Sensitive Marker Of Inflammation Research Articles

High-sensitivity C-reactive protein is a predictor of all-cause mortality in a rural Japanese population.

High-sensitivity C-reactive protein (hsCRP) is a sensitive marker of inflammation. This study aimed to determine whether increased hsCRP levels are associated with all-cause mortality rate. We examined data for participants from the 2002 Nomura Cohort Study who attended follow-ups for 20 years (follow-up rate: 93.3%). Of these, 793 were male (aged 61 ± 14 years) and 1040 were female (aged 63 ± 11 years). The Japanese Basic Resident Registry provided data on adjusted relative hazards for all-cause mortality. The data were subjected to a Cox regression analysis using a time variable of age and confounding risk factors. The median (interquartile range) follow-up period was 6548 days (6094-7452 days). The follow-up confirmed that there were 632 (34.8%) deaths, of which 319 were male (40.2% of all males) and 313 were female (30.6% of all females). Multivariable-adjusted hazard ratio(1.27; 95% confidence interval, 1.01-1.59) in the highest hsCRP category was also significantly higher compared with reference. A higher hsCRP was associated with a greater risk of all-cause mortality in male participants aged ≥65 years, a BMI < 25 kg/m2 , and no history of CVD or diabetes, and this association was particularly significant among participants with both of the latter two risk factors (p = 0.004 and 0.022 for interaction, respectively). Our results indicate a significant association between hsCRP levels and all-cause mortality in a rural Japanese population. Specifically, hsCRP appears to be a crucial biomarker for predicting long-term survival, particularly among older persons.

Inflammatory Markers in Hemophagocytic Lymphohistiocytosis - a Single Centre Study

BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) has significant clinical and biochemical overlap with other cytokine storm syndromes including Adult-Onset Still's disease (AOSD) and COVID-19 cytokine storm (CCS). Diagnosis of HLH is based largely on the HLH-2004 criteria which carry certain limitations. Many of the tests included in these criteria such as flow cytometry for NK cell cytotoxicity and soluble CD25 levels are only available in specialized centres. Moreover, they can take days to weeks to result, leading to delays in diagnosis. Biomarkers that are unique to HLH and more readily available are needed to ensure a timelier diagnosis of this life-threatening disease. C-reactive protein (CRP) is a sensitive marker of inflammation that is driven by IL-6 activity, a cytokine that is significantly elevated in AOSD and CCS but comparatively less so in HLH. Our study sought to determine whether lower levels of CRP, in conjunction with other patterns of inflammatory markers, could reliably distinguish HLH from AOSD and CCS. METHODS This was a single-centre, retrospective study examining adult ( n=45) and pediatric ( n=12) patients with HLH, and adult patients with AOSD ( n=11) and CCS ( n=13). Patients were enrolled from Vancouver General Hospital between January 1 st, 2000, to June 28 th, 2023. CRP and ferritin levels were collected for each patient if available, and values were included in analysis only if drawn prior to HLH-specific treatment. Ferritin levels were included to add to our understanding of different patterns of inflammation seen in similar cytokine storm syndromes. The Kruskal-Wallis test was used to compare CRP and ferritin values in total HLH cases compared to AOSD and CCS. Diagnostic performance of CRP was analyzed by performing a receiver operating characteristic (ROC) curve for CRP in HLH patients using the Youden index to identify the optimal cut-off point for CRP values. RESULTS In total, eighty-one patients were included in the study. Median CRP was significantly lower in HLH compared to AOSD (68.9 mg/L versus 168.0 mg/L, p &amp;lt; 0.001) and CCS (68.9 mg/L versus 121.0 mg/L, p = 0.024) (Figure 1). Median serum ferritin levels were significantly lower in CCS compared to HLH (1,386 ng/mL versus 16,722, p &amp;lt; 0.001) and AOSD (1,3860 ng/mL versus 12,480 ng/mL, p = 0.016). There was no significant difference in ferritin levels between HLH and AOSD. The ROC curve was performed for CRP values in total HLH cases which demonstrated an Area Under the Curve (AUC) of 0.799, indicating a fair diagnostic performance in differentiating HLH, with a sensitivity of 66.1% and specificity of 87.5% for CRP values less than 94.5 mg/L, as calculated by Youden's index. CONCLUSION CRP is significantly lower in HLH compared to AOSD and CCS, suggesting that mild to moderate elevations in CRP reflect the comparatively lower IL-6 activity underlying HLH. When used in conjunction with other inflammatory markers, especially marked hyperferritinemia, a comparatively lower CRP value helps capture the unique cytokine pattern underlying HLH, and is a useful, easily accessible biomarker than can aid in the diagnosis of HLH.

Role of interleukin-6 in coronavirus disease 2019 pneumonia: sensitive marker of inflammation, a predictor of ventilatory support and early marker of post-coronavirus disease lung fibrosis. A single center experience

Abstract Background Robust data on interleukin-6 (IL-6) is available in bacterial infection, and now it can be utilized in the currently ongoing coronavirus disease 2019 (COVID-19) pneumonia pandemic to guide treatment strategy as a marker of inflammation. Patients and methods Prospective, observational, and 12 weeks follow-up study, included 1000 COVID-19 cases confirmed with reverse transcription PCR. All cases were assessed with lung involvement documented and categorized on high-resolution computed tomography thorax, oxygen saturation, IL-6 at the entry point, and follow-up. Age, sex, comorbidity, and bilevel positive airway pressure/noninvasive ventilation (BIPAP/NIV) use and outcome as with or without lung fibrosis as per computed tomography severity. Statistical analysis is done by χ 2 test. Results In the study of 1000 COVID-19 pneumonia cases, age (&lt;50 and &gt;50 years) and sex has a significant associations with IL-6. High-resolution computed tomography severity score at entry point has significant correlation with IL-6 level (P&lt;0.00001). IL-6 level has a significant association with duration of illness (P&lt;0.00001) comorbidities has a significant association with IL-6 level (P&lt;0.00001). IL-6 level has a significant association with oxygen saturation (P&lt;0.00001). BIPAP/NIV requirement has a significant association with IL-6 level (P&lt;0.00001). Timing of BIPAP/NIV requirement during the course of hospitalization has significant association with IL-6 level (P&lt;0.00001). Follow-up IL-6 titer during hospitalization as compared with entry point abnormal IL-6 has a significant association in post-COVID lung fibrosis (P&lt;0.00001). Follow-up IL-6 titer during hospitalization as compared with entry point normal IL-6 has a significant association in post-COVID lung fibrosis (P&lt;0.00001). Follow-up IL-6 titer during hospitalization as compared with entry point abnormal IL-6 has a significant association in predicting cytokine storm irrespective normal or abnormal of IL-6 at entry point (P&lt;0.0001). Conclusion IL-6 has documented a very crucial role in COVID-19 pneumonia in predicting the severity of illness, progression of illness, and ‘cytokine storm.’ Sequential IL-6 titers will help assess response to treatment during hospitalization and analyze post-COVID lung fibrosis.

Calprotectin, a sensitive marker of inflammation, is robustly assessed in plasma from patients with early or established rheumatoid arthritis by use of different laboratory methods

Calprotectin (S100A8/S100A9, MRP8/MRP14) is a major leukocyte protein found to be more sensitive than C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) as a marker of inflammation in patients with rheumatoid arthritis (RA). The present objective was to explore the robustness of calprotectin assessments by comparing two different laboratory methods assessing calprotectin in plasma samples from patients with early or established RA. A total of 212 patients with early RA (mean (SD) age 52(13.3) years, disease duration 0.6(0.5) years) and 177 patients with established RA (mean (SD) age 52.9(13.0) years, disease duration 10.0(8.8) years) were assessed by clinical, laboratory, and ultrasound examinations. Frozen plasma samples (−80 °C) were analysed for calprotectin levels at baseline, 1, 2, 3, 6 and 12 months by use of either enzyme-linked immunosorbent assay (ELISA) or fluoroenzyme immunoassay (FEIA). The ELISA technique used kits from Calpro AS and the FEIA technology was assessed on an automated Thermo Fisher Scientific instrument. The results showed high correlations between the two methods at baseline and during follow-up, with Spearman correlation at baseline 0.93 (p < 0.001) in the early and 0.96 (p < 0.001) in the established RA cohorts. The correlations between each of the two calprotectin assessments and clinical examinations had similar range. Calprotectin correlated well with clinical examinations, with at least as high correlations as CRP and ESR. The present study showed similar results for the two analytical methods, supporting the robustness of calprotectin analyses, and suggest calprotectin in plasma to be included in the assessments offered by clinical routine laboratories.

#3750 SERUM AMYLOID A AS PROGNOSTIC MARKER FOR CKD AND NON-CKD COVID-19 PATIENTS ADMITTED TO THE EMERGENCY ROOM

Abstract Background and Aims Patients with chronic kidney disease (CKD) and a SARS-CoV-2 infection are at higher risk of developing acute kidney injury (AKI) and of mortality after hospital admission. Herein, we assessed whether serum amyloid A (SAA) was associated with outcomes (AKI and/or death). Method The study group included 160 patients: 70 Covid-19-positive CKD patients (eGFR &amp;lt;60 mL/min), 50 Covid-19-positive patients with no history of kidney disease, 20 Covid-19-negative CKD patients, and 20 healthy controls. We collected data on patients’ gender, age, co-morbidities, and laboratory results from blood and urine samples taken at admission into the ER, and from healthy volunteers. All participants gave their informed consent for trial with protocol №12/31.05.2022 approved by the ethical committee KENIMUS of the Medical University of Sofia, Bulgaria. Laboratory values included calculated eGFR (by the CKD-EPI 2021 formula), highly sensitive inflammatory markers, D-dimer, blood-cell counts, and changes in urine parameters. Co-morbidities included hypertension, obesity, diabetes mellitus, vascular disease, and CKD. All patients had been treated by the official protocol of the Republic of Bulgaria for SARS-CoV-2. We determined the levels of SAA across the four groups to assess if this biomarker could predict AKI, risk of mortality, and if there was a significant difference between the CKD and non-CKD patients. Results Overall, median age of Covid-19 patients was 56.4 years; gender ratio was 50% M/F in all groups. Median duration of symptoms before hospitalization was 6 days. Of the 160 patients, 30% were febrile with temperatures &amp;gt;38oC. Overall, creatinine level on admission was elevated in 40% of cases; eGFR was &amp;lt;60 mL/min/1.73 m2 in 37.5% of patients. Mean value of eGFR on admission was 82.3 mL/min/1.73 m2 for the non-CKD Covid-19-positive group, 49.5 mL/min/1.73 m2 for the CKD Covid-19-positive group, 62.3 mL/min/1.73 m2 for the CKD patients without COVID-19, and 111.1 mL/min/1.73 m2 for the healthy control group. In total, three Covid-19 patients needed renal-replacement therapy: two patients from the CKD group and one from the non-CKD group. AKI occurred in 38 Covid-19 patients (23.7%). Of these, 31 had CKD (44.3% of the Covid-19 positive CKD patients). Overall, within our cohort of 160 patients, in-hospital mortality was 14.3% (23 patients): of these, 82.6% had AKI (19 patients). Overall, 100% of patients that did not survive Covid-19 also had CKD. We analyzed the levels of SAA across the groups. The reference limits considered for negative results were &amp;lt;7 pg/mL; the ELISA could measure values up to 300 pg/mL. Of the 23 patients that died, 19 had levels &amp;gt;300 pg/ml (82.6%), whilst the remainder had results &amp;gt;250 pg/mL. The other patients who survived the infection in our cohort had levels well below 200 pg/ml. When the patients with AKI and without AKI were compared on the basis of SAA, patients with AKI had significantly higher biomarker values (p- = 0.02). When compared across the four groups, no significant differences were found except when comparing the healthy control group with the other three groups, where there was significance of p&amp;lt;0.0001 in each comparison. Conclusion We confirm that SAA was a reliable biomarker for predicting AKI in Covid-19 patients. It also acted as a predictor for a fatal outcome in patients with severely Covid-19 infection. In conclusion, SAA is a reliable marker, highly informative in the emergency department setting, enabling us to have an early prognosis for the outcome of the Covid-19 infection for the patients in our cohort.

35 Effects of melatonin on inflammatory marker serum amyloid A in horses after exercise

Performance horses are regularly exposed to various stressors, such as training and exercise, that negatively impact their performance which may lead to increased oxidative stress (OS) and inflammation. Although important for the adaptive response, prolonged and unresolved OS and inflammation may decrease athletic performance or cause unnecessary cellular damage. Dietary supplements, such as antioxidants, have been shown to mitigate the negative effects of OS and inflammation and therefore may enhance performance. One such antioxidant that has been of interest is melatonin. The objectives of this study were to evaluate the potential of melatonin to reduce Serum Amyloid A (SAA), a sensitive inflammatory marker, in horses after exercise. Horses (n = 6) were randomly assigned to 2 groups (CON; n = 3, no supplement or MEL; n = 3, 20 g melatonin). Horses received diet based on BW (1% BW Nutrena Impact 12% Pellets and 2% BW bermudagrass hay/d). A switchback design was used, with 2 experimental trial periods lasting 14-d with a 30-d washout period in-between. Supplementation was given orally on exercise days during each trial period. Horses underwent 1.5hr of moderate-intensity exercise (avg >90 BPM), at 0700 3 d/wk. Blood was drawn before exercise (PRE), and at 30- and 90-min post-exercise. On exercise days (ED), horses received supplementation after PRE blood draw and before exercise (0630).After the washout period, the treatment groups were swapped, and the study was repeated, resulting in 12 ED total. Blood was collected via jugular venipuncture, immediately processed to separate plasma, and stored for analysis. SAA ELISA kits (Thermo Fisher Scientific Inc., Massachusetts) were used to determine blood SAA concentration. The first and last ED of each trial period were analyzed (ED1/ED6/ED7/ED12), and interactions of treatment, time, and day were analyzed with significance set at (P ≤ 0.05). PRE ED1 and 7 were set as baseline values, with no significant differences in baseline levels between treatments (P > 0.1862). There was a significant difference between treatments at 30- (P ≤ 0.01) and 90-min (P ≤ 0.01) post-exercise on ED1, 7, and 12, with average plasma SAA concentrations being lower for MEL group at all time points. There was also a treatment*day interaction for ED1 (P = 0.0005), ED7 (P = 0.0218), and ED12 (P = 0.0001), with MEL having lower SAA blood concentrations as compared with CON. Lower concentrations of SAA in MEL horses suggest melatonin supplementation may reduce inflammatory blood markers and, in turn, may suggest lower levels of inflammation in horses after exercise.

Assessment of hs –CRP in Patients with Hypothyroidism at University of Maiduguri Teaching Hospital, Maiduguri Borno State

Introduction: High sensitive c-reactive protein (hs-CRP) is an important sensitive inflammatory marker, but not a routine laboratory investigation for diagnosis of hypothyroidism. However, many thyroidal conditions involve inflammation in the present study, the level of hs-CRP and its link with hypothyroidism was assessed. Materials &amp; Methods: A total of 60 males and 50 females aged 20-55 years were assessed for the study. Evaluation of hs-CRP was done on SD biosensor standard F200 fluorescent immunoassayauto analyser in serum was also assayed for FT3 FT4 and TSH by enzyme linked immunosorbent assay (ELISA) technique using Stat-fax-2100. Result: In our study, we have found the values of FT3 in cases as 1.21+0.89 pg/ml lower than control values of 1.92+ 0.66 pg/ml, values of FT4 in cases is 0.60+ 0.53 ng/dl as compared to control group value of 1.40 +0.39 ng/dl, values of TSH as 2.07+ 1.19 miu/l higher than the control group of 0.48+1.67 miu/l. The mean values of hs-CRP for cases as 7.85+0.72 higher than the control group with 3.50+0.54. Conclusion: Our study findings suggest that patients with hypothyroidism also have elevated hs-CRP which can have implication related to cardiovascular disease.

Correlation of oxidative stress and metabolic risk factors in apparently healthy adults

Background: Diabetes, hypertension, obesity, and dyslipidemia, all are the risk factors of metabolic syndrome (MS). Various studies have shown that each risk factor is associated with increased inflammation. hsCRP is a non-specific, sensitive inflammatory marker that is raised in various inflammatory conditions. Similarly, glutathione is an antioxidant which binds with ROS produced during inflammation and reduces damage caused by ROS. Aims and Objectives: This study has been planned to find the correlation between oxidative stress and metabolic risk factors in apparently healthy adults. Materials and Methods: We recruited apparently healthy adults (n = 120) and measured waist circumference, blood pressure, lipid profile, Fasting blood sugar, serum GSH, and hsCRP in all the subjects. Seventy-seven subjects were found to have at least one or more metabolic risk factors (Group A) according to NCEP ATP III criteria with waist circumference &gt;90 cm for male and &gt;80 cm for female and 43 were without any metabolic risk factors (Group B). Thereafter, we compared the serum levels of hsCRP and serum GSH with persons having one or more risk factors for MS. Results: In this study, we observed that subjects with metabolic risk factors were having more oxidative stress indicated by increased hsCRP (4783.1 ± 2060.21) and low serum GSH (3.17 ± 0.81) in comparison to controls (1640.5 ± 547.47 and 4.79 ± 0.77, respectively). This increase in hsCRP and decrease in GSH in case group was statistically significant. We also found the higher basal hsCRP levels in control group as per AHA/CDC study. Conclusion: We observed in this study that Indians without any risk factors for MS have relatively higher CRP levels and are at intermediate risk for cardiovascular disease. It was also observed that as the number of metabolic risk factors increases, the levels of hsCRP increases, and serum GSH decreases. This indicates that more risk factors are associated with higher oxidative stress.

Gastrointestinal Involvement in Extra-Digestive Disease: Which Is the Role of Fecal Calprotectin?

Fecal calprotectin (FC) is a very sensitive marker of inflammation of the gastrointestinal tract. Its clinical utility can be appreciated in both intestinal and extraintestinal diseases. Recent evidence suggests a link between intestinal inflammation and dermatological, rheumatic and neurological diseases. This review focuses on the role of FC in non-gastrointestinal disease, such as rheumatic, dermatologic, neurologic and last but not least SARS-CoV-2 infection.

Oral Cavity Calprotectin and Lactoferrin Levels in Relation to Radiotherapy.

Background: Lactoferrin, an iron-binding glycoprotein, and calprotectin, a calcium binding protein, are sensitive markers of inflammation and their fecal levels increase during radiotherapy of prostate cancer patients. With this background, we analyzed mouthrinse calprotectin and lactoferrin levels of head- and neck-cancer patients before, during and after radiotherapy. Methods: Twenty cancer patients (mean age 55.85 ± 15.01, 80% male), who had been planned to undergo radiotherapy to the head and neck area, were included in this study. Mouthrinse samples were collected before radiotherapy, at the 3rd and 6th weeks of radiotherapy and 4 weeks after the radiotherapy. Mouthrinse samples were analyzed for calprotectin and lactoferrin using commercial ELISA kits. Results: Calprotectin levels increased significantly during radiotherapy (p = 0.022). Both markers, lactoferrin (p = 0.011) and calprotectin (p = 0.006), decreased significantly after the treatment. Conclusions: Present study results may suggest that the elevations in calprotectin and lactoferrin levels during radiotherapy reflect the increased and emerging inflammatory environment in the oral cavity, thus may increase the risk of periodontal disease initiation or progression.

Sialic acid: an attractive biomarker with promising biomedical applications.

This broad, narrative review highlights the roles of sialic acids as acidic sugars found on cellular membranes. The role of sialic acids in cellular communication and development has been well established. Recently, attention has turned to the fundamental role of sialic acids in many diseases, including viral infections, cardiovascular diseases, neurological disorders, diabetic nephropathy, and malignancies. Sialic acid may be a target for developing new drugs to treat various cancers and inflammatory processes. We recommend the routine measurement of serum sialic acid as a sensitive inflammatory marker in various diseases.

Features of the course of community-acquired pneumonia in children before and during the COVID-19 pandemic

Introduction. The basis of the work was a retrospective analysis of the course of community-acquired pneumonia (CAP) in children with COVID-19. Aim. To determine the features of the course of CAP before and during the COVID-19 pandemic in children from birth to 18 years. Materials and methods. A retrospective analysis of the medical records of ninety five children (n = 95) who were treated at the Speransky Children’s Hospital No. 9 before the pandemic (October-November 2019; n = 45) and during the COVID-19 pandemic (April-May 2020 and October-November 2020; n = 50). All the received data are processed statistically. Results. It was found that before the COVID-19 pandemic, mainly adolescents aged 13-17 years were ill, during the pandemic younger children (6-12 years old) became ill more often. With the onset of the pandemic, the course of CAP changed significantly: fever, cough, shortness of breath were typical clinical signs; local signs were more pronounced in children during the pandemic: weakened and hard breathing was more often detected. Leukocytosis and accelerated ESR prevailed in patients with CAP before the pandemic. At the same time, CRP was a more sensitive marker of inflammation. It was revealed that with the beginning of the COVID-19 pandemic, the number of atypical pneumonia decreased, which may be due to anti-epidemic measures, but the prevalence of pneumonia of unknown etiology increased. Decreased oxygen saturation was a more frequent rule in CAP during the pandemic. Lobar pneumonia prevailed in children before the pandemic, and polysegmental pneumonia prevailed in patients during the pandemic. Conclusion. The features presented by the authors of the manifestations of community-acquired pneumonia in children before and during the COVID-19 pandemic make it possible to optimize their diagnosis using clinical and laboratory signs.

Role of D-Dimer in Covid-19 pneumonia: sensitive marker of inflammation, predictor of mechanical ventilation, thromboembolic events and early marker of post covid-lung fibrosis; Prospective Multicentric, Observational, Interventional study in tertiary care setting in India

Introduction: Covid-19 pneumonia is heterogeneous disease with variable effect on lung parenchyma, airways and vasculature leading to long term effects on lung functions. Materials and methods: Multicentric, prospective, observational and interventional study included 1000 covid-19 cases confirmed with RT PCR. All cases were assessed with HRCT thorax, oxygen saturation, inflammatory marker as D-Dimer at entry point and follow up. Age, gender, Comorbidity and use BIPAP/NIV and outcome as with or without lung fibrosis were key observations. In selected cases, lower limb venous doppler and CT pulmonary angiography to rule out DVT or PTE. Statistical analysis is done by using Chi square test. Observations and analysis: Age (&lt;50 and &gt;50 years) and gender (male versus female) has significant association with D-Dimer level. [p&lt;0.00001] &amp; [p&lt;0.010] respectively. CT severity score at entry point with D-Dimer level has significant correlation. [p&lt;0.00001] D-Dimer level has significant association with duration of illness prior to hospitalization. [p&lt;0.00001] Comorbidities have significant association with D-Dimer level. [p&lt;0.00001] D-Dimer level has significant association with oxygen saturation. [p&lt;0.00001] BIPAP/NIV requirement has significant association with D-Dimer level. [p&lt;0.00001] Timing of BIPAP/NIV requirement during hospitalization has significant association with DDimer level. [p&lt;0.00001] Follow-up D-Dimer titer during hospitalization as compared normal &amp; abnormal to entry point level has significant association with post-covid lung fibrosis, deep vein thrombosis and pulmonary thromboembolism. [p&lt;0.00001]. Conclusion: D-Dimer has documented very crucial role in covid-19 pneumonia in predicting severity of illness and assessing response to treatment during hospitalization and follow up titers have significant role in step-up or step-down interventions in critical care setting.

Diagnostic utility of combined immature and total neutrophil counts along with C-reactive protein in early detection of neonatal sepsis: A cross-sectional study

IntroductionA timely diagnosis is critical for management of Neonatal sepsis. Blood Culture is considered to be the “Gold Standard” for its diagnosis, but it has some limitations. In recent times, highly sensitive and specific inflammatory markers like interleukins, ELISA, counter immune-electrophoresis etc. have been in use for its diagnosis. But these are impractical for developing countries, due to their high cost and requirement of sophisticated equipments. A combination of haematological parameters like total leucocyte count (TLC), immature to total neutrophil ratio (I/T ratio), absolute neutrophil count (ANC), platelet count and C-reactive protein (CRP) estimation provide an early diagnosis of bacteremia. This study was undertaken to evaluate the usefulness of the above mentioned parameters as indicators for early diagnosis of neonatal sepsis. Material and methodsIn the present cross-sectional study, we intent to analyse various hematologic parameters in 160 neonates admitted in the neonatal care unit of a tertiary care hospital in Delhi. We obtained data from the records of blood culture and complete blood counts of neonates from pathology and microbiology departments of the hospital. Out of 160 admitted neonates, 80 were taken as cases and remaining 80 were taken as controls. Medical records were studied to identify infants born at ≥ 34 weeks gestation. CBCs was analysed, blood cultures and CRP were done in department of Microbiology. CBC, CRP and Blood culture was done as per standard protocols and clinical assesment by paediatrician. The statistical analyses were performed using SPSS version 22 for windows. ResultsAmong 80 neonates, who were in early neonatal sepsis, 44 cases (55%) were females, and 36 (45%) were males. The Microbiological profile of 80 septic neonates was analysed. The I/T value, ANC and CRP values were significantly higher in the neonates suffering from sepsis as compared to the control group. Among 80 septic neonates (cases), 30 (37.5%) were having normal ANC while 50 (62.5%) were having increased ANC and 34 (42.5%) were having normal I:T ratio while 46 (57.5%) were having increased I:T ratio. Out of 80 septic neonates (cases), 18 (22.5%) were having normal CRP while 62 (77.5%) were having increased CRP. ConclusionANC, I/T Ratio and CRP are quick, simple and cost-effective routine laboratory tests which help in early diagnosis of neonatal sepsis. Although there are many serological markers available, ANC and I/T Ratio serves as a reliable predictor of neonatal sepsis. With a good sensitivity, high specificity and a good negative predictive value these parameters can therefore help in timely and early identification of neonatal sepsis.

High sensitivity C-reactive protein and dyslipidemia as a marker for the risk for cardiovascular disease

Background: High sensitivity C-reactive protein (hs-CRP), a sensitive marker of inflammation and tissue damage is an acute phase reactant. It is raised in hypertension and predicts cardiovascular outcome. Moreover elevated levels of inflammatory markers such as hs-CRP and altered lipid profile are commonly seen in hypertension which may develop cardiovascular events, hence, hs-CRP, lipid profile and nitric oxide (NO) have been incorporated in the study. The aims of this study were to find out a relationship of serum hs-CRP and dyslipidemia in hypertensives and to find out an association of serum hs-CRP with the risk for Cardiovascular disease (CVD). Methods: A case-control study was done among the patients visiting the outpatient department (OPD) of BP Koirala Institute of Health Sciences, Dharan, Nepal in which forty seven newly diagnosed hypertensives as cases and fifty age and sex matched healthy normotensives as controls, were enrolled in the study with the prior informed consent. hs-CRP, nitric oxide (NO) and lipid profile were estimated in both the cases and controls. Results: Hypertensives have significantly raised levels of hs-CRP, non-high density lipoprotein cholesterol (non-HDL-C) and NO compared to that in controls (P&lt; 0.05). hs-CRP has a significant positive correlation with systolic as well as diastolic blood pressure, BMI, and with triglyceride (TG) (P&lt; 0.05). However, the correlation of hs-CRP with NO is negative but statistically significant (0.000). Conclusion: The level of hs-CRP, which is thought to be a marker of inflammation, is significantly raised in hypertensives. Moreover, the majority of hypertensives are dyslipidemic suggesting hypertensives to be at an increased risk for the development of CVD. Key words: Cardiovascular diseases, dyslipidemia, hs-CRP, hypertension, inflammation.

Role of “Ferritin” in COVID-19 pneumonia: Sensitive marker of inflammation, predictor of mechanical ventilation, and early marker of post-COVID-lung fibrosis – A prospective, observational, and interventional study in a tertiary care setting in India

Aims and Objectives: Robust data of ferritin are available as a prognostic marker in bacterial infection and we have analyzed its usefulness in coronavirus disease 2019 (COVID-19) pneumonia in predicting severity of illness, response to treatment, and final outcome. Materials and Methods: A multicentric, prospective, observational, and interventional study included 1000 COVID-19 cases confirmed with reverse transcription–polymerase chain reaction. All cases were assessed with lung involvement documented and categorized on high-resolution computed tomography (CT) thorax, oxygen saturation, inflammatory marker, ferritin at entry point, and follow-up during hospitalization. Age, gender, comorbidity and use of BIPAP (bilevel positive airway pressure)/NIV (non-invasive ventilation) /NIV, and outcome as with or without lung fibrosis as per CT severity were key observations. Statistical analysis was done using Chi-square test. Observations and Analysis: In a study of 1000 COVID-19 pneumonia cases, age (<50 and > 50 years) and gender (male versus female) had a significant association with ferritin (P < 0.00001 and P < 0.010, respectively). CT severity score at entry point with ferritin level had a significant correlation in severity score (P < 0.00001). Ferritin level had a significant association with duration of illness (P < 0.00001). Comorbidities had a significant association with ferritin level (P < 0.00001). Ferritin level had a significant association with oxygen saturation (P < 0.00001). BIPAP/NIV during hospitalization had a significant association with ferritin level (P < 0.00001). Timing of BIPAP/NIV requirement in critical care setting had a significant association with ferritin level (P < 0.00001). Follow-up ferritin titer during hospitalization as compared to entry point normal and abnormal ferritin had a significant association in post-COVID lung fibrosis, respectively (P < 0.00001). Conclusions: Ferritin has documented very crucial role in COVID-19 pneumonia in predicting severity of illness, progression of illness and requirement of mechanical ventilation, assessing response to treatment during hospitalization. Follow up ferritin titre during hospitalization and at discharge can be used as early predictor of post-covid lung fibrosis.

C-Reactive Protein And Lipid Profile In Ischemic Heart Disease A Cross-Sectional Analytical Study

Inflammation plays a major role in the initiation, progression &amp; destabilization of atheroma. C-reactive protein (CRP) is a sensitive marker of inflammation, and elevated levels have been associated with future risk of myocardial infarction (MI). Risk of coronary heart disease &amp; other forms of atherosclerotic vascular disease rises with plasma cholesterol concentration &amp; in particular the ratio of total cholesterol to high density lipoprotein (HDL-C) cholesterol. Measurement of C- reactive protein (CRP) adds to the predictive value of total cholesterol (TC) and HDL cholesterol (HDL-C) in determining subsequent risk of first myocardial infarction. Methods: This cross-sectional analytical study was undertaken to observe association between high sensitive CRP and lipid profile level with chronic ischaemic heart disease and was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka from July 2010 to June 2011. A total 50 cases were selected purposively according to the selection criteria from the patients admitted in the Department of Cardiology, Dhaka Medical College Hospital with chronic ischaemic heart disease (IHD). Diagnosed IHD patients were taken as cases; age- &amp; sex- matched 50 healthy subjects were taken as controls. Serum hsCRP and serum TC, TAG, LDL-C &amp; HDL-C were measured in all study subjects. Results: The mean serum CRP concentration in cases and controls were 11.22+/-7.64 mg/dl and 1.72+/-0.98 mg/dl respectively. Mean serum TC, TAG, HDL-C and LDL-C in cases groups were 314+/-74 mg/dl, 288+/-60 mg/dl, 36+/-4 mg/dl, and 178+/-22 mg/dl respectively and in controls groups were 175+/-19 mg/dl, 118+/-12 mg/dl, 43+/-2 mg/dl &amp; 126+/-11 mg/dl respectively. Serum hsCRP, Total Cholesterol, TAG &amp; LDL-C were significantly higher in cases than control subjects. Serum HDL-C was significantly lower in cases than control subjects. Conclusions: The present study reveals that the patients of chronic ischaemic heart disease have been found to have close association of increased level of hsCRP and lipid profile.

Perbaikan kadar trigliserida dan Hs-CRP pada tikus Wistar Diabetes Mellitus tipe 2 dengan biskuit biji bunga matahari

Diabetes Mellitus is a group of metabolic diseases characterized by hyperglycemia due to defects in insulin secretion or insulin action. Increased glucose allows free fatty acids to enter as raw material for forming triglycerides. Hs-CRP can be used to identify the most sensitive inflammatory markers in diabetes. This study aims to analyze the effect of sunflower seed biscuits on triglyceride levels and Hs-CRP in Wistar rats with type 2 diabetes mellitus. The method is a true experiment with a randomized pre-post test with a control group design. The research sample size was 24 male Wistar rats, divided into four control groups K(-), K(+), and treatment P1, P2. The intervention was carried out for 28 days, and triglycerides were measured by spectrophotometer, and Hs-CRP was measured using the ELISA method. Statistical analysis used three tests, namely the Paired T-Test, the Kruskal Wallis test, and the Spearman correlation test. There are differences after the intervention and changes between groups with triglyceride values before intervention 145 mg/dl and after intervention 145 mg/dl and Hs-CRP values before intervention 14.8 mg/l and after intervention 14,8 mg/l. Changes between groups of triglyceride and Hs-CRP levels after statistical tests (p= 0,000) and (p= 0,000), respectively. The conclusion is a provision of sunflower seed biscuits showed an effect on triglyceride and Hs-CRP levels of type 2 diabetes mellitus rats. The lowest decrease in triglyceride and Hs-CRP levels was found in the treated rats with a dose of 1440 mg / 200 g of rats

Reappraising the role of baseline plasma C-reactive protein levels on recurrence after catheter ablation of persistent atrial fibrillation: insight from EARNEST-PVI trial

Abstract Background Subclinical inflammation is an important pathogenesis of developing and sustaining atrial fibrillation (AF). Because AF itself contribute to the inflammatory response, the role of baseline subclinical inflammation on AF recurrence after catheter ablation (CA) remains controversial in patients with persistent AF. Purpose To evaluate whether baseline plasma C-reactive protein (CRP) levels, a sensitive marker of inflammation, are associated with AF recurrence following CA. Methods The analysis was performed from the EARNEST-PVI trial, a randomized controlled trial designed to assess a CA strategy for persistent AF, which was conducted in the Osaka region of Japan. A total of 441 patients (median age, 67 years; 26% female; 25% long-standing persistent AF) whose plasma CRP levels were measured at baseline were included in this study. Results At baseline, a median (interquartile range) of plasma CRP level was 0.10 [0.06–0.19] mg/dl. Plasma CRP levels significantly increased at discharge (0.83 [0.21–1.84] mg/dl, p&amp;lt;0.001) and decreased 1 year after CA (0.10 [0.05–0.20] mg/dl, p=0.040) compared to the baseline value. During the follow-up of 1 year, 115 patients (26%) experienced AF recurrence, and the incidence was significantly higher in 124 patients with low CRP levels at baseline (cut-off ≤0.06 mg/dl) than the other 317 patients (33.9% vs. 23.0%, p=0.017). After adjustment of age, gender, body mass index, long-standing persistent AF, CA strategy, and plasma brain natriuretic peptide levels, low plasma CRP levels was a significant predictor of AF recurrence (hazard ratio, 1.51; 95% confidence interval, 1.02–2.24; p=0.042). Conclusions Low plasma CRP levels at baseline predicted AF recurrence in the EARNEST-PVI trial. Reappraising the role of CRP on AF recurrence may be needed in patients with persistent AF. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Johnson &amp; Johnson KK

Association between high mobility group box 1 protein and juvenile idiopathic arthritis: a prospective longitudinal study

ObjectiveTo analyze the levels of high mobility group box 1 (HMGB1) protein on different courses of juvenile idiopathic arthritis (JIA).MethodsIn our prospective longitudinal study, children with JIA were included with their blood samples collected at the first visit, 1-month, 3-month, and 6-month follow-up, respectively. Samples were also collected from healthy controls and children with reactive arthritis at the first visit. Levels of HMGB1 were determined using enzyme-linked immunosorbent assays. Clinical disease characteristics and routine laboratory findings were analyzed as well.ResultsA total of 64 children were enrolled, of whom 31 (48.4%) were female. The median age at the first visit for participants with JIA was 9.25 years (range, 1.42–15.42) and the median duration of disease was 2.38 months (range, 1.53–49.31). Serum HMGB1 levels at the first visit were significantly elevated in children with systemic JIA compared with other groups, and so were in enthesitis-related arthritis versus healthy controls. Significant correlations were established at the first visit between HMGB1 levels and duration of disease, C-reactive protein, percentage of neutrophils, and ferritin. Data from all samples revealed that serum HMGB1 levels in JIA were significantly associated with erythrocyte sedimentation rates, C-reactive protein, percentage of neutrophils, and disease activity scores.ConclusionsSerum HMGB1 may be associated with clinical disease activity of JIA and specifically increased at the first visit in children with systemic JIA, suggesting its function as a sensitive inflammatory marker. Further large-scale studies are warranted to explore its spectrum in JIA.