Is C-reactive protein elevation a common finding in colonic diverticular disease?

Background: Acute appendicitis is a common surgical condition and the most common cause of acute surgical abdomen. Commonly used tests for diagnosis of acute appendicitis were WBC, CRP ESR and procalcitonin (PCT) levels. In present study we correlated the serum levels of CRP with the histopathology of the removed appendix, to study predictive value of serum C- reactive protein in diagnosis of acute appendicitis. Material and Methods:Present study was conducted in patients with possibility of acute appendicitis, underwent appendicectomy. The histopathology report was considered as the final diagnosis. CRP more than 6 mg/dl was considered to be positive. Results: In present study total 88 patients were included. Male to female ratio was 1.4:1, most common age group was 21-30 years (35.23%) followed by 31-40 years (27.27%). Abdominal pain (92.05%), McBurney tenderness (80.68%), vomiting (76.14%), rebound tenderness (67.05%) and fever (55.68%) were common signs and symptoms noted in present study. On histopathology examination, inflammed appendix (51.14%) was most common finding, others were gangrenous appendix (23.86%), perforated appendix (5.68%) and normal appendix (19.32%). In present study diagnostic efficacy of serum CRP was sensitivity (80%), specificity (84.62%), positive predictive value (96.77%), negative predictive value (42.31%), diagnostic accuracy (80.68%). Conclusion. Serum CRP estimation is useful adjunct in diagnosis of acute appendicitis along with clinical diagnosis. Serum CRP value should be interpreted in combination with clinical findings.

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C-reactive Protein to Albumin Ratio among Patients Admitted to Intensive Care Unit of a Tertiary Care Hospital: A Descriptive Crosssectional Study

Journal of Nepal Medical Association ◽

10.31729/jnma.7047 ◽

2021 ◽

Vol 59 (244) ◽

pp. 1247-1251

Author(s):

Pratiksha Gyawali ◽

Himal Shrestha ◽

Vivek Pant ◽

Prabodh Risal ◽

Sharad Gautam

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Binary Data ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Common Finding ◽

Care Hospital ◽

C Reactive Protein ◽

Albumin Ratio ◽

Reactive Protein

Introduction: Sepsis is the most common cause of mortality among patients admitted to intensive care unit. There is emerging evidence on the role of C-reactive protein to albumin ratio (C-reactive protein/Albumin) in predicting outcomes in patients with critical illness and sepsis, admitted to intensive care unit. We aimed to find out the median value of C-reactive protein/Albumin ratio among patients admitted to intensive care unit of a tertiary care hospital. Methods: We conducted a descriptive cross-sectional study of 110 critically ill patients (>18 years old) admitted to intensive care unit of Dhulikhel Hospital from April, 2014 to June, 2016. The ethical approval (Reference number.51/16) was obtained from Institutional Review Committee at Kathmandu University School of Medical Sciences. C-reactive protein/albumin ratio was calculated from records of patients admitted to the intensive care unit. Convenience sampling was done. Data were entered into Microsoft Excel and analysed using Statistical Package for Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequencies and percentages for binary data. Results: Among 110 patients admitted to the intensive care unit, the median value of C-reactive protein/Albumin ratio was found to be 3.4 (Interquartile range: 3.1-4.5). Conclusions: Our study showed higher median C-reactive protein /Albumin similar to toher studies. Sepsis is a common finding among patients admitted to intensive care unit. Monitoring of C-reactive protein/albumin level in a patient admitted to intensive care unit could be useful for stratifying patients with a high risk of developing sepsis.

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Atypical Presentation of Colonic Diverticular Disease

Bangladesh Journal of Medicine ◽

10.3329/bjm.v33i1.56797 ◽

2021 ◽

Vol 33 (1) ◽

pp. 94-98

Author(s):

Refaya Tasnim ◽

Nawsabah Noor ◽

Quazi Tarikul Islam

Keyword(s):

Gastrointestinal Bleeding ◽

Diverticular Disease ◽

Lower Gastrointestinal Bleeding ◽

Common Finding ◽

Fresh Blood ◽

Colonic Diverticulosis ◽

Infectious Colitis ◽

Colonic Neoplasia ◽

Life Threatening ◽

Colonic Diverticular Disease

Hematochezia or passage of fresh blood per rectum is a relatively common finding in medical practice which mostly indicates lower gastrointestinal bleeding. The causes for lower gastrointestinal bleeding include diverticular disease, vascular ectasia, ischemic, inflammatory or infectious colitis, colonic neoplasia, hemorrhoids, anal fissures and small bowel lesions (Crohn’s disease, Vascularectasia, Meckel’s diverticulum).If a patient comes with severe hematochezia, the first and foremost task is to stabilize the patient and then find out the source of bleeding as soon as possible. Elderly patients presenting with severe hematochezia, is most likely due to colorectal malignancy but benign causes like colonic diverticulosis can also present as life threatening bleeding in rare occasions. Here we report a case of 70-years-old male patient presenting with severe painless hematochezia leading to severe anemia due to diverticulosis. Bangladesh J Medicine July 2022; 33(1) : 94-98

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Thrombocytosis as a Predictor of Serious Bacterial Infection in Febrile Infants

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v16i41.1673 ◽

2019 ◽

Vol 16 (41) ◽

pp. 401-404

Author(s):

Deepak Mishra ◽

Amit Kumar Das ◽

Ram Hari Chapagain ◽

Nitu Kumari Jha ◽

Ganesh Kumar Rai

Keyword(s):

Bacterial Infection ◽

Bacterial Infections ◽

Diagnostic Marker ◽

Common Finding ◽

P Value ◽

C Reactive Protein ◽

Cross Sectional ◽

Reactive Protein ◽

Young Infants

Background: Most of the febrile infants <90 days old will have no more than a mild viral infection but there is a substantial minority that will be diagnosed as having serious bacterial infection at a reported prevalence of 10–14%. A simple, readily available, inexpensive diagnostic marker that yields results quickly and also accurately identifies bacterial infections in febrile infants would be of great value in management of these infants. This study aims to assess the role of thrombocytosis in predicting serious bacterial infection in young febrile infants beyond neonatal period.Methods: A hospital based cross-sectional observational study was conducted from May 2016 to April 2017 on 76 febrile infants of age group 29-90 days in Kanti Children’s Hospital.Results: The incidence of serious bacterial infection was found 43 (56.6%). Thrombocytosis, elevated C-reactive protein and pyuria were significantly higher in serious bacterial infection cases (p value <0.05). Thrombocytosis alone had the sensitivity of only 53.5%, but had specificity of 90.9%. Elevated C-reactive protein had the best sensitivity (81.4%). Combination of leukocytosis, elevated C-reactive protein, pyuria and thrombocytosis had better sensitivity (93.0%) than these parameters alone. The overall ability of platelet count to identify infants with SBI was only moderate (AUC: 0.722). Elevated C-reactive protein was found to have better ability to identify infants with serious bacterial infection (AUC: 0.846).Conclusions: Thrombocytosis is a common finding in young infants diagnosed with serious bacterial infection. It has however, moderate ability in identifying infants with serious bacterial infection. Combining thrombocytosis with elevated C-reactive protein, leukocytosis and pyuria has better sensitivity in diagnosing serious bacterial infection than these individual parameters alone. Hence, combining these parameters may help in early prediction of febrile young infants at risk of serious bacterial infection.Keywords: Febrile young infants; serious bacterial infection; thrombocytosis.

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An unusual course of COVID-19 infection with late increase in C-reactive protein (clinical case reports)

Russian Pulmonology ◽

10.18093/0869-0189-2020-30-5-709-714 ◽

2020 ◽

Vol 30 (5) ◽

pp. 709-714

Author(s):

S. Yu. Chikina ◽

M. Yu. Brovko ◽

V. V. Royuk ◽

S. N. Avdeev

Keyword(s):

Comprehensive Evaluation ◽

Case Reports ◽

Severe Disease ◽

Clinical Status ◽

Clinical Signs ◽

Common Finding ◽

C Reactive Protein ◽

Laboratory Findings ◽

Antiinflammatory Therapy ◽

Reactive Protein

Clinical signs of COVID-19 infection are non-specific and diagnosis is typically based on comprehensive evaluation of the patient’s history, clinical status, radiological and laboratory findings. A common finding in COVID-19 patients is increased C-reactive protein (CRP), though in some patients, CRP remains within normal range notwithstanding the presence of other criteria of severe disease. We describe two clinical cases of COVID-19 with severe bilateral pneumonia and late increase in CRP. Similar cases re quite challenging for making the diagnosis and indicating the antiinflammatory therapy.

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1069 Diverticular Disease: An Audit of Adherence to NICE Guidelines

British Journal of Surgery ◽

10.1093/bjs/znab259.419 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

O Lesi ◽

M R Iqbal ◽

L Khan

Keyword(s):

Diverticular Disease ◽

Complicated Diverticulitis ◽

University Hospital ◽

Full Blood Count ◽

C Reactive Protein ◽

Nice Guidelines ◽

Reactive Protein ◽

Presenting Symptoms ◽

Uncomplicated Diverticulitis ◽

Retrospective Audit

Abstract Introduction Diverticular disease is a common surgical problem ranging from diverticulosis to uncomplicated diverticulitis to complicated diverticulitis. The NICE Guidelines for diverticular disease recommended that antibiotics should only be given in patients who are systemically unwell, background of immunosuppression or have complicated diverticulitis. We aimed to access the compliance to these guidelines with regards to the use of antibiotics at our local institute. Method This was a retrospective audit reviewing the management of patients with Computed Tomography Scan findings of uncomplicated acute diverticulitis (Hinchey Ia) at the surgical emergency unit at Basildon University Hospital between August 2018 and May 2020. Data obtained included demographic data, presenting symptoms (fever, abdominal pain), haematological investigations (full blood count and c-reactive protein) and use of intravenous/oral antibiotics. Results Twenty patients were included, the M:F ratio was 1:1.9, the age range was between 36-80 years. 13 patients (65%) had left iliac fossa pain as part of their presenting symptom while only three (15%) had pyrexia. Seventeen patients(85%) had NEWS score between 0-1 with 60% of the patients presenting with elevated white blood cell count and 75% with c-reactive protein >5. All our patients were prescribed antibiotics. Conclusions There was no discrimination in the use of antibiotics/admission for uncomplicated diverticulitis as all patients had antibiotics and as such there is need for increased awareness about the guidelines among the surgical team and adherence to the protocol to prevent indiscriminate use of antibiotics.

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C-REACTIVE PROTEIN/ALBUMIN RATIO AND NEUTROPHIL-LYMPHOCYTE RATIO AS PREDICTORS OF COVID-19 SEVERITY

International Journal of Advanced Research ◽

10.21474/ijar01/13919 ◽

2021 ◽

Vol 9 (12) ◽

pp. 374-378

Author(s):

M.V. Madhav ◽

◽

Y. Sirisha ◽

V. Anjaneya Prasad ◽

◽

...

Keyword(s):

Inflammatory Markers ◽

World Health ◽

Common Finding ◽

C Reactive Protein ◽

Albumin Ratio ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

First Case ◽

Severity Prediction

Coronavirus disease 2019 (COVID-19) was announced in early December 2019. By genome sequencing, the virus was recognised. From Wuhan City, the virus spread globally. The pandemic situation was declared by the World Health Organization.The first case of COVID-19 in Indiawas reported in Kerala on January 27, 2020.The clinical features varied with disease severity. Most COVID-19 patients have non-severe manifestations and show a good prognosis. However, patients with severe disease may progress to pulmonary dysfunction, multiple organ dysfunction, and death. COVID-19 related to a considerable mortality rate in older patients and cases had other morbidities. Studies suggested that the inflammatory storm is a common finding in other coronaviruses.Similarly, increases in the inflammatory markers like C-reactive protein (CRP),ferritin,interleukin-6 (IL-6) and were described in COVID-19 (1). Albumin levels decreased in the inflammatory conditions reduced levels were confirmed in severe COVID-19 patients. Hypoalbuminemia and high CRP/albumin ratio were previously linked to the mortality of various clinical conditions as critically ill patients.To avoid the unnecessary or inappropriate utilisation of the healthcare resources, early prediction of the severity of COVID-19 will be helpful. Severity prediction will also improve the prognosis by reducing the mortality rate.Thus, this study aimed to evaluate the role of inflammatory markers in estimating the severity and predicting the prognosis of COVID-19. This study hypothesised that elevated values of CRP/ albumin ratio and the neutrophil-lymphocyte ratio at the time of COVID-19 diagnosis are associated with COVID-19 severity and mortality.

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