Study of C-reactive protein, procalcitonin, and immunocyte ratios in 194 patients with sepsis

Abstract Background Evidence suggests that C-reactive protein (CRP), procalcitonin (PCT), and immune cells can predict sepsis severity in adult patients. However, the specific values of these indicators are not consistent in predicting prognosis. Methods A retrospective study analyzed the medical records of 194 patients based on the concept of sepsis in 2016 (Sepsis 3.0) from January 2017 to December 2019. A comparative analysis of inflammatory factors associated with patients in the sepsis survival and the non-survival group was performed. The concentrations of CRP and PCT, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) were measured. ROC curve was used to assess the diagnosis and analysis of the selected indices of sepsis. According to each index’s cut-off value of the ROC curve, the patients were divided into two groups, and the prognosis was calculated. Results Among the 194 patients, 32 died (16.49%), the median age of the patients was 79 (66.0, 83.3) years, and 118 were male (60.8%). Analysis of related inflammatory indicators showed that CRP, NLR, MLR, PLR, and CRP*PCT in the non-survival group were statistically higher than those in the survival group (all p values were < 0.05). Regression analysis showed that PCT, CRP, NLR, PLR, and CRP*PCT were all independent prognostic factors for patients. The ROC curve results showed that CRP*PCT had the best diagnostic value (AUC = 0.915). The cut-off values of PCT, CRP, NLR, PLR, MLR, and CRP*PCT were 0.25 ng/mL, 85.00 mg/L, 8.66, 275.51, 0.74%, and 5.85 (mg/L)2, respectively. Kaplan-Meier survival estimate showed that patient prognosis between the CRP, PCT, NLR, PLR, and CRP*PCT was statistically different (all values P < 0.05, respectively). However, there was no statistically significant difference in gender and MLR (all values P > 0.05, respectively), grouping based on diagnostic cut-off values. Conclusions In this study, inflammation-related markers PCT, CRP, NLR, MLR, PLR, and CRP*PCT can be used as independent risk factors affecting the prognosis of patients with sepsis. Furthermore, except for MRL, these indicators have cut-off values for predicting patient death.

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Diagnostic value of procalcitonin, erythrocyte sedimentation rate (ESR), quantitative C-reactive protein (CRP) and clinical findings associated with osteomyelitis in patients with diabetic foot

Human Antibodies ◽

10.3233/hab-210439 ◽

2021 ◽

pp. 1-7

Author(s):

Zahra Soleimani ◽

Fatemeh Amighi ◽

Zarichehr Vakili ◽

Mansooreh Momen-Heravi ◽

Seyyed Alireza Moravveji

Keyword(s):

Erythrocyte Sedimentation Rate ◽

Sedimentation Rate ◽

Roc Curve ◽

Diabetic Foot ◽

Diagnostic Value ◽

Clinical Findings ◽

Diabetic Patients ◽

C Reactive Protein ◽

Reactive Protein ◽

Erythrocyte Sedimentation

BACKGROUND: The diagnosis of osteomyelitis is a key step of diabetic foot management. Procalcitonin (PCT) is a novel infection marker. This study aimed to investigate the diagnostic value of procalcitonin and other conventional infection markers and clinical findings in diagnosis of osteomyelitis in diabetic foot patients. METHODS AND MATERIALS: This diagnostic value study was carried out on ninety patients with diabetic infected foot ulcers admitted in Kashan Beheshti Hospital, 2016. After obtaining consent, 10 cc blood sample was taken for measuring serum PCT, CBC, ESR, CRP and FBS. Clinical characteristics of the wounds were noted. Magnetic resonance imaging of the foot was performed in all patients to diagnose osteomyelitis. All statistical analyses were done with the use of SPSS-16. RESULTS: PCT levels were 0.13 ± 0.02 ng/mili patients with osteomyelitis (n= 45) and 0.04 ± 0.02 ng/ml in patients without osteomyelitis (n= 45). PCT, Erythrocyte sedimentation rate and C-reactive protein was found significantly higher in patients with osteomyelitis (p< 0.001). The ROC curve was calculated for PCT. The area under the ROC curve for infection identification was 1 (p< 0.001). The best cut-off value for PCT was 0.085 ng/ml. Sensitivity, specificity, and positive and negative predictive values were 100%, 97.8%,97.8% and 100%, respectively. CONCLUSION: In this group of patients, PCT was useful to discriminate patients with bone infection. Also, Erythrocyte sedimentation rate and C-reactive protein can be used as a marker of osteomyelitis in diabetic patients.

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Evaluation of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and C-Reactive Protein in Tension-Type Headache Patients

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1730124 ◽

2021 ◽

Author(s):

Hasan Hüseyin Özdemir ◽

Ahmet Dönder

Keyword(s):

Systemic Inflammation ◽

Tension Type Headache ◽

Neutrophil To Lymphocyte Ratio ◽

Control Group ◽

C Reactive Protein ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Significant Difference ◽

Type Headache

Abstract Objectives A tension headache is the most common type of headache, and its causes are multifactorial. A relationship has been shown between migraine headaches and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP). In this study, we investigated the NLR, PLR, and serum CRP levels in frequent episodic tension-type headache (FETTH) and chronic tension-type headache (CTTH) patients. Materials and Methods This retrospective study included 64 patients with FETTH, 80 patients with CTTH, and 60 healthy controls who were followed up in the neurology clinic. Hematological parameters were compared between the patient and control groups. Results In CTTH patients, platelets, NLR, PLR, and CRP values were statistically higher than in FETTH patients and patients in the control group. In FETTH patients, the PLR value was higher than in patients in the control group, but there was no statistically significant difference in NLR and CRP values between FETTH patients and patients in the control group. Also, there was no correlation between these values and age and gender. Conclusion Increase platelet count might have an effect on tension-type headache pathophysiology. Systemic inflammation parameters were shown to be significantly higher in CTTH patients. More comprehensive studies are needed to evaluate the effect of systemic inflammation on the chronicity of tension headaches.

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

Diagnostics ◽

10.3390/diagnostics10100829 ◽

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.

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A Promising New Predictive Factor for Detecting Bowel Resection in Childhood Intussusception: Lymphocyte-C Reactive Protein Ratio

10.21203/rs.3.rs-936960/v1 ◽

2021 ◽

Author(s):

Bailin Chenilin Chen ◽

Jian Cao ◽

Chengwei Yan ◽

Chao Zheng ◽

Jingyu Chen ◽

...

Keyword(s):

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Bowel Resection ◽

Intestinal Resection ◽

Inflammatory Factors ◽

C Reactive Protein ◽

Intestinal Necrosis ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Receiver Operating

Abstract Background: The most critical concern for management of childhood intussusception is the bowel resection due to the intestinal ischemia and necrocis. It is of great importance for early prediction of this problem. We investigate the value of various combinations of inflammatory factors to predict the intestinal necrocis and resection.Methods: We retrospectively reviewed the medical records of pediatric patients with intussusception, which undergone surgical management. During the research period, 47 patients undergone intestinal resection due to intestinal necrocis and 68 patients without intestinal resection were enrolled. We evaluated the diagnostic values of various combination of inflammatory markers from preoperative period laboratory analyses using the receiver operating characteristic (ROC) method.Results: In the current cohort, 115 patients were operated for intussusception, among them, 47 patients (40.9%) undergone intestinal resections. In patients with intestinal resections, neutrophil count(p=0.013), CRP(p=0.002), platelet–lymphocyte ratio(PLR, p=0.008), NLR(neutrophil–lymphocyte ratio, p=0.026), and LCR(lymphocyte–CRP ratio, p<0.001) values were significantly higher than those in the patients without any resections. Receiver operating characteristic (ROC) analysis results showed that the combination of lymphocytic count along with C-reactive protein levels (LCR) demonstrated the highest correlation with intestinal resection due to intussusception compared with other parameters in patients, with sensitivity of 0.82(0.73–0.86) and specifficity of 0.80(0.57–0.94) for the diagnosis of strangulation. Conclusion: The preoperative LCR level is a useful marker to predict the need for intestinal resection due to intestinal necrosis in patients with intussusception.

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Serum Cystatin C Levels in COPD: Potential Diagnostic Value and Relation Between Respiratory Functions

Journal of Medical Biochemistry ◽

10.1515/jomb-2017-0063 ◽

2018 ◽

Vol 37 (4) ◽

pp. 434-440 ◽

Cited By ~ 7

Author(s):

Selda Telo ◽

Mutlu Kuluöztürk ◽

Figen Deveci ◽

Gamze Kırkıl ◽

Önsel Öner ◽

...

Keyword(s):

Cystatin C ◽

Diagnostic Value ◽

Serum Urea ◽

C Reactive Protein ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Positive Correlation ◽

Reactive Protein ◽

Cell Counts ◽

Significant Difference

SummaryBackground:The aim of this study was to determine the level of serum cystatin C (CysC) in patients with Chronic Obstructive Pulmonary Disease (COPD) during exacerbation and stable periods and to investigate its potential diagnostic value and the relationship between CysC levels and the pulmonary function test (PFT).Methods:One hundred twenty-six patients with COPD (68 in stable periods, 58 during exacerbation periods) and 50 healthy subjects were included in the study. PFT, body mass index (BMI), white blood cell counts, C-reactive protein (CRP), serum urea and creatinine levels were evaluated in both groups of patients. CysC levels were measured in all participants.Results:Serum CysC levels were statistically higher in both COPD groups than the control group (p<0.001 for both) although there was no statistically significant difference between COPD groups (p>0.05). CysC levels showed negative correlation with forced expiratory volume in 1 second (FEV1) and a positive correlation with C-reactive protein (CRP) levels in patients with stable COPD. There was a positive correlation between serum CysC levels and serum urea, creatinine, CRP levels in patients with COPD exacerbation (r=0.333, p=0.011; r=0.260, p=0.049; r=0.414, p<0.01 respectively). When stable COPD and control groups were evaluated, serum CysC had an area under the curve (AUC) in the receiver operating characteristic (ROC) curve of 0.951 (0.909–0.994 95% CI: p<0.001).Conclusions:Our results showed that CysC levels increased in both COPD groups. Increased CysC levels may be related with lung function decline and inflammation in COPD patients. In addition, CysC levels may be a potential indicator for the diagnosis of COPD.

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NALP3-Inflammasome-Related Gene Polymorphisms in Patients with Prehypertension and Coronary Atherosclerosis

BioMed Research International ◽

10.1155/2016/7395627 ◽

2016 ◽

Vol 2016 ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Xin Zhao ◽

Chonghuai Gu ◽

Chenghui Yan ◽

Xiaolin Zhang ◽

Yi Li ◽

...

Keyword(s):

Coronary Atherosclerosis ◽

Early Stage ◽

Serum Levels ◽

Arterial Stenosis ◽

Inflammatory Factors ◽

Related Gene ◽

C Reactive Protein ◽

Nalp3 Inflammasome ◽

Reactive Protein ◽

Significant Difference

Objectives. Prehypertension is an early stage of hypertension that is characterized by inflammatory factors. Inflammation also plays an essential role in the development of coronary atherosclerosis (CAS). The present study evaluated the NALP3-inflammasome and its related genes,NLRP3,NOD2, andCARD8, using SNP linkage and gene haplotypes in prehypertensive patients.Methods. A total of 576 patients with prehypertension and suspected coronary heart disease (CHD) were enrolled. According to coronary angiography, patients were divided into two groups: arterial stenosis <50% of the diameter (control) and arterial stenosis >50% of the diameter (case). Fifteen polymorphisms in theNOD2,NLRP3, andCARD8genes were analyzed, and serum levels of C-reactive protein (CRP) were measured.Results. When comparing allele frequencies, none of these 15 SNPs inNOD2,CARD8, andNLPR3genes showed a significant difference using multiple logistic regression. However, the CTACATAA (p=0.0064) and CCACATAG (p=0.0126) haplotypes of theNOD2gene SNPs were significantly different between cases and controls.Conclusions. Although our study excludes a significant association of selected SNPs in these genes with CHD in prehypertension patients, this work suggests that the CTACATAA and CCACATAG haplotypes were associated with CHD in theNOD2locus. This work suggests that the CTACATAA and CCACATAG haplotypes were associated with CHD in prehypertension patients in theNOD2locus.

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A promising new predictive factor for detecting bowel resection in childhood intussusception: the lymphocyte-C-reactive protein ratio

BMC Pediatrics ◽

10.1186/s12887-021-03068-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Bailin Chen ◽

Jian Cao ◽

Chengwei Yan ◽

Chao Zheng ◽

Jingyu Chen ◽

...

Keyword(s):

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Bowel Resection ◽

Intestinal Resection ◽

Inflammatory Factors ◽

C Reactive Protein ◽

Intestinal Necrosis ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Receiver Operating

Abstract Background The most critical concern for the management of childhood intussusception is bowel resection due to intestinal ischemia and necrosis. The early prediction of this problem is of great importance. We investigated the value of various combinations of inflammatory factors to predict intestinal necrosis and resection. Methods We retrospectively reviewed the medical records of pediatric patients with intussusception who underwent surgical management. During the research period, 47 patients who underwent intestinal resection due to intestinal necrosis and 68 patients who did not undergo intestinal resection were enrolled. We evaluated the diagnostic value of various combinations of inflammatory markers from preoperative laboratory analyses using the receiver operating characteristic (ROC) method. Results In the current cohort, 115 patients underwent operations for intussusception; among them, 47 patients (40.9%) underwent intestinal resections. In the patients with intestinal resection, the neutrophil count(p = 0.013), CRP level(p = 0.002), platelet–lymphocyte ratio (PLR, p = 0.008), NLR (neutrophil–lymphocyte ratio, p = 0.026), and LCR (lymphocyte–CRP ratio, p < 0.001) values were significantly higher than those in the patients without any resection. The receiver operating characteristic (ROC) analysis results showed that the combination of lymphocytic count along with C-reactive protein levels (LCR) demonstrated the highest correlation with intestinal resection due to intussusception compared with other parameters in the patients, with a sensitivity of 0.82 (0.73–0.86) and specificity of 0.80 (0.57–0.94) for the diagnosis of strangulation. Conclusion The preoperative LCR level is a useful marker to predict the need for intestinal resection due to intestinal necrosis in patients with intussusception.

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Comparing the Diagnostic Value of the C-Reactive Protein to Albumin Ratio With Other Inflammatory Markers in Patients With Stable Angina Pectoris

Angiology ◽

10.1177/0003319719897490 ◽

2019 ◽

Vol 71 (4) ◽

pp. 360-365 ◽

Cited By ~ 4

Author(s):

Zulkif Tanriverdi ◽

Fatih Gungoren ◽

Mustafa Begenc Tascanov ◽

Feyzullah Besli ◽

Ibrahim Halil Altiparmak

Keyword(s):

Uric Acid ◽

Angina Pectoris ◽

Stable Angina ◽

Diagnostic Value ◽

C Reactive Protein ◽

Stable Angina Pectoris ◽

Albumin Ratio ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Inflammatory Parameters

Several laboratory parameters have been used to assess inflammatory process and determine cardiovascular risk. The C-reactive protein to albumin ratio (CAR) is a novel marker of inflammation and its clinical importance has not been clearly elucidated in coronary artery disease (CAD). We compared the diagnostic value of CAR with other inflammatory parameters in detecting significant CAD. Patients (n = 421) with stable angina pectoris who underwent coronary angiography for the suspected CAD were included. Neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio, uric acid, monocyte to high-density cholesterol (HDL-C) ratio, mean platelet volume to lymphocyte ratio (MPVLR), and platelet to mean corpuscular volume (MCV) ratio were measured. Patients with significant CAD had a significantly higher NLR ( P = .043), MLR ( P = .004), uric acid ( P < .001), monocyte to HDL-C ratio ( P = .004), and CAR ( P < .001) compared to patients without significant CAD. However, MPVLR and platelet to MCV ratio weren’t different between 2 groups. The area under the curve (AUC) of CAR was the highest AUC among all inflammatory parameters for predicting significant CAD. Multivariate analysis showed that age (odds ratio [OR]: 1.046, 95% confidence interval [CI], 1.020-1.072, P < .001) and CAR (OR: 1.175, 95% CI, 1.126-1.226, P < .001) were the only independent predictors of significant CAD. In conclusion, CAR had the strongest diagnostic value in detecting significant CAD among the inflammatory parameters evaluated in this study.

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C-Reactive Protein-to-Albumin Ratio as a Prognostic Inflammatory Marker in COVID-19

Journal of Laboratory Physicians ◽

10.1055/s-0041-1741439 ◽

2022 ◽

Author(s):

Aliye Çelikkol ◽

Eda Çelik Güzel ◽

Mustafa Doğan ◽

Berna Erdal ◽

Ahsen Yilmaz

Keyword(s):

Disease Severity ◽

Predictive Value ◽

Rt Pcr ◽

C Reactive Protein ◽

Albumin Ratio ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Cell Counts ◽

Nonparametric Distribution ◽

Significant Difference

Abstract Objectives As a result of developed generalized inflammation, the main prognostic factor determining morbidity and mortality in coronavirus disease 2019 (COVID-19) patients is acute respiratory distress syndrome. The purpose of our study was to define (1) the laboratory tests that will contribute to the diagnosis and follow-up of COVID-19 patients, (2) the differences between the laboratory-confirmed (LC), unconfirmed (LUC), and control (C) groups, and (3) the variation between groups of acute-phase reactants and biomarkers that can be used as an indicator of disease severity and inflammation. Materials and Methods A total of 102 patients undergoing treatment with COVID-19 interim guidelines were evaluated. Reverse transcriptase-polymerase chain reaction (RT-PCR) test was positive in 56 (LC), classified as mild or severe, and negative in 46 (LUC) patients. In addition, 30 healthy subjects (C) with negative RT-PCR tests were also evaluated.All statistical analyses were performed with the SPSS 22.0 program and the p-values for significant findings were less than 0.05. Parametric/nonparametric distribution was determined by performing the Kolmogorov–Smirnov test for all groups. Student's t-test was used for variables with parametric distribution and the Mann–Whitney U-test for variables with the nonparametric distribution. A cut-off level for biomarkers was determined using the ROC (receiver operator characteristic) curve. Results In the LC group, platelet, platecrit, mean platelet volume, platelet diameter width, white blood cell, lymphocyte, eosinophil, neutrophil, immature granulocyte, immature lymphocyte, immature monocyte, large immune cell, and atypical lymphocyte counts among the complete blood count parameters of mature and immature cell counts showed a significant difference according to the C and LUC groups. C-reactive protein, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein-to-albumin ratio (CAR) indices were significantly elevated in LC patients and were significantly higher in patients classified as severe compared to mild. When CAR optimal cutoff was determined as 0.475, area under the curve was 0.934, sensitivity was 90.91%, specificity was 86.21%, positive predictive value was 92.59%, and negative predictive value was 83.33%. The diagnostic accuracy for CAR was 89.29%. Conclusion The CAR index with the highest diagnostic value and the highest predictability could be the most useful biomarker in the diagnosis and evaluation of disease severity in COVID-19 patients.

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