scholarly journals Clinical outcomes and inflammatory marker levels in patients with Covid-19 and obesity at an inner-city safety net hospital

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243888
Author(s):  
Anahita Mostaghim ◽  
Pranay Sinha ◽  
Catherine Bielick ◽  
Selby Knudsen ◽  
Indeevar Beeram ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Inflammatory Markers ◽  
Inflammatory Marker ◽  
Safety Net ◽  
Reactive Protein ◽  
Safety Net Hospital ◽  
All Cause Mortality ◽  
Icu Transfer ◽  
Poor Outcomes ◽  
D Dimer

Objectives Patients with Covid-19 and obesity have worse clinical outcomes which may be driven by increased inflammation. This study aimed to characterize the association between clinical outcomes in patients with obesity and inflammatory markers. Methods We analyzed data for patients aged ≥18 years admitted with a positive SARS-CoV-2 PCR test. We used multivariate logistic regression to determine the association between BMI and intensive care unit (ICU) transfer and all-cause mortality. Inflammatory markers (C-reactive protein [CRP], lactate dehydrogenase [LDH], ferritin, and D-dimer) were compared between patients with and without obesity (body mass index [BMI] ≥30 kg/m2). Results Of 791 patients with Covid-19, 361 (45.6%) had obesity. In multivariate analyses, BMI ≥35 was associated with a higher odds of ICU transfer (adjusted odds ratio [aOR] 2.388 (95% confidence interval [CI]: 1.074–5.310) and hospital mortality (aOR = 4.3, 95% CI: 1.69–10.82). Compared to those with BMI<30, patients with obesity had lower ferritin (444 vs 637 ng/mL; p<0.001) and lower D-dimer (293 vs 350 mcg/mL; p = 0.009), non-significant differences in CRP (72.8 vs 84.1 mg/L, p = 0.099), and higher LDH (375 vs 340, p = 0.009) on the first hospital day. Conclusions Patients with obesity were more likely to have poor outcomes even without increased inflammation.

scholarly journals 365. Assessing Provider Utilization of COVID-19 Inflammatory Marker Trends in Hospitalized Patients and Implications in Optimizing Value-Based Care During a Pandemic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S285-S286
Author(s):  
Praveen Subramanian ◽  
Lucy Stun ◽  
Nathan Bahr ◽  
Lewis Satterwhite ◽  
Maharshi Bhakta ◽  
...  
Keyword(s):  
Health System ◽  
Patient Outcomes ◽  
Inflammatory Markers ◽  
Inflammatory Marker ◽  
Secondary Infection ◽  
Cost Savings ◽  
Medical Decision ◽  
Reactive Protein ◽  
Value Based Care ◽  
D Dimer

Abstract Background Numerous inflammatory markers may serve a role in prognostication of patients hospitalized with COVID-19. Early in the pandemic, our health system created an admission order set which included daily d-dimer, c-reactive protein (CRP), lactate dehydrogenase (LDH), and ferritin. Given more available outcomes data, limiting standing order of studies that do not affect daily management could result in significant cost savings to the health system without adverse patient outcomes. The purpose of this study was to determine ordering and utilization patterns of inflammatory markers by physicians caring for patients hospitalized with COVID-19 infections. Methods An anonymous 10-question survey was distributed to 125 physicians (Infectious Diseases, Hospitalist, Pulmonary and Critical Care faculty). Responses were tallied and values greater than 50% were identified as the majority of the surveyed group. Results Of the 125 physicians surveyed, 77 (62%) responded. A total of 57.1% (44/77) of physicians reported ordering daily inflammatory markers for 3-10 days from admission. Another 31.2% (24/77) ordered markers until clinical improvement or hospital discharge. D-dimer was used for care decisions by 83.1% (64/77) of respondents; 93.8% (60/64) of those reported utilizing it in determining anticoagulation dose. CRP was used by 61% (47/77) of physicians to help identify a secondary infection or determine steroid dose or duration. LDH and ferritin were not used for management decisions by the majority of physicians. Inflammatory markers were not used routinely after isolation precautions had been discontinued, even when ongoing care required mechanical ventilation. Conclusion Of the markers studied, both d-dimer and CRP were considered useful by most respondents. LDH and ferritin were used less frequently and were not considered as useful in guiding medical decision making. Discontinuation of standing daily LDH and ferritin orders is believed to have potential to result in cost savings to the health care system with no adverse patient outcomes. Disclosures All Authors: No reported disclosures

scholarly journals Active middle-aged men have lower fasting inflammatory markers but the postprandial inflammatory response is minimal and unaffected by physical activity status

2009 ◽  
Vol 107 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Natalie C. Dixon ◽  
Tina L. Hurst ◽  
Duncan C. S. Talbot ◽  
Rex M. Tyrrell ◽  
Dylan Thompson
Keyword(s):  
Physical Activity ◽  
Inflammatory Markers ◽  
Metabolic Response ◽  
Inflammatory Marker ◽  
Middle Aged ◽  
Mixed Meal ◽  
Reactive Protein ◽  
Fasted State ◽  
Single Use ◽  
Postprandial Inflammation

Physical activity modifies some postprandial responses such as glycemic control, although it is unclear whether this translates into lower postprandial inflammation. Our objective in this study was to determine whether postprandial inflammatory markers are lower in active compared with sedentary middle-aged men. Thirteen active and twelve sedentary middle-aged men consumed a mixed meal on one occasion. Blood was taken via a cannula before and up to 8 h after the meal and with a single-use needle before and 8 h after the meal. Active men had lower fasted IL-6 (0.6 ± 0.2 vs. 1.2 ± 0.3 pg/ml; P = 0.004) and C-reactive protein (1.3 ± 0.3 vs. 2.9 ± 0.6 mg/l; P = 0.04) concentrations than sedentary men. Cannula blood IL-6 concentrations increased by 3.49 pg/ml in the 8 h following the meal ( P < 0.001); however, this increase was minimal (0.36 pg/ml) in blood taken via a single-use needle from the contralateral arm ( P = 0.013). The sedentary group had larger glucose ( P = 0.034), insulin ( P = 0.013), and triacylglycerol ( P = 0.057) responses to the meal. These results provide further evidence that physical activity is associated with lower inflammatory marker concentrations in a fasted state and a lower postprandial metabolic response to a meal. However, this does not translate into lower postprandial inflammatory markers since the only evidence of postprandial inflammation (a large increase in serum IL-6) was actually due to the cannula used for blood sampling.

scholarly journals Association between childhood infection, serum inflammatory markers and intelligence: findings from a population-based prospective birth cohort study

2017 ◽  
Vol 146 (2) ◽  
pp. 256-264 ◽  
Author(s):  
N. MACKINNON ◽  
S. ZAMMIT ◽  
G. LEWIS ◽  
P. B. JONES ◽  
G. M. KHANDAKER
Keyword(s):  
Birth Cohort ◽  
Inflammatory Markers ◽  
Intellectual Development ◽  
Inflammatory Marker ◽  
Population Based ◽  
Birth Cohort Study ◽  
Reactive Protein ◽  
Parents And Children ◽  
High Infection ◽  
Prospective Birth Cohort

SUMMARYA link between infection, inflammation, neurodevelopment and adult illnesses has been proposed. The objective of this study was to examine the association between infection burden during childhood – a critical period of development for the immune and nervous systems – and subsequent systemic inflammatory markers and general intelligence. In the Avon Longitudinal Study of Parents and Children, a prospective birth cohort in England, we examined the association of exposure to infections during childhood, assessed at seven follow-ups between age 1·5 and 7·5 years, with subsequent: (1) serum interleukin 6 and C-reactive protein (CRP) levels at age 9; (2) intelligence quotient (IQ) at age 8. We also examined the relationship between inflammatory markers and IQ. Very high infection burden (90+ percentile) was associated with higher CRP levels, but this relationship was explained by body mass index (adjusted odds ratio (OR) 1·19; 95% confidence interval (CI) 0·95–1·50), maternal occupation (adjusted OR 1·23; 95% CI 0·98–1·55) and atopic disorders (adjusted OR 1·24; 95% CI 0·98–1·55). Higher CRP levels were associated with lower IQ; adjusted β = −0·79 (95% CI −1·31 to −0·27); P = 0·003. There was no strong evidence for an association between infection and IQ. The findings indicate that childhood infections do not have an independent, lasting effect on circulating inflammatory marker levels subsequently in childhood; however, elevated inflammatory markers may be harmful for intellectual development/function.

Effect of antiplatelet therapy on inflammatory markers in atherothrombotic patients

2010 ◽  
Vol 103 (01) ◽  
pp. 71-82 ◽  
Author(s):  
Joseph Muhlestein
Keyword(s):  
Antiplatelet Therapy ◽  
Inflammatory Markers ◽  
Thrombus Formation ◽  
Inflammatory Marker ◽  
Vascular Inflammation ◽  
Antiplatelet Agents ◽  
Cd40 Ligand ◽  
Reactive Protein ◽  
Atherosclerotic Lesions

SummaryInflammation is central to the pathogenesis and progression of atherosclerosis and thrombosis, the underlying cause of major cardiovascular disease. Platelets, in addition to their role in haemostasis, play a key role in both thrombus formation and inflammation following vascular injury, especially atherosclerotic lesions. An increasing body of evidence suggests that inhibition of platelet function can modulate inflammatory markers, particularly those associated with activated platelets, such as CD40 ligand, P-selectin, and C-reactive protein. The currently available antiplatelet agents aspirin, clopidogrel, prasugrel, abciximab, and eptifibatide have shown varying effects on inflammatory markers. These effects seem to be mostly indirect, i.e. mediated primarily through reduced platelet activation that results in reduced inflammatory marker expression. However, there is some evidence that suggests direct effects (i.e. those independent of platelets) may also play a role in modulating inflammatory markers. Evidence linking inflammation and thrombosis supports the hypothesis that agents with both anti-inflammatory and antiplatelet effects may reduce vascular inflammation and limit acute and long-term thrombotic events. An assessment of the involvement of inflammatory mediators in atherosclerosis may provide further insight into important predictive markers of cardiovascular outcomes that may also serve as potential therapeutic targets. This review examines the evidence for and potential clinical relevance of the effects of antiplatelet therapy on inflammatory markers.

scholarly journals Evolution of the Use of Corticosteroids for the Treatment of Hospitalised COVID-19 Patients in Spain between March and November 2020: SEMI-COVID National Registry

2021 ◽  
Vol 10 (19) ◽  
pp. 4610
Author(s):  
David Balaz ◽  
Philip Erick Wikman-Jorgensen ◽  
Vicente Giner Galvañ ◽  
Manuel Rubio-Rivas ◽  
Borja de Miguel Campo ◽  
...  
Keyword(s):  
Observational Study ◽  
Oxygen Saturation ◽  
Inflammatory Markers ◽  
National Registry ◽  
Mortality Benefit ◽  
C Reactive Protein ◽  
Potential Influence ◽  
Reactive Protein ◽  
Higher Doses ◽  
D Dimer

Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence of new recommendations. Material and methods: A retrospective, descriptive, and observational study was conducted on adults hospitalised due to COVID-19 in Spain who were included in the SEMI-COVID-19 Registry from March to November 2020. Results: CTs were used in 6053 (36.21%) of the included patients. The patients were older (mean (SD)) (69.6 (14.6) vs. 66.0 (16.8) years; p < 0.001), with hypertension (57.0% vs. 47.7%; p < 0.001), obesity (26.4% vs. 19.3%; p < 0.0001), and multimorbidity prevalence (20.6% vs. 16.1%; p < 0.001). These patients had higher values (mean (95% CI)) of C-reactive protein (CRP) (86 (32.7–160) vs. 49.3 (16–109) mg/dL; p < 0.001), ferritin (791 (393–1534) vs. 470 (236–996) µg/dL; p < 0.001), D dimer (750 (430–1400) vs. 617 (345–1180) µg/dL; p < 0.001), and lower Sp02/Fi02 (266 (91.1) vs. 301 (101); p < 0.001). Since June 2020, there was an increment in the use of CTs (March vs. September; p < 0.001). Overall, 20% did not receive steroids, and 40% received less than 200 mg accumulated prednisone equivalent dose (APED). Severe patients are treated with higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%. Conclusions: Patients with greater comorbidity, severity, and inflammatory markers were those treated with CTs. In severe patients, there is a trend towards the use of higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%.

scholarly journals CNS and systemic inflammation underlying neuropsychiatric symptoms and related cognitive decline in older people.

2020 ◽  
Author(s):  
Christopher Clark ◽  
Jonas Richiardi ◽  
Bénédicte Maréchal ◽  
Gene L. Bowman ◽  
Loïc Dayon ◽  
...  
Keyword(s):  
Older People ◽  
Cognitive Decline ◽  
Inflammatory Markers ◽  
Psychiatric Symptoms ◽  
Inflammatory Marker ◽  
Neuropsychiatric Symptoms ◽  
Interferon Γ ◽  
Elderly Subjects ◽  
Csf Biomarkers ◽  
Reactive Protein

Abstract BACKGROUND Neuroinflammation may contribute to psychiatric symptoms in older people, in particular in the context of Alzheimer’s disease (AD). Here, our objective was to determine systemic and central nervous system (CNS) inflammatory signatures associated with neuropsychiatric symptoms (NPS) in older subjects, and investigate their relationships with AD pathology and cognitive decline.METHODS We quantified a panel of inflammatory markers in both cerebrospinal fluid (CSF) and circulating blood serum in elderly subjects with normal cognition or with beginning cognitive decline. We further performed a comprehensive clinical assessment including longitudinal cognitive and neuropsychiatric evaluations and measured CSF biomarkers of core AD pathology. Multivariate analysis selected CSF and serum neuroinflammatory molecules associated with the presence of overall NPS and specific symptoms.RESULTS The presence of NPS was associated with distinct inflammatory markers profiles involving soluble intracellular cell adhesion molecule-1 (sICAM-1), C-reactive protein (CRP), Interleukin (IL) -8 and 10 kDa interferon-γ-induced protein (IP-10) in CSF; and Eotaxin-3, IL-6 and CRP in serum. Further analysis identified specific inflammatory marker signatures associated with anxiety, depression and disinhibition. Presenting NPS was associated with subsequent cognitive decline and this association was mediated by CSF sICAM-1.CONCLUSIONS These results suggest that NPS in older people are associated with distinct systemic and CNS inflammatory processes. Neuroinflammation may explain the link between NPS and more rapid clinical disease progression.

scholarly journals The Inflammatory Markers of Multisystem Inflammatory Syndrome in children (MIS-C) and Adolescents During the COVID-19 Pandemic: A Meta-Analysis

2021 ◽  
Author(s):  
Yan Zhao ◽  
Li-juan Yin ◽  
Jenil Patel ◽  
Lei Tang ◽  
Ying Huang
Keyword(s):  
Inflammatory Markers ◽  
Meta Analysis ◽  
Absolute Lymphocyte Count ◽  
Older Children ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation ◽  
Quality Check ◽  
Inflammatory Syndrome ◽  
D Dimer

Abstract As per the indicated need in literature, we conducted a systematic review and meta-analysis to characterize inflammatory markers of MIS-C patients with COVID-19, Kawasaki disease (KD), and coronary artery abnormalities. We searched nine databases for studies on inflammatory markers of MIS-C. After quality check, data were pooled using a fixed- or random-effects model. Inflammatory markers included white blood cell count (WBC) or leukocytes, absolute lymphocyte count (ALC), absolute neutrophil count (ANC), platelet count (PLT), C-reactive protein (CRP), procalcitonin (PCT), ferritin, D-dimer, lactate dehydrogenase (LDH), fibrinogen and erythrocyte sedimentation rate (ESR) for comparisons by severity and age. Twenty studies with 2,990 participants yielded 684 MIS-C patients. Compared to non-severe COVID-19 patients, MIS-C patients had lower ALC and higher ANC, CRP and D-dimer levels. Compared to severe COVID-19 patients, MIS-C patients had lower LDH and PLT counts and higher ESR levels. Compared to KD patients, MIS-C patients had lower ALC and PLT, and higher CRP and ferritin levels. Severe MIS-C patients had higher levels of WBC, CRP, D-dimer and ferritin. For MIS-C, younger children had lower CRP and ferritin levels than medium-aged/older children. Measurement of inflammatory markers might assist clinicians in accurate evaluation and diagnosis of MIS-C and the associated disorders.

scholarly journals 1259Adherence to healthy diet reduces mortality associated with systemic inflammation

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Yoko Wang ◽  
Amanda Page ◽  
Tiffany Gill ◽  
Yohannes Adama Melaku
Keyword(s):  
Systemic Inflammation ◽  
Diet Quality ◽  
Inflammatory Marker ◽  
Cross Sectional Study ◽  
Healthy Eating Index ◽  
Multivariable Logistic Regression Analysis ◽  
Cross Sectional ◽  
Reactive Protein ◽  
All Cause Mortality ◽  
The Cross

Abstract Background Systemic inflammation is a precursor of many chronic diseases that contributes to morbidity and mortality. In this study, we examined the joint association of systemic inflammation and diet quality with all-cause mortality. Methods A total of 27,305 adults (mean age = 50 years, male: 50.6%) from the National Health and Nutrition Examination Survey (1999-2010 and 2015-2018) were included in the study. A serum inflammatory marker, C-reactive protein (CRP), was measured. The Healthy Eating Index-2015 (HEI-15) was computed. Multivariable logistic regression analysis was used to determine the cross-sectional association between HEI-15 and inflammation. Multivariable Cox proportional hazard models were performed to assess the risk of all-cause mortality associated with the joint classification of inflammation and diet quality. Results In the cross-sectional study, a higher tertile of HEI-15 was associated with reduced odds of inflammation (OR = 0.85, 95% CI: 0.78-0.93) in all participants. Similar results were observed in obese and non-obese groups. In the prospective study (median follow-up = 9.4 years), a higher adherence to HEI-15 was associated with a reduced risk of mortality. Compared to non-obese group, obese participants with high levels of inflammation had a higher risk of all-cause mortality (HR = 1.26, 95% CI: 1.08-1.47; HR = 1.60, 95% CI: 1.19-2.17, respectively). Conclusions A higher adherence to HEI-15 was associated with reduced inflammation. Higher diet quality may reduce mortality risks associated with inflammation, particularly in non-obese groups and obese participants with moderate inflammation. Key messages Adhering to a high quality diet may mitigate the mortality risk associated with increased inflammation.

scholarly journals Risk factors associated with 28-day all-cause mortality in older severe COVID-19 patients in Wuhan, China: a retrospective observational study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yi Jiang ◽  
Subi Abudurexiti ◽  
Meng-Meng An ◽  
Da Cao ◽  
Jie Wei ◽  
...  
Keyword(s):  
Risk Factors ◽  
Osmotic Pressure ◽  
Older Patients ◽  
Troponin I ◽  
High Sensitivity ◽  
C Reactive Protein ◽  
Factors Associated ◽  
Reactive Protein ◽  
All Cause Mortality ◽  
D Dimer

AbstractWe aimed to analyse clinical characteristics and identify risk factors predicting all-cause mortality in older patients with severe coronavirus disease 2019 (COVID-19). A total of 281 older patients with severe COVID-19 were categorized into two age groups (60–79 years and ≥ 80 years). Epidemiological, clinical, and laboratory data, and outcome were obtained. Patients aged ≥ 80 years had higher mortality (63.6%) than those aged 60–79 years (33.5%). Anorexia and comorbidities including hypertension, diabetes and COPD, higher levels of lactate dehydrogenase (LDH), osmotic pressure, C-reactive protein, D-dimer, high-sensitivity troponin I and procalcitonin, and higher SOFA scores were more common in patients aged > 80 years than those aged 60–79 years and also more common and higher in non-survivors than survivors. LDH, osmotic pressure, C-reactive protein, D-dimer, high-sensitivity troponin I, and procalcitonin were positively correlated with age and sequential organ failure assessment (SOFA), whereas CD8+ and lymphocyte counts were negatively correlated with age and SOFA. Anorexia, comorbidities including hypertension, diabetes, and chronic obstructive pulmonary disease (COPD), LDH, osmotic pressure, and SOFA were significantly associated with 28-day all-cause mortality. LDH, osmotic pressure and SOFA were valuable for predicting 28-day all-cause mortality, whereas the area under the receiver operating characteristic curve of LDH was the largest, with sensitivity of 86.0% and specificity of 80.8%. Therefore, patients with severe COVID-19 aged ≥ 80 years had worse condition and higher mortality than did those aged 60–79 years, and anorexia and comorbidities including hypertension, diabetes, COPD, elevated plasma osmotic pressure, LDH, and high SOFA were independent risk factors associated with 28-day all-cause mortality in older patients with severe COVID-19. LDH may have the highest predictive value for 28-day all-cause mortality in all examined factors.

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