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.

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 C-reactive protein concentration as a risk predictor of mortality in intensive care unit: a multicenter, prospective, observational study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rong Qu ◽  
Linhui Hu ◽  
Yun Ling ◽  
Yating Hou ◽  
Heng Fang ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Inflammatory Markers ◽  
Prospective Observational Study ◽  
Apache Ii ◽  
Apache Ii Score ◽  
C Reactive Protein ◽  
Icu Mortality ◽  
Reactive Protein ◽  
Risk Reclassification ◽  
Multicenter Prospective Observational Study

Abstract Background It is not clear whether there are valuable inflammatory markers for prognosis judgment in the intensive care unit (ICU). We therefore conducted a multicenter, prospective, observational study to evaluate the prognostic role of inflammatory markers. Methods The clinical and laboratory data of patients at admission, including C-reactive protein (CRP), were collected in four general ICUs from September 1, 2018, to August 1, 2019. Multivariate logistic regression was used to identify factors independently associated with nonsurvival. The area under the receiver operating characteristic curve (AUC-ROC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the effect size of different factors in predicting mortality during ICU stay. 3 -knots were used to assess whether alternative cut points for these biomarkers were more appropriate. Results A total of 813 patients were recruited, among whom 121 patients (14.88%) died during the ICU stay. The AUC-ROC values of PCT and CRP for discriminating ICU mortality were 0.696 (95% confidence interval [CI], 0.650–0.743) and 0.684 (95% CI, 0.633–0.735), respectively. In the multivariable analysis, only APACHE II score (odds ratio, 1.166; 95% CI, 1.129–1.203; P = 0.000) and CRP concentration > 62.8 mg/L (odds ratio, 2.145; 95% CI, 1.343–3.427; P = 0.001), were significantly associated with an increased risk of ICU mortality. Moreover, the combination of APACHE II score and CRP > 62.8 mg/L significantly improved risk reclassification over the APACHE II score alone, with NRI (0.556) and IDI (0.013). Restricted cubic spline analysis confirmed that CRP concentration > 62.8 mg/L was the optimal cut-off value for differentiating between surviving and nonsurviving patients. Conclusion CRP markedly improved risk reclassification for prognosis prediction.

scholarly journals Δείκτες φλεγμονής και λοίμωξης στους αρρώστους της εντατικής θεραπείας

2013 ◽  
Author(s):  
Λαμπρινή Τίνα
Keyword(s):  
Protein C ◽  
Tumor Necrosis ◽  
Antithrombin Iii ◽  
Area Under The Curve ◽  
Interleukin 10 ◽  
Apache Ii ◽  
C Reactive Protein ◽  
C Protein ◽  
Reactive Protein ◽  
Necrosis Factor

Σκοπός: Σειρά μελετών έχουν ασχοληθεί με το φαινόμενο της σήψης. Δεν έχει γίνει όμως προσπάθεια μέχρι τώρα να μελετηθούν βαρέως πάσχοντες ασθενείς κατά την πορεία τους στα διάφορα στάδια της σήψης για να διαπιστωθεί αν υπάρχουν κλινικά ή εργαστηριακά ευρήματα που να μπορούν να προβλέψουν την επιδείνωση ή βελτίωση των ασθενών αυτών. Έτσι σκοπός της μελέτης μας αποτέλεσε η εύρεση εκείνων των κλινικών αλλά κυρίως εργαστηριακών παραμέτρεων που θα μπορούσαν να προσφέρουν την δυνατότητα πρόβλεψης της μεταβολής σταδίου των σηπτικών αρρώστων της ΜΕΘ. Μέθοδος: Σην μελέτη μας συμπεριλήφθησαν 56 ασθενείς ΜΕΘ: με SIRS, σε διάφορα στάδια σήψης (σήψη, βαρειά σήψη και σηπτική καταπληξία) και σε καταστάσεις που δυνητικά μπορούν να εξελιχθούν σε SIRS και σήψη (πολυτραυματίες και χειρουργημένοι ασθενείς). Μετρήθηκαν στο ορό του αίματος Θρομβοποιητίνη thrombopoitin TPO, Προκαλσιτονίνη procalcitonin - PCT, C αντιδρώσα πρωτεΐνη C reactive protein - CRP, Ιντερλευκίνη 6 Interleukin 6 -IL-6, Παράγοντας νέκρωσης των όγκων Α Tumor Necrosis Factor a-TNFα, Ιντερλευκίνη 1β Interleukin 1b - IL-1b Ιντερλευκίνη 10 Interleukin 10 - IL-10 Αντιθρομβίνη ΙΙΙ antithrombin III - ATIII, Πρωτεΐνη C protein C - PrC, Δ Διμερή D – dimmers – dds, Ινωδογόνο fibrinogen – Fibrin, Πλασμινογόνο Plasminogen, Παράγοντες πήξης FV, FVII, FVIII, FIX, FvWillebrand, FX. Επίσης μετρήθηκαν αέρια αίματος, οι συνήθεις εργαστηριακοί παράμετροι (λευκά (WBC) και ερυθρά αιμοσφαίρια (RBC), αιματοκρίτης (HT), αιμοπετάλια (PTL), κρεατινίνη (CRE), χολερυθρίνη (BIL), χρόνος προθρομβίνης (PT) και μερικής θρπομβοπλαστίνης (PTT,) γαλακτικό οξύ (lactate), σάκχαρο αίματος (glu), αλβουμίνη πλάσματος (alb). Η πρώτη μέτρηση έγινε κατά την εισαγωγή στην ΜΕΘ. Στην συνέχεια πραγματοποιήθηκαν επαναλαμβανόμενες μετρήσεις (από 48 ώρες και κάθε 2 ημέρες για 10 ημέρες συνολικά (μέχρι 6 μετρήσεις)). Παράλληλα συνεχίσθηκε η κλινική αξιολόγηση του σταδίου της σήψης και των υπόλοιπων κλινικών στοιχείων των ασθενών. Σε περίπτωση παρατεταμένης νοσηλείας, επανελήφθησαν οι μετρήσεις των εξεταζόμενων παραγόντων κάθε φορά που ο ασθενής άλλαζε στάδιο σήψης είτε βελτιούμενος είτε επιδεινούμενος. Αποτελέσματα: Κατά την εισαγωγή, οι ασθενείς στα διάφορα στάδια της σήψης, αυτοί με Sirs κοι οι πολυτραυματίες ή χειρουργημένοι ασθενείς είχαν διαφορετικά APACHE II και SOFA scores (p<0.05 και για τα δυο). Τα επίπεδα TNFα ήταν σημαντικά υψηλότερα σε ασθενείς με τραύμα/χειρουργημένους που στην πορεία νοσηλείας τους επιδεινώθηκαν σε SIRS ή στα διάφορα στάδια της σήψης (p=0.002). Οι ασθενείς με SIRS που επιδεινώθηκαν στα διάφορα στάδια της σήψης εμφάνισαν θρομβοπενία σε αντίθεση με αυτούς που βελτιώθηκαν (p=002). Οι ασθενείς με σήψη που επιδεινώθηκαν σε σοβρή σήψη και σηπτικό shock είχαν αυξημένα επίπεδα IL-1b και IL-10 και υψηλότερα APACHE II, SOFA and Lung Injury scores σε σχέση με αυτούς που βελτιώθηκαν (p<0.05-0.001). Οι ασθενείς με σηπτικό shock που απεβίωσαν είχαν χαμηλότερη δραστηριότητα FVII, FIX και PrC και υψηλότερα επίπεδα γαλακτικού οξέως και LIS score (p<0.05-0.01). Η καμπύλη ROC που σχεδιάσθηκε για την προγνωστική ικανότητα του TNFα να διακρίνει ποιοι ασθενείς με τραύμα/χειρουρική επέμβαση θα επιδεινωθούν σε sirs ή στα στάδια της σήψης είχε περιοχή κάτω από την καμπύλη (area under the curve AUC) 0.86, τιμή cutoff 1.39 pg/ml με ευαισθησία 75% και ειδικότητα 90%. Η AUC για την τιμή των αιμοπεταλίων που μπορεί να προβλέψει ποιοι ασθενείς με sirs θα επιδεινωθούν στα διάφορα στάδια της σήψης ήταν 0.84 με τιμή cutoff 1.56 x 105/mm3 με ευαισθησία 70% και ειδικότητα 80%. AUCs για IL-1b, TNFa, SOFA και LIS scores για την πρόγνωση ασθενών με σήψη που θα επιδεινωθούν ήταν 0.85, 0.80, 0.82 και 0.82, αντίστοιχα. AUCs για FIX, lactate και λόγου PaO2/FiO2 για τους ασθενείς με σηπτικό shock που θα απεβιώσουν ήταν 0.83, 0.87 και 0.779 αντίστοιχα. Συμπεράσματα: Οι διαταραχές πηκτικότητας και οι φλεγμονώδεις κυττοκίνες μπορούν να προβλέψουν ποιοι ασθενείς που εισάγονται στην ΜΕΘ θα επιδεινωθούν ή θα βελτιωθούν κατά την διάρκεια της νοσηλείας τους, ενώ άλλοι δείκτες όπως η προκαλσιτονίνη ή ή θρομβοποιητίνη και η C αντιδρώσα πρωτεϊνη δεν έχουν προγνωστική αξία.Συμπεράσματα: Οι διαταραχές πηκτικότητας και οι φλεγμονώδεις κυττοκίνες μπορούν να προβλέψουν ποιοι ασθενείς που εισάγονται στην ΜΕΘ θα επειδινωθούν ή θα βελτιωθούν κατά την διάρκεια της νοσηλείας τους, ενώ άλλοι δείκτες όπως η προκαλσιτονίνη ή ή θρομβοποιητίνη και η C αντιδρώσα πρωτεϊνη δεν έχουν προγνωστική αξία.

scholarly journals Procalcitonin and BISAP score versus c-reactive protein and APACHE II score in early assessment of severity and outcome of acute pancreatitis

2012 ◽  
Vol 69 (5) ◽  
pp. 425-431 ◽  
Author(s):  
Mihailo Bezmarevic ◽  
Zoran Kostic ◽  
Miodrag Jovanovic ◽  
Sasa Mickovic ◽  
Darko Mirkovic ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Form ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Serum Concentrations ◽  
Key Factors ◽  
Early Assessment ◽  
Adequate Treatment ◽  
Reactive Protein ◽  
Score Apache

Background/Aim. Early assessment of severity and continuous monitoring of patients are the key factors for adequate treatment of acute pancreatitis (AP). The aim of this study was to determine the value of procalcitonin (PCT) and Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring system as prognostic markers in early stages of AP with comparison to other established indicators such as Creactive protein (CRP) and Acute Physiology and Chronic Health Evaluation (APACHE) II score. Methods. This prospective study included 51 patients (29 with severe AP). In the first 24 h of admission in all patients the APACHE II score and BISAP score, CRP and PCT serum concentrations were determined. The values of PCT serum concentrations and BISAP score were compared with values of CRP serum concentrations and APACHE II score, in relation to the severity and outcome of the disease. Results. Values of PCT, CRP, BISAP score and APACHE II score, measured at 24 h of admission, were significantly elevated in patients with severe form of the disease. In predicting severity of AP at 24 h of admission, sensitivity and specificity of the BISAP score were 74% and 59%, respectively, APACHE II score 89% and 69%, respectively, CRP 75% and 86%, respectively, and PCT 86% and 63%, respectively. It was found that PCT is highly significant predictor of the disease outcome (p < 0,001). Conclusion. In early assessment of AP severity, PCT has better predictive value than CRP, and similar to the APACHE II score. APACHE II score is a stronger predictor of the disease severity than BISAP score. PCT is a good predictor of AP outcome.

scholarly journals APACHE II score, C-reactive protein and Marshall score in acute pancreatitis. Association with admission at critical care unit. A cohort study

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e321-e322
Author(s):  
H. Losada Morales ◽  
A. Troncoso Trujillo ◽  
L. Burgos San Juan ◽  
J. Silva Abarca ◽  
L. Acencio Barrientos ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Critical Care ◽  
Cohort Study ◽  
Critical Care Unit ◽  
Apache Ii ◽  
Apache Ii Score ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Marshall Score

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.

scholarly journals C-Reactive Protein Concentration as A Risk Predictor of Mortality in Intensive Care Unit: A Multicenter, Prospective, Observational Study

2020 ◽  
Author(s):  
Rong Qu ◽  
Linhui Hu ◽  
Yun Ling ◽  
Heng Fang ◽  
Huidan Zhang ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Inflammatory Markers ◽  
Prospective Observational Study ◽  
Apache Ii ◽  
Apache Ii Score ◽  
C Reactive Protein ◽  
Icu Mortality ◽  
Reactive Protein ◽  
Risk Reclassification ◽  
Multicenter Prospective Observational Study

Abstract Background: It is not clear whether there is value inflammatory markers for prognosis judgment in the intensive care unit (ICU). We therefore conducted a multicenter, prospective, observational study to evaluate the prognostic role of inflammatory markers.Methods: The clinical and laboratory data of patients at admission, including C-reactive protein (CRP), were collected in four general ICUs from September 1, 2018, to August 1, 2019. Multivariate logistic regression was used to identify factors independently associated with nonsurvival. The area under the receiver operating characteristic curve (AUC-ROC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the effect size of different factors in predicting mortality during ICU stay. 3 knots was used to assess whether alternative cut points for these biomarkers were more appropriate. Results: A total of 813 patients were recruited, among whom 121 patients (14.88%) died during the ICU stay. The AUC-ROC values of PCT and CRP for discriminating ICU mortality were 0.696 (95% confidence interval [CI], 0.650-0.743) and 0.684 (95% CI, 0.633-0.735), respectively. In the multivariable analysis, only APACHE II score (odds ratio, 1.166; 95% CI, 1.129-1.203; P=0.000) and CRP concentration > 62.8 mg/L (odds ratio, 2.145; 95% CI, 1.343-3.427; P=0.001), were significantly associated with an increased risk of ICU mortality. Moreover, the combination of APACHE II score and CRP > 62.8 mg/L significantly improved risk reclassification over the APACHE II score alone, with NRI (0.556) and IDI (0.013). Restricted cubic spline analysis confirmed that CRP concentration >62.8 mg/L was the optimal cut-off value for differentiating between surviving and nonsurviving patients.Conclusion: CRP markedly improved risk reclassification for prognosis prediction.

scholarly journals Novel biomarker for predicting sepsis mortality: vitamin D receptor

2021 ◽  
Vol 49 (8) ◽  
pp. 030006052110347
Author(s):  
Murat Erdoğan ◽  
Hüseyin Avni Fındıklı
Keyword(s):  
Vitamin D ◽  
Disease Severity ◽  
Vitamin D Receptor ◽  
Area Under The Curve ◽  
Apache Ii ◽  
C Reactive Protein ◽  
Cross Sectional ◽  
Reactive Protein ◽  
Kaplan Meier ◽  
Poor Outcomes

Objective There are currently no studies on the role of vitamin D receptor (VDR) levels as a cause of or risk factor for sepsis. We aimed to establish the association between VDR levels and 28-day mortality in critically ill patients with sepsis. Methods This prospective cross-sectional observational study included 148 patients diagnosed with sepsis who were treated in the intensive care unit. We measured VDR levels, laboratory characteristics, and health scores and related them to survival. Results The 148 patients included 96 survivors and 52 non-survivors, with VDR levels of 1.92 and 1.36 ng/mL, respectively. Baseline VDR was a significant predictor of 28-day mortality, with an area under the curve of 0.778. A low VDR level was significantly associated with lower overall survival in patients with sepsis according to Kaplan–Meier curve analysis. VDR levels were also negatively correlated with lactate, C-reactive protein, acute physiological and clinical health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores, and disease severity. Conclusions VDR levels were associated with high 28-day mortality and negatively correlated with lactate, C-reactive protein, APACHE II and SOFA scores, and disease severity in patients with sepsis. VDR levels can predict poor outcomes in patients with sepsis.

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