Routine CRP Research Articles

Network analysis of depressive symptoms and C-reactive protein levels in major depressive disorder

BackgroundC-reactive protein (CRP) levels have been implicated in the severity and symptomatology of major depressive disorder (MDD). The aim of this study was to explore the structure of depressive symptoms in patients with MDD according to different groups of CRP levels using network analysis. MethodsThe study included 864 individuals (mean age = 54.05, 67.48 % male) diagnosed with MDD from the 2015–2020 National Health and Nutrition Examination Survey (NHANES). Analyses examined how depressive symptoms and CRP level were related to each other, and how the network structure of depressive symptoms differed across groups with different CRP levels. ResultsA direct positive correlation was observed between CRP levels and specific depressive symptoms (e.g., appetite change, energy loss, and feelings of worthlessness). Moreover, there was a stronger correlation between depressive symptoms in the medium CRP and high CRP groups compared to the low CRP group. Furthermore, it was observed that there were notable structural differences between the high-CRP and moderate-CRP groups. LimitationsThe study is based on cross-sectional data, which precludes the drawing of causal conclusions. Furthermore, it does not take into account confounding factors such as body mass index (BMI) and lifestyle. ConclusionsThe findings underscore the pivotal role of CRP as a marker of the severity of depressive symptoms. Routine CRP level testing and anti-inflammatory therapies may be beneficial for depressed patients with elevated CRP levels in clinical practice.

Antibiotic stewardship in NICU: De-implementing routine CRP to reduce antibiotic usage in neonates at risk for early-onset sepsis.

Antibiotic overuse is common in the neonatal intensive care units (NICUs). We evaluated the change in antibiotic utilization rate (AUR) by eliminating routine CRP in the management of early-onset sepsis (EOS). Retrospective before-after cohort study in a Level 3B NICU. We made the following practice changes in the management of EOS: (1) stop routine CRP and (2) implement an automatic stop order (ASO) for antibiotics at 48 h. We compared the AUR, defined as any antibiotic use per 1000 patient days before and after practice change. There was an absolute reduction of 30% in AUR and a decrease in the proportion of neonates receiving antibiotics from the day of life 3-6 in postintervention period. We did not identify any case of partially treated EOS with change in practice. Elimination of routine CRP and ASO implementation for antibiotics in neonates at risk for EOS decreased AUR.

CRP monitoring in fractured neck of femur. A waste of resource?

AimWe aim to assess post-operative CRP serum values in a cohort of patients who underwent surgical treatment for neck of femur fracture (NOF#), and whether CRP is a valid tool for the assessment of these patients post-operatively. Study Design and MethodsRetrospective analysis was carried out on all NOF#'s admitted for surgical fixation between August 2015 and July 2016 in a district general hospital. Primary analysis included serum CRP levels until day 7 post-operatively, with secondary analysis of any documented evidence of post-operative complications (medical and surgical) within 30 days post-operatively. ResultsA total of 365 patients were surgically treated for NOF#’s over the study period. CRP serum levels peaked over the first two days post-operatively to median (IQ range) of 226 mg/L (158–299 mg/L), decreasing to 67 mg/L (45.5–104 mg/L) by day 7 post-operatively. 116 patients had documented post-operative complications within 30 daysof operation. CRP levels in patients with and without complications showed no statistical significance in day-1, day-2 and day-3 post-operatively. However, a significant difference was demonstrated on day-4 (p = 0.017), day-5 (p = 0.003), day-6 (p = 0.02) and day-7 (p = 0.031). ConclusionsDuring the first three days of the postoperative period we cannot recommend routine CRP serum blood test monitoring in NOF# patients, as it is not diagnostic in the acute inflammatory phase for medical or surgical complications.

Preoperative localisation of parathyroid adenomas with mibi and ultrasonography: Is there an advantage of a combined approach?

s / International Journal of Surgery 11 (2013) 589e685 634 ABSTRACTS Clinical teaching was provided to junior AE Countess Chester Hospital, Chester, UK. Aim: To evaluate the outcome of sialendoscopy performed at Arrowe Park DGH, and to compare this to NICE findings. Method: A first cycle audit was performed. Retrospectively, the case notes of patients undergoing sialendoscopy between December 2004 and November 2008 were reviewed. Data was collected with regards to patient demographics, presentation, operative findings, length of stay, complications and outcome. A second cycle comparing the same parameters was subsequently undertaken for patients undergoing sialendoscopy between December 2008 to August 2012. Results: 51 patients in the 1st cycle and 61 in the second were reviewed. In both there is a female preponderance and an average age of 54 and 50 respectively. Swelling is the most prevalent presentation, and the most frequent gland affected is the left parotid. 61% of cases in the 1st cycle were daycase procedures, increasing to 90% in the 2nd. In comparison to NICE findings 80-88% of our patients had symptom relief (82-87% NICE). 2-3% suffered ductal wall perforation (9% NICE) and no patients had nerve damage (1 patient NICE). Our own complication rate also decreased between the two cycles. Conclusion: The outcome of sialendoscopy at our unit is improving over time and is comparable with NICE findings. 0417: PREOPERATIVE LOCALISATION OF PARATHYROID ADENOMAS WITH MIBI AND ULTRASONOGRAPHY: IS THERE AN ADVANTAGE OF A COMBINED APPROACH? Edward Ridyard , Derek Siau , Simon Hargreaves . University of Manchester, Manchester, UK; Royal Bolton Hospital, Farnworth, UK. Aim: To identify whether the combination of MIBI and ultrasound (USS) in localising a parathyroid adenoma preoperatively is more effective than either MIBI or USS used alone as the limitations of both imaging modalities are well documented. Method: Retrospective manual analysis of patients’ operative and medical notes (n1⁄476) reviewing the position of parathyroid adenoma localised via MIBI, USS and the subsequent confirmation of parathyroid adenoma on histological evaluation. Results: The combination of MIBI and USS provided a statistically significant improvement in preoperative localisation of parathyroid adenoma over MIBI or USS used alone (p1⁄40.033 and p1⁄40.043 respectively). There was no significant correlation between tumour volume and serum calcium or serum PTH (p1⁄40.234 and p1⁄40.742 respectively). There was a significant reduction in serum calcium and serum PTH postoperatively (p1⁄4 0.05). Conclusion: The value of CRP and coagulation tests in secondary PTH remains to be seen within our results. We suggest that routine CRP and coagulation studies should not be performed on PTH patients because it does not change management and isunlikely todiagnoseanunderling coagulopathy. If bleeding disorders are suspected clotting factors are a more appropriate investigation.

C-reactive protein predicts further ischemic events in transient ischemic attack patients

Although patients with transient ischemic attack (TIA) experience cardiovascular events frequently, strong clinical predictors of recurrence are lacking. High-sensitivity C-reactive protein (hs-CRP) has been shown to be a powerful predictor of future first-ever and recurrent coronary and cerebral ischemic events. We aimed to investigate the relationship between hs-CRP and the risk of further ischemic events in TIA patients. High-sensitivity C-reactive protein level was determined <24 h after symptom onset among 135 consecutive TIA patients and stroke recurrence or any new vascular event was recorded during 1 year follow-up period. A total of 38 (28.1%) patients experienced an end point event: 28 (20.7%) cerebral ischemic events, six (4.4%) heart ischemic events, four (3%) peripheral arterial disease, and nine (6.7%) vascular deaths. Cox proportional hazards multivariate analyses identified age [hazard ratio (HR) 1.07, 95% confidence interval (CI) 1.01-1.12, P = 0.01], large-artery occlusive disease (HR 2.73, 95% CI 1.16 to 6.41, P = 0.02) and hs-CRP> 4.1 mg/l (HR 2.81, 95% CI 1.12-7.10, P = 0.03) as independent predictors of stroke. Moreover, age (HR 1.05, 95% CI 1.01-1.10, P = 0.02), large-artery occlusive disease (HR 3.12, 95% CI 1.48-6.58, P < 0.01), coronary disease (HR 2.39, 95% CI 1.11-5.16, P = 0.03), and hs-CRP> 4.1 mg/l (HR 2.71, 95% CI 1.16-6.30, P = 0.02) were also independent predictors of any vascular event. High-sensitivity C-reactive protein serum level predicts further ischemic events following TIA. Routine CRP measurement might be a useful tool for identifying high-risk TIA patients in order to plan aggressive diagnostic protocols and prevention therapies.