamabad from January to July 2019, 114 patients underwent appendectomy for clinically diagnosed acute appendicitis. The decision to operate the patient was given by senior registrar. The blood samples for C-reactive protein were drawn before taking the patient to the operating theatre. Removed appendices were sent for histopathological confirmation of diagnosis. The C-reactive protein was then compared with the results of histopathology to determine its validity. The data was entered and analysed in SPSS 23.&#x0D; Results: The sensitivity, specificity, positive and negative predictive values of C-reactive protein in patients with clinical diagnosis of acute appendicitis were found to be 94%, 78%, 93% and 74 % respectively.&#x0D; Conclusion: CRP is helpful in making diagnosis of acute appendicitis. It is highly sensitive but has a relatively low specificity.&#x0D;

Evaluation of the Predictive Value of C-reactive Protein, Interleukin-6 and Their Derived Immune-Inflammatory Indices in COVID-19 Egyptian Patients

Evaluation of the Predictive Value of C-reactive Protein, Interleukin-6 and Their Derived Immune-Inflammatory Indices in COVID-19 Egyptian Patients

Effect of preoperative immunonutrition on postoperative major morbidity after cytoreductive surgery and hipec in patients with peritoneal metastasis

Rationale: Preoperative immunonutrition intake effect on postoperative major complications in patients following cytoreductive surgery was assessed. The predictive value of C-Reactive Protein (CRP) for detecting postoperative complications was also analyzed.

Predictive Value of C-Reactive Protein for Early Postoperative Complications in Children After Hypospadias Surgery.

Background: This study explored the predictive value of postoperative C-reactive protein in children with hypospadias for postoperative complications and the risk factors.Methods: The clinical and follow-up data of 106 children with hypospadias who were treated with operations at Kunming Children's Hospital in 2020 were, respectively, analyzed. According to the occurrence of postoperative complications, the patients were divided into two groups: 25 patients with postoperative complications were the complications group, and 81 without postoperative complications were the control group. The baseline data, clinical characteristics, laboratory test indexes, and outcome of the two groups were collected. Receiver operating characteristic (ROC) was used to calculate the optimal cutoff value of C-reaction protein (CRP). Logistic regression was used to analyze the risk factors of hypospadias after surgery. A probability value (P) < 0.05 was considered statistically significant.Results: According to the result of the ROC curve, the optimal cutoff value of CRP was 11.7 mg/L. Logistic regression showed that the length of urethral defect, the urethral material, the operative produce, and the postoperative CRP level were related to the occurrence of postoperative complications of patients with DCC. The length of the urethral defect and the CRP level were the independent risk factors of the prognosis of hypospadias patients. The CRP level was related to the occurrence of postoperative complications and fistula.Conclusions: Postoperative CRP level can be used as a reliable marker for predicting the prognosis of hypospadias patients.

Post-operative kinetics of C-reactive protein to distinguish between bacterial infection and systemic inflammation in infants after cardiopulmonary bypass surgery: the early and the late period.

Differentiation between post-operative inflammation and bacterial infection remains an important issue in infants following congenital heart surgery. We primarily assessed kinetics and predictive value of C-reactive protein for bacterial infection in the early (days 0-4) and late (days 5-28) period after cardiopulmonary bypass surgery. Secondary objectives were frequency, type, and timing of post-operative infection related to the risk adjustment for congenital heart surgery score. This 3-year single-centre retrospective cohort study in a paediatric cardiac ICU analysed 191 infants accounting for 235 episodes of CPBP surgery. Primary outcome was kinetics of CRP in the first 28 days after CPBP surgery in infected and non-infected patients. We observed 22 infectious episodes in the early and 34 in the late post-operative period. CRP kinetics in the early post-operative period did not accurately differentiate between infected and non-infected patients. In the late post-operative period, infected infants displayed significantly higher CRP values with a median of 7.91 (1.64-22.02) and 6.92 mg/dl (1.92-19.65) on days 2 and 3 compared to 4.02 (1.99-15.9) and 3.72 mg/dl (1.08-9.72) in the non-infection group. Combining CRP on days 2 and 3 after suspicion of infection revealed a cut-off of 9.47 mg/L with an acceptable predictive accuracy of 76%. In neonates and infants, CRP kinetics is not useful to predict infection in the first 72 hours after CPBP surgery due to the inflammatory response. However, in the late post-operative period, CRP is a valuable adjunctive diagnostic test in conjunction with clinical presentation and microbiological diagnostics.

Metabolic Syndrome and Related Inflammation, Prevalence, and Predictive Value of C-Reactive Protein in South Asian Youths.

Background: Metabolic syndrome (MetS) is widely prevalent in the South Asian (SA) population. The syndrome leads to a high risk of premature atherosclerosis and diabetes. Obesity, specifically abdominal obesity, is a central pathological mechanism of disease in this population. Ethnic-specific modified measurements of waist circumference (WC) have been proposed for the diagnosis in various populations, including those of SA phenotype. We studied the prevalence of MetS and subclinical inflammation in young physically fit students in a major urban city of Pakistan. Specifically, we addressed the new lower WC measurement and its relationship with MetS and inflammation. C-reactive protein (CRP) was measured as a marker for subclinical inflammation. Methods: A total of 509 respondents (mean age 19.86 years) filled out self-administered questionnaires for data collection. Measurements were made by trained nurses using standardized equipment and fasting blood samples were drawn for chemical analysis. Data were verified, tabulated, and statistically analyzed. Results: MetS was identified in 6% of this cohort and 16% had subclinical information as measured by CRP. Higher CRP levels were noted with higher WC and independently identified subjects with MetS. CRP levels of ≥2.2 mg/dL predicted presence of MetS. Conclusions: MetS is widely prevalent in young, otherwise physically fit, individuals. High proportion of this young cohort had evidence of subclinical inflammation as measured by CRP. Increasing WC showed significant correlation with higher CRP levels, level of 2.2 mg/dL independently identified MetS in this cohort.

Predictive value of C-reactive protein for radiographic spinal progression in axial spondyloarthritis in dependence on genetic determinants of fibrin clot formation and fibrinolysis

ObjectiveGenetic determinants of fibrin clot formation and fibrinolysis have an impact on local and systemic inflammatory response. The aim of the present study was to assess whether coagulation-related genotypes affect...

C-reactive Protein for Stroke Detection in the Emergency Department in Patients With Dizziness Without Neurological Deficits.

Background: Stroke diagnosis can be challenging in patients with dizziness without neurologic deficits. The aim of this study was to evaluate the predictive value of C-reactive protein (CRP) for identifying acute stroke in such patients.Methods: Data from adult patients (>18 years) admitted to the emergency department from August 2019 to February 2020 were evaluated. The study subjects were 1,188 patients presenting with dizziness without neurological deficits whose serum CRP level was measured within 2 h of arriving at the emergency department and who underwent brain magnetic resonance imaging. The relationship between CRP and acute stroke was analyzed using univariable and multivariable models.Results: Acute stroke was detected in 53 (4.4%) patients (40 with brain infarction, 10 with vertebrobasilar insufficiency, 2 with intracerebral hemorrhage, and 1 with subarachnoid hemorrhage). The CRP levels did not differ significantly between the acute stroke and non-stroke groups [0.10 (0.10–0.31) vs. 0.10 (0.10–0.16), P = 0.074]. The area under receiver operating characteristic curve of CRP for acute stroke was not statistically significant (0.567, P = 0.101). On multivariable analysis, the following variables were associated with acute stroke: age (odds ratio [OR], 1.041; 95% confidence interval [CI], 1.011–1.071), history of cerebrovascular accidents (OR, 1.823; 95% CI, 1.068–3.110), white blood cell count (OR, 1.126; 95% CI, 1.017–1.248), and hemoglobin (OR, 1.316; 95% CI, 1.056–1.640). However, CRP (P = 0.183) was not associated with acute stroke.Conclusion: Serum CRP levels do not have significant discriminative value for identifying acute stroke in patients with dizziness without definite neurologic deficits.

Predictive value of C-reactive protein to albumin ratio as a biomarker for initial and repeated intravenous immunoglobulin resistance in a large cohort of Kawasaki disease patients: a prospective cohort study

BackgroundIntravenous immunoglobulin (IVIG) resistance prediction is one pivotal topic of interests in Kawasaki disease (KD). This study aimed to prospectively investigated the value of C-reactive protein-to-albumin (CAR) in predicting both initial and repeated IVIG resistance in patients with KD, and to test the hypothesis that CAR was more valuable or accurate than either C-reactive protein (CRP) or albumin (ALB) alone in IVIG resistance prediction.MethodA prospective cohort study involving 550 patients with KD was conducted. The clinical and laboratory data were compared between IVIG-response group and IVIG-resistance group. Multivariate logistic regression analysis was performed to identify the independent risk factors of initial/repeated IVIG resistance. Receiver operating characteristic (ROC) curves analysis was applied to assess the validity of CAR, CRP and ALB in predicting both initial and repeated IVIG resistance.ResultsCAR was significantly higher in IVIG non-responders and was identified as independent risk factor for both initial and repeated IVIG resistance in KD. The best cut-off value of CAR for initial and repeated IVIG resistance prediction was 2.07 and 3.34, with a corresponding sensitivity of 0.610 and 0.548, a specificity of 0.552 and 0.813, respectively. The value of CAR was not better than either CRP or ALB alone for both initial and repeated IVIG resistance prediction.ConclusionA higher CAR was an independent risk factor for both initial and repeated IVIG resistance. However, similar with that of CRP or ALB, the predictive value of CAR was not good enough for both initial and repeated IVIG resistance prediction in KD.

Laparoscopic colorectal resection for deep infiltrating endometriosis: can we reliably predict anastomotic leakage and major postoperative complications in the early postoperative period?

Anastomotic leakage (AL) and major complications after colorectal resection for deep infiltrating endometriosis (DIE) have a remarkable impact on patient outcomes. The aim of this study is to assess the predictive value of C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBCs) and the Dutch Leakage Score (DLS) as reliable markers in the early diagnosis of AL and major complications after laparoscopic colorectal resection for DIE. 262 consecutive women undergoing laparoscopic colorectal resection for DIE between September 2017 and September 2018 were prospectively enrolled. WBCs, CRP, PCT and DLS were recorded at baseline and on postoperative day (POD) 2, 3 and 6 then statistically analyzed as predictors of AL and severe postoperative complications. The AL rate was 3.2%. The major morbidity rate was 11.2%. No postoperative mortality was recorded. The postoperative trend of DLS and serum levels of CRP and PCT, but not WBCs, were significantly higher in women developing AL and severe complications. DLS had better sensitivity and specificity than biomarkers on all postoperative days as a predictor of AL and major complications. CRP and PCT have a low positive predictive value (PPV) and a high negative predictive value (NPV) for AL and major complications on POD3 and POD6. The risk of malnutrition was significantly related to AL. The combination of DLS as a standardized postoperative clinical monitoring system and CRP and PCT as serum biomarkers, allows the exclusion of AL and major complications in the early postoperative period after laparoscopic colorectal resection for DIE, thus ensuring a safe patient discharge.

A study to assess the predictive value of CRP in detecting type-II diabetes mellitus with nephropathy

To assess C reactive protein (CRP) in detecting type-II diabetes mellitus with nephropathy. Patients with a history of diabetes type 2 with nephropathy and patients with diabetes type 2 without nephropathy were included in the study. A total of 30 cases, both male and female, were recruited and compared with30 normal healthy adults. Each participant (age, gender, BMI, i.e. body mass index and WHR, i.e. waist-hip ratio) were recorded. CRP was measured by immunoturbidimetric method. Total cholesterol, triglycerides, and high-density lipoprotein (HDL) cholesterol were measured by the CHOD-POD method, GPO-PAP method, and CHOD-POD/phosphotungstic method. Low-density lipoprotein (LDL)cholesterol and very low-density cholesterol were measured by Friedewald formula. Lipoprotein ratios ware also calculated. CRP was significantly (p=0.0001) higher among cases (12.60±3.30) compared to controls (5.47±4.29). CRP &gt;9.5 correctly (efficacy) predicted DM2 with DN among 46.7% cases with sensitivity and specificity of 93.3 (95%CI=84.4-102.3) and 76.7 (95%CI=61.5-91.8) respectively. The area under the curve (AUC) was also high (AUC=0.85, 95%CI=0.75-0.95). There was a poor correlation of CRP with lipid profile among DM-2 with DN. Linear regression analysis showed that lipid biomarkers such as HDL, LDL, VLDL &amp; total cholestarol-to-HDL ratio as well as BMI and WHR were positive predictors of CRP after adjusted for age and sex. In turn, HDL, LDL, VLDL and TC to HDL ratio level were a negative predictive factor of CRP levels. The increase of 1 unit on HDL was associated with a reduction of 1.25 in CRP levels. However, all the predictors had no statistical significance (p&gt;0.05). In this study, the level of CRP was higher among cases compared to controls. This study also found that CRP &gt;9.5 had good sensitivity and specificity in predicting DM2 with DN.

The diagnostic value of C-reactive protein for predicting pancreatic fistula following pancreatoduodenectomy

Introduction Pancreaticoduodenectomy is the preferred treatment of neoplasms in the pancreas and duodenum. Postoperative pancreatic fistula is a critical complication. A potential predictive marker is C-reactive protein. This retrospective study examined the predictive value of C-reactive protein as a marker for development of postoperative pancreatic fistulas. Methods All patients who had a pancreaticoduodenectomy from 1 January 2015 to 31 December 2019, were included. Levels of the biomarker and linear trajectory were determined for postoperative days one to four. Univariate analysis was used to identify predictive variables for a postoperative pancreatic fistula. Receiver operating characteristics curves, specificity, and sensitivity were calculated. Results Five hundred and fifty-two patients underwent pancreaticoduodenectomy. C-reactive protein level greater than 121.5mg/L on the third postoperative day and an increase in C-reactive protein level between the first and fourth postoperative days, greater than 21.7mg/L, seemed to be reliable predictors. For Grade C postoperative pancreatic fistulas, increases in C-reactive protein, greater than 40.6ml/L the first four postoperative days, had a sensitivity of 100%. White blood cell count did not have similar reliability in predicting postoperative pancreatic fistulas. Conclusion Our findings indicate that small rises in C-reactive protein during the first postoperative days after pancreaticoduodenectomy are associated with an increased risk of developing postoperative pancreatic fistula.

The Predictive Value of C-reactive Protein to Albumin Ratio to Detect Contrast-induced Acute Kidney Injury in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

The Predictive Value of C-reactive Protein to Albumin Ratio to Detect Contrast-induced Acute Kidney Injury in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Predictive Value of C-reactive Protein, Lactate Dehydrogenase, Ferritin and D-dimer Levels in Diagnosing COVID-19 Patients: a Retrospective Study.

Background:Since December 2019. millions of people in the world have been affected with the novel Coronavirus disease-2019 (COVID-19) pandemic, and high economic impact has affect many countries especially low socioeconomic one like Iraq due to the high cost and limited availability of RT-PCR for diagnosis of COVID-19, so there should be predictive low cost easily available laboratory tests that can be used before proceeding to the high cost techniques.Objective:In this retrospective study we aimed to evaluate the diagnostic accuracy of CRP, ferritin, LDH and D-dimer in predicting positive cases of COVID-19 in Iraq.Methods:It is a retrospective observational cohort study based on STARD guidelines to determine the diagnostic accuracy of (CRP, LDH, ferritin and D dimer) for COVID-19 of electronic medical records of private medical center in Najaf city, at which 566 individuals were recruited. The investigated subjects were either in close contact with previously COVID-19 positive patients or have one or more symptoms of COVID-19. They were categorized into 2 groups, 205 subjects diagnosed with RT-PCR as COVID-19 negative, and 361 COVID-19 positive patients, results of study variables of the cohort were recruited from the medical records.Results:Combining of these parameters had the following findings: CRP + ferritin; AUC: 0.77 with 55% sensitivity and 97% specificity, Ferritin + LDH; AUC: 0.83 with 65% sensitivity and 92% specificity, CRP+LDH; AUC: 0.78 with 56% sensitivity and 98% specificity, CRP + LDH + ferritin; AUC: 0.85, with 73% sensitivity and 88% specificity, CRP + LDH + ferritin + D dimer; AUC: 0.85 75% sensitivity and 87% specificity.Conclusion:Combination of routine laboratory biomarkers (CRP, LDH and ferritin ±D dimer) can be used to predict the diagnosis of COVID-19 with an accepted sensitivity and specificity before proceeding to definitive diagnosis by RT-PCR.

Periprosthetic infection risks and predictive value of C-reactive protein / albumin ratio for total joint arthroplasty.

Background and aim:There are no gold standard markers to estimate the risk of developing periprosthetic infections. Our aim is to compare the risks of periprosthetic infection in patients with THA and THA and to investigate the predictive significance of the CRP / albumin ratio.Methods:This is a retrospective study containing data from 241 osteoarthritis patients and 19 patients with periprosthetic infections who underwent TKA and THA in our hospital from January 2014 to January 2019.12 risk factors(CRP/ albumin, albumin, CRP, age, gender, BMI, DM, ASA, nasal culture, urine culture, hospital stay, operation time) were analyzed.Results:In the binary logistic regression model and multivariate regression analysis, the rate of CRP / albumin was 17.161 times higher than the patients with ≤0.16 cut-off value. (CRP / albumin ratio (odds ratio (OR) = 17.16, 95% CI: 1.55-189.03, P: 0.02). High BMI increased the risk of periprosthetic infection 1.3 times. Nasal bacterial colonization (OR = 0.99, 95% CI: 0.868-1.38, P: 0.7) and bacterium in urine (OR = 0.502, 95% CI: 0.07-3.598, P: 0.703) did not pose a significant risk for periprosthetic infection.Conclusion:According to our findings, the CRP / albumin ratio has a more prognostic capacity than other risks in determining the risk of periprosthetic infection for total joint arthroplasty. CRP / albumin ratio is a cheap and easy to apply marker. Routine urine and nasal bacteria screening is not required before total joint arthroplasty.