Risk Factors for Sever Forms of COVID-19 - A Second Level Moroccan Hospital Experience

The new coronavirus (2019-nCoV) has caused the death of more than 1.68 million patients worldwide, including 6,909 deaths registered in Morocco until 12/20/2020. The main objective of this study is to investigate epidemiological, clinical, and paraclinical factors predicting progression to the severity in order to identify patients at risk and adopt strategies for individualized management.We conduct this observational, descriptive, and analytical study from 01/09/2020 to 25/12/2020, at AL FARABI regional hospital in Oujda. 567 patients were eligible for our study out of 2000 patients who were admitted since our first case on April 2020. Our sample was divided into two groups based on pulse oxygen saturation on admission. We identified 294 as a Severe/Critical case and 273 as a Mild/Moderate form on admission. The mean age was significantly higher in the severe group (63.28 ± 12.4 vs 55.13 ± 17.2). The sex ratio M/F was 0.87. Compared with non-severe cases, severe cases exhibited more comorbidities, including diabetes (60.4% vs 39.6%; P 0.003), and hypertension (63.6% vs 26.4%; P 0.002). Several biological parameters were associated with disease severity in univariate analysis, the most important being lymphopenia, elevated C-reactive protein, and ferritin levels. lymphopenia (OR 3.76; 95% CI, 4.25-9.23), elevated C-reactive protein (OR, 5.7; 95% CI, 3.84-8.48) ferritin levels (OR, 3.6; 95% CI, 1.64-7.89) were significantly associated with severe cases of COVID-19. Mortality is 2.9% for all of our patients; it increases to 4.5% if we consider severe cases only. Identification and evaluation of epidemiological, clinical, and paraclinical parameters are important to identify patients at high risk of SARS-COV2 severity to guide treatment.

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Direct Versus Calculated LDL Cholesterol and C-Reactive Protein in Cardiovascular Disease Risk Assessment in the Framingham Offspring Study

Clinical Chemistry ◽

10.1373/clinchem.2019.304600 ◽

2019 ◽

Vol 65 (9) ◽

pp. 1102-1114 ◽

Cited By ~ 3

Author(s):

Hiroaki Ikezaki ◽

Virginia A Fisher ◽

Elise Lim ◽

Masumi Ai ◽

Ching-Ti Liu ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Ldl Cholesterol ◽

Disease Risk ◽

Univariate Analysis ◽

Significant Risk ◽

C Reactive Protein ◽

Cox Regression Analysis ◽

Reactive Protein ◽

Standard Risk

AbstractBACKGROUNDIncreases in circulating LDL cholesterol (LDL-C) and high-sensitivity C-reactive protein (hsCRP) concentrations are significant risk factors for cardiovascular disease (CVD). We assessed direct LDL-C and hsCRP concentrations compared to standard risk factors in the Framingham Offspring Study.METHODSWe used stored frozen plasma samples (−80 °C) obtained after an overnight fast from 3147 male and female participants (mean age, 58 years) free of CVD at cycle 6 of the Framingham Offspring Study. Overall, 677 participants (21.5%) had a CVD end point over a median of 16.0 years of follow-up. Total cholesterol (TC), triglyceride (TG), HDL cholesterol (HDL-C), direct LDL-C (Denka Seiken and Kyowa Medex methods), and hsCRP (Dade Behring method) concentrations were measured by automated analysis. LDL-C was also calculated by both the Friedewald and Martin methods.RESULTSConsidering all CVD outcomes on univariate analysis, significant factors included standard risk factors (age, hypertension, HDL-C, hypertension treatment, sex, diabetes, smoking, and TC concentration) and nonstandard risk factors (non-HDL-C, direct LDL-C and calculated LDL-C, TG, and hsCRP concentrations). On multivariate analysis, only the Denka Seiken direct LDL-C and the Dade Behring hsCRP were still significant on Cox regression analysis and improved the net risk reclassification index, but with modest effects. Discordance analysis confirmed the benefit of the Denka Seiken direct LDL-C method for prospective hard CVD endpoints (new-onset myocardial infarction, stroke, and/or CVD death).CONCLUSIONSOur data indicate that the Denka Seiken direct LDL-C and Dade Behring hsCRP measurements add significant, but modest, information about CVD risk, compared to standard risk factors and/or calculated LDL-C.

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Serum C-reactive protein metabolite (CRPM) is associated with incidence of contralateral knee osteoarthritis

Scientific Reports ◽

10.1038/s41598-021-86064-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Anne-Christine Bay-Jensen ◽

Asger Bihlet ◽

Inger Byrjalsen ◽

Jeppe Ragnar Andersen ◽

Bente Juhl Riis ◽

...

Keyword(s):

Phase Iii ◽

Response To Treatment ◽

C Reactive Protein ◽

Two Phase ◽

Knee Oa ◽

Reactive Protein ◽

Inflammatory Phenotype ◽

The Mean ◽

Using Data

AbstractThe heterogeneous nature of osteoarthritis (OA) and the need to subtype patients is widely accepted in the field. The biomarker CRPM, a metabolite of C-reactive protein (CRP), is released to the circulation during inflammation. Blood CRPM levels have shown to be associated with disease activity and response to treatment in rheumatoid arthritis (RA). We investigated the level of blood CRPM in OA compared to RA using data from two phase III knee OA and two RA studies (N = 1591). Moreover, the association between CRPM levels and radiographic progression was investigated. The mean CRPM levels were significantly lower in OA (8.5 [95% CI 8.3–8.8] ng/mL, n = 781) compared to the RA patients (12.8 [9.5–16.0] ng/mL, n = 60); however, a significant subset of OA patients (31%) had CRPM levels (≥ 9 ng/mL) comparable to RA. Furthermore, OA patients (n = 152) with CRPM levels ≥ 9 ng/mL were more likely to develop contra-lateral knee OA assessed by X-ray over a two-year follow-up period with an odds ratio of 2.2 [1.0–4.7]. These data suggest that CRPM is a blood-based biochemical marker for early identification OA patients with an inflammatory phenotype.

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Neonatal Toxic Shock Syndrome–Like Exanthematous Disease in North America

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piz060 ◽

2019 ◽

Author(s):

Megan Culler Freeman ◽

Stephanie Mitchell ◽

John Ibrahim ◽

John V Williams

Keyword(s):

North America ◽

Diagnostic Criteria ◽

Skin Rash ◽

Toxic Shock Syndrome ◽

Disease Process ◽

Toxic Shock ◽

C Reactive Protein ◽

Reactive Protein ◽

First Case

Abstract Neonatal toxic shock syndrome (TSS)-like exanthematous disease (NTED) is a syndrome first reported in Japan. Neonates develop systemic exanthema, thrombocytopenia, and fever usually during the first week of life. The disease is distinguished from frank TSS because affected infants are not severely ill and do not meet TSS criteria. Most infants are confirmed to be colonized with TSST-1 producing strains of S. aureus. Suggested diagnostic criteria for NTED include a skin rash with generalized macular erythema and one of the following symptoms: fever >38.0°C, thrombocytopenia <150 x103uL, or low positive C-reactive protein (1-5 mg/dL) in the absence of another known disease process. NTED is common in Japanese NICUs, but outside Japan, only one case has been reported in France. We describe the first case of NTED reported in North America.

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FXa Inhibition and Coagulation Changes During DVT Prophylaxis by Enoxaparin Over the Course of a 15-Day Follow-Up in Septic Patients

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029609345686 ◽

2009 ◽

Vol 16 (5) ◽

pp. 584-590 ◽

Cited By ~ 7

Author(s):

Zuzana Zenáhlíková ◽

Jan Kvasnička ◽

Zuzana Kudrnová ◽

Magda Sudrová ◽

Radka Brzežková ◽

...

Keyword(s):

Severe Sepsis ◽

Protein C ◽

Factor Xa ◽

Inclusion Criteria ◽

C Reactive Protein ◽

Once Daily ◽

Reactive Protein ◽

Factor Xa Inhibition ◽

The Mean

The objective of our study was to examine the changes in coagulation parameters and inflammatory reaction over the course of 15 days in patients with severe sepsis. We tried to identify mechanisms by which sepsis-induced pathophysiological changes may influence the effectiveness of subcutaneously (SC) administered enoxaparin 40 mg once daily. A total of 16 patients (8 men, 8 women; age 35-83 years) meeting the inclusion criteria of severe sepsis were enrolled in this study. The follow-up was performed on days 1, 2, 3, 6, 9, 12, and 15 of hospitalization at the intensive care unit (ICU). Blood coagulation (activated partial thromboplastin time [aPTT], prothrombin time [PT], fibrinogen, antithrombin (AT), protein C [PC], D-dimer, fragment 1.2 [F1.2], factor Xa [FXa] inhibition) and inflammatory reactants (interleukin 6 [IL-6], C-reactive protein [CRP], orosomucoid, α-1-antitrypsin) were tested. The mean FXa inhibition was 0.17 (±0.17) IU/mL. The arbitrarily established range of FXa inhibition for prophylaxis, 0.2 to 0.4 IU/mL, was reached in 22 cases (20%), while in 74 cases (68%), it was below and in 13 cases (12%) above the aforementioned range. Factor Xa inhibition positively correlated with AT (r = .42; P < .001) and PC (r = .45; P < .001) activities. A negative correlation was found between the FXa inhibition and α-1-antitrypsin concentrations (r = —.33; P = .01) but only in the subgroup with α-1-antitrypsin concentrations ≥2.2 g/L. We confirmed that in most patients with sepsis, the prophylaxis with enoxaparin did not lead to the required FXa inhibition. The inhibition of FXa by enoxaparin depends mainly on the AT and PC activities.

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Comparison of Clinical Features Between Patients with Positive and Negative Appendectomy

10.21203/rs.3.rs-117309/v1 ◽

2020 ◽

Author(s):

Guner Cakmak ◽

Baris Mantoglu ◽

Emre Gonullu ◽

Kayhan Ozdemir ◽

Burak Kamburoglu

Keyword(s):

Acute Appendicitis ◽

Clinical Features ◽

Total Bilirubin ◽

Negative Appendectomy ◽

C Reactive Protein ◽

Future Studies ◽

Female Patients ◽

Reactive Protein ◽

Male Patients ◽

The Mean

Abstract Background: The objective of this study was to retrospectively compare clinical features and prognostic values between the patients who were referred to the general surgery clinic of our hospital with the presumed diagnosis of acute appendicitis and underwent positive or negative appendectomy.Methods: Patients were divided into two groups as positive (PA) (n:362) and negative appendectomy (NA) (n:284) and the data obtained were compared between these two groups.Laboratory investigations were performed in all patients, and white blood cell (WBC), mean platelet volume (MPV), neutrophils count (NEU), neutrophils (%) (NEU%), C-reactive protein (CRP) and total bilirubin (TBIL) values were studied.Results: The mean MPV value was found as 7.88 fl in PA groups and 8.09 fl in NA group, and the mean MPV value was not statistically significantly difference in PA group, compared to NA groups (p=0.012). Laboratory parameters were also compared between genders. Accordingly, the mean MPV value was statistically significantly higher in female patients compared to male patients in PA group (p = 0.04). The mean TBIL value was 0.97 mg/dl in PA group and 0.69 mg/dl in NA group, and the mean TBIL value was statistically significantly higher in PA group (p< 0.001). Finally, TBIL value was statistically significantly lower in female patients compared to male patients in NA and PA group (p < 0.05).Conclusions: According to the results of our study, MPV and T. BIL values differ in PA and NA groups depending on gender. Therefore, these values may not be used as specific biomarkers in predicting positive acute appendicitis. We believe that these results will contribute to the literature and will be guiding for future studies.

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A Comparative Study between C-Reactive Protein and Procalcitonin in Iraqi Burn Patients

Al-Mustansiriyah Journal of Science ◽

10.23851/mjs.v28i1.310 ◽

2017 ◽

Vol 28 (1) ◽

pp. 41

Author(s):

Alia E. Al-Ubadi

Keyword(s):

Burn Injury ◽

Total Body Surface Area ◽

Latex Agglutination ◽

Burn Patients ◽

C Reactive Protein ◽

Reactive Protein ◽

Survivor Group ◽

Significant Difference ◽

The Mean ◽

Total Body

Association between Procalcitonin (PCT) and C-reactive protein (CRP) and burn injury was evaluated in 80 burned patients from Al-Kindy and Imam Ali hospitals in Baghdad-Iraq. Patients were divided into two groups, survivor group 56 (70%) and non-survivor group 24 (30%). PCT was estimated using (Human Procalcitonin ELISA kit) provided by RayBio/USA while CRP was performed using a latex agglutination kit from Chromatest (Spain). Our results declared that the mean of Total Body Surface Area (TBSA %) affected were 63.5% range (36%–95%) in non-survivor patients, while 26.5% range (10%–70%) in survivor patients. There is a significant difference between the two groups (P = 0.00), the higher mean percentage of TBSA has a significant association with mortality. Serum PCT and CRP were measured at the three times of sampling (within the first 48hr following admission, after 5thdays and after 10th days). The mean of PCT serum concentrations in non-survivor group (2638 ± 3013pg/ml) were higher than that of survivor group (588 ± 364pg/ml). Significantly high levels of CRP were found between the survivor and non-survivor groups especially in the 10th day of admission P=0.000, present study show that significant differences is found within the non-survivor group through the three times P= 0.01, while results were near to significant differences within survivor group through the three times (P= 0.05).

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The Prognostic Value of A Preoperative Lymphocyte Count and C-Reactive Protein Ratio In Osteosarcoma

10.21203/rs.3.rs-154092/v1 ◽

2021 ◽

Author(s):

Shu-Yu Ji ◽

Hai-Jun Tang ◽

Xiao-Ting Luo ◽

Wei-Feng Liang ◽

Xian-Ying Huang ◽

...

Keyword(s):

Multivariate Analysis ◽

Lymphocyte Count ◽

Tumor Metastasis ◽

Univariate Analysis ◽

White Blood Cells ◽

C Reactive Protein ◽

Optimal Cutoff ◽

Reactive Protein ◽

Cutoff Values ◽

Enneking Stage

Abstract Background: Systemic inflammatory response and nutritional status are closely related to tumor development, and both have been recognized as predictors of tumors. Our study investigated the effect on the prognosis of osteosarcoma by analyzing the ratio of lymphocytes to C-reactive protein (LCR) before surgery.Methods: Patients who were diagnosed with osteosarcoma and underwent surgery in the First Affiliated Hospital of Guangxi Medical University from 2012 to 2019 were included in this retrospective study. The albumin (g/L) +5 × total lymphocyte count (PNI), neutrophil/lymphocyte count (NLR), platelet/lymphocyte count (PLR) and platelet × neutrophil/lymphocyte count (SII) were calculated from preoperative peripheral white blood cells, C-reactive protein and serum albumin. The optimal cutoff values of LCR, PNI, NLR, PLR and SII were determined by receiver operating characteristic (ROC) analysis. According to the Optimal cutoff values, LCR, PNI, NLR, PLR and SII were divided into high and low groups. The Kaplan-Meier method was used to compare the overall survival (OS) between the high and low LCR groups. Univariate analysis was used to determine the influence of age, gender, tumor size, Enneking stage and neoadjuvant chemotherapy on the prognosis of osteosarcoma.The independent predictors of OS were determined by Cox multivariate analysis.Results: The optimal cutoff values for LCR, PNI, NLR, PLR and SII were 0.093, 48.4, 1.23, 157.03 and 314.27, respectively. A low preoperative LCR was significantly correlated with tumor metastasis, stage, NLR, PLR and SII. However, a low preoperative PNI was significantly associated with tumor metastasis, stage, and PLR.Kaplan-Meier survival analysis indicated that the postoperative OS was significantly correlated with preoperative LCR and PNI (P < 0.05). Univariate analysis showed that Enneking stage, metastasis and preoperative LCR, PNI, NLR, PLR and SII were important factors affecting OS (P < 0.05). For multivariate analysis, the results revealed that the preoperative LCR (HR, 0.401; 95% CI, 0.199-0.807; P = 0.01) and Enneking stage (HR, 2.717; 95%CI, 1.067-6.919; P = 0.036) is an independent prognostic factor affecting the postoperative OS of osteosarcoma.Conclusions: The high preoperative LCR is strongly associated with longer survival time in patients with osteosarcoma. Enneking stage and preoperative LCR may be important parameters for the prognosis of osteosarcoma.

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Highly sensitive C-reactive protein levels in Iranian patients with pulmonary complication of sulfur mustard poisoning and its correlation with severity of airway diseases

Human & Experimental Toxicology ◽

10.1177/0960327109354311 ◽

2009 ◽

Vol 28 (12) ◽

pp. 739-745 ◽

Cited By ~ 20

Author(s):

Davood Attaran ◽

Shahrzad M Lari ◽

Mohammad Khajehdaluee ◽

Hossein Ayatollahi ◽

Mohammad Towhidi ◽

...

Keyword(s):

Lung Function ◽

Sulfur Mustard ◽

Chronic Obstructive ◽

Case Group ◽

C Reactive Protein ◽

Cross Sectional ◽

Reactive Protein ◽

Highly Sensitive ◽

The Mean ◽

Hs Crp

Background: Sulfur mustard (SM) is a chemical warfare agent that can cause serious pulmonary complications. This study was designed to determine serum highly sensitive C-reactive protein (hs-CRP) and evaluate its correlation with lung function parameters in patients with chronic obstructive pulmonary disease (COPD) due to SM poisoning. Methods: Fifty consecutive SM patients with stable COPD and a mean age 46.3 ± 9.18 years were enrolled in this cross sectional study. Thirty healthy men were selected as controls. Lung function parameters were evaluated. Serum hs-CRP by immunoturbidometry assay was measured in both the patients and controls. Results: In the case group, the mean forced expiratory volume in one second (FEV1) was 2.14 ± 0.76 L (58.98% ± 17.51% predicted). The mean serum hs-CRP was 9.4 ± 6.78 SD and 3.9 ± 1.92 SD mg/L in the cases and controls, respectively, with significant statistical differences (p < .001). There was negative correlation between the serum hs-CRP and FEV1 levels (p = .01). The serum hs-CRP levels were also correlated with Global Initiative for Chronic Obstructive Lung disease (GOLD) stages (r = .45, p < .001). Conclusions: Our findings suggest that the serum hs-CRP level is increased in SM patients with COPD and may have a direct correlation with disease severity. It may then be used as a marker for the severity of COPD in patients with SM poisoning.

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Prothrombotic Changes in Hemostatic Parameters and C-reactive Protein in the Elderly with Winter Acute Respiratory Tract Infections

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615704 ◽

2001 ◽

Vol 85 (02) ◽

pp. 245-249 ◽

Cited By ~ 27

Author(s):

John Horan ◽

Charles Francis ◽

Ann Falsey ◽

John Kolassa ◽

Brian Smith ◽

...

Keyword(s):

Older Adults ◽

Heart Disease ◽

Respiratory Tract ◽

Ischemic Heart Disease ◽

Respiratory Tract Infections ◽

C Reactive Protein ◽

Acute Respiratory Tract Infections ◽

Reactive Protein ◽

The Mean ◽

Tract Infections

SummaryMortality rates attributable to cerebrovascular and ischemic heart disease increase among older adults during the winter. Prothrombotic changes in the hemostatic system related to seasonal factors, such as ambient temperature changes, and winter acute respiratory tract infections, may contribute to this excess seasonal mortality. A prospective nested case-control study was conducted to assess the impact of winter acute respiratory tract infections on fibrinogen, factor VII, factor VIIa, D-dimer, prothrombin fragment 1.2, PAI-1, soluble P-selectin and C-reactive protein (CRP) in older adults. The change in laboratory parameters from baseline (fall) to the time of infection in both middle-aged and elderly individuals was compared with matched non-infected controls. In older adult participants with winter acute respiratory tract infections, significant increases occurred in fibrinogen and C-reactive protein, but not in any other markers. The mean fibrinogen increased 1.52 g/L (38%) and the mean CRP increased 37 mg/L (370%) over baseline (both p < 0.001). In a multivariate analysis, both infection and season were associated with the increase in fibrinogen, but only infection was associated with the CRP increase. Old age magnified the increase in CRP but not in fibrinogen. Winter acute respiratory tract infections induce an exaggerated inflammatory response in older adults. The associated increase in fibrinogen, an independent risk factor for ischemic heart disease, may be partly responsible for the excess winter vascular mortality.

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Monitoring both serum amyloid protein A and C-reactive protein as inflammatory markers in infectious diseases

Clinical Chemistry ◽

10.1093/clinchem/39.2.293 ◽

1993 ◽

Vol 39 (2) ◽

pp. 293-297 ◽

Cited By ~ 79

Author(s):

T Nakayama ◽

S Sonoda ◽

T Urano ◽

T Yamada ◽

M Okada

Keyword(s):

Inflammatory Markers ◽

Bacterial Infections ◽

Viral Infections ◽

Protein A ◽

Acute Stage ◽

Serum Amyloid ◽

Amyloid Protein ◽

C Reactive Protein ◽

Reactive Protein ◽

The Mean

Abstract We examined serum amyloid protein A (SAA) and C-reactive protein (CRP) as inflammatory markers of viral and bacterial infections. Both acute-phase reactants increased in the acute stage and thereafter decreased in the convalescent stage. In viral infections, the mean serum concentrations of SAA during the acute stage were 141 mg/L in infections with adenovirus, 77 mg/L with measles virus, 63 mg/L with influenza virus, 55 mg/L with parainfluenza virus, 31 mg/L with respiratory syncytial virus, and 31 mg/L in aseptic meningitis. The mean serum concentration of CRP was 19 mg/L for adenovirus infection and < 7 mg/L in all other viral infections. The SAA concentrations were 5- to 11-fold greater than the CRP concentrations. Both the SAA and the CRP concentrations were higher in bacterial infections than in viral infections. Changes in the concentrations of serum SAA paralleled those in serum CRP in bacterial infection; during the course of viral infection, however, serum SAA tended to disappear more quickly than CRP did. SAA appears to be a clinically useful marker of inflammation in acute viral infections, with or without significant changes in the CRP concentration.

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