C-Reactive Protein in Simple Community-Acquired Pneumonia

Increased monocyte chemoattractant protein-1 levels indicating early vascular damage in lean young PCOS patients

Although both serum albumin and C-reactive protein (CRP) levels are separately recognized as predictors of adverse outcomes in many illnesses, the predictive value of their combination for adverse outcomes has not been evaluated. We therefore sought to examine the prognostic value of serum albumin for in-hospital mortality in the presence or absence of severe inflammation, as indicated by high CRP levels. In this cohort study, we measured serum albumin and CRP levels in 1638 older patients (aged 65 years or older) hospitalized for medical problems, and examined their utility, both separately and in combination, for predicting in-hospital mortality. In separate analyses of CRP and albumin, both high CRP levels (> or =5 mg/dl) and hypoalbuminemia (<3.5 g/dl) were associated with risk of in-hospital death. After dividing participants into four groups based on CRP and albumin levels (<5 mg/dl CRP and <3.5 mg/dl albumin), subjects with severe inflammation (CRP > or =5 mg/dl) and hypoalbuminemia were associated with an adjusted relative risk (ARR) of 3.8 for in-hospital mortality when compared with the reference (high albumin and low CRP). Even in the absence of severe inflammation, the presence of severe hypoalbuminemia was associated with an ARR of 2.6 for in-hospital mortality, when compared with patients without hypoalbuminemia. Both serum CRP and albumin levels are predictors of in-hospital mortality. However, high serum albumin levels may have a protective effect in older patients, regardless of degree of inflammation. Serum albumin levels remain a useful predictor for in-hospital mortality in older hospitalized patients.

Chronic Kidney disease (CKD) is a serious life threatening disease associated with morbidity and mortality in India. Hypothetical relationship between serum uric acid and C-Reactive protein (CRP) levels has been demonstrated in the pathophysiology of CKD. Fifty chronic kidney disease patients before dialysis and fifty controls were executed for measurement of serum uric acid and C-Reactive protein as well as other biochemical parameters analysis. Serum C-Reactive protein was measured by quantitative turbidimetric immunoassay. In this study, serum uric acid, creatinine, urea and C-Reactive protein levels were significant raised in CKD group to that of controls. Notably serum C-Reactive protein levels were significantly higher in the CKD patients associated with non-diabetic factors in comparison to diabetic associated CKD patients. A receiver operating characteristic curve (ROC) exhibited a strong association between uric acid and C-Reactive protein levels. A strong direct relationship between serum uric acid and C-Reactive protein in CKD patients are plausibly culprits in the progression of diseases.

Objective To explore the diagnosis significance of serum procalcitonin (PCT) and C-reactive protein(CRP) in the fever of hematological maliganancies. Methods The levels of serum PCT and CRP in 186 fever patients with hematological maliganancies and 30 non-fever patients with hematological maliganancies were analyzed retrospectively. According to the clinical characteristics, the patients were divided into infectious fever patients (165 cases), non-infectious fever patients (21 cases) and non-fever patients (30 cases). The infectious fever patients were divided into the bacterial infection (102 cases), the fungal infection (27 cases), and the virus infection (36 cases). The patients confirmed with bacteria infection were divided into blood culture positive patients (24 cases, including 12 cases of gram-negative bacteria infection and 12 cases of gram-positive bacteria infection) and blood culture negative patients (78 cases) according to the result of blood culture. The levels of serum PCT and CRP were compared. Results The levels of serum PCT and CRP in infectious fever patients were higher than those in non-infectious fever patients and non-fever patients:1.40(0.02-54.81) μg/L vs. 0.45(0.04-12.80) μg/L and 0.30(0.01-0.98) μg/L, 78.9(3.6-199.6) mg/L vs. 17.1(2.4-78.9) mg/L and 6.7(1.0-24.2) mg/L,and there were significant differences (P 0.05). The level of serum PCT in bacterial infection was higher than that in fungal infection and virus infection:1.60 (0.28-54.81) μg/L vs. 0.55 (0.17-9.60) μg/L and 0.38 (0.02-12.45) μg/L, and there was significant difference (P 0.05). There was no significant difference in the level of serum CRP among bacterial infection, fungal infection and virus infection (P >0.05). The level of serum PCT and the positive rate of PCT in blood culture positive patients were higher than those in blood culture negative patients: 2.10 (0.35-54.81) μg/L vs. 0.78(0.28-22.41) μg/L, 87.5% (21/24) vs. 66.7% (52/78), there were significant differences (P 0.05). There were no significant differences in the level of serum CRP and the positive rate of CRP between blood culture positive patients and blood culture negative patients, or between gram-negative bacteria infection and gram-positive bacteria infection (P >0.05). Conclusions Serum PCT concentration can help to distinguish the infectious fever and non-infectious fever, especially to gram-negative bacteria infection. Serum CRP concentration is significant in distinguishing the infectious fever and non-infectious fever. Key words: Hematologic neoplasms; Fever; C-reactive protein; Procalcitonin

Background and AimsHyponatremia is associated with aggravation of inflammation in COVID-19 patients. However, to the best of our knowledge, no study has used longitudinal data and investigated the association between hyponatremia and COVID-19. Therefore, we analyzed COVID-19 patients’ changes in serum sodium (Na) levels from admission to discharge.MethodWe conducted a retrospective, single-center, observational cohort study, involving adult COVID-19 patients who were admitted to Japan Self-Defense Forces Central Hospital between April 1 and May 31, 2020. Serum Na level of < 135 mEq/L was defined as hyponatremia, 135–145 mEq/L as normonatremia, and > 145 mEq/L as hypernatremia. Inflammation was assessed by serum C-reactive protein (CRP) levels. Univariate logistic regression analyses were used to assess associations between hyponatremia at admission and need for oxygen or death during hospitalization. A comparison of serum Na levels at admission and discharge was tested using a paired t-test. Cross-sectional associations between serum Na and CRP levels at admission or days from onset to admission were analyzed using multivariate linear regression analyses. A restricted cubic spline (RCS) curve incorporated in one of these multivariate linear regression analyses was used to identify when serum Na levels were the lowest. In addition, we employed a mixed-effect model to examine the longitudinal association between changes in serum Na and CRP levels during hospitalization.ResultsNinety-eight patients were enrolled, of whom 53 (54%) were male and 39 (40%) had a smoking history. Mean (SD) or median (IQR) of age, eGFR, body mass index (BMI), serum Na, and CRP at admission were 50 (17) years, 82 (20) mL/min/1.73m2, 23.3 (5.5), 138 (3.7) mEq/L, and 1.8 (0.2–6.0) mg/dL, respectively. It took an mean of 8.9 (3.7) days from onset to admission due to social disruption. According to government policies, during observation period, patients diagnosed with COVID-19 have to be hospitalized, even if they have minor or improving clinical symptoms.At admission, hyponatremia was observed in 11 (11.2%) patients; the rest of the patients had normonatremia. Twenty-seven (27.6%) patients received oxygen, and 4 (4.1%) died during hospitalization. Hyponatremia at admission was significantly associated with the need for oxygen (odds ratio: 41.2; 95% CI: 4.9–344; P=0.001) and death (odds ratio: 32.3; 95% CI: 3.0-347; P=0.004). Irrespective of hyponatremia at admission, the serum Na levels at discharge were significantly higher than those at admission (Fig. 1).In both cross-sectional and longitudinal analyses, serum Na levels were negatively associated with serum CRP levels after adjustment for age, sex, eGFR, BMI, and smoking history (P<0.001), which suggests that serum Na levels may reflect the activity of COVID-19. Furthermore, the serum Na levels at admission were positively associated with days from onset to admission after adjustment for age, sex, eGFR, BMI, smoking history, and serum CRP levels (P=0.035), and the RCS curve showed that the serum Na levels tended to be the lowest around the 7th day after onset (Fig. 2).ConclusionHyponatremia in COVID-19 may occur secondarily, and a condition called “COVID-19-induced hyponatremia” might exist.

Preoperative C-reactive protein levels are associated with tumor size and lymphovascular invasion in resected non-small cell lung cancer

Diagnosis of Periprosthetic Joint Infection

Severe acute pancreatitis (SAP) is a serious systemic disease with high mortality. Ulinastatin is a drug widely used for patients with SAP and multiple organ failure syndrome. The present study aimed to investigate the capacity of the serum C-reactive protein (CRP) levels to predict the therapeutic effects of ulinastatin combined with somatostatin as well as determine the severity of SAP. SAP patients were treated with ulinastatin combined with somatostatin and serum CRP levels were measured. The computed tomography severity index (CTSI), acute physiology and chronic health evaluation II (APACHE II) and gastrointestinal failure scores were used to determine the therapeutic effects. All patients were assigned to the effective group and the ineffective group. Receiver operating characteristic curve analysis was performed to determine the sensitivity and specificity of CRP levels in predicting the severity of SAP and patient prognosis. Logistic regression analysis was adopted to investigate the factors influencing the therapeutic effects. Prior to and after treatment, serum CRP levels in patients of the effective and ineffective groups were significantly different. After treatment, serum CRP levels in patients of the effective group exhibited a more obvious reduction. The sensitivity and specificity of serum CRP levels in predicting the therapeutic effects of ulinastatin combined with somatostatin in SAP patients upon hospital admission were 0.813 and 0.934, respectively. Serum CRP levels were positively correlated with APACHE II, CTSI and gastrointestinal failure scores of SAP patients. The logistic regression demonstrated that serum albumin, creatinine and CRP levels on admission were factors influencing the therapeutic effects of ulinastatin combined with somatostatin in SAP patients. These results indicate that serum CRP levels may have a predictive value regarding the therapeutic effects of ulinastatin combined with somatostatin and are an indicator of the severity of gastrointestinal failure in SAP.

OBJECTIVES: In this study, we aimed to investigate plasma homocysteine (Hcy) and serum C-reactive protein (CRP) levels in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients, and the relation among them. MATERIALS AND METHODS: This study was carriedout on 52 HD patients, 26 CAPD patients and a control group of 22 healthy persons. Blood samples were taken from the patients for Hcy and CRP measurements. RESULTS: Serum CRP level was found to be high in 48.1% of HD patients, 69.2% of CAPD patients and 4.5% of the healthy control group. Plasma Hcy level was found out to be above the normal limits in 73.1% of HD patients, 65.4% of CAPD patients and 9% of the healthy control group. There was a significant positive relation (r = 0.384, p < 0.001) between the levels of plasma Hcy and serum CRP in HD and CAPD patients. CONCLUSION: The high levels of Hcy and CRP were found out to be higher in HD and CAPD patients than in the control group. In order to determine the risk rate of Hcy and CRP for coronary artery disease, extensive investigations are required in patients with chronic renal failure that also have coronary artery disease.

Aim of the studyThe basic uses of C-reactive protein (CRP) and procalcitonin (PCT) in clinical practice are in the diagnosis and follow-up of infectious disease. The fact that CRP already achieves high levels in cases with lung cancer, however, limits its diagnostic specificity. Procalcitonin may be an important marker in the differential diagnosis of lung cancer patients who have fever and high CRP levels. Our objective in this study was to determine the levels of CRP and PCT in patients with newly diagnosed non-infectious non-small cell lung cancer (NSCLC) and to relate these results to patient and disease characteristics.Material and methodsSerum CRP and PCT levels were measured in 79 histopathologically proven NSCLC patients and 20 healthy controls. Results were compared with demographic and clinical variables in patients with NSCLC.ResultsSerum CRP concentrations were significantly higher in NSCLC patients compared to the control group [38.30 (7.79–185) mg/dl vs. 7.79 (3.36–26.10) mg/dl; p < 0.001]. There was no significant difference between the two groups in PCT levels (p > 0.05). A mild, positive correlation was found between CRP level and tumor diameter. When comparing CRP levels in the lung cancer patients grouped according to age, sex, smoking status, clinical TNM staging and performance status (PS), the only significant difference found was that for PS score.ConclusionsHigh serum CRP levels in non-infectious NSCLC patients are mainly related to PS status and weakly to tumor size. Adding serum PCT measurement may contribute to exclusion of infections in patients with NSCLC.

Objective To investigate the roles of leptin, adiponectin and other inflammatory factors in the inflammatory reaction of chronic obstructive pulmonary disease induced by smoking through studying the effects of smoking cessation on the levels of serum leptin,adiponectin, interleukin-6 (IL-6) and C-reactive protein (CRP). Methods Thirty male Wistar rats were randomly divided into smoking group,smoking cessation group and control group,ten rats in each group. Rats in smoking group smoked ten cigarettes every time, twice per day, six days per week, 20 weeks in total. Rats in smoking cessation group stopped smoking for ten weeks after smoking for 20 weeks. Serum leptin, adiponectin, and CRP levels were detected by enzyme-linked immunosorbent assay. Serum IL-6 level was detected by double antibody sandwich enzyme-linked immunosorbent assay. Results ① Compared with control group [(128. 00 + 13. 25) ng/L],the serum leptin levels in smoking group [(56. 23±8. 64) ng/L] and smoking cessation group [(60. 36±7. 42) ng/L] were lower (all P <0. 05). There was no statistical significance between smoking cessation group and smoking group. ②Compared with control group [(0. 369 ±0. 032) μg/L],the serum adiponectin level in smoking group [(0. 322±0. 045) μg/L] decreased ( P <0. 05). There was no statistical significance between smoking cessation group[(0. 333 ± 0. 059) μg/L] and control group and smoking group. ③Compared with control group [(23. 94 + 4. 44) ng/L].the serum IL-6 levels in smoking group [(39. 67±3. 13) ng/L] and smoking cessation group [(34. 27±7. 01) ng/L] increased (all P < 0.05). The serum IL-6 level in smoking cessation group was lower than that in smoking group ( P < 0. 05). ④Compared with control group [(494. 49 ± 124.44) μg/L],the serum CRP levels in smoking group [(809. 50± 141. 66) μg/L] and smoking cessation group [(632. 60± 182. 85) μg/L] increased (all P <0. 05). The serum CRP level in smoking cessation group was lower than that in smoking group ( P < 0. 05). ⑤Adiponectin was negatively correlated with IL-6 (y= -0.198, P <0. 05) and CRP (γ = - 0.489, P<0. 05). IL-6 was positively correlated with CRP (γ = 0.598, P <0. 05). Conclusions Smoking can decrease serum leptin and adiponectin, increase the levels of IL-6 and CRP. After smoking cessation, the levels of leptin and adiponectin show a rising trend, the levels of IL-6 and CRP decrease correspondingly. In addition,adiponectin is negatively correlated with IL-6 and CRP. These results suggest that leptin,adiponectin and other inflammatory factors may be involved in inflammatory reaction of chronic obstructive pulmonary disease induced by smoking. Key words: Chronic obstructive pulmonary diseases Smoking; Leptin; Adiponectin; Inflammatory reaction

Aim To investigate the association between serum C-reactive protein (CRP) levels and coronary collateral circulation (CCC) in Chinese patients with angiography-proven ≥95% coronary stenosis.Methods In this study, 1158 patients with angiography-proven ≥95% occlusion in ≥1 major epicardial coronary artery were enrolled, and then classified into two groups: poor CCC (Rentrop grades 0–1) and good CCC (Rentrop grades 2–3). CRP levels were grouped using the following two models: Model 1 discretized CRP group with 33.33% and 66.66% as the critical values and Model 2 with 1.0 and 3.0 mg/L as the cut off values.Results There were significant differences in serum CRP levels between the two groups (5.76 ± 3.45 vs. 3.49 ± 2.44 mg/L, respectively; p < 0.001), and compared with the first CRP tertile, the risks of poor CCC were higher in the second and third CRP tertiles (OR 2.31, 95%CI [1.67–3.19], OR 6.25, 95%CI [4.52–8.62], respectively). The receiver operating characteristic curve analysis indicated that the optimal cutoff value of CRP to predict poor CCC was 4.21 mg/L with 59.6% sensitivity and 74.33% specificity.Conclusions CRP levels are an independent predictor for poor CCC and might supply a useful biomarker in clinical applications.Key messagesC-reactive protein (CRP) is a non-specific inflammatory marker that is regarded as an independent risk and prognostic factor for individuals who suffer from coronary artery disease (CAD) and cardiovascular disorders.In a Chinese cohort of patients with coronary artery occlusion or stenosis of ≥95% TIMI grade 1 anterograde-flow, the relationship between CRP concentrations and angiographically visible coronary collateral (CC) was assessed.Our data indicated that elevated CRP associated with a significant impairment in CC development, and might supply a useful biomarker in clinical applications.

Objective To investigate the clinical value of prealbumin (PA) and C-reactive protein (CRP) level for the diagnosis of children patients with bacterial community acquired pneumonia (CAP).Methods Seventy-two children with bacterial CAP (CAP group) between July 2012 and December 2013 were enrolled in the study.Fifty healthy children were selected as healthy control group.The level of serum PA and CRP were measured by flow cytometry and turbidimetric immunoassay respectively.The results were compared.Results Before treatment,the level of CRP in CAP group was higher than that in healthy control group,and the level of PA in CAP group was lower than that in healthy control group,there was significant difference (P ＜ 0.01).The level of white blood cell count and the rate of neutrophilic granulocyte in CAP group was higher than that in healthy control group,but there was no significant difference(P ＞ 0.05).After treatment,the level of CRP in CAP group was decreased and the level of PA was increased,there was significant difference (P ＜ 0.05).Pearson analysis showed that the level of CRP in CAP patients had negative relationship with the level of PA (r =-0.613,P ＜ 0.01).Conclusion Detection of serum PA and CRP contributes to clinical diagnosis of children bacterial CAP and evaluation of anti-infection effect. Key words: Prealbumin; C-reactive protein; Pneumonia; Children

Stroke is the third most common cause of death in developed country after cancer &amp; ischemic heart disease. It is also one of the leading causes of death in developing countries like Bangladesh. Several studies have been done on stroke. But the difference between ischemic and hemorrhagic stroke on the basis of serum C-reactive protein (CRP) level has not been yet studied in Bangladesh. The aim of the study was to evaluate the differentiating role of CRP level between ischemic &amp; hemorrhagic stroke patient in Bangladeshi population. A cross sectional prospective study was performed on 50-stroke patients in Bangabandhu Sheikh Mujib Medical University from January 2006 to December 2007. The study subjects were divided into ischemic &amp; hemorrhagic groups on the basis of CT scan report. Serum CRP &amp; Lipid profile was determined by standard method. Statistical analysis was performed by using SPSS software. Mann whitney. U test was done to see the level of significance. The study showed that mean serum CRP level was 9.69 mg/L that was higher than normal subjects &amp; serum CRP level is 3.25 mg/L in ischemic &amp; 13.05 mg/L in hemorrhagic stroke patient. The present study showed that serum CRP level is higher in hemorrhagic stroke than ischemic stroke. The study revealed that serum CRP level is a differentiator between ischemic and hemorrhagic stroke patients &amp; helps the physician to take necessary management plan. J. Dhaka National Med. Coll. Hos. 2013; 19 (01): 39-42

ObjectivePrognosis of myocardial infarction tends to be worse when serum C-reactive protein (CRP) level is high. miRNAs are also known to be involved in different pathogeneses of heart diseases such as myocardial infarction. However, how CRP is involved in myocardial infarction has not been fully elucidated. We hypothesized that serum CRP changes the miRNA profile during ischemia-reperfusion injury (IRI) of the myocardium. To confirm this hypothesis, we performed global miRNA expression profiling of myocardium using IRI and CRP infusion rat model.MethodsAfter ligation of the coronary artery of rat hearts, human serum CRP was intravenously injected, and reperfusion was performed (I/R+CRP group, n = 6). Control group consisted of the sham group (n = 3), IV CRP infusion group (CRP only, n = 3), and the I/R-only group (I/R only, n = 5). We evaluated 423 miRNA expression in non-ischemic areas and areas at risk (AAR) of each group using NanoString nCounter miRNA expression assay.ResultsMiR-124 was downregulated in non-ischemic myocardium in CRP-only group. In AAR, 7 miRNAs were commonly upregulated in both I/R-only and I/R+CRP groups. And additional 6 miRNAs were upregulated in the I/R+CRP group (miR-33, miR-409-3p, miR-384-3p, miR-3562, miR-101a, and miR-340-5p). Similarly, in the non-ischemic areas, 6 miRNAs were commonly upregulated in both I/R-only and I/R+CRP groups, and additional 5 miRNAs changed in the I/R+CRP group (upregulation of miR-3559-5p, miR-499, and miR-21 and downregulation of miR-500 and miR-532-3p).ConclusionWe showed that when serum CRP level is high, IRI results in multiple miRNA profile changes not only in ischemic areas but also in non-ischemic myocardium. Our results may provide a strong basis for studying the role of CRP and miRNAs in ischemic heart disease.