Routine Inflammatory Markers Research Articles

Pentraxin 3 level in acute migraine attack with aura: Patient management in the emergency department

ObjectivesWe investigated the state of inflammation, PTX3 level and other routine inflammatory markers (high sensitivity C-reactive protein [hsCRP], and white blood cells [WBC]), in patients who presented to the emergency department (ED) with migraine. We also investigated the relationship between the clinical presentation, PTX3 level, and other routine inflammatory markers in the emergency management of these patients. MethodsThe study included 44 patients (group 1) who presented to the ED due to a migraine attack with aura and 44 controls (group 2) with similar demographic characteristics. ResultsThe WBC count was 8.82 ± 2.10 × 109/L in group 1 and 7.85 ± 2.04 × 109/L in group 2. The mean PTX3 level was 11.57 ± 3.99 ng/mL in patients who presented at the ED with a migraine attack, and 4.59 ± 1.28 ng/mL in controls. The differences values of WBC and PTX3 between the two groups were significant (respectively; P = 0.031, P < 0.001). ROC analyses indicated significant results for PTX3 as a marker for acute migraine attack. It had a sensitivity of 93% and specificity of 84% at a cut-off value of 5.80 ng/mL. ConclusionThis is the first study to investigate plasma levels of PTX3 in patients with acute migraine. PTX3 as a biomarker may be used as an additional examination to the current subjective criteria to support the diagnosis of patients presenting to the ED with an acute migraine attack.

Predicting mortality in patients with spontaneous bacterial peritonitis using routine inflammatory and biochemical markers.

Spontaneous bacterial peritonitis (SBP) is a common and high-mortality infectious complication of patients with cirrhosis. New inflammatory markers are associated with morbidity/mortality in various diseases. The aim of our study was to find the 30-day mortality rate of SBP and their predictors. Seventy patients with cirrhosis complicated with SBP and 55 non-SBP controls were enrolled into the study, and patients were evaluated for mortality rate and its predictors. The 30-day and 3-month mortality rates in the SBP group were 26.1 and 50.7%, respectively. Mortality rates were higher in the SBP group than in the controls. Symptoms at hospital admission and cell counts in ascitic fluid made no difference in predicting 30-day mortality. Patients with SBP with high serum neutrophil counts, high neutrophil-lymphocyte ratio, high C reactive protein (CRP)/albumin ratio, and high model for end-stage liver disease (MELD) score had higher 30-day mortality rates. We determined optimal cutoff values of MELD scores and serum neutrophil counts for predicting 30-day mortality as 20.5 and 6850/mm, respectively. The sensitivity and specificity for the MELD cutoff value were 83.3 and 80.4%, respectively. We also followed up patients for 60 months after SBP; the patients with high inflammatory markers and MELD scores at the time of SBP diagnosis had worse survival compared with the group with lower levels. Our results suggest that SBP has high 30-day mortality. MELD scores and inflammatory markers (CRP, CRP albumin ratio, neutrophil-lymphocyte ratio) may be used to predict mortality in patients with SBP.

O1.2 PERIPHERAL INFLAMMATORY MARKERS ARE PREDICTIVE OF CLINICAL CHARACTERISTICS AND OUTCOME IN PSYCHOSIS

BackgroundDysregulation of the immune system represents an important vulnerability factor for schizophrenia. A rise in peripheral inflammatory markers has previously been demonstrated in psychosis; however, its significance remains uncertain. Characterising this relationship aids our understanding of the role of immunological factors in psychosis, as well as potentially identifying candidate biomarkers to guide diagnosis, treatment and prognosis. Whilst specialized inflammatory marker assays have been found to be associated with outcome and treatment, these tests are not typically available in clinical practice. We sought to establish whether routine inflammatory markers are associated with clinical characteristics and outcomes in patients with schizophrenia and related disorders.MethodsA multi-site cohort study of patients admitted to an acute psychiatric ward between January 2013 and December 2016 within a large Mental Health Trust was undertaken. Cases were identified from an electronic database containing full clinical records. Inclusion criteria were patients aged 18 and 65 years with a discharge diagnosis of schizophrenia, or related disorder and a routine blood test within 3 days of admission. Exclusion criteria were diagnoses of drug-induced psychosis, organic brain disorder, or admission during the perinatal period. Pro-inflammatory (white blood cell total and differential count, C-reactive protein) and anti-inflammatory markers (albumin) recorded during the admission were extracted. Clinical characteristics were based upon the Health of the Nation Outcome Scale, a 12-item clinician rated tool contemporaneously rated at admission and discharge.ResultsA total of 968 patients met the inclusion criteria. 309 patients were female and mean age was 38 years. The most frequent ethnicities were White, Black African, Black Other and Black Caribbean and the commonest diagnoses were schizophrenia, unspecified non-organic psychosis and schizoaffective disorder. Mean interval from admission to admission blood test was 0.8 days.Patients with affective psychosis had a significantly higher white cell count, monocyte count and lymphocyte count than patients with non-affective psychosis on admission. Furthermore, among patients with affective psychosis, a partial correlation controlling for age, body mass index, blood pressure, physical health and smoking status found a significant association between symptom severity and monocyte count. There was a highly significant association between both neutrophil count and white cell count with hallucinatory symptoms. There was also a highly significant positive association between C-reactive protein and self-injurious behaviour, replicating recently published findings in smaller samples. There was a significant reduction in overall psychiatric symptoms over the course of admission, which was significantly associated with admission monocyte count. A partial correlation found white cell count and neutrophil count at admission were associated with reductions in hallucinatory symptoms. Eosinophil count was significantly associated with admission length.DiscussionIn a large cohort of patients admitted due to psychotic disorder, pro-inflammatory markers were associated with affective psychosis and overall symptom severity, and predicted admission length and reduction in symptom severity. The study supports an association between immune dysregulation and psychosis. Furthermore, the study highlights the role of routinely and inexpensively measured peripheral inflammatory markers as potential diagnostic and prognostic biomarkers in psychosis.

Clinical Parameters, Routine Inflammatory Markers, and LTA4H Genotype as Predictors of Mortality Among 608 Patients With Tuberculous Meningitis in Indonesia.

Damaging inflammation is thought to contribute to the high morbidity and mortality of tuberculous meningitis (TBM), but the link between inflammation and outcome remains unclear. We performed prospective clinical and routine laboratory analyses of a cohort of adult patients with TBM in Indonesia. We also examined the LTA4H promoter polymorphism, which predicted cerebrospinal fluid (CSF) leukocyte count and survival of Vietnamese patients with TBM. Patients were followed for >1 year. We included 608 patients with TBM, of whom 67.1% had bacteriological confirmation of disease and 88.2% had severe (ie, grade II or III) disease. One-year mortality was 43.7% and strongly associated with decreased consciousness, fever, and focal neurological signs. Human immunodeficiency virus (HIV) infection, present in 15.3% of patients, was associated with higher mortality and different CSF characteristics, compared with absence of HIV infection. Among HIV-uninfected patients, mortality was associated with higher CSF neutrophil counts (hazard ratio [HR], 1.10 per 10% increase; 95% confidence interval [CI], 1.04-1.16), low CSF to blood glucose ratio (HR, 1.16 per 0.10 decrease; 95% CI, 1.04-1.30), CSF culture positivity (HR, 1.37; 95% CI, 1.02-1.84), and blood neutrophilia (HR, 1.06 per 109 neutrophils/L increase; 95% CI, 1.03-1.10). The LTA4H promoter polymorphism correlated with CSF mononuclear cell count but not with mortality (P = .915). A strong neutrophil response and fever may contribute to or be a result of (immuno)pathology in TBM. Aggressive fever control might improve outcome, and more-precise characterization of CSF leukocytes could guide possible host-directed therapeutic strategies in TBM.

Copeptin, Procalcitonin and Routine Inflammatory Markers–Predictors of Infection after Stroke

BackgroundEarly predictors for the development of stroke-associated infection may identify patients at high risk and reduce post-stroke infection and mortality.MethodsIn 383 prospectively enrolled acute stroke patients we assessed time point and type of post-stroke infections (i.e. pneumonia, urinary tract infection (UTI) other infection (OI)). Blood samples were collected on admission, and days 1, and 3 to assess white blood cells (WBC), monocytes, C-reactive protein (CRP), procalcitonin (PCT), and copeptin. To determine the magnitude of association with the development of infections, odds ratios (OR) were calculated for each prognostic blood marker. The discriminatory ability of different predictors was assessed, by calculating area under the receiver operating characteristic curves (AUC). Prognostic models including the three parameters with the best performance were identified.ResultsOf 383 patients, 66 (17.2%) developed an infection after onset of stroke. WBC, CRP, copeptin and PCT were all independent predictors of any infection, pneumonia and UTI developed at least 24 hours after measurements. The combination of the biomarkers WBC, CRP and copeptin (AUC: 0.92) and WBC, CRP and PCT (AUC: 0.90) showed a better predictive accuracy concerning the development of pneumonia during hospitalization compared to each marker by itself (p-Wald <0.0001).ConclusionAmong ischemic stroke patients, copeptin, PCT, WBC and CRP measured on admission were predictors of infection in general, and specifically for pneumonia and UTI within 5 days after stroke. The combination of these biomarkers improved the prediction of patients who developed an infection.

Cerebrospinal Fluid Neopterin and Cryopyrin-Associated Periodic Syndrome

Cryopyrin-associated periodic syndrome is a category of autoinflammatory disorders caused by mutations of the NLRP3 gene, with chronic infantile neurologic cutaneous and articular syndrome being the severest clinical phenotype. Various pterins have been reported as mediating immunologic functions in the central nervous system, but to date studies of pterin cerebrospinal fluid (CSF) values and cryopyrin-associated periodic syndrome have been lacking. A 2-year-old child was affected with a severe atypical form of cryopyrin-associated periodic syndrome, suspected based on the analysis of neopterin in CSF. He initially presented isolated neurologic manifestations mimicking a neuroregressive disorder. Blood and CSF analyses did not present any routine inflammatory markers, but CSF neopterin was elevated. Later, the patient developed arthritis and recurrent episodes of fever, and the cryopyrin-associated periodic syndrome diagnosis was confirmed by genetic studies. Neopterin was the most altered indicator over the time. Child neurologists should be on the alert when unexplained neurologic signs appear, giving consideration to the possibility of inflammatory or immune-mediated diseases. The present case demonstrates the clinical utility of measurement of CSF neopterin levels in screening for these immune-mediated diseases, especially when neurologic symptoms are associated with normal results on routine CSF tests.

Inflammatory cytokines, endothelial markers and adhesion molecules in rheumatoid arthritis: effect of intensive anti-inflammatory treatment

Tumour necrosis factor alpha (TNF-alpha) and interlekin-6 (IL-6) are key inflammatory cytokines in the pathogenesis of rheumatoid arthritis (RA), a disease also associated with endothelial perturbation and increased serum levels of adhesion molecules. As relationships between these processes and molecules are unclear, we tested the hypotheses (a) that TNF-alpha and IL-6 are linked to endothelial activation/damage and levels of soluble adhesion molecules, and (b) that intensive anti-inflammatory treatment improves levels of these indices. We recruited 66 patients with RA, 48 community controls (CC), and 25 disease controls (DC). Plasma TNF-alpha and IL-6 were compared to markers of vascular biology (vWF, sE-sel), soluble adhesion molecules (sICAM, sVCAM) and routine inflammatory markers (CRP and ESR). Blood was obtained at baseline and at 1 week and again 4 weeks after anti-inflammatory treatment in a subgroup of 29 patients with RA. With the exception of sE-selectin, RA patients had increased levels of all plasma markers compared to the HCs, whilst levels in the DCs were largely intermediate between RA and the CCs. Within the RA group, sEsel correlated with both CRP and ESR whilst TNF-alpha correlated with sVCAM (all r > 0.32, P < 0.01). After 1 week of combined anti-inflammatory therapy, only CRP, ESR, sEsel and sVCAM were significantly reduced (all P < 0.05). In RA, endothelial activation (as sEsel) correlates with classical markers of inflammation and is reduced by intensive anti-inflammatory medications.

Correlaton between soluble transferrin receptor concentration and inflammatory markers

Purpose: The concentration of soluble transferrin receptor (sTfR) is estimated as an iron parameter to evaluate erythropoiesis and iron status. The aim of our study is to evaluate the correlation between sTfR concentration and inflammatory parameters and to distinguish iron deficiency anemia from anemia of inflammation. Methods: One hundred and forty-four infants younger than two years of age who visited Gyeongsang University Hospital for 7 years from 2000 to 2006 were enrolled. Patients who had hemoglobin (Hb) <11 g/dL and ferritin <12 mg/L were excluded. Routine hematologic lab, serum ferritin, sTfR, and inflammatory markers [C-reactive protein(CRP), interleukin-6(IL-6), and absolute neutrophil count (ANC)] were investigated. Results: In all patients, the sTfR concentration showed a correlation with Hb, ferritin, MCV, and ANC, but not with CRP and IL-6. In multiple regression models, positive correlations were found between sTfR concentration and IL-6 (r=0.078, P=0.043), and negative correlations were found between sTfR concentration and ANC (r=-0.117, P=0.033) and MCV (r=-0.027, P=0.009). Conclusion: sTfR concentration was influenced by inflammatory parameters. Therefore, sTfR does not appear to be a useful parameter for discriminating between iron deficiency anemia and anemia of inflammation in infants. (Korean J Pediatr 2009;52:435-440)

Risk Factors Associated with Different Stages of Atherosclerosis in Colombian Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is associated with an increased prevalence of cardiovascular disease (CVD). Since atherosclerosis development is a gradual process of damage inside the artery wall, and the phenotype-genotype correlation of complex diseases may vary depending on ethnicity, we sought to investigate the influence of clinical features, routine inflammatory markers, and the genetic component of RA on different stages of atherosclerosis in northwestern Colombian patients with RA. A group of 140 patients with RA were enrolled in this study. All patients underwent a noninvasive evaluation of endothelial function by flow-mediated vasodilation (FMV) and an assessment of carotid intima-media thickness (IMT) by high-resolution B-mode ultrasonography. The patients were classified into 3 categories: endothelial dysfunction (FMV <5%), increased IMT (0.91-1.29 mm), and plaque (IMT >1.30 mm). The risk of being in each category was assessed by investigating traditional and nontraditional cardiovascular risk factors. For each stage of atherosclerosis development, we searched for nontraditional risk factors that were significantly associated with the stage after adjusting for traditional risk factors and current age. Rheumatoid factor seropositivity was significantly associated with endothelial dysfunction (adjusted odds ratio, AOR = 3.0). A duration of RA >10 years (AOR = 29.0) and being a carrier of an HLA-DRB1 shared epitope allele (AOR = 4.8) were associated with atherosclerotic plaque. No association of extra-articular manifestations, anticyclic citrullinated peptide (anti-CCP3) antibodies, and tumor necrosis factor -308 polymorphism with CVD was found. Our results reveal the presence of RA-related risk factors for CVD which act independently of traditional risk factors. These factors can be used by clinicians to predict CVD in RA patients, and this data should assist in the development of public health policies in our population for the improvement of patient outcomes.

Inflammatory markers for acute appendicitis in children: are they helpful?

Background/Purpose Diagnosis of acute appendicitis in children remains challenging, and the role of blood tests in the decision-making process is still unclear. We prospectively evaluated if routine inflammatory markers could contribute to exclude the presence of acute appendicitis in children. Methods Preoperative white blood cell count (WBCC) and C-reactive protein (CRP) were prospectively tested in children undergoing surgery for suspected appendicitis. Surgery was indicated on the basis of clinical findings and/or ultrasound scan, but WBCC and CRP values were ignored during the decision-making process. Sensitivity of individual markers and their combinations were assessed. Results One hundred children (55 males) with a mean age of 9.34 years (SD, 3.54 years) had pathologically confirmed diagnosis of appendicitis. A perforated appendix was found in 23% of cases. Elevated WBCC alone had a sensitivity of 0.6 (confidence interval [CI], 0.506-0.694). Sensitivity of elevated CRP alone was 0.86 (CI, 0.926-0.793). Elevation of either WBCC or CRP or both had a sensitivity of 0.98 (CI, 1.0-0.953). Conclusions White blood cell count or CRP values alone do not appear to provide any useful additional information to the surgeon. However, the sensitivity of the 2 combined tests is extremely high, and normal values of both WBCC and CRP are very unlikely in pathologically confirmed appendicitis.