[Etiology and prognosis of highly elevated C-reactive protein levels (≥500 mg/L): a retrospective study about 168 measures in a series of 113 patients]. / Profil étiologique et pronostique des valeurs extrêmes (≥500 mg/L) de protéine C-réactive : étude rétrospective de 168 valeurs chez 113 patients.

PURPOSE: The C-reactive protein (CRP) is a useful inflammatory marker with a rapid kinetics during the inflammatory process. The objective of this study was to determine the etiology and prognosis of extremely elevated CRP values greater or equal to 500 mg/L. METHODS: We performed an exhaustive retrospective study from January 2004 to July 2009, in a general hospital, of all patients with a CRP value above 500 mg/L, admitted in all clinical departments. Clinical data were collected by a single observer using a standardized questionnaire. RESULTS: One hundred and sixty-eight CRP values greater or equal to 500 mg/L were identified amongst 106,758 tests (0.16%) corresponding to 113 patients: 51% were men and their mean age was 59.5 years. Mean CRP value was 561 mg/L (500-772). An immunocompromised condition was observed in 52% of the patients. All but 13 patients presented an infectious disease. Microbiological analysis of the infected patients identified 59 Gram-positive cocci (20 Staphylococcus spp., 35 Streptococcus spp. including 21 Streptococcus pneumoniae), two Gram-negative cocci, 48 Gram-negative bacilli (including 19 Escherichia coli), three Gram-positive bacilli, 16 fungal infections, one viral infection. Site of infection was respiratory in 63%, urinary in 17% and abdominal in 16%. At day 30, mortality rate was 27% and only 41% of the patients were discharged at home. CONCLUSION: CRP value above 500 mg/L is highly related to bacterial infections, without over-representation of a given microorganism. One-month mortality is high (27%).

Influenza vaccination in patients with haematologic malignancies: analysis of practices in 200 patients in a single center.

GOALS OF WORK: Despite recent studies demonstrating immunogenicity and tolerance of influenza vaccine in patients with haematologic malignancies, practices are still heterogeneous. The aim of this study was to analyse practices and factors influencing vaccination in a single centre, in the light of recent literature data. PATIENTS AND METHODS: Two hundred patients with haematologic malignancies were included and filled out a standardized questionnaire about influenza vaccination. They were observed prospectively during the epidemic season. MAIN RESULTS: Our study revealed a poor uptake of influenza vaccination (vaccinal rate: 25.5%), in particular in patients younger than 65 y and those with no comorbidities. The main reasons for not being vaccinated were: the vaccination was not suggested to patients (53.7%), vaccination was contraindicated by doctors (24.2%), the patient refused it (21.5%). The main reasons for physicians for contraindicating the vaccine were: haematologic malignancy could be worsened by vaccination (33.3%), vaccination could generate illness or asthenia (27.8%), vaccination would not be efficient (16.7%), unknown (22.2%). CONCLUSIONS: We believe that a better knowledge by physicians of tolerance and efficiency of the vaccine could enhance the vaccination coverage.

Prevalence and clinical significance of auto-antibodies in adults with cystic fibrosis.

The aim of this study was to determine the prevalence of different auto-antibodies in adult, French cystic fibrosis (CF) patients and to look for a correlation between autoimmunity, patient characteristics and survival. The sera of 144 patients were screened for a wide range of antibodies. Clinical, biological and bacteriological characteristics and the cystic fibrosis transmembrane conductance regulator genotype were recorded and progression of lung disease was examined. 113 (78.5%) patients displayed one or several auto-antibodies, predominantly immunoglobulin (Ig)A anti-Saccharomyces cerevisiae antibodies (ASCA; 43.7%) and antineutrophil cytoplasmic antibodies (ANCA; 40%), of which 59% showed bactericidal/permeability-increasing protein (BPI) specificity. The presence of BPI-ANCA was associated with the number of antibiotic courses, low body mass index, Pseudomonas aeruginosa colonisation, the presence of resistant P. aeruginosa, low forced expiratory volume in 1 s, CF-related liver disease, hypergammaglobulinaemia, male sex and inflammatory syndrome. The presence of ASCA-IgA was correlated with male sex and hypergammaglobulinaemia. 41 patients presented with chronic respiratory failure and/or requested lung transplantation or died during follow-up. These events were more frequent in patients with BPI-ANCA or ASCA-IgA. These findings confirm the high frequency of auto-antibodies in CF, particularly BPI-ANCA and ASCA-IgA, and the link between BPI-ANCA, severity of lung disease and CF prognosis.