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RESUMEN Introducción: Los protocolos de diagnóstico acelerado de dolor torácico, con el avance de la troponina de alta sensibilidad, permiten identificar a los pacientes que ingresan al servicio de urgencias con dolor torácico de bajo riesgo para un evento cardiovascular adverso mayor, que podrían ser dados de alta de forma temprana y segura, con ahorro de tiempo y recursos. Objetivo: Evaluar ensayos clínicos que utilicen protocolos de diagnóstico acelerado basados en troponina de alta sensibilidad. Material y métodos: se realizó una búsqueda de ensayos clínicos aleatorizados que evaluaran protocolos de diagnóstico acelerado basados en troponina de alta sensibilidad en los servicios de urgencias, en las bases de datos MEDLINE/Ovid, Cochrane y EMBASE utilizando los criterios de evaluación del manual Cochrane y la estrategia PRISMA Resultados: Tras una tamización de 3509 estudios se incluyeron 5 ensayos clínicos que incluyeron 1513 pacientes; se identificaron 409 (27%) altas tempranas, el 91% para el protocolo 0/3 h ESC, 72% para el 0/1 h, 48% para el EDACS, 40% para el HEART, 19 y 32% para ADAPT y 8 y 18% para el cuidado usual. El valor predictivo negativo fue alto, en un rango de 99,1 al 100% La duración media de la estancia hospitalaria fue más baja para los protocolos 0/1 h y 0/3 h ESC, con 4,6 y 5,6 horas respectivamente. Conclusiones: Los protocolos de diagnóstico acelerado en dolor torácico que implementan el uso de troponina de alta sensibilidad permiten lograr alta proporción de altas tempranas con baja tasa de eventos cardiovasculares mayores, con disminución del tiempo de estancia y recursos consumidos.
ABSTRACT Background: Accelerated diagnostic protocols for chest pain, with the advancement of high-sensitivity troponin, make it possible to identify patients admitted to the emergency department with chest pain and low risk for a major adverse cardiovascular event, who could be discharged immediately, early and safely, saving time and resources. Objective: The aim of this study was to assess clinical trials using accelerated diagnostic protocols based on high-sensitivity troponin. Methods: A search of randomized clinical trials evaluating accelerated diagnostic protocols based on high-sensitivity troponin in emergency services was carried out in MEDLINE/Ovid, Cochrane and EMBASE database, using the assessment criteria of the Cochrane manual and the PRISMA strategy. Results: After screening 3509 studies, 5 clinical trials, including 1513 patients, were analyzed. Early discharges were identified in 409 (27%) of patients, in 91% of cases for ESC 0/3-h protocols, 72% for 0/1-h, 48% for EDACS, 40% for HEART, 19% and 32% for ADAPT and 8% and 18% for standard care protocols. The negative predictive value was high, in the 99.1-100% range. Mean length of hospital stay was lower for the 0/1-h and ESC 0/3-h protocols, with 4.6 and 5.6 hours, respectively. Conclusions: Accelerated diagnostic protocols in chest pain using high-sensitivity troponin allow a higher proportion of early discharges with a low rate of major cardiovascular events, with reduction in length of hospital stay and resources used.
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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.
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Objective:To explore the predictive value of single high-sensitivity cardiac troponin I (hs-cTnI) concentration of 30-day cardiovascular adverse events in patients with suspected acute coronary syndrome (ACS).Methods:This is a multicenter, prospective and observational clinical study. Patients with suspected ACS who were admitted into the emergency department of Fuwai Hospital, the First Affiliated Hospital of Sun Yat-sen University and Nanjing First Hospital from January 2017 to September 2020 were enrolled. hs-cTnI result at the time of visit was obtained from patients with suspected ACS. Patients were followed up for 30 days and patients were divided into no events group and events group according to the presence or absence of 30-day cardiovascular adverse events (acute myocardial infarction (including index), unplanned revascularization and cardiovascular death). The predictive value of single Hs-cTnI at different concentration thresholds on the adverse event was evaluated in terms of sensitivity, negative predictive value (NPV) and 95% confidence interval ( CI). The best threshold was defined as: missed diagnosis rate <2% and NPV >99%. Patients were sub-grouped according to the confounders of hs-cTnI (sex, age, chest pain duration, estimated glomerular filtration rate), and Chi-square test was used to compare sensitivity and NPV among various subgroups. Results:A total of 1 461 patients were included. Among them, 387 patients (26.5%) had 30-day adverse cardiovascular events and 1 074 patients (73.5%) had no adverse cardiovascular events. Mean age was (62±12) years old and 905 were males (61.9%). When the concentration of hs-cTnI was less than 2 ng/L (limit of detection), the missed diagnosis rate of 30-day cardiovascular adverse events was 0.8% (3/387), the sensitivity was 99.2% (95% CI 97.6%-99.8%), and NPV was 98.7% (95% CI 96.0%-99.7%). When hs-cTnI concentration was less than 6 ng/L, the missed diagnosis rate was 1.8%, the sensitivity was 98.2% (95% CI 96.1%-99.2%), and NPV was 99.0% (95% CI 97.9%-99.6%). Subgroup analysis showed that the sensitivity and NPV of single hs-cTnI concentration <6 ng/L for 30-day cardiovascular adverse events were lower in patients with chest pain less than 3 h than those with chest pain time>3 hours ( P<0.05). Conclusions:Single hs-cTnI concentration less than 6 ng/L can predict the risk of 30-day cardiovascular adverse events in suspected ACS patients, but continuous monitoring is recommended for patients with chest pain onset≤3 hours.
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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.
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Abstract Objectives Cardiac involvement is one of the most serious complications of idiopathic inflammatory myopathy (IIM) that indicates poor prognosis. However, there is a lack of effective biomarkers for the identification of cardiac involvement and the prediction of prognosis in IIM. Here, we aimed to explore the value of different cardiac biomarkers in IIM patients. Methods A total of 142 IIM patients in the Department of Rheumatology and Immunology, Ruijin Hospital from July 2019 to October 2022 were included in this study. The clinical characteristics, laboratory tests, treatments and prognosis were recorded. The disease activity was assessed according to the core set measures. The correlations of the serum cardiac biomarkers levels with disease activity were analyzed by the Spearman correlation test. Risk factors for cardiac involvement were evaluated by multivariate logistic regression analysis. Results Higher high-sensitivity cardiac troponin I (hs-cTnI) levels were associated with cardiac involvement (n = 41) in IIM patients [adjusted OR 7.810 (95% CI: 1.962-31.097); p = 0.004], independent of other serum cardiac biomarkers. The abnormal hs-cTnI had the highest AUC for distinguishing of cardiac involvement in IIM patients (AUC = 0.848, 95% CI: 0.772,0.924; p < 0.001). Besides, we found that high serum levels of hs-cTnI were significantly correlated with disease activity. Moreover, patients with higher serum levels of hs-cTnI tended to suffer from poor prognosis. Conclusions Serum hs-cTnI testing may play a role in screening for cardiac involvement in IIM patients. Abnormal levels of serum hs-cTnI were associated with increased disease activity and poor prognosis. Key Points Among all the cardiac biomarkers, the serum levels of hs-cTnI were independently associated with cardiac involvement in IIM patients. The serum levels of hs-cTnI were significantly correlated with disease activity in IIM patients. The abnormal hs-cTnI levels were correlated with poor prognosis in IIM patients.
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ABSTRACT Objective: Polycystic ovary syndrome (PCOS) begins in adolescence and has cardiovascular and metabolic components in later years. Cystatin C and high-sensitivity C-reactive protein (hs-CRP) levels and neutrophil-lymphocyte and platelet-lymphocyte ratios are associated with metabolic and inflammatory events. Here, we evaluated inflammatory and metabolic parameters in normal and overweight adolescents with PCOS. Materials and methods: This prospective case-control study enrolled 90 adolescents with PCOS and 100 matched by age and BMI healthy adolescents classified as either normal weight (NW) and overweight (OW). Groups were compared based on inflammatory and metabolic parameters (serum cystatin C, hs-CRP, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lipids, fasting blood glucose-insulin (FBG-FI), HOMA-IR levels, waist circumference [WC], and waist-hip ratio [WHR]). The relationship between the parameters were compared and predictive abilities were evaluated. Results: Cystatin C, hs-CRP, NLR, triglyceride (TG), FBG-FI, HOMA-IR, WC, and WHR were significantly higher in those with PCOS. The NW PCOS group had significantly higher TG, cystatin C, hs-CRP, and NLR versus OW controls. The highest HOMA-IR values were observed in OW PCOS (p < .05). Cystatin C and hs-CRP sensitivity and specificity were significant (p < 0.05). Cystatin C and hs-CRP were positively correlated with other metabolic parameters. Conclusion: Independent of BMI, inflammatory and metabolic parameters are significantly higher in adolescents with PCOS compared to controls and even worse in those who are also OW. Therefore, adolescents with PCOS should be encouraged to maintain healthy lifestyles and weights to avoid metabolic risks. Hs-CRP and cystatin C could be promising markers to predictive of future metabolic risks.
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Background: Diabetes mellitus is a chronic and progressive endocrine disorder that may result in macro and microvascular complications. Objective: This study assessed some biochemical analytes in Nigerians who were recently (≤ 6 months) diagnosed with Type 2 diabetes mellitus (T2DM). Methods: 160 T2DM and 90 non-diabetic control participated in this study. Blood samples were collected and analyzed for Heart-type fatty acid-binding protein (HFABP), high sensitivity C-reactive protein (hs-CRP), electrolytes, lipid and renal profile parameters, glycated haemoglobin (HBA1C) and fasting blood glucose (FBG), using standard guidelines. Result: The body mass index (BMI) of the T2DM volunteers was higher than control (P <0.001). The lipid profile, potassium, glucose, HBA1C, urea and creatinine values were elevated (P <0.001) while estimated glomerular filtration rate (eGFR) was lower (P<0.05) in diabetes. The median HFABP and hs-CRP were raised (P <0.05) in T2DM. Positive associations existed between FBG and urea (P <0.001), Creatinine and HBAIC (P <0.001). A logistic regression analysis, shows that an increased BMI, HBA1C, FBG, Cholesterol, urea and creatinine were associated with higher odds (p<0.001) of cardiovascular and renal complications. Conclusion: Elevated hs-CRP, glycated haemoglobin, urea and creatinine among T2DM increase the odds of cardiovascular and renal insults in this population
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Glycated Hemoglobin , Diabetes Mellitus, Type 2 , Renal Insufficiency, Chronic , C-Reactive Protein , NigeriaABSTRACT
Objective:To systematically evaluate the correlation of high sensitivity C-reactive protein (hs-CRP) with contrast-induced nephropathy (CIN) in patients following coronary angiography (CAG) or percutaneous coronary intervention (PCI).Methods:PubMed, web of science, CBM, CNKI and Wanfang Data were searched for studies on hs-CRP levels in patients undergoing CAG or PCI patients from the incipience of the database to March 7, 2021. Meta-analysis was performed by RevMan 5.3 and Stata 12.0 software.Results:Fourteen related studies were included involving 11 885 patients undergoing CAG or PCI (1 034 cases with CIN and 10 851 cases without CIN). The results of meta-analysis showed that the level of hs-CRP in CIN group was significantly higher than that in non-CIN group (WMD=3.77,95 %CI:2.80—4.74, P<0.001, I2=93%), patients with higher levels of hs-CRP before CAG or PCI were more likely to develop CIN. Sensitivity analysis shows that the results of this study had good stability. The results of subgroup analysis show that the differences in sample size, study population, geographical location and the definition of CIN were statistically significant. Conclusion:Available evidence shows that high hs-CRP level is a risk factor for CIN in patients undergoing CAG or PCI, large sample trials are still needed to support this conclusion.
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Objective:To analyse the relationship between serum electrolyte concentrations and risk of cardiovascular events in physical examination population.Methods:A cross-sectional study design was applied to survey 8 445 adults whose serum high-sensitivity cardiac tropon Ⅰ (hs-cTnⅠ) and serum electrolytes (chloride, phosphorus, calcium, sodium, potassium and magnesium) concentrations were measured at the health examination center of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 1, 2018 to February 28, 2022. The risk of cardiovascular events was classified into three levels according to the serum hypersensitive cardiac troponin Ⅰ(hs-cTnⅠ) concentration: low, middle or high risk group. One-way analysis of variance was applied to compare the differences in serum electrolyte concentrations of participants with different risk levels of cardiovascular events. Ordered multi-category logistic regression was performed to analyze the correlation between serum electrolyte levels and the risk of cardiovascular events.Results:The concentration of potassium and magnesium ion in the subjects with low risk of cardiovascular events were both higher than those in the middle and high risk group [potassium ion (4.28±0.29) vs (4.24±0.34), (4.23±0.36) mmol/L, magnesium ion (0.88±0.06) vs (0.87±0.07), (0.87±0.07) mmol/L](both P<0.05), while the concentration of sodium ion was lower [(140.54±1.75) vs (140.88±1.73), (140.81±2.20) mmol/L]( P<0.001); the concentration of phosphorus ion in the high-risk group was lower than those in the middle and low risk groups [(1.04±0.17) vs (1.08±0.16), (1.05±0.15) mmol/L]( P=0.001); no significant difference was found in the concentrations of chloride and calcium ion among the three groups (both P>0.05). Compared to subjects with normal concentrations of electrolyte, the risk level of cardiovascular events in subjects with hypokalemia ( OR=6.96, 95% CI: 3.67-13.10) and hypomagnesemia ( OR=5.00, 95% CI: 1.01-24.50) was higher(both P<0.05). Within the normal range, sodium concentration was positively correlated with the risk of cardiovascular events ( OR=1.08, 95% CI: 1.03-1.14; P<0.001). Conclusions:The serum sodium, potassium and magnesium concentrations in health examination subjects are correlated with the risk of cardiovascular events. Maintaining the balanced concentration of serum potassium and magnesium, as well as low sodium levels within normal limits may help prevent cardiovascular events.
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Objective:To analyze the relationship between the high sensitivity C-reactive protein (hs-CRP) and anxiety levels in patients hospitalized with cardiovascular-related diseases and hypertension.Methods:A total of 221 patients hospitalized with cardiovascular-related diseases in the Fuwai Hospital were selected by a voluntary sampling method from September to December 2021. Participants were divided into hypertensive and non-hypertensive groups ( n=119 and n=102) based on the diagnosis of hypertension in their inpatient medical records. Anxiety levels were assessed using the Zung Self-Rating Anxiety Scale, and the levels of serum hs-CRP were estimated by automatic immunoanalyzer. Multivariate logistic regression was used to analyze the relationship between hs-CRP and anxiety. Results:In the hypertensive group, the risk of anxiety in patients with abnormal hs-CRP (>3 mg/L) was 4.239 times (95% CI: 1.569-11.748, P=0.005) higher than those in normal hs-CRP (≤3 mg/L). In turn, compared with patients without anxiety, those with anxiety had 3.878 times greater probability of experiencing abnormal hs-CRP (95% CI: 1.495-10.062, P=0.005), while those with mild anxiety and moderate to severe anxiety had 4.525 times (95% CI: 1.392-14.714, P=0.012) and 3.286 times (95% CI: 0.911-11.357, P=0.070) greater odds of experiencing abnormal hs-CRP, respectively. No similar significant association was seen in the non-hypertensive group. Conclusion:There is an interrelationship between elevated hs-CRP and anxiety in hospitalized patients with cardiovascular-related diseases and hypertension.
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ABSTRACT Background: Recently, studies had shown that incretin-based therapies could reduce the levels of pro-inflammatory markers. The data on the effects of incretin-based therapies on serum high-sensitivity C-reactive protein (hs-CRP) in type 2 diabetes (T2DM) were inconsistent. Objective: The objective of the study was to assess the effects of incretin-based therapies on hs-CRP in patients with T2DM by meta-analysis. Methods: We searched PubMed, EMBASE, the Cochrane Collaboration Library, and Web of Science to identify the eligible randomized clinical trials until August 2019. The pooled standard mean differences (SMD) were calculated by random-effects model using STATA 11.0. Results: Twenty-five studies with 28 randomized controlled trials were finally included into the meta-analysis. Meta-analysis revealed a significant reduction in hs-CRP following treatment with incretin-based regimens compared to controls (SMD = −0.452, p < 0.001). Subgroup analysis of different class of incretin-based drugs showed that therapy with both dipeptidyl peptidase 4 inhibitors (DPP-4Is, SMD = −0.338, p = 0.026) and glucagon-like peptide 1 receptor agonists (GLP-1 RAs, SMD = −0.544, p = 0.003) caused significant reductions in hs-CRP. Besides, there was a significant reduction in hs-CRP with an intervention duration more than 24 weeks (SMD = −0.465, p = 0.001), while no significant difference with <24 weeks. Meta-regression analyses showed that better glycemic control and more body mass index (BMI) decline were associated with hs-CRP reduction after incretin-based therapies. Conclusions: This meta-analysis suggests that incretin-based therapies, both GLP-1 RAs and DPP-4Is, can cause a significant reduction in hs-CRP in patients with T2DM, which is related to long intervention duration, better glycemic control, and more BMI decline.
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ABSTRACT Objective: To examine the relationship of serum magnesium and high-sensitive C-reactive proteins (hsCRPs) with overweight/obesity, and its association with hypertension in lean versus overweight/obese (O/O), female, adolescent school learners living in Mthatha, Eastern Cape, South Africa. Methods: A case-control study was conducted involving age-matched, non-pregnant and nonlactating lean and O/O females aged 13-17 years. Relevant data on demography, anthropometry (height, weight, and waist and hip circumferences), blood pressure and venous blood samples were collected. Results: A significant inverse correlation was observed between serum magnesium and waist circumference (WC) (r = −0.3153; 95% CI = −3.843, −0.8681; p = 0.0022). Serum hsCRP levels were significantly higher in O/O participants. Participants with a WC > 80 cm had significantly higher mean systolic blood pressure and mean diastolic blood pressure (MDBP). A hip circumference (HC) > 94 cm was associated with higher mean systolic blood pressure (MSBP) and MDBP (120 ± 2 vs 113 ± 2, p = 0.009 and 73 ± 2 vs 68 ± 1, p = 0.003). Both WC and HC were found to be positively correlated with both MSBP (r = 0.2691; 95% CI = 0.042, 0.457; p = 0.018 and r = 0.2758; 95% CI = 0.03184, 0.3001; p = 0.0159) and MDBP (r = 0.2686; 95% CI = 0.0286, 0.320; p = 0.19 and r = 0.2836; 95% CI = 0.05382, 0.4455; p = 0.013), respectively. Conclusion: In our study, low-grade inflammation and early-onset hypertension in O/O adolescent females were consistent with evidence that support the beneficial effect of maintaining lean body habitus. There is an urgent need to prevent overweight/obesity among adolescents.
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Humans , Female , Adolescent , C-Reactive Protein/analysis , Hypertension/blood , Magnesium/blood , Obesity/blood , Biomarkers/blood , Case-Control Studies , Cross-Sectional Studies , Risk FactorsABSTRACT
@#Introduction: Cardiovascular disease (CVD) remains the leading cause of death in Malaysia. Identification of asymptomatic at-risk individuals is often achieved by means of a risk prediction algorithm. Traditional CVD risk factors and their associated algorithms are, however, limited by residual CVD risk. High sensitivity C-reactive protein (hsCRP) has emerged as a novel CVD risk factor. This study aimed to evaluate hsCRP as an adjunct CVD risk marker among the adult Malaysian population by determining its correlation with the Framingham Risk Score (FRS). Comparison analyses were done according to sociodemographic, clinical and laboratory factors and between subjects with and without Metabolic Syndrome (MetS). Method: This cross-sectional study involved eighty-three (n=83) adults attending a health screening program at Universiti Putra Malaysia (UPM). Demographic data, anthropometric measurements and blood samples for fasting blood glucose (FBG), fasting lipid profile (FSL), glycated haemoglobin (HbA1c) and hsCRP were taken. Respondents were grouped according toFRSand the Joint Interim Statementinto 10-year CVD risk categories (low, intermediate and high) and MetS, respectively. Results: hsCRP was significantly increased in patients with high body mass index (BMI) (p=0.001), at-risk waist circumference (WC) (p=0.001) and MetS (p=0.009). Spearman’s correlation coefficient showed a significant positive correlation between hsCRP level and total FRS score (r=0.26, p<0.05) and HDL-C score (r=0.22, p<0.05). Conclusion: The significant difference of hsCRP levels across obesity levels and MetS with its modest correlation with FRS scores supported the adjunctive role of hsCRP in CVD risk prediction, most likely capturing the inflammatory pathological aspect and thus partly accounting for the residual CVD risk.
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Objective:To investigate the predictive value of plasma high-sensitivity C-reactive protein/albumin ratio (HCRP/ALB) for the death in patients with acute coronary syndrome (ACS).Methods:The clinical data of patients with ACS [including unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI), ST segment elevation myocardial infarction (STEMI)] admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2018 to August 2020 were retrospectively analyzed. The plasma HCRP and ALB were recorded and the HCRP/ALB ratio was calculated. Patients were divided into death group and survival group according to the hospital outcome. The differences of baseline data and biochemical indexes between the two groups were compared. Receiver operating characteristic curve (ROC curve) was used to analyze the predictive value of each variable to death. Logistic regression was used to analyze the risk factors of death.Results:Among the 1 722 ACS patients, 74 died in hospital. Comparison of baseline data between death group and survival group showed that the other baseline data were statistically different except for the rate of hyperlipidemia. Among them, patients in death group had higher heart rate (HR), HCRP, B-type natriuretic peptide (BNP), HCRP/ALB [HR (bpm): 89±19 vs. 73±15, HCRP (mg/L): 23.24 (9.79, 33.69) vs. 3.57 (1.03, 14.26), BNP (ng/L): 424.0 (164.3, 1 596.1) vs. 79.0 (31.0, 211.4), HCRP/ALB: 0.700 (0.289, 1.017) vs. 0.089 (0.026, 0.368), all P < 0.01], while ALB was lower (g/L: 35.37±5.16 vs. 39.97±6.43, P < 0.01). ROC curve analysis showed that area under ROC curve and 95% confidence interval [AUC (95% CI)] of BNP, HCRP and HCRP/ALB for predicting death were 0.781 (0.717-0.845), 0.790 (0.724-0.856) and 0.803 (0.738-0.869), respectively. The Youden index of HCRP/ALB was 0.559, and the corresponding HCRP/ALB was 0.246. The patients were divided into low HCRP/ALB group (HCRP/ALB≤ 0.246, 1 163 cases) and high HCRP/ALB group (HCRP/ALB > 0.246, 559 cases). Except for gender, previous smoking, hypertension and diabetes rates, the other baseline data were statistically different between the two groups. Patients in the high HCRP/ALB group had a higher mortality (10.4% vs. 1.4%, P < 0.01), higher rates of implanted intra-aortic balloon pump (IABP, 12.7% vs. 2.7%, P < 0.01), higher BNP, HCRP, HCRP/ALB [BNP (ng/L): 253.0 (82.8, 749.0) vs. 60.0 (26.0, 145.2), HCRP (mg/L): 25.42±17.47 vs. 2.62±2.43, HCRP/ALB: 0.700±0.435 vs. 0.066±0.062, all P < 0.01], while lower ALB (g/L: 36.89±4.30 vs. 41.17±6.83, P < 0.01). Logistic regression analysis showed that higher HR [odds ratio ( OR) = 1.037, 95% CI was 1.020-1.055, P = 0.000] and higher HCRP/ALB ( OR = 3.835, 95% CI was 1.612-9.125, P = 0.002) were independent risk factors for the death in ACS patients, while higher ALB could reduce the mortality in ACS patients ( OR = 0.884, 95% CI was 0.818-0.957, P = 0.002). Conclusions:The higher the HCRP/ALB, the higher the risk of death in patients with ACS. When HCRP/ALB is greater than 0.246, the patient has a higher mortality. Therefore, HCRP/ALB in patients with ACS can be used as an effective predictor for death risk.
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Objective:To analyze the diagnostic and prognostic value of heparin-binding protein (HBP) combined with procalcitonin (PCT) and high sensitivity C-reactive protein (hs-CRP) in early sepsis.Methods:The clinical data of 116 patients with sepsis admitted to Zhejiang Xin′an International Hospital from August 2018 to December 2019 were retrospectively analyzed. They were divided into mild sepsis group (40 cases), severe sepsis group (46 cases) and septic shock group (30 cases) according to the severity of illness. According to the clinical prognosis, they were divided into survival group (87 cases) and death group (29 cases). In the same period, 104 outpatients were selected as control group. The levels of HBP, PCT and hs-CRP were compared in each group and the guiding value of HBP, PCT and hs-CRP in the diagnosis of early sepsis were analyzed by receiver operating characteristic (ROC) curve.Results:The levels of HBP, PCT and hs-CRP in sepsis group were higher than those in control group: (83.45 ± 11.29) μg/L vs. (4.81 ± 0.62) μg/L, (8.19 ± 1.14) μg/L vs. (0.24 ± 0.03) μg/L, (87.94 ± 13.58) mg/L vs. (1.34 ± 0.15) mg/L, and the differences were statistically significant ( P<0.05). The levels of HBP, PCT and hs-CRP were gradually increased with the aggravation of disease, and the differences were statistically significant ( P<0.05). The levels of HBP, PCT and hs-CRP in survival group were lower than those in death group: (67.94 ± 8.91) μg/L vs. (129.98 ± 18.43) μg/L, (6.46 ± 0.93) μg/L vs. (13.38 ± 1.77) μg/L, (65.19 ± 10.62) mg/L vs. (129.19 ± 22.46) mg/L, and the differences were statistically significant ( P<0.05). The ROC curve analysis showed that the area under the curve of HBP, PCT, hs-CRP and HBP + PCT + hs-CRP were 0.828, 0.835, 0.787 and 0.940, the sensitivity was 72.4%, 69.0%, 79.3% and 86.2%, and the specificity was 85.1%, 88.5%, 74.7% and 90.8%. Conclusions:HBP, PCT and hs-CRP joint detection have certain guiding value in the diagnosis of early sepsis, and can reflect the disease severity and prognosis.
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Objective:To investigate the effects of preoperative oral high glucose solution on postoperative recovery, homeostasis model assessment-insulinresistance and high sensitivity C-reactive protein level in patients with gastric cancer.Methods:A total of 83 patients with gastric cancer diagnosed and treated in Hefei Hospital of Anhui Medical University from Jan. 2018 to Jun. 2020 were selected and divided into study group (42 cases) and control group (41 cases) according to whether or not they were given oral glucose solution before operation. In the first 4 hours, 500 ml of 10% glucose solution (glucose solution, GS) was taken orally, and the control group did not take it before surgery. The postoperative recovery (time of first exhaust after operation, time of first defecation, length of hospitalization after operation) , postoperative complications, HOMA-IR and serum hsCRP levels between the two groups were observed and compared.Results:The two groups had very small differences in general information such as gender, age, BMI, TNM staging, and surgical methods ( P>0.05) . In comparison of HOMA-IR index, before treatment, the difference of HOMA-IR index between the two groups was small ( P>0.05) ; after treatment, the difference of HOMA-IR index between the two groups increased (1.80±0.45 vs 5.65±1.46 for the study group before and after treatment, 1.92±0.43 vs 11.70±3.05 for the control group before and after treatment) , and the HOMA-IR index of the control group was higher than that of the study group ( P<0.05) . In comparison of hsCRP levels, before treatment, there was little difference in hsCRP levels between the two groups ( P>0.05) ; after treatment, hsCRP levels in the two groups increased (1.23±0.90 vs 40.40±27.05 for the study group before and after treatment, and 1.40±1.15 vs 80.05±38.85 for the control group before and after treatment) , and the hsCRP level of the control group was higher than that of the study group ( P<0.05) . In terms of postoperative recovery, the study group’s first exhaust time, first defecation time, and postoperative hospital stay were significantly shorter than those of the control group [ (3.35±0.50, 4.05±0.50, 14.65±1.90) vs (4.30±0.90, 5.70±1.15, 16.15±2.05) , P<0.05]. In comparison with postoperative complications, the total incidence of postoperative gastric bleeding, anastomotic leakage, intestinal obstruction, and other complications was 11.9% for the study group and the total incidence of complications was 14.63% in the control group ( P>0.05) . Conclusions:After operation, oral GS can reduce insulin resistance and inflammation in patients with gastric cancer. It has positive significance to promote postoperative rehabilitation.
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Background: Ischemic Stroke is a common cause of morbidity and mortality. Various parameters, both clinical and laboratory have been studied as markers of Early Neurological Deterioration (END) out of which CRP has been the most important. This retrospective study of ours is an attempt to study its influence on END by minimizing other variables as much as possible.Methods: 50 patients were chosen retrospectively strictly according to laid down inclusion and exclusion criteria, their data recorded and analyzed with 17.0 SPSS software. Any p value <0.05 was taken as significant.Results: Significantly raised CRP values were found in elderly patients (p=0.0001) and in males (p=0.003). Higher incidences of ENDs were also found in elderly patients (p=0.326) and males (p=0.846) and patients with raised CRP levels (p=0.057).Conclusions: Higher Values of CRP are associated with increased frequency of ENDs. But in patients with multiple factors which can influence both CRP and END, CRP alone should not be thought of as the only culprit.
ABSTRACT
Background: Stroke is the second leading cause of death worldwide according to WHO. High sensitivity C-Reactive Protein (hs-CRP) is an acute phase reactant which is being studied extensively to delineate its role in development of stroke as well as in prognostication. This study was done to assess correlation of hs-CRP with risk factors of stroke and its association with types of stroke and prognosis.Methods: A prospective case control study of 100 patients with acute stroke along with 100 controls was conducted with informed consent. At baseline, hs-CRP levels were measured and Modified Rankin Scale (MRS) was assessed. On day 90 the Modified Rankin Scale was assessed again. Patients were divided into groups based on hs-CRP levels and MRS and the results were analysed.Results: Prevalence of stroke was more in men than women (p=0.0002). Statistically significant difference was found between mean hs-CRP levels in men (4.722±0.8982 mg/L) and women (4.133±0.9446 mg/L) (p=0.005) and between cases and controls (p=0.0003). There was no significant association with type of stroke (p=0.456). Mean total cholesterol levels between cases and controls showed statistically significant difference (p=0.0005). High MRS was significantly associated with high hs-CRP levels (p=0.003). Higher hs-CRP on day 1 correlated with higher MRS on day 90.Conclusions: hs-CRP level is increased in stroke and shows significant association with severity of stroke and prognosis.
ABSTRACT
Metabolically Healthy Obesity/Metabolic Healthy Obesity (MHO) is a paradox in scientific medical literature and discussion is still on regarding the safety status of MHO phenotype. It is an obesity phenotype where the subjects have BMI more than or equal to 30 Kg/m2 but are devoid of conventional metabolic complications such deranged lipid profile, altered glucose tolerance, or metabolic syndrome as they have less adverse inflammatory profile, low visceral fat, less disturbed insulin signalling, and lipid metabolism. But recently studies are coming up with robust evidence that MHO is not a benign condition. It may lead to metabolic syndrome in future and it is also associated with cardiometabolic risks.METHODSThis cross-sectional study was done in a tertiary care hospital conducted for a period of two years from October 2017 to October 2019. After obtaining institutional ethical clearance, this cross-sectional study was conducted on 120 MHO subjects, 120 metabolic syndrome (MS) and 120 Metabolic Healthy Non-Obese (MHNO) subjects. Anthropometric data was obtained, and hs-CRP was estimated and compared with MS and MHNO group. The data was analysed using appropriate statistical significance tests.RESULTSIn one-way Analysis of Variance (ANOVA), anthropometric determinants and metabolic variables differed significantly across the groups (p<0.0001). The mean hs-CRP in MHO was; 4.45 ± 1.46 and in the control group it was 1.84 ± 0.77 (p<0.0001). Using Pearson’s correlation coefficient, significant positive correlation was found between hs-CRP with other anthropometric and metabolic parameters. In multiple regression analysis, Body Mass Index (BMI), Waist Circumference (WC), were significantly associated with elevated hs-CRP. Adjusted odd’s (AOR) of abnormal hs-CRP in MHO was 1.9 times that of MHNO subjects.CONCLUSIONSMHO phenotype is associated with increased hs-CRP levels as compared to MHNO phenotype suggesting that obesity even if associated with a healthy metabolic profile, still harbour subclinical inflammation. So, subjects with MHO should be targeted for appropriate preventive strategies in the form of health education, lifestyle alterations to avoid future cardiovascular morbidities. MHO phenotype with evidence of subclinical vascular inflammation should not be considered a benign condition.