Preoperative Serum C-reactive Protein Research Articles

Age-related changes in intraoperative mean values of nociceptive response in patients undergoing non-cardiac surgery under general anesthesia: A retrospective cohort study.

Intraoperative nociception is affected by preoperative factors, surgical invasiveness, and anesthesia. Although age-related changes in nociception in conscious humans have been well examined, those in intraoperative nociception in unconscious patients under general anesthesia are unknown. To clarify associations between age and intraoperative nociception under general anesthesia, we performed a retrospective cohort study in consecutive patients of all ages undergoing non-cardiac surgery under general anesthesia from January 2019 to July 2023. The intraoperative nociception value in each surgery was assessed by the averaged value of nociceptive response (mean NR) index during surgery. Patient characteristics, including age, sex, body mass index (BMI), emergent surgery, preoperative serum C-reactive protein (CRP) level, and comorbidities were also collected. After excluding patients with missing data of CRP and mean NR index, 22,061 patients were enrolled, and were divided into low, intermediate, and high surgical risk groups. Multivariable regression analysis showed a significant association between age and mean NR index in all three surgical procedure risk groups. The preoperative variables of CRP levels, BMI, emergent surgery, atrial fibrillation, renal failure, and long-term steroid use also showed significant associations with mean NR index in all three groups. Sensitivity analysis showed that intraoperative mean NR index was higher in younger children than that in both older children and younger adults, and it gradually increased again in older adults to the same level as in younger children. In conclusion, there is likely an association between age and intraoperative mean NR index in patients under general anesthesia.

Comparison of the decompressive craniectomy results in patients with ischemic stroke and acute subdural hematoma and determination of prognostic markers

Aims: This study aimed to investigate the therapeutic effectiveness of decompressive craniectomy in patients with traumatic acute subdural hematoma and stroke patients and to determine the parameters that could predict the risk of mortality in these patients. Methods: Patients diagnosed and operated on with acute subdural hematoma (ASH) or stroke between January 2022 and September 2023 were grouped into the ASH group and the CVO group. The patients were also divided into DEAD and SURVIVED groups according to mortality. Age, gender, anisocoria, the area of the craniectomy field, length of stay in the intensive care unit (ICU), length of stay in the hospital, and Glasgow Outcome Scale scores were recorded. In addition, Glasgow Coma Scale (GCS) scores, the amount of midline shift, and the blood biochemistry results were recorded pre-and postoperatively. Results: This study consisted of 11 (5 male and 6 female) patients. Sex, preoperative GCS score, anisocoria, postoperative sedation anesthesia time, postoperative GCS score, duration of stay in the ICU, preoperative serum blood urine nitrogen, preoperative serum C-reactive protein (CRP), postoperative neutrophil-to-lymphocyte ratio, and postoperative CRP values were different between the ASH and CVO groups (p<0.05). Furthermore, the preoperative GCS score, postoperative GCS score, postoperative sedation anesthesia duration, postoperative serum aspartate aminotransferase (AST), and postoperative serum CRP level values were different between the DEAD and SURVIVED groups (p<0.05). The correlation analysis results revealed a positive correlation between mortality and preoperative GCS score and a negative correlation between mortality and anisocoria (p<0.05). The ROC-curve analysis revealed that preoperative GCS and postoperative GCS score, postoperative midline shift, postoperative serum AST level value, and postoperative serum CRP level value could predict mortality risk (p<0.05). However, Logistic Regression analysis showed that any study parameter could be used as the best marker for prediction of the postoperative mortality risk (p>0.05). Conclusion: This study showed that decompressive craniectomy may offer more satisfactory results in severe head trauma patients. It was also argued that preoperative and postoperative GCS scores, postoperative midline shift values, and postoperative serum AST and CRP level values could be used to predict mortality risk.

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.

Association between preoperative serum C-reactive protein level and leukocyte count and postoperative pain after otolaryngological surgery

PurposeTo determine whether the preoperative inflammatory serum C-reactive protein (CRP) and leukocyte count (LEUK) are associated with postoperative pain and complaints after otolaryngological surgery.MethodsRetrospective evaluation of 680 patients (33% female, median age 50 years) receiving otolaryngological surgery between November 2008 and March 2017 in a tertiary university hospital. Postoperative pain on the first postoperative day was assessed using the validated questionnaire of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including a numeric rating scale for assessment of postoperative pain (NRS, 0–10). The influence of preoperative parameters including CRP and LEUK on patients' postoperative pain was estimated.ResultsMean CRP value was 15.6 ± 34.6 mg/l and mean LEUK value 7.8 ± 3.2 Gpt/l. Patients with pharyngeal surgery had the highest CRP values (34.6 ± 52.9 mg/l), highest LEUK values (9.2 ± 4.2 Gpt/l) and the highest pain levels (3.1 ± 2.4 NRS) compared to all other surgical procedures (all p < 0.05). Higher postoperative pain was associated with LEUK values > 11.3 Gpt/l (r = 0.093, p = 0.016) and higher preoperative chronic pain (r = 0.127, p = 0.001). Multivariate analysis confirmed younger age, female gender, duration of surgery, preoperative chronic pain, type of surgery, and higher LEUK values > 11.3 as independent factors for postoperative pain. Perioperative antibiotics had no effect on the postoperative pain.ConclusionBeyond known factors, preoperative LEUK as inflammation marker is an independent predictor for pain on the first postoperative day.

Do Elevated Serum C-Reactive-Protein Levels Excuse Delayed Surgery for Femoral Neck Fractures?

In elderly patients with femoral neck fractures, preoperative serum C-reactive protein (CRP) values might be elevated due to active infections. Although there are limited data on CRP as a predictor of periprosthetic joint infection (PJI), out of concern, this could lead to delayed surgery. Therefore, we aim to investigate whether elevated serum-CRP levels justify delayed surgery for femoral neck fractures. A retrospective analysis was performed of the records of patients undergoing arthroplasty who were found to have an elevated CRP level of 5 mg/dL or more between January 2011 to December 2020. The patients were stratified to three groups, according to initial serum CRP levels at a cut off of 5 mg/dL and the time between admission and surgery (<48 vs. ≥48 h after admission). This study revealed that the patients with elevated serum CRP levels and delayed surgery showed a worse survival rate and significantly more postoperative complications than the patients on whom surgery was performed immediately. There were no significant differences in terms of PJI and prolonged wound healing in the inter-group comparison. Therefore, delays to surgery on the basis of elevated CRP values offer no benefits to patients with femoral neck fractures.

What is the concordance rate of preoperative synovial fluid aspiration and intraoperative biopsy in detecting periprosthetic joint infection of the shoulder ?

The accuracy of preoperative synovial fluid culture for microbe detection in shoulder periprosthetic joint infection (PJI) is poorly described. To evaluate the utility of preoperative culture data for early pathogen identification for shoulder PJI, we determined the concordance between preoperative synovial fluid culture results and intraoperative tissue culture results. Fifty patients who met the 2014 Musculoskeletal Infection Society criteria for shoulder PJI between January 2016 and December 2019 were retrospectively reviewed for clinical and demographic data. This cohort of patients was divided in two groups based on the concordance between preoperative and intraoperative culture results. The pathogens identified on preoperative and intraoperative cultures were classified as high-virulence or low-virulence. Student's t tests and Mann-Whitney U tests were used as appropriate for continuous variables and chi-square and Fisher's exact tests were used as appropriate for categorical variables. Concordance between preoperative aspiration and intraoperative tissue culture was identified in 28 patients out of 50 (56%). Preoperative cultures positive for Gram-positive species were more likely to be concordant than discordant (p=0.015). Preoperative cultures positive for Cutibacterium acnes were more likely to be concordant with intraoperative cultures (p=0.022). There were more patients with polymicrobial infection in discordant group compared to concordant group (p<0.001). No statistically significant correlation between preoperative serum CRP level and intraoperative category of bacteria was reported. Staphylococcus aureus and coagulase-negative Staphylococci were associated with high specificity and negative predictive value (NPV). Preoperative cultures positive for Cutibacterium acnes demonstrated sensitivity, specificity, positive predictive value (PPV) and NPV lower than 0.8. Gram-negative pathogens demonstrated the highest sensitivity (1) and specificity (1), while polymicrobial infections exhibited the lowest sensitivity and PPV. Preoperative synovial fluid aspiration for shoulder PJI poorly predicts intraoperative culture results, with discordance of 44%. More favorable concordance was observed for monomicrobial preoperative cultures, particularly for Gram-negative organisms and methicillin-sensitive Staphylococcus aureus. The overall high rate of discordance between preoperative and intraoperative culture may prompt surgeons to base medical and surgical management on patient history and other factors and avoid relying solely on preoperative synovial fluid culture data.

Accuracy of C-Reactive Protein Level in the Diagnosis of Acute Appendicitis on Histopathology

Background: Acute appendicitis (AA) is one among most common condition requiring emergency surgery throughout the world. Acute appendicitis most common diagnosis in patients seeking medical help in emergency room due to acute abdomen causing 72,000 deaths among 16 million cases reported globally. This study will help the surgeons in making timely decisions, thus reducing the morbidity and mortality associated with complicated appendicitis. The aim of this study was to accuracy of C - reactive protein (CRP) levels in acute appendicitis. Material and Methods: Six-month descriptive cross-sectional research from 16 February to 16 August 2019 was completed. The Khyber Teaching Hospital in Peshawar served as the study's location. A total of 216 patients were monitored throughout this investigation. The history, clinical examination, and regular laboratory tests, such as the total leucocyte count (TLC) and differential leucocyte count (DLC) on admission, were used to make the diagnosis of acute appendicitis. All of these patients were given Nil by Mouth to prepare them for emergency surgery, and baseline testing included HBs Ag and Anti-HCV serology as well as pre-operative serum CRP levels (Liver function tests, renal function tests and serum electrolytes). Following preparation, every patient on the emergency list had surgery. Intra-operative results were recorded, and a biopsy was collected from the excised appendices and forward to histopathology for further processing. Results: The mean age in this research was 48 years, with an SD of 12.311. Male patients made up 55% of the total population, while female patients made up 45%. The diagnostic accuracy of C-reactive protein levels was determined to be 84.2% in this study. The specificity was found to be 33.3%, while the sensitivity was observed to be 85.7%. By using histopathology, it was discovered that the positive predictive value was 97.2% and the negative predictive value was 84.2%. Conclusion: According to our study, using histopathology, the diagnostic accuracy of C-reactive protein levels was 84.25% with sensitivity of 85.71%, specificity of 33.33%, and positive predictive values of 97.25% and 184.25%. The findings will also open the door for any further research in this area. . The higher CRP levels will therefore predict the complexity of acute appendicitis and help the general practitioners to do early referrals therefore avoiding life threatening complications Keywords: Acute Appendicitis, C-Reactive Protein, Histopathology, CRP, Gold Standard

Editors' Note: Shoulder-Tap Test for Functional Gait Disorders: A Sign of Abnormal Anticipatory Behavior

We evaluated the significance of the preoperative serum C-reactive protein (CRP) level as a prognostic indicator in patients with non-small cell lung cancer (NSCLC). Patients and Methods: Two hundred and three patients who had undergone a curative resection of NSCLC were retrospectively reviewed. Results: The proportion of the tumor size over 3 cm per patient in the CRP-positive group (≥0.5 mg/dL: n=38) was significantly higher than that in the CRP-negative group (&lt;0.5 mg/dL: n=165). The proportion of the adenocarcinoma in CRP-positive group was significantly lower than that in CRP-negative group. The overall and disease specific survival rates in the CRP-positive group were significantly lower than the rates in the CRP-negative group. Based on a multivariate analysis, the preoperative serum CRP level was selected as one of the unfavorable indicators regarding survival. Conclusion: The preoperative serum CRP level is an independent and significant indicator predictive of a poor prognosis in patients with NSCLC.

Survival Outcome after Reduced-Port Laparoscopic Radical Cystectomy for Bladder Cancer: Long-Term Follow-Up Analysis

Introduction: This study had two objectives: (i) to evaluate oncological outcomes in a long-term follow-up of patients with bladder cancer after reduced-port laparoscopic radical cystectomy (RP-LRC) and (ii) to assess the effect of modified Glasgow prognostic scores (mGPS) on patient outcomes. Methods: Consecutive patients (n = 100) who received RP-LRC between March 2012 and December 2018 at our institution and affiliated hospital were retrospectively reviewed. Preoperative serum albumin and C-reactive protein levels were determined. Patients were grouped based on clinical T stage (≤cT2: n = 75, ≥cT3: n = 25) using pooled cumulative data. Oncological outcomes and mGPS as a prognostic biomarker were analyzed retrospectively. Kaplan-Meier curves displayed recurrence and survival rates. Univariate and multivariate Cox regression analyses evaluated potential prognostic factors for recurrence-free survival (RFS) and cancer-specific survival (CSS). Results: Patient characteristics between the two groups were statistically similar for preoperative hematological and mGPS status, blood loss level, rate of allogeneic transfusion, and pneumoperitoneum time. After a median follow-up period of 55 months, 40/100 patients experienced disease relapse. RFS and CSS for ≤cT2 were significantly less than for ≥cT3 (p < 0.001, p < 0.05, respectively). Distant metastasis occurred in 30 patients with similar distributions of relapse sites between T-stage cohorts. Median RFS for mGPS 1/2 were 18.9 (95% confidence interval [CI]: 8.8–not assessed [NA]) and 35.0 (95% CI: 8.7–NA) months, respectively, significantly worse than for mGPS 0 (median NA, 95% CI: NA–NA); CSS was similar. Univariate and multivariate analyses revealed ≥cT3 stage, worse clinical N stage, and poor mGPS status were significant prognostic factors for short RFS and CSS. Conclusions: A large proportion of bladder cancer patients who undergo RP-LRC experience relapse, with ≥cT3 stage, worse clinical N stage or poor mGPS status identified as significant prognostic factors. Our findings may contribute to improved surgical procedures for such patients.

Prognostic impact of preoperative Geriatric Nutritional Risk Index in oral squamous cell carcinoma.

To investigate the prognostic impact of preoperative Geriatric Nutritional Risk Index (GNRI) values in older adults undergoing radical surgery for oral squamous cell carcinoma (OSCC). This retrospective study included 61 patients ≥65 years old with OSCC (43 men, 18 women; age: 72.1 ± 5.4 years) who underwent radical surgery between 2013 and 2020. Factors influencing overall survival (OS) and disease-free survival (DFS) were examined. Receiver operating characteristic curve analysis indicated that the optimal GNRI value for classifying patients into low-GNRI (<93.7; OS: n=19 [31.1%], DFS: n=42 [68.9%]) and high-GNRI groups (≥93.7; OS, n=19 [31.1%]; DFS, n=42 [68.9%]) was 93.7. OS and DFS rates were significantly lower in the low-GNRI group than in the high-GNRI group. Univariate analysis indicated that alcohol use, preoperative serum C-reactive protein level, lymphatic invasion, postoperative treatment, and GNRI were significantly correlated with OS, while lymphatic invasion, postoperative treatment, and GNRI were significantly correlated with DFS. In multivariate analysis, only GNRI was significantly correlated with OS. DFS and postoperative treatment were independent predictors of DFS. Preoperative GNRI may be a significant prognostic factor in older adults with OSCC. GNRI assessment and nutritional intervention may improve prognosis in patients at high nutritional risk.

Potential Blood Biomarkers for Diagnosing Periprosthetic Joint Infection: A Single-Center, Retrospective Study.

Background: Blood biomarkers are first-line tools for identifying periprosthetic joint infection (PJI). C-reactive protein (CRP) is currently recognized as the standard biomarker for PJI diagnosis. Other recently reported novel biomarkers, including plasma fibrinogen, platelet count, monocyte/lymphocyte ratio (MLR), neutrophil/lymphocyte ratio (NLR), and platelet count/lymphocyte ratio (PLR), have also shown promise in diagnosing PJI. This study aimed to evaluate whether these biomarkers were superior to CRP for identifying PJI. Methods: Patients who underwent revision hip or knee arthroplasty at our hospital from January 2008 to September 2020 were included consecutively and divided into infected and non-infected groups according to the 2013 International Consensus Meeting Criteria. Blood samples were collected preoperatively, and erythrocyte sedimentation rate (ESR), CRP, interleukin-6, fibrinogen, platelet count, MLR, NLR, and PLR were analyzed. The diagnostic values of the tested biomarkers and their combinations were compared with CRP based on the area under the receiver operating characteristic curve (AUC) using the z-test. Classification trees were constructed to explore more accurate combinations of the tested markers for identifying PJI. Results: A total of 543 patients were included, of whom 245 had PJI. Among the tested biomarkers, CRP with a cutoff of 7.39 mg/L showed the highest AUC, which gave a sensitivity of 79.1% and specificity of 86.0%. The AUCs of pairwise combinations of tested markers including CRP also were inferior to CRP itself, as were combinations derived from classification trees. Conclusions: Preoperative serum CRP with a low cutoff may be the best reliable blood biomarker for identifying PJI, and those traditional or novel available blood biomarkers could not further improve the diagnostic ability on the basis of CRP.

C-reactive protein kinetics to predict recurrence of high-risk renal cell carcinoma after radical surgery.

With new options in adjuvant settings, clinical biomarkers to predict recurrence after radical surgery for high-risk renal cell carcinoma (hrRCC) are in need but are scarcely investigated. We aimed to verify the predictive value of perioperative C-reactive protein (CRP) kinetics on hrRCC recurrence. We retrospectively evaluated 154 patients who underwent radical surgery for hrRCC (≥ pT3 and/or N1-2 and M0) at two institutions. Patients were classified into Normal (< 0.5) and High (≥ 0.5) according to their preoperative serum CRP (mg/dL). The High group were further classified into Normalized (< 0.5 at post) or Non-normalized (≥ 0.5 at post), and recurrence-free survival (RFS) was compared between groups. Factors for RFS were further analysed, and Harrell's concordance index (C-index) for the accuracy of predicting RFS was compared with and without the addition of CRP-related variables to pre-existing models. The RFS was significantly shorter in the High (n = 72, 46.8%) compared to the Normal (n = 82, 53.2%) group (9.7 vs. 66.7months, p < 0.001). Within the High group, Non-normalized (n = 27, 17.5%) patients showed a significantly shorter RFS compared to the Normalized (n = 45, 29.2%) group (6.2 vs. 20.3, p = 0.009). In the multivariable stepwise analysis, CRP kinetics (hazard ratio 2.15, p = 0.029) effectively predicted RFS while baseline CRP fell short of significance. Higher C-index improvement was observed with CRP non-normalization than the baseline value when added to factors in the Karakiewicz and University of California Los Angeles Integrated Staging System models. CRP kinetics effectively predicted RCC recurrence after surgery and may aid in decision-making for adjuvant systemic therapy.

Preoperative serum C-reactive protein concentration can be used to detect gallbladder rupture in dogs with gallbladder mucocele.

To determine whether serum C-reactive protein (CRP) concentration could be used to detect gallbladder rupture (GBR) prior to surgery in dogs undergoing cholecystectomy for treatment of gallbladder mucocele (GBM). 45 dogs that underwent cholecystectomy because of GBM at a companion animal referral hospital from 2017 to 2020. Electronic medical records were reviewed, and dogs were included if serum CRP concentration had been measured within 24 hours prior to cholecystectomy. Dogs were grouped as to whether the gallbladder was found to be ruptured or intact during surgery. Accuracy of using preoperative CRP concentration to predict GBR was compared with accuracy of abdominal ultrasonography and other preoperative blood tests. GBR was present in 15 dogs at the time of surgery. Median preoperative CRP concentration was significantly higher in dogs with GBR (15.1 mg/dL; interquartile range, 7.4 to 16.8 mg/dL) than in dogs with an intact gallbladder (2.65 mg/dL; interquartile range, 0.97 to 13.4 mg/dL). Sensitivity, specificity, and accuracy of using preoperative CRP concentration to predict GBR were 100%, 67%, and 78%, respectively. Measurement of preoperative CRP concentration provided excellent sensitivity and moderate specificity for detection of GBR in dogs undergoing cholecystectomy because of GBM. Accuracy of using preoperative CRP concentration for detection of GBR was not superior to the accuracy of preoperative abdominal ultrasonography. However, when CRP concentration was combined with results of ultrasonography, the sensitivity, specificity, and accuracy for detection of GBR were 100%, 93%, and 96%, respectively.

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 independently predicts survival in pancreatic neuroendocrine neoplasms

Pancreatic neuroendocrine neoplasms (pNEN) are highly variable in their postresection survival. Determination of preoperative risk factors is essential for treatment strategies. C-reactive protein (CRP) has been implicated in the pathogenesis of pNEN and shown to be associated with survival in different tumour entities. Patients undergoing surgery for pNEN were retrospectively analysed. Patients were divided into three subgroups according to preoperative CRP serum levels. Clinicopathological features, overall and disease-free survival were assessed. Uni- and multivariable survival analyses were performed. 517 surgically resected pNEN patients were analysed. CRP levels were significantly associated with relevant clinicopathological parameters and prognosis and were able to stratify subgroups with significant and clinically relevant differences in overall and disease-free survival. In univariable sensitivity analyses CRP was confirmed as a prognostic factor for overall survival in subgroups with G2 differentiation, T1/T2 and T3/T4 tumour stages, patients with node positive disease and with and without distant metastases. By multivariable analysis, preoperative CRP was confirmed as an independent predictor of postresection survival together with patient age and the established postoperative pathological predictors grading, T-stage and metastases. Preoperative serum CRP is a strong predictive biomarker for both overall and disease free survival of surgically resected pNEN. CRP is associated with prognosis independently of grading and tumour stage and may be of additional use for treatment decisions.

Incidence and predictors of blood transfusions in one-stage bilateral total hip arthroplasty: a single center prospective cohort study.

The safety of performing one-stage bilateral total hip arthroplasty (THA) remains controversial among the orthopedic community. The aim of the present study was to determine the incidence and predictors of blood transfusions in one-stage bilateral THA performed in a high-volume single center. Patients undergoing one-stage bilateral THA between 2015 and 2017 were included. The following data were collected from the hospital medical records: age, body mass index (BMI), American Society of Anaesthesiologists (ASA) score, smoking habit, comorbidities, preoperative serum creatinine, serum iron, ferritin, C-reactive protein (CRP), and hemoglobin (Hb). The Hb levels at postoperative day 1 and 3 were also collected. A total of 367 patients with a mean age of 56.1years (range, 32-79) were included. Forty-eight (13%) patients were transfused with a mean number of 1.6 blood units per patient. In non-transfused patients, the average Hb drop was 3.6 (SD ± 1) g/dL and 4.9g/dL (SD ± 1.3) at postoperative day 1 and day 3, respectively. The average preoperative Hb level was 14.64 (SD ± 1.21) g/dL. In the univariate logistic regression, the following variables were predictive factors for transfusions: male gender (OR 0.447; P = 0.01), preoperative hemoglobin level (OR 0.622; P = 0.001), preoperative ferritin level (OR 0.995; P = 0.016), BMI (OR 0.837; P = 0.001), cardiopathy (OR 3.534; P = 0.046), preoperative anaemia (OR 10.54; P = 0.011). In the multivariate logistic regression only preoperative hemoglobin level (OR 0.666; P = 0.01), and BMI (OR 0.868; P = 0.007) were statistically significant. The incidence of blood transfusions after one-stage bilateral THA is low in non-anemic patients operated on at a high-volume arthroplasty center. The main predictors of blood transfusions are preoperative Hb level and BMI.

Impact of the preoperative modified Glasgow Prognostic Score on disease outcome after radical cystectomy for urothelial carcinoma of the bladder.

To investigate the predictive and prognostic value of the preoperative modified Glasgow Prognostic Score (mGPS) in patients with urothelial carcinoma of the bladder (UCB) treated with radical cystectomy (RC). We conducted a retrospective analysis of an established multicenter database consisting of 4335 patients who were treated with RC±adjuvant chemotherapy for UCB between 1979 and 2012. The mGPS of each patient was calculated on the basis of preoperative serum C-reactive protein and albumin. Uni- and multivariable logistic and Cox regression analyses were performed. The discriminatory ability of the models was assessed by calculating the area under receiver operating characteristics curves (AUC) and concordance-indices (C-Index). The additional clinical net-benefit was assessed using the decision curve analysis (DCA). A mGPS of 0, 1, and 2 was observed in 3,158 (72.8%), 1,020 (23.5%), and 157 (3.6%) patients, respectively. On multivariable logistic regression analyses, mGPS of 1 or 2 were associated with an increased risk of pT3/4 disease at RC (OR 1.25, P=0.004 and OR 2.58, SP<0.001, respectively) and/or lymph node metastasis (OR 1.7, P<0.001 and OR 3.9, P<0.001, respectively). Addition of the mGPS to a predictive model based on preoperatively available variables improved its accuracy for prediction of lymph node metastasis (change of AUC +3.7%, P<0.001). On multivariable Cox regression analyses, mGPS of 1 or 2 remained associated with worse recurrence-free survival (HR 1.14, P=0.03 and HR 1.89 P<0.001, respectively), cancer-specific survival (HR 1.16, P=0.032 and HR 2.1, P<0.001, respectively) and overall survival (HR 1.5, P=0.007 and HR 1.92 P<0.001, respectively) compared to mGPS of 0. The additional discriminatory ability of the mGPS for prognosis of survival outcomes in separate models that included either established pre- or postoperative variables did not improve the C-Index by a prognostically relevant degree (change of C-Index <2% for all models). On DCA, the inclusion of the mGPS did not meaningfully improve the net-benefit for clinical decision-making regarding survival outcomes. We confirmed that an elevated mGPS is an independent risk factor for non-organ confined disease and poor survival outcomes in patients with UCB undergoing RC. However, the mGPS showed little value in improving the discriminatory ability of predictive and prognostic models that relied on either pre- or postoperative clinicopathological variables. The discriminatory ability of this biomarker in the age of immunotherapy warrants further evaluation.

The Natural Course of Serum D-Dimer, C-Reactive Protein, and Erythrocyte Sedimentation Rate Levels After Uneventful Primary Total Joint Arthroplasty

BackgroundThis study aimed to assess the baseline levels of D-dimer, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) and monitor the natural course of these serum markers after uneventful primary total joint arthroplasty. MethodsThis prospective study enrolled 81 patients undergoing primary total knee arthroplasty or total hip arthroplasty. The level of serum D-dimer, CRP, and ESR was measured preoperatively and on postoperative days 1, 3, 5, 15, and 45. Mean peak values, peak times, and distribution were compared between D-Dimer, CRP, and ESR. ResultsThe mean preoperative serum D-dimer, CRP, and ESR level was 412 ± 260 (range 200-980) ng/mL, 2.93 ± 2.1 (range 1-18) mg/L, and 22.88 ± 17.5 (range 3-102) mm/h, respectively. The highest mean peak for D-dimer, CRP, and ESR was at postoperative day 1, 3, and 5, respectively. ConclusionD-dimer levels reached peak levels on postoperative day 1 and then declined rapidly to a plateau level by postoperative day 3. A second, albeit small, peak in the level of D-dimer occurred on postoperative day 15. The level of CRP and ESR remained elevated for much longer with CRP returning to baseline on postoperative day 45 and the level of ESR had not returned back to normal on postoperative day 45.

Risk Factors for Systemic Inflammatory Response Syndrome in Patients with Negative Preoperative Urine Culture after Percutaneous Nephrolithotomy.

To explore the risk factors for systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL) in patients with preoperative negative urine culture (UC). Observational study. Department of Urology, Gazi Hospital, Samsun, Turkey, from January 2015 to January 2020. Two hundred and twenty-eight patients, who underwent conventional PCNL for renal stones, were evaluated. The patients were divided into non-SIRS (Group 1) and SIRS (Group 2) groups, and the effects of the variables were investigated to predict the development of SIRS. Despite preoperative sterile UC, SIRS developed postoperatively in 29 (12.7%) patients. The univariate analysis revealed a statistically significant difference between groups in preoperative serum C-reactive protein (CRP) (p <0.001), platelet-to-lymphocyte ratio (PLR) (p <0.001), neutrophil-to-lymphocyte ratio (p = 0.001), urine white blood cell (p = 0.034), stone size (p = 0.023), operative time (p = 0.041), hemoglobin drop (p <0.001), blood transfusion (p = 0.002), hospital stay (p = 0.006), and complication rate (p = 0.001). Receiver operating characteristic analysis indicated that PLR >117.36 (p <0.001), CRP >3.16 mg/L (p <0.001), stone burden >471 mm2 (p = 0.023) and hemoglobin drop >2.3 g/L (p <0.001) are independent risk factors for post-operative SIRS after PCNL. PLR, CRP, stone size, and hemoglobin drop can predict SIRS after PCNL. This finding may help classify risk in patients before PCNL, especially in those with a sterile urine culture. Key Words: C-reactive protein, Percutaneous nephrolithotomy, Platelet/lymphocyte ratio, Systemic inflammatory response syndrome.

Variation in Inflammatory Biomarkers Among Demographic Groups Significantly Affects Their Accuracy in Diagnosing Periprosthetic Joint Infection

BackgroundDiagnosis of periprosthetic joint infection (PJI) is a multistep process that involves performing various tests including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The latter two tests, despite being used at all times for PJI diagnosis, are known to be nonspecific and substantially affected by demographic characteristics, including age, gender, race, and body mass index. It is unknown how these variations affect the diagnostic utility of serological markers for PJI. MethodsInstitutional databases were queried to identify patients undergoing revision arthroplasty between 2010 and 2018, in whom preoperative serum ESR and CRP was performed. Patient demographics were collected, and patients were cross-referenced with an internal database to determine their infection status. Analyses were performed to determine how ESR and CRP varied with respect to demographic factors, including age, gender, race, and infection status. Given that patient infection status was known at the time of revision, conclusions were drawn about the effect of these variations in inflammatory markers on the diagnostic utility of ESR and CRP. ResultsThe value of ESR increased by age was higher in females and African American race. No significant differences were observed in the value of CRP among the demographic factors, although a slight positive trend was observed with respect to age. The variation in inflammatory markers significantly affected the sensitivity, specificity, and accuracy of ESR and CRP for PJI diagnosis. ConclusionUnderstanding how the accuracy of diagnostic tests varies with respect to demographic factors can help physicians avoid subjecting patients to unnecessary additional testing and reach more accurate diagnoses of PJI.