Serum C-reactive Protein Values Research Articles

Alpha-Defensin Offers Limited Utility in Work-Up Prior to Reimplantation in Chronic Periprosthetic Joint Infection in Total Joint Arthroplasty Patients

BackgroundAlpha-defensin (AD) is a synovial biomarker included in the 2018 consensus criteria for diagnosing periprosthetic joint infection (PJI). Its value in assessing eradication of infection prior to second stage reimplantation is unclear. The purpose of this study was to evaluate the impact of AD on eligibility for reimplantation following resection for chronic PJI. MethodsThis study included patients who previously underwent resection arthroplasty for PJI. Synovial fluid aspirated from 87 patients was retrospectively reviewed. All patients completed a 6-week course of intravenous antibiotics and an appropriate drug holiday. Synovial white blood cell count, percentage neutrophils, and culture from the AD immunoassay laboratory were reviewed with serum erythrocyte sedimentation rate and C-reactive protein values from our institution. A modified version of the 2018 consensus criteria was used, including white blood cell count, percentage neutrophils, erythrocyte sedimentation rate, and C-reactive protein. AD was then added to determine if it changed diagnosis or clinical management. ResultsFour patients were categorized as “infected” (score >6), none exhibited a positive AD or positive culture. Sixty eight patients were diagnosed as “possibly infected” (score 2 to 5), none had a positive AD, and one had a positive culture (Cutibacterium acnes). AD did not change the diagnosis from “possibly infected” to “infected” in any case or alter treatment plans. Fifteen patients had a score of <2 (not infected) and none had a positive AD. ConclusionThe routine use of AD in the work-up prior to a second-stage arthroplasty procedure for PJI may not be warranted.

The Natural Course of Adult-Onset Food Protein-Induced Enterocolitis Syndrome

Adult-onset food protein-induced enterocolitis syndrome (FPIES) has been increasingly recognized in recent years. Adult FPIES differs from pediatric FPIES in terms of dietary triggers and symptoms, thus further broadening the clinical phenotypes of the disease. The natural history of FPIES in adulthood is poorly characterized. To evaluate the natural course of FPIES in adults. We performed an ambispective study of adults diagnosed with acute FPIES during 2016-2021. Data on age, sex, symptoms, implicated food, and oral food challenge (OFC) outcomes at baseline and during follow-up were analyzed. Forty-two adults were included (83.3% female; median age at diagnosis, 40 years). The predominant symptoms were diarrhea (92.9%) and abdominal cramps (71.4%); vomiting was reported by 59% of patients. The most common triggers were shellfish (n= 19, 45.2%) and fish (n= 19, 45.2%). The mean number of reactions before diagnosis was 6.3 (2-15). Twenty-one OFCs were carried out with the offending food in 15 patients. Six patients achieved tolerance (40%) after a mean of 17.8 months (range, 6-36 months). Twelve of all OFCs performed were positive (57.1%). The absolute leukocyte and neutrophil counts measured before and 1 to 2 hours after the positive challenge showed a mean increase of 3045 and 2736 cells/μL, respectively. Serum tryptase, C-reactive protein, and eosinophil and platelet values did not change significantly after the OFC. Some patients may outgrow adult-onset FPIES.

The Prognostic Role of the C-Reactive Protein and Serum Lactate Dehydrogenase in a Pediatric Series of Bone Ewing Sarcoma.

Simple SummaryEwing sarcoma is a rare and aggressive tumor of childhood and adolescence. Over the years, different prognostic factors have been explored to stratify high-risk patients. The roles of C-reactive protein (CRP) and serum lactate dehydrogenase (LDH) as potential new prognostic factors would be a useful and simple for risk stratification, but they have rarely been investigated. In our work, we analyze the role of LDH and CRP as prognostic factors in a population of pediatric and adolescent patients affected by Ewing sarcoma. Our study confirms the potential prognostic role of LDH at diagnosis as an independent prognostic factor. LDH evaluation is not expensive, and it can be beneficial for developing countries where diagnostic and staging resources in the pediatric oncology field are poor. Background: Ewing sarcoma (ES) is a rare and aggressive pediatric cancer. Numerous studies have attempted to identify new prognostic biomarkers. The predictive value of serum LDH and CRP has not been clearly described, to date. Methods: The objective of our retrospective study was to investigate the prognostic value of LDH and CRP levels and their association with overall survival in a series of ES patients. Results: Between 2004 and 2019, 89 ES patients were included. In a univariable analysis, high levels of LDH and CRP were associated with the worst prognosis. In a multivariable analysis, only higher LDH values remained associated with a lower survival. The high-LDH-level group experienced all 21 deaths registered in our population (24%) and about 90% of disease progressions. The 5-year overall survival was 66.4% in the high-LDH-level group, while no deaths were observed in the low-LDH-level group. The 5-year progression-free survival was 57.9% in the high-LDH-level group versus 80.4% in the low-LDH-level group. Conclusions: In our study, LDH levels at diagnosis were strongly correlated with the prognosis, and they might be considered a prognostic factor in Ewing sarcoma. The LDH value, along with its very low cost and its reproducibility in almost all centers, make it suitable as a potential prognostic biomarker in clinical practice.

Comparison of pleural drain amylase and serum C-reactive protein for early detection of intrathoracic esophago-gastric anastomotic leaks

IntroductionEarly detection of anastomotic leaks following esophagectomy has the potential to reduce hospital length of stay and mortality. The aim of this study was to compare the predictive value of pleural drain amylase and serum C-reactive protein for the early diagnosis of leak.MethodsA retrospective observational cohort study was conducted on 121 patients who underwent Ivor Lewis esophagectomy and intrathoracic gastric conduit reconstruction. Pleural drain amylase levels were measured daily until postoperative day (POD) 5 and compared with CRP values measured on POD 3, 5, and 7. Specificity and sensitivity for both tests, and the respective ROC curves, were calculated.ResultsAnastomotic leak occurred in 12 patients. There was a significant statistical association between pleural drain amylase and serum CRP levels and the presence of anastomotic leakage. Pleural drain amylase cutoff of 209 IU/L on POD 2 yielded a sensitivity of 75% and a specificity of 94% (AUC = 0.813), whereas CRP cutoff value of 22.5 mg/dL on POD 3 yielded a sensitivity of 56% and a specificity of 92% (AUC = 0.772). The negative likelihood ratio of pleural drain amylase was 0.27 and 0.12 on POD 2 and 5, respectively. There was no statistically significant difference between ROC curves of amylase and CRP on POD 3 and 5 (p = 0.79 and p = 0.14, respectively).ConclusionsPleural drain amylase seems more efficient than serum CRP for early detection of esophago-gastric anastomotic leak. The practice of monitoring drain amylase and CRP may allow safer implementation of enhanced postoperative recovery pathway.

Retrospective analysis of biochemical markers in COVID-19 intensive care unit patients

BackgroundThe aim of the study was to evaluate the presence and effects of hematological and biological parameters in the diagnosis of the disease by performing blood tests on COVID-19 patients admitted to the intensive care unit (ICU).ResultsBiochemical parameters from the blood samples of 279 patients who were confirmed to have COVID-19 and met the criteria for admission to the ICU were compared between discharged and deceased patients. Multiple logistic regression analysis was performed in terms of mortality and probability of being discharged. The predictive value of serum C-reactive protein (CRP), procalcitonin (PCT), lymphocyte, neutrophil, leucocyte, and platelet (PLT) levels was evaluated by measuring the area under the receiver operating characteristic curve (AUROC).Comparisons made according to deceased and survival patients results revealed that while no statistically significant difference was observed between test groups lymphocyte and platelet-lymphocyte ratio values, statistically significant difference was found between the test groups regarding platelet, leukocyte, neutrophil, PCT, neutrophil-lymphocyte ratio (NLR), and thrombocyte count × neutrophil count/lymphocyte count (SII) values.ConclusionsThis study showed that biochemical parameters examined are important in determining the prognosis of the disease and may be useful in determining the direction of the treatment process and predicting the risk of discharge or death after the initial evaluation of the patients in the ICU.

C-reactive protein elevation is associated with increased morbidity and mortality in elderly burned patients

BackgroundC-reactive protein (CRP) is an acute-phase protein produced in response to inflammation after traumatic injury. We posit that C-reactive protein (CRP) is reliable in predicting morbidity and mortality following severe burn. In this study, we explored the relationship between serum CRP values and clinical outcomes in the severely burned. MethodsUsing the Research Network within the TriNetX database, we queried de-identified burn patient data across the United States and enrolled 36,556 burn patients with reported CRP values from 2006 to 2020. ResultsCirculating CRP levels were elevated significantly in patients ≥60 years as well as in males and African Americans (p < 0.05). CRP levels reached the zenith on the first day after burn, and were highest when burn size reached 60% total body surface area (TBSA). After bisecting the data at 10 mg/L of CRP, we compared clinical findings between patient groups (n = 16,284/18,647 in high/low CRP levels). The risk of patient death doubled in the high CRP group from 4.687% to 9.313%, with higher incidences of sepsis, skin infection, and myocardial infarction (p < 0.05). Moreover, mortality increased from 0.9% to 1.926% in those younger than 20 years when comparing the low and high CRP groups, whereas mortality significantly increased from 8.84% to 15.818% in those ≥60 years old (p < 0.05). Both elderly and paediatric groups had significant increases in the diagnosis of sepsis-associated with increased CRP expression. However, incidences of skin infection, pneumonia, and acute kidney injury increased significantly only in the elderly group (p < 0.05). ConclusionElevated CRP expression is common in burn patients. The factor of age influenced the association of CRP expression to clinical outcomes.

Association of High-Sensitivity C-Reactive Protein and Vitamin D with Bronchial Asthma

Background: Bronchial asthma (BA) is a common lung illness and a significant health concern affecting over 315 million individuals globally. Asthma involves three main pathologies: airways hyperresponsiveness (AHR), inflammation, and remodeling. VitD has a forceful immunomodulatory effect able of reducing inflammatory responses in many cells intricate in BA. Deficiency of vitD has been linked with much inflammation and global worsening of asthmatic patients. C-reactive protein (CRP) is elevated in primary stages of inflammation of BA and high serum CRP values are observed with impaired pulmonary function and AHR.&#x0D; For that reason, it is sensible to explore the role of vitD in BA via its associations with CRP. This comparative study was aimed to evaluate the relationship between serum levels of HSCRP and vitD in patients with asthma.&#x0D; Patients and Methods: &#x0D; This is a case-control study conducted on 127 asthmatic patients with 113 (sex/aged matching) healthy control. The FeNo results had obtained in private centers, according to the ''guidelines of the American Thoracic Society (ATS)''. All participants had blood analysis of HSCRP and correlated with FeNo measures. VitD Values were classified as sufficient (&gt;30ng/ml), insufficient (20 to 30ng/ml), and deficient (&lt;20ng/mL) based on the preceding reference.&#x0D; Statistical Package for Social Sciences (SPSS/23-IBM) had used. The chi-squared test had used for univariate investigation, and a t-test had completed detecting variations between the studied groups, treatment groups, and genders. The outcomes had calculated at a 95% CI and had assigned as significant for all variables. The categorization accuracy of HSCRP, vitD, and FeNo measures had been investigated under the ''ROC curves'' for their diagnostic fitness to decide asthma prediction.&#x0D; Results&#x0D; Compared to the control group, the mean FeNo levels were significantly higher in asthmatics (p-0.001). Vitamin D mean levels were parallel between the study groups (p&gt;0.05). The mean HSCRP levels were significantly (p-0.03) higher among asthmatics. Around 40% of all participants had lower than normal levels of serum VitD and &lt;10% only revealed deficient levels. There was no effect of history of the treatment of BA on the blood levels of vitD and HSCRP. There was a positive non-significant correlation of vitD with FeNo results (r-0.067, p-0.54) and negative non-significant (r-0.082, p-0.086) correlation of vitD with HSCRP. ROC-curve analysis showed a significant ability (p-0.001) of FeNo to distinguish asthma, with high accuracy, sensitivity and specificity: 0.967, 93.5%, 93.2%, at 95% CI [0.946-1.000], respectively. Likewise, ROC analysis of HSCRP revealed significant ability (p-0.001), but with lower accuracy (0.881), sensitivity (87.1%), and specificity (76.3%) at 95% CI [0.812-0.950] to distinguish asthma patients from healthy subjects. Unlikely, VitD had a non-significant (p-0.085) and lower ability to predict asthma from healthy participants showing AUC (0.612), sensitivity (54.8%), and specificity (68.3%) at 95% CI [0.488 -0.736].&#x0D; Conclusion&#x0D; No relation or minor conflicting correlations between serum levels of vitD with asthma severity, treatment history, and inflammation (as indicated by HSCRP). Highly sensitive CRP is correlated with asthma.

MO326: Factors Influencing Death Rate in COVID-19-Associated Acute Kidney Injury

BACKGROUND AND AIMSDuring a 2-year pandemic, COVID-19 proved to be a condition with a high potential to affect various organs other than the lungs. Acute kidney injury (AKI) in hospitalized COVID-19 patients is associated with a poor prognosis. The aim of this study was to identify factors influencing in-hospital mortality.METHODIn a retrospective analysis, we included 268 adult patients with RT-PCR-confirmed SARS-CoV-2 infection and AKI admitted to two Emergency University Hospitals during a 6-month period, between 1 November 2020 and 30 April 2021. Data were retrieved from the electronic databases of the two hospitals. We analysed kidney and patient outcomes at discharge and the potential risk factors for mortality in AKI patients. We defined and staged AKI according to KDIGO 2012 creatinine criteria.RESULTSIn our cohort the mean age was 72.28 years, 169 (63%) patients were men, and 111 (41.4%) had previously known chronic kidney disease. 81 patients were classified as having stage 1 AKI, 79 patients had stage 2 AKI and 108 had stage 3 AKI. A total of 135 (50.37%) patients died during hospitalization.Statistic analysis using the Mann–Whitney U-test revealed significant differences (P < .01) between survivors and non-survivors regarding peak values of serum urea (137.9 versus 190.9 mg/dL), creatinine (2.88 versus 3.94 mg/dL), procalcitonin (3.56 versus 15.86 ng/mL), C-reactive protein (92.32 versus 176.09 mg/L), interleukin-6 (243 versus 9552 pg/mL), ferritin (1331 versus 5189 ng/ml) and d-dimers (3.68 versus 6.88 mcg/ml). No significant differences were found between survivors and non-survivors regarding peak values of erythrocyte sedimentation rate (69 versus 71 mm/1 h; P = .35) and fibrinogen (629 versus 645 mg/dL; P = .24) and also regarding the lowest lymphocyte count during hospitalization (519 versus 649/mmc; P = .80).The analysis using Fisher’s exact test showed that deceased patients were significantly more associated with AKI KDIGO stage 2 or 3 (51.9%/63% versus 32.1%), with higher need for renal replacement theraphy (RRT) (68.8% versus 47.9%), with ICU (intensive care unit) admission (90.1% versus 22.3%) (Table 1). Moreover, death was associated more frequently with partial or absent renal function recovery (20%/50% versus 6.4%) (P < .05) (Table 1).In a logistic regression model (using KDIGO stages, serum urea and need for RRT), it was proved that only serum urea had a significant prediction power (P = .001): every increase of serum urea with 1 unit increases the risk of death by 1.007 times (95% confidence interval 1.003–1.011).CONCLUSIONMortality of COVID-19 patients associating AKI is proportionally augmented by both markers of severity of SarS-CoV-2 and also by severity of AKI. In our study, the peak value of serum urea during hospitalization was the best predictor for death in COVID-19.

Application Value of Serum Hcy, TLR4, and CRP in the Diagnosis of Cerebral Small Vessel Disease.

Objective To evaluate the application value of combined detection of serum homocysteine (Hcy), Toll-like receptor 4 (TLR4), and C-reactive protein (CRP) in the diagnosis of cerebral small vessel disease (CSVD). Methods 90 patients with CSVD admitted to our hospital within the past year were identified as the research subjects, and the patients with cognitive dysfunction were assigned to the experimental group, and those with normal cognitive function were assigned to the control group according to the evaluation of cognitive dysfunction by the Montreal Cognitive Assessment (MoCA), with 45 cases in each group. Results The experimental group obtained remarkably elevated Hcy levels than the control group (P < 0.05). The patient's cognitive dysfunction is mainly attributed to the impact of serum Hcy. TLR4 and Hcy were negatively correlated with MoCA scores (P > 0.05). In comparison with the control group, the experimental group had significantly higher levels of Hcy, serum CRP, and interleukin (IL)-6 (P < 0.05). Conclusion The combined detection of serum Hcy, TLR4, and CRP features a high clinical value in the diagnosis of CSVD, which contributes to the prevention and treatment of cognitive dysfunction in patients.

UTILITY OF SERUM ALBUMIN AND C-REACTIVE PROTEIN FOR ASSESSING THE SEVERITY OF DENGUE INFECTION- A RECORD BASED CASE SERIES STUDY.

Background: Dengue is the most rapidly spreading mosquito borne viral disease in the world. Dengue viruses are avivirus, which include four serotypes 1, 2, 3 and 4. Clinical expression of dengue virus infection vary from asymptomatic infection to severe dengue with shock. Incidence has increased 30- fold in the last 50 years with increasing geographic expansion to new countries and, in the present decade, from urban to rural settings. At present, dengue fever (DF) causes more illness and death than any other arboviral disease of humans. Aims and objectives: To determine the value of serum albumin and C-reactive protein (CRP) in the assessment of severity of dengue infection in patients admitted to SNMC and HSK hospital. Materials and methods: Record based study done on patients admitted to general medicine department of S Nijalingappa Medical College and HSK hospital, bagalkot, Karnataka. Patients with Dengue NS1 Ag or IgM positive are included in the study after meeting inclusion and exclusion criteria. Results: A total of 65 patients were studied according to the inclusion criteria. Majority of the patients were between 20-40years of age with 56.9% being male patients and 43.1% were females. 40% of the patients had dengue without warning signs, 52.3% had dengue with warning signs and 7.7% had severe dengue. Mean serum albumin of 2.66g/dl was seen in severe dengue group whereas a value of 3.65g/dl and 3.06g/dl was seen in dengue without warning signs and dengue with warning signs respectively. Mean CRP of severe dengue group was 98.84mg/L whereas it was 9.49mg/L and 53.60mg/L among dengue without warning signs and dengue with warning signs respectively. Conclusion: Serum albumin and C-reactive protein can be used as potential markers to predict severity of illness in dengue infection.

Does the delivery mode affect post-birth neonatal serum C-reactive protein levels? A causal effect analysis.

AimTo determine if the delivery mode has a causal effect on neonatal serum C‐reactive protein (CRP) levels. If such a causal effect exists, we aim to quantify its magnitude.MethodsWe investigated the causal effect of the delivery mode on serum CRP levels 6–8 h after delivery, with appropriate statistical tools for retrospective studies, combining classical and machine‐learning methods. The statistical inference is followed by sensitivity analysis to quantify the magnitude of unobserved bias required in order to alter the study's conclusion.ResultsThis retrospective study reviewed laboratory records of neonates after birth who underwent blood tests due to suspected sepsis. A total of 440 newborns were included, 324 of which underwent a vaginal delivery, 59 an urgent caesarean delivery, and 57 an elective caesarean delivery. Our results revealed that serum CRP values following elective caesarean deliveries were 50% less than those following a vaginal delivery (P = 0.030; −0.907; 95% CI [−1.545, −0.268] in log‐CRP units). No significant effect was found for urgent caesarean deliveries compared to vaginal deliveries (P = 0.887). Those results were strengthened by (1) a sensitivity magnitude of 1.6 to unobserved bias and (2) non‐significant effects when analysis is repeated on blood collected 12–24 h after birth.ConclusionCRP concentrations in neonatal blood during the first 6–8 h of life are higher following vaginal deliveries compared to elective caesarean deliveries. Further studies with the intent of improving EONS detection should include information on the delivery mode.

Serum Lipid Profile and C-Reactive Protein as Prognostic Markers in Oral Submucous Fibrosis

Introduction: Oral submucous fibrosis is a chronic, premalignant condition of the oral mucosa, affecting millions of people globally and it is one of the precancerous conditions most prevalent in India. Previously published studies have evaluated the serum lipid profile and C-reactive protein in various potentially malignant disorders and oral squamous cell carcinoma, but to our knowledge, no studies are available comparing the pre- and post-treatment serum lipid profile and C-reactive protein values in oral potentially malignant disorders, so that their real prognostic value can be assessed. Aim: The present study aims to evaluate the serum lipid profile and C-reactive protein as a prognostic marker in Oral Submucous Fibrosis patients. Materials and Methods: A total of 30 clinically diagnosed OSF patients of either gender in the age group of 20 – 50 years were selected. A complete history taking followed by a thorough oral examination was done on all patients. About 5 mL of blood sample was collected before treatment and after 6 weeks of treatment for estimation of serum lipid profile and C-reactive protein Results: The mean values of serum lipid profile were decreased among OSF patients and the difference between pre- and post-treatment was statistically significant. The comparison of the mean values of the pre- and post-treatment CRP level of the study subjects among OSF patients was found to be statistically significant (P = 0.022). Conclusion: Hence, pre- and post-treatment serum lipid profile and CRP levels contribute to being of prognostic value in OSF.

Association of Serum C-Reactive Protein Level and Treatment Duration in Acute Cholecystitis Patients Treated Conservatively.

Background: Acute cholecystitis (AC) is one of the most common gastrointestinal diseases that require hospitalization and surgical treatment. The treatment of the disease depends upon the severity of the disease and the patients’ medical status.Objective: In this study, we aimed to investigate if there is an association between the serum C-reactive protein (CRP) value and treatment response and the duration and length of hospital stay in AC patients who are treated conservatively.Methodology: The medical records of all patients with the diagnosis of AC who were treated with conservative management were included in the study. The demographic and laboratory data including CRP level at first admission to hospital, length of hospital stay, and complications during the conservative treatment were obtained from the patients’ records. Patients were divided into two groups according to the treatment response and length of hospital stay. Group 1 patients were defined as patients who responded to the medical treatment in less than three days, and Group 2 patients were defined as patients who did not respond to the medical treatment in three days and stayed at the hospital for more than three days.Results: We identified 101 patients with AC treated medically. Mean age (51.3 ± 16.3, 59.5 ± 15.7; p = 0.013), total leukocyte count (11.8 ± 4.4, 8.2 ± 2.8; p = 0.0005), and CRP value (19.3 ± 13.9, 9.6 ± 5.2; p = 0.0003) were higher in Group 2 compared to Group 1. Correlation analyses demonstrated a significant positive association between the length of hospital stay, total leukocyte count (r = 0.35; p = 0.0002), and CRP value (r = 0.59; p = 0.0004).Conclusion: We found that CRP level is associated with treatment duration and hospital stay in AC patients. However, large-scale, prospective further studies are needed to confirm our results and to determine whether CRP levels can be used to discriminate which patient would benefit from medical treatment.

Clinical and laboratory predictors at ICU admission affecting course of illness and mortality rates in a tertiary COVID-19 center

BackgroundSurvival rates of critically ill COVID-19 patients are affected by various clinical features and laboratory parameters at ICU admission. Some of these predictors are universal but others may be population specific. ObjectiveTo determine utility of baseline clinical and laboratory parameters in a multivariate regression model to predict outcomes in critically ill COVID-19 patients in a tertiary hospital in Croatia. Methods692 critically ill COVID-19 patients treated during a 10-month period were included in this retrospective observational trial to assess the risk factors determining mortality rates. Various anthropometric features, comorbidities, laboratory parameters, clinical features and therapeutic interventions were included in the analysis. ICU mortality rates and length of ICU stay were primary endpoints analyzed in this study. ResultsAfter multivariate adjustment, only the SOFA score, PaO2/FiO2 and history of arterial hypertension had an effect on ICU mortality, as well as the need to initiate invasive mechanical ventilation. Increase in PaO2/FiO2 over the first 7 days was present in survivors, while reverse applied to SOFA. Length of ICU stay was 9 (4–14) days. Factors affecting survival times were admission from wards, congestive heart failure, invasive mechanical ventilation, bacterial superinfections, age > 75 years, SOFA score, and serum ferritin, CRP and IL-6 values at ICU admission. ConclusionElevated inflammatory biomarkers and SOFA score at ICU admission were detected as significant predictors of ICU mortality in this cohort, while initiation of invasive mechanical ventilation is the most relevant interventional mortality risk factor in critically ill COVID-19 patients.

Predictive value of Serum C-Reactive protein and serum lactate in intestinal obstruction with suspected strangulation

Background: Intestinal obstruction is one of the common clinical problems encountered in surgical practice, and the dreadful complication of intestinal obstruction is strangulation, which requires an emergency surgery for management. The main objective of our study was to evaluate patients with clinical suspicious intestinal obstruction and to find out the significant levels of serum C-reactive protein (CRP) and serum lactate in the early detections of strangulation preoperatively. Materials and Methods: A total of 30 patients who aged between 15 and 80 years were included in the study after excluding the patients of comorbid medical illness and patients with findings other than obstruction or strangulation. The serum values of CRP and lactate were measured pre-operatively and compared between obstruction with strangulation and obstruction without strangulation. Receiver operating characteristic (ROC) curve was drawn, and cut-off values for the diagnosis of strangulation were calculated along the calculation of sensitivity, specificity, positive predictive values (PPVs) and negative predictive values (NPVs). Results: Fifteen patients of strangulated bowel obstruction had significantly higher values of serum CRP and lactate when compared with 15 patients of simple bowel obstruction (99 vs. 38.3 mg/L and 35 vs. 9.9 mg/dl, respectively, P < 0.05). Using ROC analysis, the area under the curve of serum CRP and lactate was found to be 0.809 and 0.947, respectively for bowel strangulation. The serum CRP test has the sensitivity of 80.0%, specificity of 66.7%, PPV of 70.6% and NPV of 76.9% to detect the obstruction with strangulation when using a cut-off value of 49 mg/L. The serum lactate test has the sensitivity of 86.7%, specificity of 73.3%, PPV of 76.5% and NPV of 84.6% to detect the obstruction with strangulation when using a cut-off value of 19 mg/dl. Conclusion: The serum CRP and lactate are useful and reasonable diagnostic markers for predicting strangulation in cases of acute intestinal obstruction in an emergency setting.

Identification of hematological and inflammatory parameters associated with disease severity in hospitalized patients of COVID-19.

Background and Objectives:India has emerged as the second worst hit nation by the Coronavirus pandemic in terms of total number of cases. Our data on hematological and inflammatory markers associated with COVID-19 is very limited. This study was conducted to assess the utility of various biomarkers in identifying severe disease.Materials and Methods:All confirmed cases of COVID-19 admitted in our tertiary care centre from 1st March 2021 to 31st March 2021 were enrolled in the study. They were categorized into severe and non-severe disease categories based on pre-decided criteria. Their complete blood count parameters, D-dimer levels, serum C-reactive protein (CRP), ferritin and Lactate dehydrogenase (LDH) values were retrieved.Statistical Analysis:All parameters were expressed as Mean ± Standard deviation for the two groups of patients. Student's t-test was used to test significance of the above markers between severe and non- severe disease. (P value < 0.05 was taken as statistically significant).Results:A total of 150 COVID RT-PCR positive patients were evaluated. The patients with higher Absolute Neutrophil Count (ANC), Neutrophil to lymphocyte Ratio (NLR), Platelet to lymphocyte ratio (PLR), D-dimer levels and raised serum CRP, LDH, ferritin along with lymphocytopenia were associated with severe disease (P < 0.05). Hemoglobin, total leucocyte count and platelet count showed no correlation with disease severity.Conclusion:These biomarkers associated with disease severity especially NLR, PLR, D-dimer and serum CRP levels could be used to triage patients at the time of admission thereby identifying those requiring intensive care and enabling optimal resource utilization.

Predictive value of serum sodium level in determining perforated appendicitis.

The aim of the study was to investigate the predictive value of hyponatremia as a new biochemical marker for the early and accurate preoperative diagnosis of complicated appendicitis in the adult population. 732 patients who were operated for acute appendicitis (AA) and diagnosed as perforation intraoperatively were evaluated retrospectively. Serum sodium, C-reactive protein (CRP), and leukocyte levels of patients with perforated and nonperforated appendicitis were compared. Perforated appendicitis patients had statistically lower serum Na values (p<0.001). Similarly, patients without perforated appendicitis had higher serum CRP values (p<0.001). In patients diagnosed with perforated AA, the sensitivity of plasma sodium concentration was 63%, and the specificity was 66%. The threshold value of plasma sodium concentration ≤137.5 mEq/L had the best possible sensitivity and specificity. Hyponatremia is a new marker of perforated appendicitis and therefore, serum sodium level measurement should be considered in patients with a clinical presentation consistent with appendicitis if complications are suspected.

Clinical Value of Serum Procalcitonin and C-reactive Protein in the Treatment of Patients with Respiratory Infection

Clinical Value of Serum Procalcitonin and C-reactive Protein in the Treatment of Patients with Respiratory Infection

The Diagnostic Value of Serum Ang, VEGF, and CRP Combined with the Chinese Medicine Antitumor Formula in the Treatment of Advanced Renal Carcinoma.

Objective To explore the diagnostic value of serum angiopoietin (Ang), vascular endothelial growth factor (VEGF), and C-reactive protein (CRP) combined with the Chinese medicine antitumor formula in the treatment of advanced renal carcinoma. Methods Retrospective analysis was performed for the data of 60 patients with advanced renal cancer admitted at Yantaishan Hospital from February 2019 to February 2020. All patients were treated with Chinese medicine antitumor formula. The serum Ang, VEGF, and CRP levels in venous blood samples were detected before and after treatment. Sensitivity, specificity, and AUC of combined serum Ang, VEGF, and CRP were analyzed utilizing the receiver operating characteristic curve (ROC) (95% CI). Results There were 52 cases of clear-cell carcinoma (86.7%), 7 cases of papillary carcinoma (11.7%), and 1 case of chromophobe renal cell carcinoma (1.7%). The average tumor diameter was (9.67 ± 0.65) cm, and the KPS score was (74.68 ± 1.52). About 75% of the patients had metastasis. After treatment, the level of serum Ang, VEGF, and CRP was immensely lower compared to that before treatment (P < 0.001). The sensitivity, specificity, and AUC (95%CI) of the combined detection of Ang, VEGF, and CRP before treatment were 86.7%, 90.0%, and 0.883 (0.817–0.950), while the sensitivity, specificity, and AUC (95%CI) of the combined detection of Ang, VEGF, and CRP were 83.3%, 86.7%, and 0.850 (0.776–0.9524), respectively. Conclusion The combined detection of serum Ang, VEGF, and CRP has high diagnostic value for patients with advanced renal cancer treated with Chinese medicine antitumor formula.

Salivary C-Reactive Protein and Mean Platelet Volume in the Diagnosis and Follow-Up of Community-Acquired Pneumonia in Infants.

Background: Community-acquired pneumonia (CAP) in infants is a major cause of morbidity and mortality, especially in developing countries. Increased salivary C-reactive protein (CRP) levels have been demonstrated in neonatal pneumonia and other diseases. We investigated the applicability of CRP and mean platelet volume (MPV) in the diagnosis and follow-up of CAP in infants. Methods: This prospective observational study included 45 infants admitted for CAP. We measured serum and salivary CRP levels via ELISA, while MPV was measured using an automated blood cell counter. Results: Both salivary and serum CRP values were significantly different in the studied population between admission and follow-up (P = 0.001 and P < 0.0001, respectively). The same was observed for MPV (P < 0.0001). We found significant positive correlations between serum and salivary CRP (r = 0.652, P < 0.0001) and between serum CRP and MPV (r = 0.495, P = 0.001), as well as between salivary CRP and MPV (r = 0.439, P = 0.003). Receiver operating curve analysis showed that salivary CRP at a cutoff value of 3.2 ng/L had a sensitivity of 97.2% and specificity of 90%, while MPV at a cutoff value of 8.4 fL showed 91% sensitivity and 90% specificity. Conclusions: The present study showed that both salivary CRP and MPV are reliable diagnostic markers of CAP in infants.