Marker Of Subclinical Inflammation Research Articles

Evaluation of Hematological Parameters as Markers for Subclinical Inflammation in Adults with Familial Mediterranean Fever.

Repeated polyserositis, another name for familial Mediterranean fever (FMF), is an autoimmune disorder with an autosomal recessive nature primarily characterized by short-lived repeated periods of peritonitis, pleuritis, and arthritis, generally accompanied by fever. Our participants were divided into two groups. Group I (patients): 100 individuals who were diagnosed as patients with FMF and were monitored. Group II (control): matched- healthy individuals (100 controls). They were compared and followed up as regards demographic, clinical, and laboratory data: routine investigations, neutrophil/lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and mean platelet volume (MPV), red cell distribution width (RDW), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Group I: MPV mean was 12.03±2.89, whereas group II MPV mean was 7.74±0.57. MPV was significantly statistically greater in group I than in group II. RDW mean in group I was 17.07±1.39 and in group II was 12.92±0.63. RDW was also significantly statistically greater in group I compared with group II. Group I's NLR mean was 3.05±0.71, whereas group II's NLR mean was 1.75±0.2. PLR mean in group I was 164.8±122.8 and in group II was 111.26±29.16. A statistically significant association was shown between the diagnosis of adult FMF and NLR, PLR, MPV, and RDW.

Chronic sleep deprivation, noise and high fat diet markedly induce C-reactive protein level in mice model

Background: C-reactive protein (CRP) is a circulating sign of systemic chronic inflammation that your liver produces if your body is inflamed. Stressful events over a long period of time are linked to inflammatory disorders. Stress pathways are triggered by noise and sleep deprivation, as well as unhealthy habits like fatty meals. Several studies have connected higher CRP levels with plasma levels. The current study aims to explore the potential association’s relationship between chronic sleep deprivation, noise, high fat diet, and CRP disorders.Methods: Three studies were carried out in our study to evaluate C-reactive protein levels in male Swiss albino mice groups after exposure to three different physical stressors for four weeks. The first study mice group were exposed to chronic sleep deprivation; second group was exposed to electrostatic speaker noise stressors; and the third group was fed a high fat diet. Quantitative estimation of C – reactive protein level in plasma using an ELISA kit.Results: Significant changes in inflammatory CRP levels in the examined plasma were detected in the sleep deprivation group. CRP levels were found to be steadily increasing after two weeks, reaching a significant peak in the fourth week (p < 0.001). Moreover, in the fourth week, there were substantial increases in CRP plasma level with independent evidence, in the experimental noise group (p < 0.001). As well, the biomarker of inflammation level increased across the dietary high density fat diet, reaching the highest level at the end of the study (p < 0.05).Conclusion: Our findings contribute to the body of evidence indicating a link between external stress and subclinical inflammatory markers. Furthermore, CRP concentrations are triggered by chronic sleep deprivation and noise exposure, and their concentrations rise with prolonged dietary fatty acid consumption.Keywords: Sleep deprivation; Noise; High fat diet; Inflammation; CRP

Metabolic fatty liver disease as a risk factor for early renal dysfunction in women of reproductive age

Objective. To study the correlation of adipocytokines with early renal dysfunction indicators in women of reproductive age with obesity and metabolic fatty liver disease. Materials and methods. The study included 100 obese females divided into 2 groups. The 1st group consisted of patients (n=50) diagnosed with metabolic fatty liver disease aged 40,5±2,8, and the 2nd group contained patients (n=50) without metabolic fatty liver disease (MFLD). The level of insulin, cystatin C, resistin, leptin, monocyte chemoattractant protein (MCP-1), vascular endothelial growth factor (VEGF), interleukin 6 (IL 6), tumor necrosis factor α (TNF) were determined in blood serum by enzyme-linked immunosorbent assay (ELISA) method. Albumin-to-creatinine ratio, TNF- α, MCP-1, IL 6, cystatin C, b2-microglobulin, VEGF were determined in morning urine. Results. Increased levels of pro-inflammatory cytokines and endothelial dysfunction were revealed in group 1 in relation to both the comparison and control groups. In patients with MFLD associations of resistin level were the following: with HOMA(r=0,60), alanine aminotransferase (ALT) (r=0,54), aspartate aminotransferase (r=0,71), gamma-glutamyl transpeptidase (r=0,71), high-density lipoprotein (HDL) (r=‒0,54), VEGF (r=0,54), TNF- α (r=0,44), MCP-1 (r=0,57) р0,05. In the 1st and 2nd groups cytokine urinary excretion and renal dysfunction markers were higher than in the control group. Associations of urinary excretion of b2-mic­ro­globulin with BMI (r=0,33), НОМА (r=0,34), resistin (r=0,30), uric acid level (r=0,50), creatinine (r=0,34), thyroglobulin (r=0,31), urinary MCP-1(r=0,60), IL 6 (r=0,70) р0,05 were revealed in the 1st group. In group 1 associations of urinary IL 6 with BMI (r=0,35), waist/hip circumference (WC/HC) (r=0,33), uric acid level (r=0,44), urinary MCP-1(r=0,74) were positive, and associations with HDL (r=‒0,44) р0,05. Conclusions. Resistin can be considered as an unfavourable marker of cardiometabolic disturbances in patients with MFLD. The association of subclinical inflammation markers and endothelial dysfunction with the markers of early renal impairment in patients with MFLD which was determined allows to expand the understanding of cardio-renal-metabolic continuum.

COMPARATIVE DIAGNOSTIC VALUE OF NEUTROPHIL-TO-LYMPHOCYTE AND PLATELET-TO-LYMPHOCYTE RATIOS FOR ACUTE APPENDICITIS

Acute appendicitis is nearly an everyday occurrence in the emergency department and consists of 10% of patients presenting to emergency service with abdominal pain. When it comes to the diagnosis of acute abdomen, appendicitis is one of the most common cause13. Early Diagnosing of appendicitis with clinical examination is Sometimes not easy and challenging14. Neutrophil-to-lymphocyte ratio (NLR) which is easily calculated from complete blood count is a simple marker of subclinical inflammation. It is also observed that Changes in the neutrophil-to-lymphocyte ratio (NLR) can be an early sign of bacterial and viral infections.Platelets are cells that help in modulating various inflammatory conditions therefore, changes in PLR may be a useful indicator of acute infection, including Acute Appendicitis.Aim is To compare Diagnostic utility of neutrophil to lymphocyte ratio vs platelet to lymphocyte ratio for diagnosis of acute appendicitis.objectives of the study as follows To calculate neutrophil to lymphocyte ratio To calculate platelet to lymphocyte ratio To compare Diagnostic utility of neutrophil to lymphocyte ratio vs platelet to lymphocyte ratio in diagnosing acute appendicitis. Our study has revealed that the Neutrophil-Lymphocyte Ratio (NLR) is significantly elevated in cases of acute appendicitis compared to the Platelet-Lymphocyte Ratio (PLR). While clinical diagnosis remains the gold standard for diagnosing acute appendicitis, NLR can also be a valuable investigative tool in the future. In our study, both NLR and PLR were elevated in response to acute appendicitis, but NLR showed a statistically significant increase. We also observed that NLR values were two to three times higher in cases of perforated or gangrenous appendicitis. Therefore, NLR is not only useful for diagnosing acute appendicitis but also for predicting complicated cases.

#2684 Free light chains levels in ANCA associated vasculitis: a new potential inflammatory biomarker

Abstract Background and Aims Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a systemic disease characterized by an immune-mediated process where inflammation plays a central role. The widely available serum biomarkers of inflammation are not always able to detect ongoing disease activity in ANCA-associated vasculitis (AAV) patients. Free light chains (FLCs) expression levels have been proposed as new promising biomarker in some immune-mediated and inflammatory diseases. The aim of this study is to evaluate the expression levels of FLCs in patients affected by AAV and investigate the potential effect of rituximab treatment on FLCs levels. Method We conducted a retrospective multicenter study enrolling AAV patients in complete remission of AAV (defined as BVAS/GPA = 0); those with clinical suspicion of underlying hematologic malignancy were excluded. We analyzed κ and λ FLCs serum concentrations and evaluated their correlation with biomarkers of immune system activation, such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum immunoglobulin (Ig) levels, serum C3 and C4 complement and albumin levels (which has a negative correlation with acute inflammatory phase). We assessed impact of rituximab (RTX) therapy within the last 6 months on the same laboratory parameters. Results A total of 137 patients with AAV were recruited, who were gender balanced, had an average age of 68 years and an estimated glomerular filtration rate of 68 (43-89) mL/min/1.73 m2. Fifty-one patients received rituximab treatment (RTX group), while 86 patients were on other immunosuppressive maintenance therapies (non-RTX group). In comparison to non-RTX group, patients treated with RTX experienced higher complement C3 levels, lower ESR levels and lower FLCs κ (p = 0.063) and λ (p = 0.013) levels. The differences between RTX and non-RTX groups in terms of FLCs were even more prominent after correction to total Ig concentration (p = 0.004 for κ /Ig and p = 0.003 for λ /Ig, respectively). Both, serum free κ and λ levels were found to correlate significantly with ESR (R = 0.55 and p < 0.001 for κ; R = 0.53 and p < 0.001 for λ) and albumin (R = ‒0.38 and p < 0.001 for κ; R = ‒0.33 and p < 0.001 for λ). Additionally, serum free κ levels showed an inverse association with C3 (R = ‒0.18 and p = 0.041). Conclusion In subjects with AAV, FLC levels were found to be associated with markers of inflammation and complement activation; hence FLCs levels may represent a promising biomarker for detection of subclinical inflammation in AAV patients on maintenance therapy. Rituximab therapy showed a potential to reduce the levels of markers of subclinical inflammation, including FLCs.

ASSOCIATION OF SUBCLINICAL INFLAMMATION MARKERS WITH PRIMARY HYPERTENSION IN CHILDREN - A SYSTEMATIC REVIEW WITH META-ANALYSIS

Objective: Primary hypertension (PH) is a growing threat to children's health. The pathogenesis of this phenomenon is not fully known, and subclinical inflammation and activation of the immune system are potential explanations. This systematic review and meta-analysis aimed to systematically determine whether there is an association between low–grade inflammation markers and PH in children. Design and method: The MEDLINE, EMBASE, and Cochrane databases were searched up to March 2023, with no language restrictions, for cohort, cross-sectional, and case-control studies; additional references were obtained from reviewed articles. The included studies needed to investigate an association between any inflammation markers and PH defined by the authors. Participants of the study were children (<18 years old) with PH and healthy controls. The main outcome measured was the concentration of any subclinical inflammation markers in children with PH and in healthy controls. This meta-analysis included 12 studies published between 2005 and 2022, enrolling 1220 patients (689 with PH and 531 healthy controls). The data were analyzed using Review Manager. Pooled mean difference (MD) with 95% confidence interval (95% CI) was used to assess the differences in inflammation markers levels. All analyses were based on the random-effect model. The risk of bias was assessed using the Newcastle-Ottawa Scale. Results: There was a significant difference between hypertensive and control groups in high-sensitivity C-reactive protein (hsRCP) concentration (MD: 0.07 95%CI [0.04,0.09]), intercellular adhesion molecule 1 (ICAM-1) (MD: 85.28 95%CI: [50.57-119.99]), vascular cell adhesion molecule 1 (VCAM-1) (MD: 259.78 95%CI: [22.65-496.91]), neutrophil count (MD: 0.80 95%CI [0.53-1.07]), monocyte count (MD: 0.07 95%CI: [0.02-0.12]), and neutrophil-to-lymphocyte ratio (NLR) (MD: 0.49 95%CI: [0.32-0.65]). There was no difference in terms of interleukin 6 (IL-6), lymphocyte count, platelet count, mean platelet volume (MPV), as well as in platelet-to-lymphocyte (PLR) and monocyte-to-lymphocyte (MLR) ratios. Conclusions: Some easily accessible markers of low-grade inflammation might be used as an additional tool for diagnosis and screening for hypertension in pediatric patients. These promising results should be validated in large and well-conducted studies.

Composition of Whole Grain Dietary Fiber and Phenolics and Their Impact on Markers of Inflammation.

Inflammation is an important biological response to any tissue injury. The immune system responds to any stimulus, such as irritation, damage, or infection, by releasing pro-inflammatory cytokines. The overproduction of pro-inflammatory cytokines can lead to several diseases, e.g., cardiovascular diseases, joint disorders, cancer, and allergies. Emerging science suggests that whole grains may lower the markers of inflammation. Whole grains are a significant source of dietary fiber and phenolic acids, which have an inverse association with the risk of inflammation. Both cereals and pseudo-cereals are rich in dietary fiber, e.g., arabinoxylan and β-glucan, and phenolic acids, e.g., hydroxycinnamic acids and hydroxybenzoic acids, which are predominantly present in the bran layer. However, the biological mechanisms underlying the widely reported association between whole grain consumption and a lower risk of disease are not fully understood. The modulatory effects of whole grains on inflammation are likely to be influenced by several mechanisms including the effect of dietary fiber and phenolic acids. While some of these effects are direct, others involve the gut microbiota, which transforms important bioactive substances into more beneficial metabolites that modulate the inflammatory signaling pathways. Therefore, the purpose of this review is twofold: first, it discusses whole grain dietary fiber and phenolic acids and highlights their potential; second, it examines the health benefits of these components and their impacts on subclinical inflammation markers, including the role of the gut microbiota. Overall, while there is promising evidence for the anti-inflammatory properties of whole grains, further research is needed to understand their effects fully.

Estimation of reference interval for neutrophil activity evaluation systems: a interim report.

Neutrophils play an important role in innate immunity and produce reactive oxygen species, but they can also cause inflammation and oxidative stress that can damage their own tissues. We have developed neutrophil activity evaluation systems that simultaneously monitors superoxide radicals and hypochlorite ions secreted by stimulated neutrophils in a few microliters of whole blood and have conducted clinical studies in humans. Here, we report normal reference intervals with our systems based on the results of 3,082 persons who underwent comprehensive cancer screening between February 2020 and March 2022. A total of 344 were extracted as reference individuals based on the results of the cancer screening and the reference intervals of the two systems were interim estimated considering gender and age. Reference intervals can be used as a marker of sub-clinical inflam-mation, which is difficult to detect with other blood markers.

The inflammatory potential of diet is associated with the risk of age‐related eye diseases

Aims/Purpose: Inflammation is involved in the pathogenesis of cataract, age‐related macular degeneration (AMD) and possibly open‐angle glaucoma (OAG). We assessed whether the inflammatory potential of diet (quantified using the dietary inflammatory index; DII) affects the incidence of these eye diseases. Serum inflammation markers were investigated as possible mediators.Methods: Participants aged >45 years were derived from the Rotterdam Study. From 1991 onwards, every 4–5 years, participants underwent extensive eye examinations. At baseline, blood samples and dietary data were collected. The DII was adapted (aDII) based on data availability. Of the 7436 participants free of eye diseases at baseline, 4036 developed incident eye diseases over time (cataract = 2895, early‐intermediate AMD = 891, late AMD = 81, OAG = 169).Results: A higher aDII was significantly associated with increased inflammation. A higher neutrophil‐lymphocyte ratio (NLR) was associated with an increased risk of cataract and AMD. Additionally, complement component 3c (C3c) and systemic immune‐inflammation index (SII) were associated with increased risks of cataract and late AMD, respectively. Every point increase in the aDII was associated with a 9% increased risk of cataract (Odds ratio [95% confidence interval]: 1.09 [1.04–1.14]). The NLR and C3c partly mediated this association. We also identified associations of the aDII with risk of AMD (early‐intermediate AMD, OR [95% CI]: 1.11 [1.03–1.19]; late AMD, OR [95% CI]: 1.24 [1.02–1.53]). The NLR partly mediated these associations. The aDII was not associated with OAG.Conclusions: We observed an unfavourable association between the aDII and cataract. More importantly, we found an association between the aDII and risk of AMD. Especially the NLR, a marker of subclinical inflammation, seems to be involved. These findings are relevant for patients with AMD and substantiate the current recommendations to strive for a healthy lifestyle to prevent blindness.

Evaluation of the relationship between subclinical inflammation markers and ketonuria in hyperemesis gravidarum

Evaluation of the relationship between subclinical inflammation markers and ketonuria in hyperemesis gravidarum

Adiponectin Resistance in Obesity: Adiponectin Leptin/Insulin Interaction.

The adiponectin (APN) levels in obesity are negatively correlated with chronic subclinical inflammation markers. The hypertrophic adipocytes cause obesity-linked insulin resistance and metabolic syndrome. Furthermore, macrophage polarization is a key determinant regulating adiponectin receptor (AdipoR1/R2) expression and differential adiponectin-mediated macrophage inflammatory responses in obese individuals. In addition to decrease in adiponectin concentrations, the decline in AdipoR1/R2 messenger ribonucleic acid (mRNA) expression leads to a decrement in adiponectin binding to cell membrane, and this turns into attenuation in the adiponectin effects. This is defined as APN resistance, and it is linked with insulin resistance in high-fat diet-fed subjects. The insulin-resistant group has a significantly higher leptin-to-APN ratio. The leptin-to-APN ratio is more than twofold higher in obese individuals. An increase in expression of AdipoRs restores insulin sensitivity and β-oxidation of fatty acids via triggering intracellular signal cascades. The ratio of high molecular weight to total APN is defined as the APN sensitivity index (ASI). This index is correlated to insulin sensitivity. Homeostasis model of assessment (HOMA)-APN and HOMA-estimated insulin resistance (HOMA-IR) are the most suitable methods to estimate the metabolic risk in metabolic syndrome. While morbidly obese patients display a significantly higher plasma leptin and soluble (s)E-selectin concentrations, leptin-to-APN ratio, there is a significant negative correlation between leptin-to-APN ratio and sP-selectin in obese patients. When comparing the metabolic dysregulated obese group with the metabolically healthy obese group, postprandial triglyceride clearance, insulin resistance, and leptin resistance are significantly delayed following the oral fat tolerance test in the first group. A neuropeptide, Spexin (SPX), is positively correlated with the quantitative insulin sensitivity check index (QUICKI) and APN. APN resistance together with insulin resistance forms a vicious cycle. Despite normal or high APN levels, an impaired post-receptor signaling due to adaptor protein-containing pleckstrin homology domain, phosphotyrosine-binding domain, and leucine zipper motif 1 (APPL1)/APPL2 may alter APN efficiency and activity. However, APPL2 blocks adiponectin signaling through AdipoR1 and AdipoR2 because of the competitive inhibition of APPL1. APPL1, the intracellular binding partner of AdipoRs, is also an important mediator of adiponectin-dependent insulin sensitization. The elevated adiponectin levels with adiponectin resistance are compensatory responses in the condition of an unusual discordance between insulin resistance and APN unresponsiveness. Hypothalamic recombinant adeno-associated virus (rAAV)-leptin (Lep) gene therapy reduces serum APN levels, and it is a more efficient strategy for long-term weight maintenance.

The inflammatory potential of diet is associated with the risk of age-related eye diseases

Inflammation is involved in the pathogenesis of cataract, age-related macular degeneration (AMD), and possibly open-angle glaucoma (OAG). We assessed whether the inflammatory potential of diet (quantified using the dietary inflammatory index; DII) affects the incidence of these common blinding age-related eye diseases. Serum inflammation markers were investigated as possible mediators. Participants aged >45 years were selected from the prospective, population-based Rotterdam Study. From 1991 onwards, every 4-5 years, participants underwent extensive eye examinations. At baseline, blood samples and dietary data (using food frequency questionnaires) were collected. The DII was adapted based on the data available. Of the 7436 participants free of eye diseases at baseline, 4036 developed incident eye diseases during follow-up (cataract=2895, early-intermediate AMD=891, late AMD=81, OAG=169). The adapted DII (aDII) ranged from-4.26 (i.e., anti-inflammatory) to 4.53 (i.e., pro-inflammatory). A higher aDII was significantly associated with increased inflammation. A higher neutrophil-lymphocyte ratio (NLR) was associated with an increased risk of cataract and AMD. Additionally, complement component 3c (C3c) and systemic immune-inflammation index (SII) were associated with increased risks of cataract and late AMD, respectively. Every point increase in the aDII was associated with a 9% increased risk of cataract (Odds ratio [95% confidence interval]: 1.09 [1.04-1.14]). The NLR and C3c partly mediated this association. We also identified associations of the aDII with risk of AMD (early-intermediate AMD, OR [95% CI]: 1.11 [1.03-1.19]; late AMD, OR [95% CI]: 1.24 [1.02-1.53]). The NLR partly mediated these associations. The aDII was not associated with OAG. A pro-inflammatory diet was associated with increased risks of cataract and AMD. Particularly the NLR, a marker of subclinical inflammation, appears to be implicated. These findings are relevant for patients with AMD and substantiate the current recommendations to strive for a healthy lifestyle to prevent blindness.

The prognostic value of neutrophile/lymphocyte ratio and serum chemerin to predict maternal-fetal complications in pregnant systemic lupus erythematosus patients.

Pregnancy in SLE continues to be a challenge. The neutrophil-to-lymphocyte ratio (NLR) and chemerin are predictors of preeclampsia in the general population; however, their role as predictors of maternal-fetal complications in pregnant SLE patients has not been analyzed. To investigate the prognostic value of NLR and serum chemerin, to predict maternal-fetal complications in pregnant SLE patients, and compare both biomarkers among three study groups. Design: Analytical cross-sectional study of cases and controls with the following study groups: systemic lupus erythematosus (SLE), preeclampsia, and healthy. NLR and chemerin serum were determined between 20 and 25weeks of gestation. Patients were evaluated every 4-6weeks until pregnancy resolution. Maternal and fetal outcomes were registered. We employed Receiver Operating Characteristic (ROC) curves to validate prognostic values. Seventy pregnant patients were included: 20 with SLE, 20 with preeclampsia, and 30 healthy pregnant women; NLR values were 4 (2.3-5.6) in SLE, 6 (4.6-9.2) in preeclampsia, and 2.8 (2.1-2.9) in the group of healthy women (p = .0001). Chemerin levels were: 26 (15.3-56.2) in SLE, 96 (37.3-146.2) in preeclampsia, and 24.6ng/mL (15.3-47.4) in the healthy group (p = .007) Maternal complications were observed in 11 (55%), 20 (100%), and 8 (26%) per group, respectively. Thrombocytopenia was the most frequent complication in all pregnant women, followed by hypertensive disorders. Fetal complications were registered in 12 (60%), 16 (80%), and 2 (6.7%), respectively. Congenital malformations and prematurity were the most frequent fetal complications. NLR had good diagnostic accuracy in predicting maternal-fetal complications (AUROC 0.715) p = .015, CI 95% 0.56-0.86, cut-off point level: 2.9, sensitivity 61%, specificity 78%, positive predictive value (PPV) 65%, negative predictive value (NPV) 75%. Regarding chemerin, a cut-off point level >43ng/mL had a sensitivity of 75%, specificity of 72% AUROC 0.75, p = .001, CI 95% 0.61-0.89, PPV 51.7% NPV 87.8%, meaning that 51.7% of patients with chemerin levels >43ng/mL have or will have preeclampsia. The NLR may help predict maternal-fetal complications in SLE pregnancy, constituting a marker of subclinical inflammation. Chemerin levels may be associated with preeclampsia. These biomarkers could improve the care of SLE patients with timely intervention of potential complications during pregnancy.

Correlation between Serum High-Sensitivity C-Reactive Protein Level and Severity of Albuminuria Measured by Urine Albumin-to-Creatinine Ratio in Type 2 Diabetic Patients

Introduction: One of complications in type 2 diabetes mellitus (DM) that require high treatment cost is diabetic kidney disease (DKD), which is characterized by the presence of albuminuria, decrease in glomerular filtration rate, or both. Researches show a positive correlation between type 2 DM and serum high-sensitivity C-reactive protein (hs-CRP) level, a sensitive marker of subclinical inflammation. This study aimed to analyze the correlation between serum hs-CRP level and severity of albuminuria measured by urine albumin-to-creatinine ratio (ACR).Methods: The study was conducted at the Endocrinology Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, on June-July 2020.Results: The study included 50 patients with type 2 DM, consisting of 25 (50%) men and 25 (50%) women, with median age of 58.0 (42-68) years and mean body mass index (BMI) of 21.91 ± 1.310 kg/m2. Median duration of DM was 12.0 (6-22) years, median HbA1c level was 7.20% (5.7%-12.3%), mean serum crEatinine level was 0.83 ± 0.180 mg/dL, and median estimated glomerular filtration rate (eGFR) value was 92.85 (61.6-121.2) mL/minute/1.73 m2. Median serum hs-CRP level was 1.20 (0.1-4.0) mg/L and median urine ACR value was 49.570 (7.78-426.00) mg/g. Normoalbuminuria was detected in 28% of subjects, microalbuminuria in 66% of subjects, and macroalbuminuria in 6% of subjects. This study showed positive and significant correlation between serum hs-CRP level and severity of albuminuria (r = 0.701; p = <0.001).Conclusion: There was positive and significant correlation betweeen serum hs-CRP level and severity of albuminuria in type 2 diabetic patients.

Ultra-High Frequency UltraSound (UHFUS) Assessment of Barrier Function in Moderate-to-Severe Atopic Dermatitis during Dupilumab Treatment.

Atopic dermatitis (AD) is a chronic multifactorial inflammatory disease characterized by intense itching and inflammatory eczematous lesions. Biological disease-modifying drugs, such as dupilumab are recommended for patients with moderate-to-severe AD, refractory to systemic immunosuppressive therapies. Disease monitoring is performed by clinical scores. Since 1970, however, the use of ultrasound and particularly high-frequency ultrasound (HFUS), has identified alterations in dermal echogenicity, called the subepidermal low-echogenic band (SLEB), that correlates with disease severity and response to treatment. We enrolled 18 patients with moderate-to-severe AD, divided into two groups: twelve patients in the dupilumab treatment (Group A) and six patients in standard treatment, from February 2019 to November 2019. We performed ultra-high frequency ultrasound (UHFUS) evaluation of lesional and non-lesional skin, focusing on SLEB average thicknesses measurement, epidermal thickness, and vascular signal in correlation with objective disease scores (EASI, IGA), patient's reported scores (Sleep Quality NRS and Itch NRS), and TEWL and corneometry at baseline (T0), after 1 month (T1) and 2 months (T2). The SLEB average thickness measurement, vascular signal, and epidermal thickness showed a statistically significant reduction in lesional skin of the biological treatment group and no significant reduction in non-lesional skin in both groups. In the lesional skin of the standard treatment group, only epidermal thickness showed a statistically significant reduction. Our study demonstrates that SLEB measurement, vascular signals, and epidermal thickness could be used as objective parameters in monitoring the AD treatment response, while the presence of SLEB in non-lesional skin could be used as a marker of subclinical inflammation and could predict development of clinical lesions, suggesting a pro-active therapy. Further follow-up and research are needed to clarify the association of SLEB decrease/disappearance with a reduction of flares/prolongment of the disease remission time.

#6368 PLATELET TO LYMPHOCYTE RATIO AND SICKLE CELL NEPHROPATHY

Abstract Background and Aims Platelet-to-lymphocyte ratio (PLR) was introduced as cheap and readily assessed biologic markers of subclinical inflammation in sickle cell disease. Microalbuminuria and hyperfiltration, early markers of Sickle cell nephropathy (SCN) have been reported to be associated with platelet-to-lymphocyte ratio (PLR). This association has not yet been assessed in Congolese Sickle cell disease (SCD) children. Therefore, the aim of the present study was to assess the association between PLR and early markers of kidney disease in SCD children living in the Democratic Republic of Congo (DRC). Method In this cross-sectional study, we have investigated 175 SCD children from four centers (Kinshasa university clinics, CMMASS, CMD Diamand, and Biamba Marie Mutumbo Dikembe) that give a comprehensive care to SCD patients. The PLR were calculated from full blood count. Elevated albuminuria and hyperfiltration, as the main outcomes of the study, were defined by urinary albumin/creatinine ratio (ACR) ≥30 mg/g and estimated glomerular filtration ratio (eGFR) >130 ml/min per 1.73 m2 for females and >140 ml/min per 1.73 m2 for males, respectively. Logistic regression analysis was used to assess the relationship between RPL and early sickle cell nephropathy. Results Of the 175 SCD children enrolled, 41(23.4%) and 67(38.3%) of them presented with abnormal albuminuria and hyperfiltration, respectively. RPL >130 was observed in 90 (51.4%) patients. RPL was strongly, significantly and independently associated with both abnormal albuminuria (aOR 3,381; IC95% 2, 22-1, 63; p = 0,000) and hyperfiltration (aOR 2, 19; 95%IC 2, 98 - 22, 25; p = 0,010). Conclusion The present study has shown that nearly fifty two out of one hundred SCD children bear a high platelet to lymphocyte ratio that is strongly and significantly associated with early markers of kidney disease.

Age-related Differences in T-cell Subsets and Markers of Subclinical Inflammation in Aging Are Independently Associated With Type 2 Diabetes in the Health and Retirement Study

ObjectivesAge-related changes in adaptive immunity and subclinical inflammation are both important risk factors for diabetes in older adults. We evaluated the independent association between T-cell subsets, subclinical inflammation, and diabetes risk in the Health and Retirement Study (HRS). MethodsWe measured 11 T-cell subsets, 5 pro-inflammatory markers, and 2 anti-inflammatory markers from the 2016 wave of the HRS (baseline). Diabetes/prediabetes status was estimated at the 2016, 2018, and 2020 waves of HRS, based on levels of blood glucose/glycated hemoglobin in plasma or self-reported status. We used survey generalized logit models to evaluate the cross-sectional associations and Cox proportional hazard models to evaluate longitudinal associations. ResultsAmong 8,540 participants (56 to 107 years of age), 27.6% had prevalent type 2 diabetes and 31.1% had prediabetes in the 2016 survey. After adjusting for age, sex, race/ethnicity, education, obesity, smoking, comorbidity index, and cytomegalovirus seropositivity, individuals with type 2 diabetes had lower naive T cells and higher memory and terminal effector T cells as compared with normoglycemic individuals. Among 3,230 normoglycemic participants in the 2016 survey, the incidence of diabetes was 1.8% over 4 years of follow-up. The baseline percentage of CD4+ effector memory T cells was associated with a lower risk of incident diabetes (hazard ratio [HR]=0.63, 95% confidence interval [CI] 0.49 to 0.80, p=0.0003) after adjustment for covariates. Baseline level of interleukin-6 (IL-6) was associated with risk of incident diabetes (HR=1.52, 95% CI 1.18 to 1.97, p=0.002). The associations between age-related changes in CD4+ effector memory T cells and risk of incident diabetes remained unchanged after adjustment for subclinical inflammation, although adjusting for CD4+ effector memory T cells nullified the association between IL-6 and incident diabetes. ConclusionsThis study showed that the baseline percentage of CD4+ effector memory T cells was inversely associated with incident diabetes independent of subclinical inflammation, but CD4+ effector memory T-cell subsets affected the relationship between IL-6 and incident diabetes. Further studies are needed to confirm and investigate mechanisms by which T-cell immunity affects diabetes risk.

Neutrophil-to-Lymphocyte Ratio Is an Independent Risk Factor for Coronary Artery Disease in Central Obesity.

Several inflammatory biomarkers were found to be associated with an increased risk of cardiovascular disease. Neutrophil-to-lymphocyte ratio (NLR) is a marker of subclinical inflammation that increases with the stress response. Visceral adiposity index (VAI) calculated as a combination of anthropometric and metabolic parameters reflects both the extent and function of visceral adipose tissue. Given the association of subclinical inflammation with both obesity and cardiovascular diseases, it is plausible that the inflammation-CVD association is modulated by the amount and function of adipose tissue. Thus, our aim was to examine the association between NLR and coronary artery calcium score (CACS), an intermediate marker of coronary artery disease in asymptomatic patients across VAI tertiles. Methods: Data from 280 asymptomatic participants of a cardiovascular screening program were analysed. In addition to the collection of lifestyle and medical history, a non-contrast cardiac CT scan and laboratory tests were performed on all participants. Multivariate logistic regression was conducted with CACS > 100 as the outcome and with conventional cardiovascular risk factors and NLR, VAI, and NLR by VAI tertile as predictors. Results: We found an interaction between VAI tertiles and NLR; NLR values were similar in the lower VAI tertiles, while they were higher in the CACS > 100 in the 3rd VAI tertile (CACS ≤ 100: 1.94 ± 0.58 vs. CACS > 100: 2.48 ± 1.1, p = 0.008). According to multivariable logistic regression, the interaction between NLR and VAI tertiles remained: NLR was associated with CACS > 100 in the 3rd VAI tertile (OR = 1.67, 95% CI 1.06-2.62, p = 0.03) but not in the lower tertiles even after adjustment for age, sex, smoking, history of hypertension, hyperlipidaemia, and diabetes mellitus, as well as high-sensitivity C-reactive protein. Our findings draw attention to the independent association between subclinical, chronic, systemic inflammation and subclinical coronary disease in obesity.

Association of High sensitivity C-reactive protein (Hs-CRP) with poor Glycaemic control and Coronary Heart Disease in Type 2 Diabetes Mellitus

High sensitivity C-reactive protein (Hs-CRP) is a sensitive marker of subclinical inflammation associated with atherosclerosis. Uncontrolled diabetes mellitus (DM) is one of the important risk factors of coronary heart disease (CHD). The aim of this study was to evaluate the association between Hs-CRP levels and both glycaemic control and CHD in Syrian type 2 diabetes mellitus (T2DM) patients. A random sample of 108 subjects was selected from T2DM and/or CHD patients seen in the National Centre for Diabetes, and the outpatient clinic of cardiology department at Tishreen University Hospital in Latakia. Four groups were formed: Group 1 [T2DM (+) CHD (-), N=29], Group 2 [T2DM (-) CHD (+), N=25], Group 3 [T2DM (+) CHD (+), N=29], and Group 4 (T2DM (-) CHD (-), N=25). Serum Hs-CRP and glycated haemoglobin (HBA1C) were determined. The SPSS 25.0 program was used for the statistical analysis. Probability (P) value less than 0.05 was considered statistically significant. Mean Hs-CRP level was higher in T2DM subjects with (5.23±1.56mg/l) or without (2.29±0.78mg/l) CHD compared to T2DM (-) CHD (-) patients (0.16±0.04mg/l), (p<0.0001 for both). Mean Hs-CRP level in T2DM with CHD was not only higher than T2DM patients without CHD (p<0.0001), but also than non-diabetic subjects with CHD (2.56±0.45mg/l) (p<0.0001). There was a positive correlation between serum Hs-CRP and HBA1C in T2DM patients with CHD (r=0.781, P<0.0001), Similarly, Hs-CRP levels were positively and significantly correlated with HBA1C in T2DM patients without CHD (r=0.800, p<0.0001). We also noticed that for every 1.0% increase in HbA1c there was an 77% increase in the likelihood of having an elevated Hs-CRP. We concluded that Hs-CRP was strongly correlated with glycaemic control in T2DM patients. The highest Hs-CRP level was observed in T2DM with CHD patients. Hs-CRP could predict the incidence of coronary heart disease in T2DM patients.

Subclinical inflammation markers in Abortus Imminens and their relation with obstetric outcomes. A case-control study

Background: In recent years, studies reveal that subclinical inflammatory markers can be used as an indicator of the inflammatory process in many diseases. Few studies have evaluated indicators of inflammation and postpartum outcomes in abortion immune patients. Objectives: The aim of the study is to investigate the relationship of subclinical inflammatory factors (Platelet crit (PCT), Neutrophil-lymphocyte ratio(NLR), Monocyte-lymphocyte ratio(MLR), Platelet-lymphocyte ratio(PLR)) obtained from complete blood count(CBC) with Abortion Immunes(AI) and obstetric results.. Material method: The study was conducted between January 2020 and January 2021. A total of 429 pregnant women, 203 of whom were pregnant with AI and 226 were healthy, were included in the study. Results: PCT, NLR, and MLR values were significantly higher and PLR values were low in the AI group (p<0.05). PCT > 0.22, NLR > 2.29, and MLR > 0.20 were significantly associated with increased risk of AI (P<0.05). PLR value above 135.5 was associated with the normal group. There was a significant difference between the group whose pregnancy was terminated by abortion and the group who gave birth in terms of PCT, NLR, MLR, and PLR values. PCT, NLR, and MLR values were high in the abortion group, and PLR values were low (p<0.05). Premature birth was developed in 11.3% (n=15) of AI patients. There was a significant difference between the preterm and term pregnancy in terms of PCT, NLR, MLR, and PLR levels (p<0.005). PCT, NLR, and MLR values were high and PLR levels were low in pregnant women who gave birth prematurely. Conclusion: We think that close follow-up of abortion imminence patients with high levels of these inflammatory factors is appropriate.