Asociación de marcadores inflamatorios y de disfunción endotelial con la depresión en la enfermedad cerebrovascular isquémica

Fundamento: la depresión es una de las complicaciones no neurológicas más frecuentes en la enfermedad cerebrovascular isquémica. Objetivo: determinar la asociación de marcadores inflamatorios y de disfunción endotelial con la depresión en pacientes con enfermedad cerebrovascular isquémica. Métodos: se realizó un estudio analítico, prospectivo de corte transversal en pacientes con enfermedad cerebrovascular isquémica en fase aguda (N=22) y no aguda (N=37); atendidos en el Instituto de Neurología y Neurocirugía y el Hospital Manuel Fajardo, de La Habana, Cuba. Se recogieron variables demográficas, factores de riesgo, etiología y localización del infarto, deficiencia neurológica, discapacidad para las actividades de la vida diaria (índice de Barthel), neuropsicológicas (depresión por inventario de Beck y test de Hamilton). Se determinó proteína C-reactiva, alfa-1-antitripsina, complementos C3 y C4 y microalbuminuria. Resultados: las puntuaciones de las pruebas neuropsicológicas no tuvieron diferencias significativas entre la fase aguda y no aguda, pero hubo un aumento estadístico de la frecuencia de pacientes sin depresión y con ligera depresión en la fase no aguda. En la fase aguda, el complemento C4 y en la fase no aguda el complemento C3, la proteína C-reactiva y el alfa-1-antitripsina se correlacionaron directamente con la puntuación del inventario de Beck. La proteína C-reactiva y C3 se correlacionaron estadísticamente con la puntuación del test de Hamilton. En el análisis multivariado, la proteína C-reactiva mostró asociación independiente con el grado de depresión por el test de Hamilton. Conclusiones: la proteína C-reactiva pudiera estar relacionada con la severidad de la depresión, quizás por asociación con la discapacidad para las actividades de vida diaria.

Foundation: depression in ischemic cerebrovascular disease is one of the most frequent non-neurological complications. Objective: to determine the association of inflammatory markers and endothelial dysfunction with depression in patients with ischemic cerebrovascular disease. Methods: an analytical, prospective, cross-sectional study was carried out in patients with acute (N=22) and non-acute (N=37) ischemic cerebrovascular disease; treated at the Institute of Neurology and Neurosurgery; and the Manuel Fajardo Hospital, in Havana, Cuba. Demographic variables, risk factors, etiology and location of the infarction, neurological deficiency, disability for activities of daily living (Barthel index), neuropsychological (depression by Beck inventory and Hamilton test) were collected. C-reactive protein, alpha-1-antitrypsin, C3 and C4 complements, and microalbuminuria were determined. Results: the scores of the neuropsychological tests did not have significant differences between the acute and non-acute phase, but there was a statistical increase in the frequency of patients without depression and with slight depression in the non-acute phase. In the acute phase, C4, and in the non-acute phase, C3, C-reactive protein and alpha-1-antitrypsin were directly correlated with the Beck inventory score. C-reactive protein and C3 were statistically correlated with the Hamilton test score. In the multivariate analysis, C-reactive protein showed an independent association with the degree of depression by the Hamilton test. Conclusions: C-reactive protein could be related to the severity of depression, perhaps by association with the disability for activities of daily living.

Inflammation in Cardiovascular Disease: Current Status and Future Perspectives

Abstract Atherosclerosis has been defined as an inflammatory disease. Three decades of research have pointed to a pivotal role of interleukin 6 for many aspects of cardiovascular disease, not the least of which is atherosclerosis. In this review, experimental and clinical studies are reported on a timeline, exploring mechanisms and possible explanations that form the basis of current knowledge. Some successful clinical trials were proof of concept studies, showing that not only inflammatory biomarkers are related to cardiovascular outcomes, but also that decreasing inflammation can reduce cardiovascular events. Great advances have been made in the management of residual cardiovascular risk due to cholesterol, thrombosis, and metabolic diseases, but the next frontier now seems to be targeting inflammation. In the upcoming years, the importance of inflammation will be evaluated in high-risk patients with chronic kidney disease, after acute coronary heart disease or heart failure with preserved ejection fraction. Inflammation seems to precede the development of cardiovascular risk factors. Moreover, counseling for a heathy lifestyle and, when necessary, the use of cardiometabolic therapies capable of decreasing inflammation, might be important.

A cross-sectional study to estimate the serum level of C-reactive protein among pediatric meningitis with bacterial etiology

Background: Bacterial meningitis is a global public health issue. C-reactive protein (CRP) has suitable diagnostic value in distinguishing between bacterial and aseptic meningitis especially in cases of negative bacterial culture of the blood and spinal fluid. Aim and Objective: The objective of this study was to estimate the serum level of CRP among pediatric meningitis cases with bacterial etiology. Materials and Methods: The hospital-based descriptive cross-sectional study was performed in a tertiary care pediatric hospital in Eastern India from June to August, 2021 with 150 samples. Patients fulfilling the inclusion criteria were selected for this study after obtaining informed consent. Cerebrospinal fluid sample was collected as per standard guidelines. Phenotypic identification of bacteria including antimicrobial susceptibility testing was done by automation (Vitek 2 compact, bioMerieux). Quantitative estimation of CRP was performed in a solid phase and sandwich-format immunometric assay using a gold antibody conjugate. Human rights, welfare, and autonomy were protected as per national ethical guidelines. Results: Median age (Inter Quartile Range) of 150 cases was 3(1–4.5) year. Escherichia coli (60.52%, 23/38) was the commonest isolate (P < 0.00000001 by Binomial test calculation) followed by Klebsiella pneumoniae (34.24%, i.e., 13/38). A total of 43/150 (28.66%) participants had higher serum CRP. Serum CRP was raised more in Gram-negative bacterial etiology (36 out of 38, 94.73%). Mean serum CRP was higher in Gram-negative cases (P < 0.05). Conclusion: Serum CRP was found significantly higher in meningitis caused by Gram-negative bacteria.

Utilidad de la proteína C-reactiva para determinar la gravedad de infección por SARS-CoV-2 en Perú

Introducción: En los últimos años se han estudiado diversos biomarcadores para determinar los casos graves de COVID-19. La proteína C-reactiva (PCR) ha mostrado alta sensibilidad en la identificación de pacientes con enfermedad grave y utilidad comparable a la tomografía. Objetivo: Determinar la utilidad de la PCR para predecir gravedad de la infección por SARS-CoV-2 en pacientes hospitalizados en el Centro Médico Naval del Perú durante el periodo enero-septiembre del año 2021. Métodos: Se empleó un diseño de tipo cuantitativo, observacional, analítico, retrospectivo, y de tipo prueba diagnóstica. Se calculó un tamaño muestral de 503 pacientes, quienes fueron divididos en dos grupos de acuerdo a su gravedad. Resultados: Se determinó un punto de corte óptimo de 10,92 mg/L de los valores de PCR para el diagnóstico de enfermedad grave por COVID-19. Se calculó un área bajo la curva (AUC) de 0,762 y se obtuvieron valores de sensibilidad, especificidad, valores predictores positivo, negativo y precisión diagnóstica de 78,88%, 66,4%; 41,42%; 87,01%; y 67,27%, respectivamente. El normograma de Fagan mostró una probabilidad posprueba de 41%. En el modelo ajustado fueron significativas la PCR (ORa = 4,853; IC95% 2,987-7,886; p = 0,001), además de la ferritina (ORa = 1,001; IC 95%: 1,001-1,002; p = 0,001) e hipotiroidismo (OR ajustado = 4,899; IC 95%: 1,272-18,872; p = 0,021). Conclusiones: El presente estudio mostró la asociación entre la PCR y la gravedad de infección por SARS-CoV-2 en un modelo ajustado, mostrando su potencial utilidad y contribuyendo a determinar el punto de corte de la PCR en población peruana y su comparación a nivel internacional.

Background: Recently, many biomarkers have been studied to determine severe cases of COVID-19. C-reactive protein (CRP) has shown high sensitivity in identifying patients with severe disease and utility comparable to computed tomography. Aim: To determine the usefulness of CRP to predict the severity of SARS-CoV-2 infection in patients hospitalized at the Naval Medical Center of Peru during the period January-September in the year 2021. Methods: A quantitative, observational, analytical, retrospective, and diagnostic test type design was used. A sample size of 503 patients was calculated, which were divided into two groups according to their severity. Results: An optimal cut-off point of 10.92 mg/L for CRP levels was determined for the diagnosis of severe COVID-19. An area under the curve (AUC) of 0.762 was calculated and sensitivity, specificity, positive and negative predictive values and diagnostic accuracy values of 78.88%, 66.4%; 41.42%; 87.01%; and 67.27%; respectively. Fagan's normogram showed a post-test probability of 41%. In the adjusted model, CRP (aOR = 4.853; 95% CI 2.987-7.886; p = 0.001), ferritin (aOR = 1.001; 95% CI: 1.001-1.002; p = 0.001) and hypothyroidism (adjusted OR = 4899; 95% CI: 1272-18872; p = 0.021) showed significance. Conclusions: The present study showed an association between CRP and the severity of SARS-CoV-2 infection in an adjusted model, showing its potential utility and contributing to determine the cut-off point of CRP in the Peruvian population and its international comparison.

Evaluation of relationship between markers of inflammation and blood pressure in subjects attending OPD in a tertiary care center in Chennai

Background: The incidence and prevalence of hypertension have been increasing steadily in the present era. Inflammation is a proven key factor in the pathogenesis of hypertension. C-reactive protein (CRP) is a known marker of vascular inflammation leading to hypertension. High-sensitivity CRP (hs-CRP) is a sensitive marker of assessment of inflammatory changes before the rise in CRP. Aims and Objectives: The goal of this study was to decipher the stage at which inflammation starts related to changes in hypertension using CRP as well as hs-CRP. Materials and Methods: This is a cross-sectional study which included 120 individuals, who were subdivided into three groups - Normotensive: 40, pre-hypertensive: 40, and hypertensive. JNC classification was used for the categorization of blood pressure. hs-CRP was analyzed as per the principle of ELISA. Results: There was a significant difference in hs-CRP between normotensive and hypertensive. A strong association between hypertension, CRP, and hs-CRP was found. Conclusion: hs-CRP is a sensitive marker for early assessment of inflammatory components in hypertension.

Proteína C reactiva y su progresión en el tiempo para la detección de las fugas anastomóticas / C-reactive protein and its progression over time for the detection of anastomotic leaks

Introducción. Las fugas anastomóticas son una complicación común y crítica en cirugía gastrointestinal, por lo que su identificación y tratamiento temprano son necesarios para evitar resultados adversos. El uso convencional con un valor límite de la proteína C reactiva ha demostrado una utilidad limitada. El objetivo de este estudio fue determinar la utilidad de la medición seriada de la proteína C reactiva en la detección de fugas anastomóticas. Métodos. Revisión prospectiva de base de datos retrospectiva de pacientes sometidos a cirugía abdominal mayor con al menos una anastomosis intestinal. Se midió la proteína C reactiva al tercer y quinto día posoperatorio. Las complicaciones se categorizaron según la clasificación de Clavien-Dindo. La precisión diagnóstica fue evaluada por el área bajo la curva. Resultados. Se incluyeron 157 pacientes, el 52 % mujeres. La edad promedio fue de 63,7 años. El mayor número de cirugías correspondió a gastrectomía (36,3 %), resección anterior de recto (15,3 %) y hemicolectomía derecha (13,4 %). El 25,5 % tuvieron alguna complicación postoperatoria y el 32,5 % (n=13) presentaron fuga en la anastomosis. El aumento de la proteína C reactiva tuvo un área bajo la curva de 0,918 con un punto de corte de aumento en 1,3 mg/L, sensibilidad de 92,3 % (IC95% 78 ­ 100) y una especificidad de 92,4 % (IC95% 88 ­ 96). Conclusiones. El aumento de 1,3 mg/L en la proteína C reactiva entre el día de la cirugía y el quinto día fue un predictor preciso de fugas anastomóticas en pacientes con cirugía abdominal mayor

Introduction. Anastomotic leaks are a common and critical complication in gastrointestinal surgery. Their identification and early treatment are necessary to avoid adverse results, and conventional use with a cutoff value of C-reactive protein has shown limited utility. The objective of this study was to determine the usefulness of serial measurement of C-reactive protein in the detection of anastomotic leaks. Methods. Prospective review of a retrospective database of patients undergoing major abdominal surgery with at least one intestinal anastomosis. C-reactive protein was measured on the third and fifth postoperative days. Complications were classified according to the Clavien-Dindo classification. Diagnostic accuracy was evaluated by the area under the curve.Results. 157 patients were included, 52% were females. The average age was 63.7 years. The largest number of surgeries corresponded to gastrectomies (36.3%), anterior resection of the rectum (15.3%) and right hemicolectomies (13.4%). 25.5% had some postoperative complication and 32.5% (n=13) had anastomosis leaks. The increase in C-reactive protein had an area under the curve of 0.918 with an increase cut-off point of 1.3 mg/L, sensitivity of 92.3% (95% CI 78-100) and specificity of 92.4%. (95% CI 88-96). Conclusions. The 1.3 mg/L increase in C-reactive protein between the day of surgery and the fifth day was an accurate predictor of anastomotic leaks in patients with major abdominal surgery

Proteína C reactiva como biomarcador predictivo de fuga anastomótica en cirugía oncológica colorrectal: estudio de cohorte retrospectivo / C-reactive protein as a predictive biomarker of anastomotic leak in colorectal cancer surgery: A retrospective cohort study

Introducción. La fuga anastomótica es la complicación más grave del tratamiento quirúrgico del cáncer de colon por su alta morbimortalidad. El diagnóstico evidente, manifestado por la salida de contenido intestinal por drenajes o la herida quirúrgica, ocurre tardíamente (entre el 6º y 8º día). El objetivo de este trabajo fue estudiar la variación de los valores de la proteína C reactiva postoperatoria para hacer un diagnóstico precoz. Métodos. Estudio observacional, analítico, retrospectivo, de una cohorte de pacientes con neoplasia, en quienes se realizó cirugía oncológica con anastomosis intestinal, entre enero de 2019 y diciembre de 2021. Se midieron los valores en sangre de proteína C reactiva postoperatoria (1°, 3° y 5° días). Resultados. Se compararon 225 casos operados que no presentaron fuga con 45 casos con fuga. En los casos sin fuga, el valor de proteína C reactiva al 3º día fue de 148 mg/l y al 5º día de 71 mg/l, mientras en los casos con fuga, los valores fueron de 228,24 mg/l y 228,04 mg/l, respectivamente (p<0,05). Para un valor de 197 mg/l al 3º día la sensibilidad fue de 77 % y para un valor de 120 mg/l al 5º día la sensibilidad fue de 84 %. Conclusión. El mejor resultado de proteína C reactiva postoperatoria para detectar precozmente la fuga anastomótica se observó al 5º día. El valor de 127 mg/l tuvo la mejor sensibilidad, especificidad y valor predictivo negativo, lo cual permitiría el diagnóstico temprano y manejo oportuno de esta complicación

Introduction. Anastomotic leak is the most serious complication of surgical treatment of colon cancer due to its high morbidity and mortality. The obvious diagnosis manifested by the exit of intestinal content through drains or the operative wound, occurs late (between the 6th and 8th day). The objective of this work was to study the postoperative C-reactive protein values to make an early diagnosis. Methods. Observational, analytical, retrospective study of a cohort of patients undergoing colorectal surgery for neoplasia, between January 2019 and December 2021, who underwent oncological surgery with intestinal anastomosis and measured CRP blood values on 1st, 3rd and 5th post-operative days. Results. Two-hundred-twenty-five operated cases that did not present leaks were compared with 45 cases with leaks, with CRP values on the 3rd and 5th day of 148mg/l and 71mg/l in cases without leakage and CRP values of 228.24mg/l and 228.04 mg/l in cases with leakage on the 3rd and 5th day, respectively (p<0.05), CRP value of 197mg/l on the 3rd day has a sensitivity of 77%; CRP value of 120mg/l on the 5th day, has a sensitivity of 84%. Conclusions. The best result for CPR to early diagnosis of anastomotic leak was observed on the 5th day, having the value of 127 mg/l the best sensitivity, specificity and NPV, which would allow early diagnosis and timely management

Proteína C-reativa como preditor para complicações pós-operatórias em cirurgias colorretais / C-reactive protein as postoperative complications predictor of colorectal surgeries

ABSTRACT Background: The use of inflammatory markers in order to accurate the diagnosis, decrease the reoperation rate and enable earlier interventions during the postoperative period of a colorectal surgery is increasingly necessary, with the purpose of reducing morbimortality, nosocomial infections, costs and time of a readmission. Objective: To analyze C-reactive protein level on the third postoperative day of an elective colorectal surgery and compare the marks between reoperated and non-reoperated patients and to establish a cutoff value to predict or avoid surgical reoperations. Methods: Retrospective study based on the analysis of electronic charts of over 18-year-old patients who underwent an elective colorectal surgery with primary anastomoses during the period from January 2019 to May 2021 by the proctology team of Santa Marcelina Hospital Department of General Surgery with C-reactive protein (CRP) dosage taken on the third postoperative day. Results: We assessed 128 patients with a mean age of 59.22 years old and need of reoperation of 20.3% of patients, half of these due to dehiscence of colorectal anastomosis. Comparing CRP rates on the third postoperative day between non-reoperated and reoperated patients, it was noted that in the former group the average was of 153.8±76.2 mg/dL, whereas in reoperated patients it was 198.7±77.4 mg/dL (P<0.0001) and the best CRP cutoff value to predict or investigate reoperation risk was 184.8 mg/L with an accuracy of 68% and negative predictive value of 87.6%. Conclusion: CRP levels assessed on the third postoperative day of elective colorectal surgery were higher in patients who were reoperated and the cutoff value for intra-abdominal complication of 184.8mg/L presented a high negative predictive value.

RESUMO Contexto: O uso de marcadores sanguíneos para tentar acurar o diagnóstico, reduzir a taxa de readmissão e possibilitar intervenções mais precoces no pós operatório de cirurgia colorretal é cada vez mais necessário, a fim de almejar reduzir a morbimortalidade, infecções nosocomiais, custos e tempo de uma reinternação. Objetivo: Analisar o nível da proteíne C reativa (PCR) no terceiro dia de pós-operatório de cirurgia colorretal eletiva e comparar os valores entre pacientes reoperados e não reoperados e estabelecer um valor de corte para prever ou afastar re-intervenção cirúrgica. Metodos: Estudo retrospectivo através da análise de prontuários eletrônicos de pacientes maiores que 18 anos submetidos a cirurgia colorretal de forma eletiva com anastomoses primárias no período de janeiro de 2019 a maio de 2021 pelo serviço de Coloproctologia do Departamento de Cirurgia Geral do Hospital Santa Marcelina com dosagem da PCR no 3º pós-operatório. Resultados: Foram avaliados 128 pacientes com média de idade de 59,22 anos e necessidade de reoperação em 20,3% dos pacientes, sendo metade desses por deiscência de anastomose colorretal. Ao se comparar os valores de PCR no 3º pós operatório entre os pacientes não reoperados e os reoperados, observou-se que nos primeiros a média foi de 153,8±76,2 mg/dL, enquanto nos pacientes reoperados foi de 198,7±77,4 mg/dL (P<0,0001) e, o melhor valor de corte de PCR para predizer ou investigar o risco de reoperação, foi 184,8 mg/dL com uma acurácia de 68% e valor preditivo negativo de 87,6%. Conclusão: Os níveis de PCR avaliados no 3º pós-operatório de cirurgia colorretal eletiva foram maiores em pacientes reoperados e o valor de corte para complicações intra-abdominal de 184,8 mg/L apresentou elevado valor preditivo negativo.

Prognostic value of serum albumin and C-reactive protein levels in the elderly for assessing morbidity and mortality in a tertiary care center

Introduction: There is an increased population of elderly globally due to advancement of technology in health care. Elderly individuals are susceptible to various diseases, owing to deficits in nutrition or healthy lifestyle. Serum albumin and C‑reactive protein (CRP) are found to be sensitive to nutritional status as well as inflammation. This study is an attempt to analyze the prognostic value of CRP and serum albumin and analyze its usefulness as a prognostic marker in assessing morbidity and mortality in elderly patients. Methodology: One hundred patients above the age of 65 years and were admitted to the emergency care facilities of our tertiary care center were recruited for the study. Serum albumin and CRP estimation was done on the day of admission along with Charlson Comorbidity Index (CCI), and was follow-up till discharge. Statistical analysis was performed to evaluate relationship between the serum values and CCI scores. Results: It was observed that 83.3% (10/12) of deaths occurred in those with low serum albumin levels, and 91.6% (11/12) with high CRP levels. The hazard ratio shows a 6% increased probability of death with one unit increase in CRP, whereas a one unit increase in serum albumin value decrease the probability of death. Conclusion: The present study concludes that low serum albumin and high CRP levels at the time of admission in the elderly population are associated with high CCI scores, longer hospital stay, and increased risk of mortality, demanding their estimation in the elderly in emergency and acute care facilities.

Prediction of coronary artery lesions based on C-reactive protein levels in children with Kawasaki Disease: a retrospective cohort study

Abstract Objective Since coronary artery lesions (CALs) are the most severe complication of Kawasaki disease (KD), clinically speaking, early prediction of CALs is crucial. The authors aimed to investigate the predictive value of C-reactive protein (CRP) in predicting CALs in KD patients. Methods KD patients were divided into the CALs group and the non-CALs group. The clinical and laboratory parameters were collected and compared. Multivariate logistic regression analysis was used to determine the independent risk factors of CALs. The receiver operating characteristic curve was applied to determine the optimal cut-off value. Results 851 KD patients who met the inclusion criteria were studied, including 206 in the CALs group and 645 in the non-CALs group. Children in the CALs group had significantly higher CRP levels than the non-CALs group (p< 0.05). Multivariable logistic regression analysis showed that incomplete KD, male, lower hemoglobin, and higher CRP were independent risk factors for predicting CAL (all p< 0.05). The optimal cut-off value of initial serum CRP for predicting CALs was 105.5 mg/L, with a sensitivity of 47.57% and a specificity of 69.61%. In addition, KD patients with high CRP (≥105.5 mg/L) had a higher occurrence of CALs than those with low CRP (<105.5 mg/L) (33% vs 19%, p< 0.001). Conclusion The incidence of CALs was significantly higher in patients with high CRP. CRP is an independent risk factor for CALs formation and may be useful for predicting CALs in KD patients.

Plasma Calcium Level and C-Reactive Protein Albumin Ratio Affect Severe Bleeding After Coronary Artery Bypass Grafting

ABSTRACT Objective: In this study, we aimed to determine whether plasma calcium level and C-reactive protein albumin ratio (CAR) as well as other demographic and hematological markers are related in predicting severe bleeding after coronary artery bypass grafting (CABG). Methods: A total of 227 adult patients who underwent CABG at our hospital between December 2021 and June 2022 were prospectively studied. Total amount of chest tube drainage was evaluated within the first 24 hours postoperatively or until the patient was re-explored for bleeding. The patients were divided into two groups - Group 1, patients with low amount of bleeding (n=174), and Group 2, patients with severe bleeding (n=53). Univariate and multivariate regression analyzes were performed to determine independent parameters related to severe bleeding within the first 24 hours after surgery. Results: When the groups were compared in terms of demographic, clinical, and preoperative blood parameters; cardiopulmonary bypass time and serum C-reactive protein (CRP) levels were found to be significantly higher in Group 2 compared to the low bleeding group. In addition, lymphocytes, hemoglobin, calcium, albumin, and CAR were found to be significantly lower in Group 2. In multivariate analysis, calcium, albumin, CRP, and CAR were found to be independent predictors of significant association with excessive bleeding. A cut-off value of 8.7 (94.3% sensitivity and 94.8% specificity) for calcium and 0.155 (75.4% sensitivity and 80.4% specificity) for CAR predicted excessive bleeding. Conclusion: Plasma calcium level, CRP, albumin, and CAR can be used to predict severe bleeding after CABG.

Gamma-glutamyl transpeptidase and indirect bilirubin may participate in systemic inflammation of patients with psoriatic arthritis

Abstract Background Previous studies have suggested that systemic metabolic abnormalities are closely related to psoriatic arthritis (PsA). Gamma-glutamyl transpeptidase (GGT) and indirect bilirubin (IBIL), two essential active substances in hepatic metabolism that have been demonstrated as an oxidative and anti-oxidative factor respectively, have been proved to be involved in oxidative stress damage and inflammation in several human diseases. However, their role in PsA remains unclear. Methods In this retrospective comparative cohort study, a case group of 68 PsA patients and a control group of 73 healthy volunteers from the Third Hospital of Hebei Medical University were enrolled. Serum GGT, IBIL, GGT/IBIL ratio and C-reactive protein (CRP), a well applied bio-marker of systemic inflammatory in PsA, were compared between the two groups. Furthermore, the relationship of GGT, IBIL and GGT/IBIL with CRP were explored in PsA patients. Finally, the patients were divided into high inflammation group and low inflammation group according to the median value of CRP. Multivariate logistic regression analyses were used for the association of systemic inflammation level with GGT, IBIL and GGT/IBIL. Results Compared with healthy controls, PsA patients exhibited significantly higher serum GGT, GGT/IBIL, and CRP levels and lower IBIL levels. Serum GGT and GGT/IBIL were positively correlated with CRP, whereas IBIL were negatively correlated with CRP. Binary logistic regression analysis revealed that serum GGT was a risk factor for high CRP in PsA, whereas IBIL was a protective factor. Furthermore, GGT/IBIL was a better indicator of high CRP condition in PsA patients than either GGT or IBIL alone, as determined by the receiver operating characteristic curves. Conclusion GGT and IBIL may participate in the pathogenesis of PsA. Additionally, GGT, IBIL and the balance of the two may reflect systemic inflammation mediated by oxidative stress events related to metabolic abnormalities to a certain extent.

Burnout e níveis de proteína c-reativa: revisão integrativa da literatura / Burnout y niveles de proteína C reactiva: revisión integradora de la literatura / Burnout and c-reactive protein levels: an integrative literature review

Resumo Objetivo Identificar as evidências científicas disponíveis na literatura sobre a associação entre Síndrome de Burnout (SB) e níveis de proteína C-reativa. Métodos Revisão integrativa da literatura de artigos publicados em português, espanhol e inglês, sem limite de data, com diferentes desenhos de estudo, disponíveis eletronicamente nas bases de dados do Cumulative Index to Nursing and Allied Health Literature (CINAHL), National Library of Medicine National Institutes of Health (PubMed), Scopus, Latin American and Caribbean Center on Health Sciences Information (LILACS), Science Direct e Springer Link. Os artigos selecionados foram analisados de acordo com a Agency for Healthcare Research and Quality. Resultados Foram analisados 7 artigos. Na maior parte dos estudos, houve associação positiva entre Burnout e níveis elevados de proteína c-reativa, apesar dos resultados gerais serem contraditórios. A maioria dos artigos que atenderam aos critérios de seleção encontrava-se em língua inglesa e indexados na base de dados CINAHL. O continente europeu concentrou a maior parte de produção. Houve predominância de desenho de estudo transversal. Conclusão Apesar da associação positiva entre Burnout e níveis elevados de proteína c-reativa os resultados dessa revisão sugerem a realização de novos estudos mais robustos na tentativa de explicar a relação entre SB e PCR.

Resumen Objetivo Identificar las evidencias científicas disponibles en la literatura sobre la relación entre el síndrome de burnout (SB) y los niveles de proteína C reactiva. Métodos Revisión integradora de la literatura de artículos publicados en portugués, español e inglés, sin límite de fecha, con diferentes diseños de estudio, disponibles electrónicamente en las bases de datos del Cumulative Index to Nursing and Allied Health Literature (CINAHL), National Library of Medicine National Institutes of Health (PubMed), Scopus, Latin American and Caribbean Center on Health Sciences Information (LILACS), Science Direct y Springer Link. Los artículos seleccionados fueron analizados de acuerdo con la Agency for Healthcare Research and Quality. Resultados Se analizaron siete artículos. En la mayor parte de los estudios, hubo asociación positiva entre burnout y niveles elevados de proteína C reactiva, aunque los resultados generales eran contradictorios. La mayoría de los artículos que cumplieron los criterios de selección estaban en idioma inglés e indexados en la base de datos CINAHL. El continente europeo concentró la mayor parte de la producción. Hubo predominancia de diseño de estudio transversal. Conclusión A pesar de la asociación positiva entre burnout y niveles elevados de proteína C reactiva, los resultados de esta revisión sugieren la realización de nuevos estudios más sólidos para explicar la relación entre SB y PCR.

Abstract Objective To identify the scientific evidence available in the literature on the association between Burnout Syndrome (BS) and C-reactive protein levels. Methods This is an integrative literature review of articles published in Portuguese, Spanish and English, with no date limit, with different study designs, available electronically in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), National Library of Medicine, National Institutes of Health (PubMed), Scopus, Latin American and Caribbean Center on Health Sciences Information (LILACS), Science Direct, and Springer Link databases. The selected articles were analyzed according to the Agency for Healthcare Research and Quality. Results Seven articles were analyzed. In most studies, there was a positive association between Burnout and high c-reactive protein levels, despite the general results being contradictory. Most articles that met the selection criteria were in English and indexed in the CINAHL database. The European continent concentrated most of studies. There was a predominance of cross-sectional study design. Conclusion Despite the positive association between Burnout and high c-reactive protein levels, the results of this review suggest that new, more robust studies be carried out in an attempt to explain the relationship between BS and CRP.

Value of peripheral blood PCT, CRP, FIB and D-D levels for early diagnosing PTB complicated with bacterial pneumonia / 中国热带医学

@#Abstract: Objective　To investigate the early diagnostic value of peripheral blood procalcitonin (PCT), C-reactive protein (CRP), fibrinogen (FIB) and D-dimer (D-D) levels in patients with pulmonary tuberculosis (PTB) complicated with bacterial pneumonia. Methods　A total of 102 patients who admitted to Department of Tuberculosis of Affiliated Nantong Hospital of Shanghai University from Jan 2021 to May 2022 were enrolled in this study and divided into a group (52 cases) with pulmonary tuberculosis (PTB) patients and a group (50 cases) with PTB patients complicated with bacterial pneumonia. The levels of PCT, CRP, FIB and D-D in the peripheral blood were measured, the differences and correlations in all indicators were compared among two groups. The sensitivity and specificity of these indicators in the early diagnosis of PTB complicated with bacterial pneumonia were analyzed by receiver operating characteristic (ROC) curve. Results　The levels of PCT, CRP, FIB and D-D in the peripheral blood from the PTB complicated with bacterial pneumonia group were 0.06 (0.04, 0.16) ng/mL, 38.00 (3.88, 96.10) mg/L, 4.51 (3.02, 6.07) g/L, and 0.59 (0.34, 1.88) mg/L, respectively, which were significantly higher than corresponding 0.04 (0.03, 0.04) ng/mL, 3.20 (0.84, 7.22) mg/L, 2.96 (2.48, 3.77) g/L, and 0.27 (0.17, 0.36) mg/L in the PTB group (Z=-4.784, -5.233, -3.853, -4.199, all P<0.001). Furthermore, the levels of CRP and FIB in the PTB complicated by bacterial pneumonia group were highly positively correlated (r=0.855, P<0.001). The area under the ROC curve (AUC) of PCT, CRP, FIB and D-D for early diagnosis of PTB complicated with bacterial pneumonia were 0.757, 0.794, 0.747 and 0.764, respectively. In addition, the AUC obtained by simultaneous measurement of PCT, CRP, FIB and D-D was as high as 0.916, and the sensitivity and specificity of diagnosing PTB complicated with bacterial pneumonia were increased to 85.7% and 96.9%, respectively, which were higher than those of individual indicators. Conclusions　Levels of peripheral blood PCT, CRP, FIB, and D-D all show varying degrees of increase in patients with PTB complicated with bacterial pneumonia, and detecting the levels of all four markers, rather than any single marker, can assist in early monitoring whether the tuberculosis patients are complicated with bacterial pneumonia.

Correlation between levels of hs-CRP and PCT in serum and alveolar fluid and disease severity in children with lobar pneumonia / 中国热带医学

@#Abstract: Objective　To explore the correlation between levels of hypersensitive C-reactive protein (hs-CRP) and procalcitonin (PCT) in serum and alveolar fluid and severity of disease in children with lobar pneumonia. Methods　A total of 112 children diagnosed with lobar pneumonia from September 2020 to September 2021 were selected as the research subjects. The levels of hs-CRP and PCT in serum and alveolar fluid were detected by double antibody sandwich enzyme-linked immunosorbent assay (ELISA). The children were divided into severe group (clinical pulmonary infection score, CPIS≥6 points) and mild group (CPIS<6 points) according to the severity of disease, and further classified into good prognosis group (cured, improved) and poor prognosis group (uncured) according to their treatment outcomes. The correlation of levels of hs-CRP and PCT in serum and alveolar fluid with disease severity in children and their predictive value on prognosis were analyzed. Results　The levels of serum hs-CRP and PCT in severe group were (17.73±3.26) μg/L and (8.59±1.84) μg/L, which were significantly higher than corresponding (12.58±3.09) μg/L, and (5.62±1.59) μg/L in mild group (P<0.05); the levels of hs-CRP and PCT in alveolar fluid in severe group were (21.25±4.18) μg/L and (8.71±1.54) μg/L, which were significantly higher than corresponding (13.79±2.76) μg/L and (5.38±1.69) μg/L in mild group (P<0.05). The levels of hs-CRP and PCT in serum and alveolar fluid were positively correlated with CPIS scores (r=0.398, 0.441; 0.475, 0.586, P<0.05). The levels of hs-CRP and PCT in serum in poor prognosis group were (20.09±4.20) μg/L and (13.35±2.91) μg/L, which were significantly higher corresponding (8.75±2.19) μg/L and (6.28±1.31) μg/L in good prognosis group (P<0.05). The levels of hs-CRP and PCT in alveolar fluid were (23.70±4.29) μg/L and (10.73±2.04) μg/L, which were higher than corresponding (15.08±3.56) μg/L and (5.79±1.10) μg/L in poor prognosis group (P<0.05). There was no significant difference in AUC between combined detection of serum indicators and combined detection of alveolar perfusion fluid indicators in predicting the prognosis of children with lobar pneumonia (P>0.05). Conclusions　The levels of hs-CRP and PCT in serum and alveolar fluid of children with lobar pneumonia are significantly increased and positively correlated with the severity of disease. However, the predictive value of the combined detection of serum indicators and combined detection of alveolar perfusion fluid indicators for the prognosis of children with lobar pneumonia is comparable.

Influencing factors for dynamic changes in the severity of fatty liver in patients with acute pancreatitis and fatty liver / 临床肝胆病杂志

Objective To investigate the dynamic change of fatty liver (FL) in patients with fatty liver-related acute pancreatitis (FLAP) and related influencing factors. Methods A total of 136 FLAP patients who were admitted to The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, from December 2017 to December 2021 were enrolled as subjects. With the first CT examination after admission as the starting point and the last CT examination before discharge as the ending point, the subjects were divided into FL aggravation group (FLAG group), FL mild mitigation group (FLMMG group), and FL significant mitigation group (FLSMG group) according to the degree of change in FL. General information and clinical data were compared between groups. General information included age, sex, length of hospital stay, etiology of acute pancreatitis (AP), and changes in body weight and temperature, and clinical data included treatment modality and the changes in laboratory markers and AP severity. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t -test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Mann-Whitney U test with Bonferroni correction was used for further comparison between two groups. Dynamic changes of data were expressed as the difference from the starting point to the ending point, and a covariance analysis was used for comparison of data with dynamic changes. The Spearman correlation analysis was used to investigate the correlation of indices with significant changes with the degree of change in FL. Results Among the 136 FLAP patients, 61 achieved mild mitigation of FL, 59 achieved significant mitigation of FL, and 16 experienced aggravation of FL at the ending point of the study. There were significant differences between the three groups in the length of hospital stay ( χ 2 =16.215, P < 0.001) and the change in body weight ( F =3.908, P < 0.05), and the FLSMG group had a greater reduction in body weight and a longer length of hospital stay. There were also significant differences between the three groups in the number of fasting days ( χ 2 =11.020, P =0.004) and the degree of changes in C-reactive protein (CRP) ( F =8.589, P < 0.001), white blood cell count (WBC) ( F =5.448, P =0.005), and CT severity index (CTSI) ( F =7.544, P =0.001), and the FLSMG group had greater reductions in CRP, WBC, and CTSI and a longer duration of fasting. Length of hospital stay, number of fasting days, and changes in CRP and CTSI were significantly correlated with the change in FL ( r =0.352, 0.372, -0.365, and -0.350, all P < 0.001). Conclusion Most FLAP patients tend to have mitigation of FL, and its dynamic changes are closely associated with the changes in CRP and CTSI.

Improvement of inflammatory cytokines level in peripheral blood, anxiety and depressive symptoms in patients with pulpitis by root canal therapy / 口腔疾病防治

Objective@# To investigate the effect of root canal therapy (RCT) on inflammatory cytokines level in peripheral blood, anxiety, and depression in patients with pulpitis.@*Methods @#A total of 155 patients with pulpitis admitted to the Stomatology Hospital of the Fourth Military Medical University from June 2021 to June 2022 were treated with root canal therapy. Another 155 persons who received health examinations during the same period were selected as the control group. The Generalized Anxiety Disorder-7 (GAD-7) scores and the Patient Health Questionnaire-9 (PHQ-9) scores of the two groups were compared. The GAD-7, PHQ-9 and pain scores of the test group before treatment and 3 and 6 weeks after treatment were compared. Pain was assessed with a visual analog scale (VAS). Inflammatory cytokine [interleukin-8 (IL-8), interleukin-1 β (IL-1β), tumor necrosis factor-α (TNF-α), c-reactive protein (CRP)] levels in the test group before treatment and 3 and 6 weeks after treatment were compared. @*Results @#The GAD-7 and PHQ-9 scores in the test group were higher than those in the control group before treatment (P<0.05). The GAD-7 and PHQ-9 scores in the test group at 3 and 6 weeks after treatment were lower than those before treatment (P<0.05); there was no significant difference between the GAD-7 and PHQ-9 scores at 3 and 6 weeks after treatment(P>0.05). The pain scores of the experimental group at 3 and 6 weeks after treatment were lower than those before treatment (P<0.05), and the pain scores 6 weeks after treatment were lower than those at 3 weeks after treatment (P<0.05). The levels of IL-8, IL-1β, TNF-α and CRP in the peripheral blood of the experimental group were lower 3 and 6 weeks after treatment than before (P<0.05), and the levels of IL-8 and IL-1β in the peripheral blood at 6 weeks after treatment were significantly lower than at 3 weeks after treatment (P<0.05). The levels of TNF-α and CRP in the peripheral blood at 6 weeks after treatment were not significantly different from those at 3 weeks after treatment (P>0.05).@*Conclusion @#The peripheral blood of patients with pulpitis has a high level of inflammatory cytokines, and the patients suffer from obvious anxiety and depression. Root canal therapy can relieve their anxiety and depression by reducing their level of inflammatory cytokines in peripheral blood.

Detection of plasma interleukin-6, C-reactive protein, D-dimer and fibrinogen among 96 patients with pneumoconiosis / 预防医学

Objective@# To investigate the plasma levels of interleukin-6 (IL-6), C-reactive protein (CRP), D-dimer (D-D) and fibrinogen (Fib) among patients with pneumoconiosis, so as to provide insights into the prevention of thrombosis among patients with pneumoconiosis.@*Methods@#Ninety-six male coal workers with stable-stage pneumoconiosis admitted to China Pingmei Shenma Group Occupational Disease Prevention and Control Hospital from February 2019 to February 2021 were included in the pneumoconiosis group, and 43 male healthy volunteers in the hospital during the same period were selected as the control group. The plasma D-D, Fib, IL-6 and CRP levels were detected from subjects in the two groups. The associations of plasma D-D and Fib levels with IL-6 and CRP levels were examined using Pearson correlation analysis among pneumoconiosis patients. @*Results@#Participants in the pneumoconiosis group and the control group had a mean age of (52.91±3.89) and (52.64±4.12) years, D-D of (1.28±0.91) and (0.44±0.11) mg/L, Fib of (4.41±0.98) and (2.88±0.61) g/L, IL-6 of (0.63±0.19) and (0.42±0.06) ng/L and CRP of (3.30±1.65) and (1.35±0.12) mg/L, respectively. Higher plasma D-D, Fib, IL-6 and CRP levels were detected in the pneumoconiosis group than in the control group (all P<0.05). The plasma D-D level correlated positively with IL-6 level among pneumoconiosis patients (r=0.347, P<0.001). @*Conclusion@#High plasma IL-6, CRP, D-D and Fib levels are detected among patients with pneumoconiosis, and the plasma D-D level correlates positively with IL-6 level among patients with pneumoconiosis.

Association of serum adiponectin and high sensitivity C-reactive protein levels to short-term outcome in patients with acute ischemic stroke / 中国康复理论与实践

ObjectiveTo study the association of serum adiponectin and high sensitivity C-reactive protein (hs-CRP) levels to short-term outcome in patients with acute ischemic stroke (AIS). MethodsClinical data of 216 patients with AIS in Beijing Bo'ai Hospital from January, 2019 to September, 2020 were collected. The serum biochemical indicator was measured in all the patients within 24 hours after enrollment, and adiponectin was detected with enzyme-linked immunosorbent assay. Meanwhile, all patients were evaluated with National Institute of Health Stroke Scale (NIHSS). Modified Rankin Scale (mRS) was used to assess the functional outcome 90 days after onset during follow-up. ResultsThe incidence of poor outcome in patients with AIS within 90 days was 48.1%. Compared with the good outcome group, the serum adiponectin was lower (t = 5.861, P < 0.001) and the serum hs-CRP level was higher (Z = 5.525, P < 0.001) poor outcome group. Reduced serum adiponectin (OR = 0.862, 95%CI 0.751 to 0.975, P < 0.001) and increased serum hs-CRP (OR = 1.215, 95%CI 1.015 to 1.455, P < 0.001) were independent risk factors for poor outcome in patients with AIS. The areas under curve (95% CI) of serum adiponectin and hs-CRP for predicting the outcome of patients with AIS were 0.819 (0.761 to 0.877) and 0.722 (0.654 to 0.791), respectively (P < 0.001). The predictive power of serum adiponectin was higher than that of hs-CRP (Z = 2.151, P = 0.032). The optimum cut-off point of adiponectin was < 3.5 mg/L, and the Yoden index was 0.609, yielding a sensitivity of 0.704 and a specificity of 0.905. ConclusionSerum adiponectin and hs-CRP can serve as independent predictors for short functional outcome in patients with AIS.

Comparison Between C-Reactive Protein and D-Dimer Serum in Pneumonia Phase as the Predictors of COVID-19 Patients’ Mortality

@#Introduction: COVID-19 was declared a global pandemic in March 2020 by WHO. Until July 2022, there have been 555 million people suffering from this disease with a death toll of 6.35 million worldwide. Systemic inflammation triggered by a cytokine storm in a hypercoagulable state is the leading cause of COVID-19 patients’ mortality. CRP and D-dimer are biomarkers that can clearly illustrate pathogenesis. This research aims to compare C-reactive protein (CRP) and D-dimer as a better predictor of mortality in COVID-19 patients. Methods: It is an analytical observational research supported by a retrospective cohort design. The research subjects were COVID-19 patients treated in the isolation room of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, between August 2020 and August 2021. CRP and D-dimer was taken during pneumonia phase and then was compared on the next steps using univariate, bivariate and prognostic statistical tests. The quality of the prognostic value was examined using the Receiver Operating Characteristic (ROC) curve to set the Area Under Curve (AUC) and discrimination value. Results: There were 195 subjects confirmed with COVID-19. CRP value was significant in mortality with a cut-off of 230.1 mg/dl (RR 1.561, 95% CI 1.117-2.182, p=0.05). D-dimer value was significant on mortality with a cut off of 1,810 ng/ml (RR 21,613, 95% CI 8,266-56,508, p= 0.0001). Prognostic test results showed the discrimination value for D-dimer set by the AUC was 96.8% (strong), while the CRP discrimination value was 65.7% (weak). Conclusion: It can be concluded that as a predictor of mortality in COVID-19 patients, D-dimer value has a better discriminatory value than CRP value.