The Time Course of Serum C-Reactive Protein is More Predictive of Mortality than its Baseline Level in Peritoneal Dialysis Patients

2005 ◽  
Vol 25 (3) ◽  
pp. 256-268 ◽  
Author(s):  
Kenan Ateş ◽  
Aşkin Ateş ◽  
Yakup Ekmekçi ◽  
Gökhan Nergizoglu
Keyword(s):  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Time Course ◽  
Left Ventricular ◽  
C Reactive Protein ◽  
Dialysis Patients ◽  
Baseline Serum ◽  
Cox Regression Analysis ◽  
Reactive Protein ◽  
Serum Crp

Background Several recent studies reported that a high baseline serum C-reactive protein (CRP) is a powerful predictor of mortality in dialysis patients. However, the acute-phase response is intermittent and not a continuous feature in an individual patient. The aim of this prospective study was to determine whether serial analysis of serum CRP during follow-up allows better prediction of mortality and echocardiographic cardiac disease than a single baseline measurement in peritoneal dialysis (PD) patients. Methods 97 PD patients were monitored for 3 years from the beginning of the treatment. We evaluated the effect of demographic features, comorbidity, blood pressure, blood biochemistry, including CRP, residual renal function, and indices of dialysis adequacy, on mortality and left ventricular hypertrophy (LVH). Cox regression analysis using both the baseline and the averaged values of the study parameters was carried out to determine factors predicting mortality. Logistic regression analysis was performed to determine which factors were independently predictive for LVH and the type of time course of serum CRP. Results Baseline serum CRP was elevated in 29 patients (29.9%). While serum CRP exhibited a stable course (normal or high) in 55 patients (56.7%), it varied considerably over time in 42 patients (43.2%). In the Cox models, both the averaged serum CRP and the type of variability of CRP were predictors of mortality. On the contrary, baseline CRP did not affect adjusted survival. The averaged CRP was also an independent factor affecting LVH, but baseline CRP was not. Age, comorbidity index, instilled dialysate glucose concentration, and Kt/V urea were independently associated with the type of time course of serum CRP. Conclusion The averaged value of serum CRP is more predictive of prognosis compared to the baseline value in PD patients. Determining serum CRP on a regular basis may be helpful to detect early signs of tissue damage or asymptomatic inflammation.

scholarly journals Relationship between Plasma Endocan Level and Clinical Outcome of Chinese Peritoneal Dialysis Patients

2019 ◽  
Vol 44 (5) ◽  
pp. 1259-1270 ◽  
Author(s):  
Peter Yam-Kau Poon ◽  
Jack Kit-Chung Ng ◽  
Winston Wing-Shing Fung ◽  
Kai-Ming Chow ◽  
Bonnie Ching-Ha Kwan ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Outcome ◽  
Cardiovascular Event ◽  
Cox Regression ◽  
Event Free Survival ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Reactive Protein ◽  
Inflammatory Conditions ◽  
Serum Crp

Background: Endocan is associated with endothelial dysfunction. In peritoneal dialysis (PD) patients, cardiovascular disease is a common cause of mortality. We examined the relationship between serum endocan level and clinical outcome of PD patients. Methods: We recruited 193 new PD patients (118 males, mean age 58.8 ± 11.6 years). Serum endocan levels were determined and stratified into tertile 1 (lowest) to 3 (highest). Nutritional status, arterial pulse wave velocity (PWV) and serum C-reactive protein (CRP) levels were measured. The patients were followed for at least 4 years for clinical outcomes. Results: For the whole cohort, patients with higher serum endocan levels had lower serum albumin and subjective global assessment score, higher carotid-femoral PWV, and higher serum CRP. For patients with suboptimal blood pressure (BP) control, cardiovascular event-free survival was 95.0, 95.5, and 78.5% for tertiles 1, 2, and 3 at 60 months respectively (p = 0.019). Multivariate Cox regression analysis showed that serum endocan level was an independent predictor of cardiovascular event-free survival. No association with cardiovascular event-free survival was found for patients with adequate BP control (95.0, 92.3, and 100% for tertile 1, 2, and 3 at 60 months, respectively, p = 0.6). Conclusions: Higher serum endocan level is associated with unfavourable nutritional, arterial and inflammatory conditions in PD patients. In patients with suboptimal BP control, higher serum endocan is also associated with worse cardiovascular outcome.

scholarly journals Impact of Early C-Reactive Protein/Albumin Ratio on Intra-Hospital Mortality Among Patients with Spontaneous Intracerebral Hemorrhage

2020 ◽  
Vol 9 (4) ◽  
pp. 1236 ◽  
Author(s):  
Michael Bender ◽  
Kristin Haferkorn ◽  
Michaela Friedrich ◽  
Eberhard Uhl ◽  
Marco Stein
Keyword(s):  
Regression Analysis ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Cox Regression ◽  
Spontaneous Intracerebral Hemorrhage ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Cox Regression Analysis ◽  
Reactive Protein ◽  
The Impact

Objective: The impact of increased C-reactive protein (CRP)/albumin ratio on intra-hospital mortality has been investigated among patients admitted to general intensive care units (ICU). However, it was not investigated among patients with spontaneous intracerebral hemorrhage (ICH). This study aimed to investigate the impact of CRP/albumin ratio on intra-hospital mortality in patients with ICH. Patients and Methods: This retrospective study was conducted on 379 ICH patients admitted between 02/2008 and 12/2017. Blood samples were drawn upon admission and the patients’ demographic, medical, and radiological data were collected. The identification of the independent prognostic factors for intra-hospital mortality was calculated using binary logistic regression and COX regression analysis. Results: Multivariate regression analysis shows that higher CRP/albumin ratio (odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.193–2.317, p = 0.003) upon admission is an independent predictor of intra-hospital mortality. Multivariate Cox regression analysis indicated that an increase of 1 in the CRP/albumin ratio was associated with a 15.3% increase in the risk of intra-hospital mortality (hazard ratio = 1.153, 95% CI = 1.005–1.322, p = 0.42). Furthermore, a CRP/albumin ratio cut-off value greater than 1.22 was associated with increased intra-hospital mortality (Youden’s Index = 0.19, sensitivity = 28.8, specificity = 89.9, p = 0.007). Conclusions: A CRP/albumin ratio greater than 1.22 upon admission was significantly associated with intra-hospital mortality in the ICH patients.

scholarly journals 1716. Baseline Serum C-Reactive Protein Level Predicts Mortality in Cryptococcal Meningitis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S629-S629
Author(s):  
Supavit Chesdachai ◽  
Nicole Engen ◽  
Joshua Rhein ◽  
Lillian Tugume ◽  
Tadeo kiiza. Kandole ◽  
...  
Keyword(s):  
Cryptococcal Meningitis ◽  
Surrogate Marker ◽  
First Episode ◽  
Event Analysis ◽  
C Reactive Protein ◽  
Serum Samples ◽  
Hiv Viral Load ◽  
Baseline Serum ◽  
Reactive Protein ◽  
Serum Crp

Abstract Background C-reactive protein (CRP) is an acute-phase protein produced by the liver in response to systemic inflammation. CRP is a helpful surrogate biomarker widely used in various infections, particularly for following the progression and resolution of infection. We aimed to determine the association between baseline CRP level and cryptococcal meningitis outcome. Methods We reviewed 168 prospectively enrolled HIV-infected Ugandans with confirmed first-episode cryptococcal meningitis. Baseline serum samples collected within 5 days from diagnosis had CRP levels measured and categorized into quartiles. We compared baseline serum CRP with 18-week survival using unadjusted time-to-event analysis. Results Of 168 participants, the first quartile of baseline serum CRP was 83.6 mg/L. Baseline CD4 count, HIV viral load, and cerebrospinal fluid results did not differ by quartile. Participants with CRP > 49.5 mg/L more likely presented with Glasgow Coma Scale <15 (P = 0.03). The 18-week mortality rate was 54.8% (46/84) in the highest two quartile CRP groups (49.5 mg/L), 40.5% (17/42) in the mid-range CRP group (29–49.5 mg/L), and 14.3% (6/42) in the low CRP group (<29 mg/L) (P < 0.001) (Figure 1). Conclusion Higher baseline serum CRP is associated with increased mortality in HIV-infected individuals with first-episode cryptococcal meningitis. The serum CRP could be a surrogate marker for undiagnosed co-infections or may reflect immune dysregulation leading to worse outcomes in persons with advanced AIDS and concomitant cryptococcal meningitis. Additional studies investigating more specific inflammatory biomarkers and the longitudinal trend in CRP with effective therapy would be informative. Disclosures All authors: No reported disclosures.

scholarly journals P1166DOES PERITONEAL PROTEIN LOSS AFFECT CARDIOVASCULAR MORTALITY OF PERITONEAL DIALYSIS PATIENTS ?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Marios Theodoridis ◽  
Stylianos Panagoutsos ◽  
Ioannis Neofytou ◽  
Konstantia Kantartzi ◽  
Efthimia Mourvati ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Dialysis Patients ◽  
Protein Loss ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Group A ◽  
Group B

Abstract Background and Aims Peritoneal protein loss (PPL) through peritoneal effluent has been a well-recognized detrimental result of peritoneal dialysis (PD). The amount of protein lost will depend on dialysis time, protein size, its serum concentration and other factors including patients’ clinical status. Peritoneal protein loss may be a manifestation of endothelial dysfunction, as with another type of capillary protein leakage, microalbuminuria, a recognized endothelial dysfunction marker. The aim of this study was to retrospectively evaluate the influence of PPL on cardiovascular mortality of peritoneal dialysis patients Method This is a single center retrospective study of 84 PD patients (m=54, f=30) with mean age of 65.2±17 years, mean PD duration of 43.2±24.9 months conducted for the time period from 2006 to 2019 (13 years). The patients were divided into two groups according to the amount of protein excreted during the modified Peritoneal Equilibration Test (PET) procedure using PD solution of 3.86% DW, 2 Lt infusion volume for total time of 4 hours. The total amount of proteins excreted was calculate from PET by multiplying the concentration of proteins at the end of the test with the total volume of PD fluid at the same time. Group A excreted a total amount of proteins &lt; 1.55 gr (median value) at the end of PET test and Group B &gt; 1.55 gr. The cumulative all-cause and cardiovascular survival of the PD patients was calculated by Kaplan Meier while the possible effect of any parameter in survival rates was evaluated by using Cox Regression analysis Results There was not any statistically significant difference between the two groups according to PD duration, age, dialysis adequacy targets, Residual Renal Function(RRF), BMI, ultrafiltration volume during PET and their transport status. The cumulative all-cause survival using Kaplan-Meier analysis revealed no statistically significant deference between the two groups (Log Rank p=0.55) even though mortality risk was adjusted for several factors (Cox Regression). When cardiovascular survival, using Cox Regression analysis, was adjusted for age, sex, Diabetes, PD modality, dialysis Kt/V and RRF we found that Group A (with protein excretion &lt; 1.55 gr) had statistically significant better cardiovascular survival (p=0.029) compared to Group B. We confirm these results while trying to find among the total of our patients the possible risk factors for cardiovascular mortality. Using Cox Regression analysis, the amount of protein excreted during PET procedure and the type of PD solutions (high or low in GDPs) used were statistically significant (p=0.019 and p=0.04 respectively) independent risk factors for cardiovascular survival in our patients. Conclusion These results indicate that protein loss during peritoneal dialysis procedure has negative impact on cardiovascular mortality and survival of PD patients. Additionally, the use of PD solutions with low Glucose Degradation Products (GDPs) and AGEs may improve PD patient’s cardiovascular survival. Randomized interventional studies are encouraged to address the pathological concern of PPL in the future, namely its effects on cardiovascular conditions or its role as marker and effort to reduce PPL using ACE inhibitors or vit D should be considered only if it diminishes cardiovascular morbidity or mortality.

scholarly journals Bleeding risk of haemodialysis and peritoneal dialysis patients

2020 ◽  
Vol 36 (1) ◽  
pp. 170-175
Author(s):  
Anita van Eck van der Sluijs ◽  
Alferso C Abrahams ◽  
Maarten B Rookmaaker ◽  
Marianne C Verhaar ◽  
Willem Jan W Bos ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Bleeding Risk ◽  
Time Dependent ◽  
Antiplatelet Drug ◽  
Dialysis Modality ◽  
Limited Information ◽  
Dialysis Patients ◽  
Cox Regression Analysis

Abstract Background Dialysis patients have an increased bleeding risk as compared with the general population. However, there is limited information whether bleeding risks are different for patients treated with haemodialysis (HD) or peritoneal dialysis (PD). From a clinical point of view, this information could influence therapy choice. Therefore the aim of this study was to investigate the association between dialysis modality and bleeding risk. Methods Incident dialysis patients from the Netherlands Cooperative Study on the Adequacy of Dialysis were prospectively followed for major bleeding events over 3 years. Hazard ratios with 95% confidence intervals (CIs) were calculated for HD compared with PD using a time-dependent Cox regression analysis, with updates on dialysis modality. Results In total, 1745 patients started dialysis, of whom 1211 (69.4%) received HD and 534 (30.6%) PD. The bleeding rate was 60.8/1000 person-years for HD patients and 34.6/1000 person-years for PD patients. The time-dependent Cox regression analysis showed that after adjustment for age, sex, primary kidney disease, prior bleeding, cardiovascular disease, antiplatelet drug use, vitamin K antagonist use, erythropoietin use, arterial hypertension, residual glomerular filtratin rate, haemoglobin and albumin levels, bleeding risk for HD patients compared with PD increased 1.5-fold (95% CI 1.0–2.2). Conclusions In this large prospective cohort of incident dialysis patients, HD patients had an increased bleeding risk compared with PD patients. In particular, HD patients with a history of prior bleeding had an increased bleeding risk.

scholarly journals Comparative Value of Simple Inflammatory Markers in the Prediction of Left Ventricular Systolic Dysfunction in Postacute Coronary Syndrome Patients

2009 ◽  
Vol 2009 ◽  
pp. 1-7 ◽  
Author(s):  
Panagiotis Aggelopoulos ◽  
Christina Chrysohoou ◽  
Christos Pitsavos ◽  
Lambros Papadimitriou ◽  
Catherine Liontou ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Coronary Syndrome ◽  
Wbc Count ◽  
Serum Crp

Objectives. We sought to assess the comparative value of inflammatory markers on the occurrence of left ventricular systolic dysfunction (LVSD) after an acute coronary syndrome (ACS).Methods. During 2006–2008, 760 patients with an ACS were enrolled. C-reactive protein (CRP) and white blood cell (WBC) count were measured during the first 12 hours of hospital admission.Results. CRP levels and WBC count were significantly higher in those who developed LVSD compared to those who did not. The analysis revealed that a 10 mg/dL increase of CRP levels and a 1000/L increase in WBC are associated with a 6% and a 7% increase in the likelihood of developing LVSD, respectively. Furthermore, WBC count at entry and CRP have almost the same predictive value for development of LVSD after an ACS ( versus ).Conclusions. Serum CRP levels and WBC count at entry are almost equally powerful independent predictors of LVSD, after an ACS.

Myocardial interleukin-6 in the setting of left ventricular mechanical assistance: relation with outcome and C-reactive protein

2015 ◽  
Vol 53 (9) ◽  
Author(s):  
Raffaele Caruso ◽  
Chiara Caselli ◽  
Lorena Cozzi ◽  
Jonica Campolo ◽  
Federica Viglione ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Circulatory Support ◽  
C Reactive Protein ◽  
Tissue Samples ◽  
Ventricular Assist ◽  
Reactive Protein ◽  
Left Ventricular Assist ◽  
Serum Crp ◽  
Circulating Levels ◽  
Post Implantation

AbstractIn left ventricular assist device (LVAD) recipients, plasma levels of interleukin (IL)-6 are associated with Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles, reflecting post-operative risk. However, it is not clear how the cardiac level of IL-6, detectable on the tissue samples at the time of implantation, can contribute to predict the post-operative outcome.In 40 LVAD recipients, blood and myocardial samples from LV-apex were collected at the time of implantation to assess plasma and cardiac IL-6 levels. Serum C-reactive protein (CRP) levels were considered as inflammatory variable routinely used in LVAD-based therapy.Cardiac IL-6 levels did not correlate with either plasma IL-6 levels (R=0.296, p=0.063) and tissue IL-6 mRNA expression (R=–0.013, p=0.954). Contrary to what happened for the plasma IL-6 and CRP, no differences were observed in cardiac IL-6 levels with respect to INTERMACS profiles (p=0.090). Furthermore, cardiac IL-6 concentrations, unlike IL-6 and CRP circulating levels, were not correlated with the length of intensive care unit stay and hospitalization.Cardiac IL-6 levels do not contribute to improve risk profile of LVAD recipients in relation to clinical inpatient post-implantation. Instead, plasma IL-6 and serum CRP concentrations are more effective in predicting the severity of the clinical course in the early phase of LVAD therapy.

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