scholarly journals C-reactive protein/albumin ratio is a prognostic indicator for predicting surgical intervention and mortality in neonates with necrotizing enterocolitis

2021 ◽  
Author(s):  
Amir T. Mohd Amin ◽  
Rafdzah A. Zaki ◽  
Florian Friedmacher ◽  
Shazia P. Sharif
Keyword(s):  
Necrotizing Enterocolitis ◽  
Surgical Intervention ◽  
Area Under The Curve ◽  
Prognostic Indicator ◽  
Operating Characteristics ◽  
C Reactive Protein ◽  
Critical Pathway ◽  
Reactive Protein ◽  
Characteristics Analysis ◽  
Prolonged Hospital

Abstract Purpose The role of hypoalbuminemia and raised C-reactive protein (CRP) levels in predicting critical prognosis has been described extensively in adult literature. However, there are limited studies in pediatrics, particularly neonates. The CRP/albumin (CRP/ALB) ratio is often associated with higher mortality, organ failure and prolonged hospital stay. We hypothesized that the serum CRP/ALB ratio has a prognostic value in predicting surgery and mortality in neonates with necrotizing enterocolitis (NEC). Methods Retrospective review of all neonates with clinical and radiological evidence of non-perforated NEC that were treated in a tertiary-level referral hospital between 2009 and 2018. General patient demographics, laboratory parameters and outcomes were recorded. Receiver operating characteristics analysis was performed to evaluated optimal cut-offs and area under the curve (AUC) with 95% confidence intervals (CI). Results A total of 191 neonates were identified. Of these, 103 (53.9%) were born at ≤ 28 weeks of gestation and 101 (52.9%) had a birth weight of ≤ 1000 g. Eighty-four (44.0%) patients underwent surgical intervention for NEC. The overall survival rate was 161/191 (84.3%). A CRP/ALB ratio of ≥ 3 on day 2 of NEC diagnosis was associated with a statistically significant higher likelihood for surgery [AUC 0.71 (95% CI 0.63–0.79); p < 0.0001] and mortality [AUC 0.66 (95% CI 0.54–0.77); p = 0.0150], respectively. Conclusions A CRP/ALB ratio of ≥ 3 on day 2 is indicative of a critical pathway in neonates with radiologically confirmed, non-perforated NEC. This could be used as an additional criterion to guide parental counselling in NEC for surgical intervention and mortality.

C-reactive Protein Is a More Sensitive and Specific Marker for Diagnosing Bacterial Infections in Systemic Lupus Erythematosus Compared to S100A8/A9 and Procalcitonin

2012 ◽  
Vol 39 (4) ◽  
pp. 728-734 ◽  
Author(s):  
HYOUN-AH KIM ◽  
JA-YOUNG JEON ◽  
JEONG-MI AN ◽  
BO-RAM KOH ◽  
CHANG-HEE SUH
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Bacterial Infections ◽  
Area Under The Curve ◽  
Specific Marker ◽  
Operating Characteristics ◽  
C Reactive Protein ◽  
Systemic Lupus ◽  
Serum Samples ◽  
Reactive Protein

Objective.C-reactive protein (CRP), S100A8/A9, and procalcitonin have been suggested as markers of infection in patients with systemic lupus erythematosus (SLE). We investigated the clinical significance of these factors for indication of infection in SLE.Methods.Blood samples were prospectively collected from 34 patients with SLE who had bacterial infections and 39 patients with SLE who had disease flares and no evidence of infection. A second set of serum samples was collected after the infections or flares were resolved.Results.CRP levels of SLE patients with infections were higher than those with flares [5.9 mg/dl (IQR 2.42, 10.53) vs 0.06 mg/dl (IQR 0.03, 0.15), p < 0.001] and decreased after the infection was resolved. S100A8/A9 and procalcitonin levels of SLE patients with infection were also higher [4.69 μg/ml (IQR 2.25, 12.07) vs 1.07 (IQR 0.49, 3.05) (p < 0.001) and 0 ng/ml (IQR 0–0.38) vs 0 (0–0) (p < 0.001), respectively]; these levels were also reduced once the infection disappeared. In the receiver-operating characteristics analysis of CRP, S100A8/A9, and procalcitonin, the area under the curve was 0.966 (95% CI 0.925–1.007), 0.732 (95% CI 0.61–0.854), and 0.667 (95% CI 0.534–0.799), respectively. CRP indicated the presence of an infection with a sensitivity of 100% and a specificity of 90%, with a cutoff value of 1.35 mg/dl.Conclusion.Our data suggest that CRP is the most sensitive and specific marker for diagnosing bacterial infections in SLE.

scholarly journals Early Changes in Blood Urea Nitrogen (BUN) Can Predict Mortality in Acute Pancreatitis: Comparative Study between BISAP Score, APACHE-II, and Other Laboratory Markers—A Prospective Observational Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Elizabeth Pando ◽  
Piero Alberti ◽  
Rodrigo Mata ◽  
María José Gomez ◽  
Laura Vidal ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Prospective Observational Study ◽  
Predictive Accuracy ◽  
Multiorgan Failure ◽  
Area Under The Curve ◽  
Apache Ii ◽  
Operating Characteristics ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Score Apache

Background. Changes in BUN have been proposed as a risk factor for complications in acute pancreatitis (AP). Our study aimed to compare changes in BUN versus the Bedside Index for Severity in Acute Pancreatitis (BISAP) score and the Acute Physiology and Chronic Health Evaluation-II score (APACHE-II), as well as other laboratory tests such as haematocrit and its variations over 24 h and C-reactive protein, in order to determine the most accurate test for predicting mortality and severity outcomes in AP. Methods. Clinical data of 410 AP patients, prospectively enrolled for study at our institution, were analyzed. We define AP according to Atlanta classification (AC) 2012. The laboratory test’s predictive accuracy was measured using area-under-the-curve receiver-operating characteristics (AUC) analysis and sensitivity and specificity tests. Results. Rise in BUN was the only score related to mortality on the multivariate analysis ( p = 0.000 , OR: 12.7; CI 95%: 4.2−16.6). On the comparative analysis of AUC, the rise in BUN was an accurate test in predicting mortality (AUC: 0.842) and persisting multiorgan failure (AUC: 0.828), similar to the BISAP score (AUC: 0.836 and 0.850) and APACHE-II (AUC: 0.756 and 0.741). The BISAP score outperformed both APACHE-II and rise in BUN at 24 hours in predicting severe AP (AUC: 0.873 vs. 0.761 and 0.756, respectively). Conclusion. Rise in BUN at 24 hours is a quick and reliable test in predicting mortality and persisting multiorgan failure in AP patients.

scholarly journals Faktor–Faktor yang Berhubungan dengan Diagnosis Pneumonia pada Pasien Usia Lanjut

2017 ◽  
Vol 3 (4) ◽  
pp. 183 ◽  
Author(s):  
Elza Febria Sari ◽  
C Martin Rumende ◽  
Kuntjoro Harimurti
Keyword(s):  
Urinary Incontinence ◽  
Functional Status ◽  
Clinical Laboratory ◽  
The Elderly ◽  
Community Acquired Pneumonia ◽  
Operating Characteristics ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Characteristics Analysis ◽  
Atypical Manifestations

Pendahuluan. Menegakkan diagnosis pneumonia pada pasien usia lanjut seringkali sulit mengingat gejala dan tanda klinis sering tidak lengkap dan manifestasi klinis yang tidak khas serta pemeriksaan penunjang yang sulit diinterpretasi. Hal ini mengkibatkan under ataupun over diagnosis dengan konsekuensi meningkatnya morbiditas dan mortalitas. Data faktor-faktor yang berhubungan dengan diagnosis pneumonia baik manifestasi khas ataupun tidak khas pada pasien usia lanjut belum banyak tersedia.Metode. Penelitian diagnostik dilakukan terhadap 158 pasien usia lanjut dengan kecurigaan pneumonia yang dirawat di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta pada kurun waktu Januari-Oktober 2010. Hubungan data klinis, laboratoris serta radiologis yang mencakup manifestasi spesifik (batuk, sputum produktif, sesak napas, demam, ronki, leukositosis , infiltrat) dan manifestasi tidak spesifik (intake sulit, jatuh, penurunan status fungsional inkontinensia urin) dengan diagnosis pneumonia komunitas dianalisis dengan regresi logistik. Kemudian, ditentukan kontribusi masing-masing determinan diagnosis terhadap diagnosis pneumonia. Kemampuan C-reactive protein dalam menegakkan diagnosis pneumonia dinilai dengan membuat kurva ROC dan menghitung AUC.Hasil. Dari 158 subjek, 106 didiagnosis pneumonia sesuai kriteria baku emas. Pada model akhir regresi logistik didapatkan tiga faktor yang berhubungan dengan diagnosis pneumonia yaitu batuk, ronki dan infiltrat dengan nilai p masing-masing secara berturut-turut yaitu <0,0001; 0,02; dan 0,0001. Nilai AUC yang diperoleh dari metode ROC untuk mengetahui kemampuan CRP dalam mendiagnosis pneumonia adalah 0,57 (IK 95%; 0,47-0,66).Simpulan. Faktor-faktor yang berhubungan dengan diagnosis pneumonia pada usia lanjut adalah batuk, ronki dan infiltrat. Sementara itu, c-reactive protein tidak memiliki peran dalam memprediksi diagnosis pneumonia pada pasien usia lanjut.Kata Kunci: diagnosis, pneumonia komunitas, usia lanjut  Factors Related to Diagnosis of Community-Acquired Pneumonia in the ElderlyIntroduction. Diagnosing community-acquired pneumonia (CAP) in the elderly remains a clinical challenge for various reasons. The clinical manifestation in the elderly is not frank and atypical manifestations, e.g. falls, decrease of functional status and food intake or urinary incontinence, may be present. These reasons may be associated with under or over diagnosis, which consequently contribute to the higher observed mortality rate in the elderly population with CAP. Study about factors related to diagnosis of CAP in the elderly was ra rely performed. Methods. From January to October 2010, 158 elderly patients suspected of having pneumonia at RSCM were registered. Relationship between clinical, laboratory and radiologic factors which consist of classic manifestations (cough, productive cough, dyspnea, fever, rales, leucocytosis, infiltrates) and atypical manifestations (decrease of intake and functional status, falls, urinary incontinence) with diagnosis community acquired pneumonia were analyzed. Receiver operating characteristics analysis of C-reactive protein was performed to find its association with diagnosis of pneumonia.Results. Of 158 subject, 106 were confirmed of having pneumonia. Final model of multiple logistics regression analysis revealed three factors: cough (p<0,0001), rales (p=0,02) and infiltrate (p<0,0001) related to diagnosis of pneumonia. All four atypical manifestations were proved unrelated with diagnosis of pneumonia. The area under the ROC curve for c-reactive protein was 0,57 (95% CI 0,47- 0,66). Conclusions. Factors related with diagnosis of community-acquired penumoni in the elderly are cough, rhales and infiltrates. All four atypical manifestations are proven unrelated with diagnosis of pneumonia. C-reactive protein does not predict diagnosis of CAP in the eldery. Keywords: community-acquired pneumonia, diagnostic factors, elderly

scholarly journals α-1-Acid Glycoprotein Concentration as an Outcome Predictor in Adult Patients with Sepsis

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Sheng-Yuan Hsiao ◽  
Yun-Ru Lai ◽  
Chia-Te Kung ◽  
Nai-Wen Tsai ◽  
Chih-Min Su ◽  
...  
Keyword(s):  
Area Under The Curve ◽  
Prognostic Indicator ◽  
Apache Ii ◽  
Stepwise Logistic Regression ◽  
C Reactive Protein ◽  
Outcome Predictor ◽  
Acid Glycoprotein ◽  
Reactive Protein ◽  
Stepwise Logistic Regression Model ◽  
Lactate Levels

Background. α-1-Acid glycoprotein (AGP) is an acute-phase protein that plays a role in first-line defense against infection and is therefore elevated in sepsis. We tested the hypothesis that AGP levels increase initially in sepsis and decrease after antimicrobial therapy and that these levels may predict treatment outcomes. Methods. AGP, biomarkers widely used in clinical practice, and maximum 24-h acute physiology and chronic health evaluation (APACHE)-II scores upon emergency department (ED) admission were prospectively evaluated and compared. We further examined changes in AGP concentrations 1, 4, and 7 days after admission and determined the value of AGP that may be used to accurately and reliably predict the prognosis in patients with sepsis. Results. Mechanical ventilation, white blood cell (WBC) counts, C-reactive protein (CRP) and lactate levels, maximum 24-h APACHE-II scores, and AGP concentrations were significantly higher upon admission in patients with sepsis who died. AGP and lactate concentrations were also significantly higher in non-survivors than in survivors on days 1, 4, and 7. As indicated by the stepwise logistic regression model analysis and area under the curve analysis, AGP was the best prognostic indicator, and the cut-off value for predicting fatality was 1307 μg/mL, and any increase 1-ng/mL in AGP concentration would increase the fatality rate by 0.5%. Conclusion. Based on our observations, AGP may be a good prognostic predictor in patients with sepsis. In addition, serial AGP levels meet the requirements for predicting outcomes in patients with sepsis.

scholarly journals Diagnostic Value of C-Reactive Protein in Discrimination between Uncomplicated and Complicated Parapneumonic Effusion

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 829
Author(s):  
Yana Kogan ◽  
Edmond Sabo ◽  
Majed Odeh
Keyword(s):  
Area Under The Curve ◽  
Diagnostic Value ◽  
Parapneumonic Effusion ◽  
C Reactive Protein ◽  
Diagnostic Efficacy ◽  
Reactive Protein ◽  
Significant Difference ◽  
Study Population ◽  
Complicated Parapneumonic Effusion

Objectives: The role of serum C-reactive protein (CRPs) and pleural fluid CRP (CRPpf) in discriminating uncomplicated parapneumonic effusion (UCPPE) from complicated parapneumonic effusion (CPPE) is yet to be validated since most of the previous studies were on small cohorts and with variable results. The role of CRPs and CRPpf gradient (CRPg) and of their ratio (CRPr) in this discrimination has not been previously reported. The study aims to assess the diagnostic efficacy of CRPs, CRPpf, CRPr, and CRPg in discriminating UCPPE from CPPE in a relatively large cohort. Methods: The study population included 146 patients with PPE, 86 with UCPPE and 60 with CPPE. Levels of CRPs and CRPpf were measured, and the CRPg and CRPr were calculated. The values are presented as mean ± SD. Results: Mean levels of CRPs, CRPpf, CRPg, and CRPr of the UCPPE group were 145.3 ± 67.6 mg/L, 58.5 ± 38.5 mg/L, 86.8 ± 37.3 mg/L, and 0.39 ± 0.11, respectively, and for the CPPE group were 302.2 ± 75.6 mg/L, 112 ± 65 mg/L, 188.3 ± 62.3 mg/L, and 0.36 ± 0.19, respectively. Levels of CRPs, CRPpf, and CRPg were significantly higher in the CPPE than in the UCPPE group (p < 0.0001). No significant difference was found between the two groups for levels of CRPr (p = 0.26). The best cut-off value calculated by the receiver operating characteristic (ROC) analysis for discriminating UCPPE from CPPE was for CRPs, 211.5 mg/L with area under the curve (AUC) = 94% and p < 0.0001, for CRPpf, 90.5 mg/L with AUC = 76.3% and p < 0.0001, and for CRPg, 142 mg/L with AUC = 91% and p < 0.0001. Conclusions: CRPs, CRPpf, and CRPg are strong markers for discrimination between UCPPE and CPPE, while CRPr has no role in this discrimination.

Abstract WP5: Outcomes Are Not Different Between Patients With Intermediate and High Dwi-aspects After Stent-retriever Thrombectomy

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Woong Yoon ◽  
Seul Kee Kim ◽  
Tae Wook Heo ◽  
Byung Hyun Baek ◽  
Jaechan Park
Keyword(s):  
Functional Outcome ◽  
Time Window ◽  
Multivariate Logistic Regression Analysis ◽  
Area Under The Curve ◽  
Stent Retriever ◽  
Operating Characteristics ◽  
Anterior Circulation ◽  
Good Outcome ◽  
Characteristics Analysis ◽  
The Impact

Introduction: Few studies have investigated the association between pretreatment DWI-ASPECTS and functional outcome after stent-retriever thrombectomy in patients with acute anterior circulation stroke. Hypothesis: Patients with acute stroke and DWI-ASPECTS <7 might have a similar chance of a good outcome compared to those with a higher DWI-ASPECTS, if they are treated with a stent-retriever thrombectomy in a short time window. However, this hypothesis has not been tested. Thus, this study aimed to investigate the impact of DWI-ASPECTS on functional outcome in patients with acute anterior circulation stroke who received a stent-retriever thrombectomy. Methods: We retrospectively analyzed the clinical and DWI data from 171 patients with acute anterior circulation stroke who were treated with stent-retriever thrombectomy within 6 hours of symptom onset. The DWI-ASPECTS was assessed by two readers. A good outcome was defined as a modified Rankin Scale score of 0-2 at 3 months. Results: The median DWI-ASPECTS was 7 (interquartile range, 6-8). Receiver operating characteristics analysis revealed an ASPECTS ≥ 7 was the optimal cut-off to predict a good outcome at 3 months (area under the curve=0.57; sensitivity, 75.3%; specificity, 34.4%). The rates of good outcome, symptomatic hemorrhage, and mortality were not different between high DWI-ASPECTS (scores of 7-10) and intermediate (scores of 4-6) groups. In patients with an intermediate DWI-ASPECTS, good outcome was achieved in 46.5% (20/43) of patients with successful revascularization (modified TICI 2b or 3), whereas no patients without successful revascularization had a good outcome ( P =0.016). In multivariate logistic regression analysis, independent predictors of good outcome were age and successful revascularization. Conclusions: Our study suggested that treatment outcomes were not different between patients with a high DWI-ASPECTS and those with an intermediate DWI-ASPECTS who underwent stent-retriever thrombectomy for acute anterior circulation stroke. Thus, patients with an intermediate DWI-ASPECTS otherwise eligible for endovascular therapy should not be excluded for stent-retriever thrombectomy or stroke trials.

Serum interleukin-6 and C-reactive protein as a prognostic indicator in hepatocellular carcinoma

Cytokine ◽  
2012 ◽  
Vol 60 (3) ◽  
pp. 686-693 ◽  
Author(s):  
Jeong Won Jang ◽  
Byong Sun Oh ◽  
Jung Hyun Kwon ◽  
Chan Ran You ◽  
Kyu Won Chung ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Interleukin 6 ◽  
Prognostic Indicator ◽  
C Reactive Protein ◽  
Reactive Protein

scholarly journals An Incarcerated Colon Inguinal Hernia That Perforated into the Scrotum and Exhibited an Air-Fluid Level

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Seisuke Ota ◽  
Toshio Noguchi ◽  
Tomoya Takao ◽  
Takumi Sakamoto ◽  
Yuichiro Kanie ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Transverse Colon ◽  
Surgical Intervention ◽  
C Reactive Protein ◽  
Fluid Level ◽  
Hernia Sac ◽  
Reactive Protein ◽  
Free Air ◽  
History Of ◽  
Cold Extremities

There are few reports of a transverse colon inguinal hernia; furthermore, an inguinal hernia perforating the scrotum is rare. Here we report the case of a 79-year-old man who died after developing an incarcerated colon inguinal hernia that perforated the scrotum and exhibited an air-fluid level. The patient was referred to our hospital in November 2011 with a complaint of inability to move. Physical examination revealed an abnormally enlarged left scrotum and cold extremities. He reported a history of gastric cancer that was surgically treated more than 30 years ago. His white blood cell count and C-reactive protein level were elevated. Abdominal and inguinal computed tomography revealed that his transverse colon was incarcerated in the left inguinal canal. Free air and air-fluid level were observed around the transverse colon, suggestive of a perforation. The patient and his family refused any surgical intervention; therefore, he was treated with sultamicillin tosilate hydrate and cefotiam hydrochloride. However, he succumbed to panperitonitis 19 days after admission. The findings from this case indicate that the transverse colon can perforate into an inguinal hernia sac.

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