Clinical value of c-reactive protein level in predicting the development of postpartum endometritis

2020 ◽  
Vol 69 (2) ◽  
pp. 5-14
Author(s):  
Tatyana V. Batrakova ◽  
Irina E. Zazerskaya ◽  
Tatyana V. Vavilova ◽  
Vitaly N. Kustarov
Keyword(s):  
Postpartum Period ◽  
Comparison Group ◽  
Threshold Value ◽  
Main Group ◽  
C Reactive Protein ◽  
Clinical Value ◽  
Septic Complications ◽  
Reactive Protein ◽  
Diagnostic Threshold ◽  
Wide Range

Hypothesis/aims of study. In the Russian Federation, postpartum septic complications are third among the causes of maternal mortality, along with obstetric bleeding and preeclampsia. A wide range of methods for predicting postpartum endometritis has been proposed. However, none of these methods has sufficient clinical efficacy. The lack of information and the lack of clear criteria highlight the difficulties in the early diagnosis and prognosis of postpartum endometritis. The aim of this study was to evaluate the role of C-reactive protein (CRP) in the prediction of postpartum endometritis in puerperas with a high risk of developing septic complications. Study design, materials and methods. The study included 135 puerperas, who were retrospectively divided into two groups. The main group consisted of women with developed postpartum endometritis (n = 72), and the comparison group comprised individuals with physiological course of the postpartum period (n = 63). Serum CRP levels were determined for all puerperas on days 1 and 3 of the postpartum period using the immunoturbodimetric method. Results. On day 1 of the postpartum period, the diagnostic threshold value for CRP levels was 69 mg / ml. The sensitivity and specificity of the method were low: 62% (95% CI 5074) and 65% (95% CI 5176), respectively. The predictability at a CRP level above 69 mg / ml was 67% (95% CI 5477). Thus, in puerperas on day 1 of the postpartum period at a CRP level above 69 mg / ml, the probability of developing postpartum endometritis was 67%, the chances of developing postpartum endometritis being extremely low, increasing by 1.76 times. There were no statistically significant differences when comparing CRP levels in the study groups of puerperas on day 1 of the postpartum period. On day 3 of the postpartum period, CRP level was significantly higher in the main group of puerperas 148 mg / ml (95% CI 126171), and in the comparison group 43 mg / ml (95% CI 3849) (p = 6 1014). On the 3rd day of the postpartum period, the diagnostic threshold value for CRP levels was 60 mg / ml. The sensitivity of the method was moderate 79% (95% CI 6886), the specificity of the method being high 93% (95% CI 8598). The predictability at a CRP level above 60 mg / ml was 93% (95% CI 8496). Thus, in postpartum women on day 3 of the postpartum period at a CRP level above 60 mg / ml, the probability of developing postpartum endometritis was 93%, with the chances of developing postpartum endometritis increased by 10 times (95% CI 530). In addition, determining CRP level on day 3 of the postpartum period is clinically informative, as evidenced by the standardized effect size (SES) equal to 1.4 (p = 6 1014). This is confirmed by the ROC analysis data: the clinical significance value (AUC indicator) was 0.89 (CI 0.810.93), according to which CRP determination is evaluated as a method with high clinical informativity. Conclusion. The determination of CRP on day 3 of the postpartum period is a clinically informative method. An increase in CRP level above 60 mg / ml is a predictor of postpartum endometritis with a sensitivity of 79% and a high probability (93%).

Optimization of prevention measures of septic complications in women with high infectious risk

2018 ◽  
pp. 108-113
Author(s):  
Yu.R. Feyta ◽  
◽  
V.I. Pyrohova ◽  
Keyword(s):  
High Risk ◽  
Postpartum Period ◽  
Comparison Group ◽  
Infectious Complications ◽  
Main Group ◽  
Septic Complications ◽  
Effective Prevention ◽  
Vaginal Gel ◽  
Infectious Risk ◽  
Treatment Techniques

Despite the introduction of modern diagnostic technologies, prophylaxis and treatment techniques in obstetrical practice, the incidence of postpartum purulent-septic complications (PPSC) remains rather high and is an important medical and social problem, as they take one of the leading places in the structure of maternal morbidity and mortality. The objective: to improve the management of parturient womenwith a perineal birth injury in anamnesis, as part of an effective prevention of purulent-septic complications of puerperium. Materials and methods. The study included 77parturient women. Main and comparative groups were formed by women with a violation of the integrity of the perineum in the previous labor and with a high risk of developing infectious complications in puerperium. Women of the main group (n = 24) during each vaginal examination in labor (and an additional injection in 15-30 minutes after the rupture of the membranes) and twice a dayat a dose of 5 ml for 5 days postpartum, an antiseptic agent in the form of a vaginal gel, which consists of: 0.02% decamethoxin (antiseptic component), 0.5% hyaluronic acid (regenerating component) and lactate buffer (regulatory component). The comparison group included 27 women, without using vaginal gel in laborand using traditional wound treatment techniques in the postpartum period. The control group consisted of 26 women with uncomplicated somatic status, physiological course of pregnancy and labor. The evaluation of the effectiveness of the prescribed treatment was based on subjective symptoms (pain, discomfort, burning in the region of the perineal sutures), clinical data (swelling, hyperemia, nature of suturing healing), generally accepted indicators in dynamics (bacterioscopy of vaginal contents, pH-metry of the vaginal environment). Results. At the background of the use of three-component vaginal gel in the main group, the level of injury of soft tissues of the birth canal in these deliveries was lower by 19.9% than in the comparison group, prevalence of the 1st degreeperineumruptures, decreased the need for repeated episio- and perineotomy, which reduced the duration stay at hospital and improved postpartum rehabilitation in relation to the comparison group. On the third day of puerperium, hyperemia and edema of the wound area in women of the main group were observed almost three times less compared with the comparison group. On the fifth day of the puerperium in the main group the complaints were insignificant and appeared on the average 5 times less often, the healing was by the primary tension without infectious complications. The use of vaginal gel reduced the number of leukocytes in wound secretions by shortening the time of wound epithelization (1.5 times faster than in the parous from the comparison group). On the fifth day of using vaginal gel, 2/3 of the patients observed normalization of the vaginal microflora, the restoration of pH was observed. The results indicate the benefits of early onset of prophylactic measures and high effectiveness of topical antiseptic therapy in women with high infectious risk. Conclusions.In order to prevent antibiotic resistance tactics of prevention of PPSC in the group of high-risk septic complications provides one of the elements of anintegrated approach to use local antiseptics. Inclusion of the latter into a complex of prophylactic and treatment measures in the management of a high-riskwomen in puerperium contributes to the reduction of traumatic and infectious complications and provides more favorable course of labor and the postpartum period. Key words: labor traumatism, postpartum purulent-septic complications, local antiseptic.

Clinical features and etiology of postpartum endometritis in women with a high risk of purulent-septic complications

2021 ◽  
Vol 69 (6) ◽  
pp. 23-30
Author(s):  
Tatyana V. Batrakova ◽  
Irina E. Zazerskaya ◽  
Yulia V. Dolgo-Saburova ◽  
Elena Yu. Vasilyeva ◽  
Darya O. Saprykina
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Species Composition ◽  
Enterococcus Faecalis ◽  
Postpartum Period ◽  
Comparison Group ◽  
Main Group ◽  
Postpartum Women ◽  
Septic Complications

Hypothesis/Aims of study. Postpartum purulent-septic complications continue to rank third in the structure of maternal mortality. In the etiology of postpartum endometritis, the key role is played by opportunistic microflora, including associations of microorganisms, as well as a history of chronic urogenital infection, bacterial vaginosis, and sexually transmitted infections. Despite numerous studies, the question of which microorganisms colonizing the birth canal are potentially dangerous in relation to the development of infectious and inflammatory pathology of the postpartum period is still a subject of discussion. The aim of this research was to study the etiology and identify the clinical features of postpartum endometritis in puerperas with risk factors for the development of purulent-septic complications. Study design, materials and methods. This retrospective comparative study included 199 puerperas, who were divided into two groups: the main group consisted of women who developed postpartum endometritis (n = 72), and the comparison group comprised women with the physiological course of the postpartum period (n = 127). Bacteriological examination of lochia was performed on the third day of the postpartum period, as well as with the development of postpartum endometritis before empirical antibiotic therapy was started. Results. During the bacteriological study of lochia in the main group of patients, potentially pathogenic microorganisms were observed in 68 % of puerperas, with the pathogen of endometritis not detected with repeated crops of lochia in 32 % of postpartum women. In the comparison group, this proportion was only 15 % (p 0.005). During pregnancy, the release of microorganisms from the cervical canal was observed in 26.4 % of cases in the main group and in 7 % of cases in the comparison group of puerperas (p 0.005). Despite the absence of clinical symptoms, all patients received systemic antibacterial therapy. Subsequently, 90 % of maternity patients in the main group revealed the ineffectiveness of empirical therapy due to antibiotic resistance of the identified microflora. When analyzing the species composition of microorganisms, intestinal microflora in monoculture was more often isolated in the patients of the main group: Escherichia coli (40 % vs. 2.4 % in the comparison group) and Enterococcus faecalis (25 % vs. 4.7 % in the comparison group). In 10 % of postpartum women with severe purulent-septic complications (sepsis, parametritis, pelvioperitonitis), the composition of the released microflora in lochiae did not differ from that of maternity women with endometritis without severe purulent-septic complications, and microbial associations were only detected in two cases. Conclusion. The etiological cause of postpartum endometritis in puerperas with risk factors for the development of purulent-septic complications is intestinal bacteria (Escherichia coli, Enterococcus faecalis) more often detected as a monoculture. The species composition of microorganisms that cause severe forms of postpartum purulent-septic complications does not differ in principle from the pathogens of uncomplicated forms of postpartum infection. Unreasonable antibacterial therapy during pregnancy is associated with antibiotic resistance of microorganisms that cause postpartum endometritis, which poses significant difficulties in the selection of antibacterial drugs for its treatment.

scholarly journals Kinetics of C-reactive protein, interleukin-6 and -10, and phospholipase A2-II in severely traumatized septic patients

2010 ◽  
Vol 67 (11) ◽  
pp. 893-897 ◽  
Author(s):  
Zeljko Lausevic ◽  
Goran Vukovic ◽  
Biljana Stojimirovic ◽  
Jasna Trbojevic-Stankovic ◽  
Vladimir Resanovic ◽  
...  
Keyword(s):  
Phospholipase A2 ◽  
Injury Severity ◽  
C Reactive Protein ◽  
Surgical Intensive Care ◽  
Septic Complications ◽  
Mean Values ◽  
Protein Levels ◽  
Reactive Protein ◽  
Significant Difference ◽  
Kinetics Of

Background/Aim. Injury-induced anergy is one of the key factors contributing to trauma victims' high susceptibility to sepsis. This group of patients is mostly of young age and it is therefore essential to be able to predict as accurately as possible the development of septic complications, so appropriate treatment could be provided. The aim of this study was to assess kinetics of interleukin (IL) -6 and -10, phospholipase A2- II and C-reactive protein (CRP) in severely traumatized patients and explore the possibilities for early detection of potentially septic patients. Methods. This prospective study included 65 traumatized patients with injury severity score (ISS) > 18, requiring treatment at surgical intensive care units, divided into two groups: 24 patients without sepsis and 41 patients with sepsis. C-reactive protein, IL-6 and -10 and phospholipase A2 group II, were determined within the first 24 hours, and on the second, third and seventh day of hospitalization. Results. Mean values of IL-6 and phospholipase A2-II in the patients with and without sepsis did not show a statistically significant difference on any assessed time points. In the septic patients with ISS 29-35 and > 35 on the days two and seven a statistically significantly lower level of IL-10 was found, compared with those without sepsis and with the same ISS. C-reactive protein levels were significantly higher in septic patients with ISS 18-28 on the first day. On the second, third and seventh day CRP levels were significantly lower in the groups of septic patients with ISS 29-35 and > 35, than in those with the same ISS but without sepsis. Conclusion. Mean levels of CRP on the first day after the injury may be useful predictor of sepsis development in traumatized patients with ISS score 18-28. Mean levels of CRP on the days two, three and seven after the injury may be a useful predictor of sepsis development in traumatized patients with ISS score more than 28. Mean levels of IL-10 on the second and seventh day after the injury may be a useful predictor of sepsis development in traumatized patients with ISS score > 28.

scholarly journals C-reactive protein and procalcitonin - laboratory markers of degrees of severity and complications of an acute necrotic pancreatitis

2020 ◽  
Vol 87 (3-4) ◽  
pp. 14-17
Author(s):  
O. V. Rotar ◽  
I. V. Khomiak ◽  
V. I. Rotar ◽  
A. I. Khomiak ◽  
S. I. Railianu
Keyword(s):  
Septic Shock ◽  
Protein Concentration ◽  
Inflammatory Process ◽  
Clinical Laboratory ◽  
C Reactive Protein ◽  
Septic Complications ◽  
Reactive Protein ◽  
Laboratory Markers ◽  
Necrotic Pancreatitis ◽  
Degrees Of Severity

Objective. To conduct comparative estimation of efficacy of C-reactive protein and procalcitonin as laboratory markers for stratification of the patients severity state suffering an acute necrotic pancreatitis. Materials and methods. Prospective cohort investigation, including 151 patients with an acute necrotic pancreatitis, was conducted. Clinical, laboratory and bacteriological investigations were accomplished. The levels of C-reactive protein and procalcitonin were determined in the blood plasm. Results. The necrotic accumulations infectioning was diagnosed in 89 (58.9%) patients: local purulent complications - in 27, sepsis - in 33,septic shock - in 29. In 62 patients with sterile pancreonecrosis a C-reactive protein concentration have raised from (5.6 ± 0.89) to (206 ± 29) mg/l (p˂0.001). Development of purulent-septic complications was accompanied by significant and trustworthy (p<0.01) elevation of procalcitonin concentration: in the patients with sepsis - up to (5.05 ± 0.92) ng/ml, in the patients with septic shock - up to (7.25 ± 2.15) ng/ml. Conclusion. Simultaneous measurement of levels of C-reactive protein and procalcitonin in the blood plasm in patients, suffering acute necrotic pancreatitis, gives permission to determine the inflammatory process character and stratify the disease severity in its early terms.

scholarly journals The Biological Context of C-Reactive Protein as a Prognostic Marker in Renal Cell Carcinoma: Studies on the Acute Phase Cytokine Profile

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1961 ◽  
Author(s):  
Helene Hersvik Aarstad ◽  
Gigja Guðbrandsdottir ◽  
Karin M. Hjelle ◽  
Leif Bostad ◽  
Øystein Bruserud ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Renal Cancer ◽  
Acute Phase ◽  
High Serum ◽  
Cytokine Profile ◽  
Phase Reaction ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Wide Range ◽  
The Impact

High serum levels of the acute phase protein C-reactive protein (CRP) are associated with an adverse prognosis in renal cancer. The acute phase reaction is cytokine-driven and includes a wide range of inflammatory mediators. This overall profile of the response depends on the inducing event and can also differ between patients. We investigated an extended acute phase cytokine profile for 97 renal cancer patients. Initial studies showed that the serum CRP levels had an expected prognostic association together with tumor size, stage, nuclear grading, and Leibovich score. Interleukin (IL)6 family cytokines, IL1 subfamily mediators, and tumor necrosis factor (TNF)α can all be drivers of the acute phase response. Initial studies suggested that serum IL33Rα (the soluble IL33 receptor α chain) levels were also associated with prognosis, although the impact of IL33Rα is dependent on the overall cytokine profile, including seven IL6 family members (IL6, IL6Rα, gp130, IL27, IL31, CNTF, and OSM), two IL1 subfamily members (IL1RA and IL33Rα), and TNFα. We identified a patient subset characterized by particularly high levels of IL6, IL33Rα, and TNFα alongside an adverse prognosis. Thus, the acute phase cytokine reaction differs between renal cancer patients, and differences in the acute phase cytokine profile are associated with prognosis.

Introducing the wide range C-reactive protein (wr-CRP) into clinical use for the detection of microinflammation

2005 ◽  
Vol 358 (1-2) ◽  
pp. 151-158 ◽  
Author(s):  
Ori Rogowski ◽  
Yaffa Vered ◽  
Itzhak Shapira ◽  
Meirav Hirsh ◽  
Vera Zakut ◽  
...  
Keyword(s):  
Clinical Use ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Wide Range

scholarly journals Clinical evaluation of point-of-care testing for wide-range C-reactive protein (wr-CRP) in neonates with suspected sepsis

2019 ◽  
Vol 43 (3) ◽  
pp. 135-140
Author(s):  
Amiel Billetop ◽  
Kerry Grant ◽  
Jennifer Beasmore ◽  
Francesca Mills ◽  
David Odd ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Point Of Care ◽  
Attractive Alternative ◽  
C Reactive Protein ◽  
Suspected Sepsis ◽  
Reactive Protein ◽  
Point Of Care Test ◽  
Wide Range ◽  
The Mean ◽  
Common Laboratory

Abstract Background The aim of this study was to validate a point-of-care C-reactive protein (CRP) test (QuikRead, wide-range [wr] CRP) against standard laboratory testing in neonates with suspected sepsis. Methods This was a single-centre prospective cohort study of neonates (n = 91). The main outcome measure was the paired evaluation of the wr-CRP point-of-care test and automated laboratory CRP tests in neonates with suspected sepsis. Results There were 126 measured CRP-sample pairs. The mean difference between the laboratory CRP and the wr-CRP point-of-care test values was 0.19 (95% confidence interval [CI]:‒1.0–0.65). Pearson’s correlation coefficient was 0.94. The area under the receiver operating characteristic (ROC) curve was 0.99 (95% CI: 0.98–1.00). At a QuikRead CRP cut-off of ≥6.2, the sensitivity and specificity were 77% and 100%, respectively. Conclusions Point-of-care wr-CRP testing can be used as a screening test in neonates with suspected sepsis. Rapid bed-side diagnostics and minimal blood volume requirements present an attractive alternative to common laboratory CRP testing.

scholarly journals Serial Measurements of C-Reactive Protein and Interleukin-6 in the Immediate Postnatal Period: Reference Intervals and Analysis of Maternal and Perinatal Confounders

2001 ◽  
Vol 47 (6) ◽  
pp. 1016-1022 ◽  
Author(s):  
Claudio Chiesa ◽  
Fabrizio Signore ◽  
Marcello Assumma ◽  
Elsa Buffone ◽  
Paola Tramontozzi ◽  
...  
Keyword(s):  
Interleukin 6 ◽  
Early Onset ◽  
Gestational Hypertension ◽  
Neonatal Infection ◽  
Reference Intervals ◽  
Postnatal Period ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Wide Range ◽  
Near Term

Abstract Background: There is a wide range of reported sensitivities and specificities for C-reactive protein (CRP) and interleukin-6 (IL-6) in the detection of early-onset neonatal infection. This prompted us to assess reference intervals for CRP and IL-6 during the 48-h period immediately after birth and to identify maternal and perinatal factors that may affect them. Methods: CRP and IL-6 values were prospectively obtained for 148 healthy babies (113 term, 35 near-term) at birth and at 24 and 48 h of life, and from their mothers at delivery. Results: Upper reference limits for CRP at each neonatal age were established. At birth, CRP was significantly lower than at 24 and 48 h of life. Rupture of membranes ≥18 h, perinatal distress, and gestational hypertension significantly affected the neonatal CRP dynamics, but at specific ages. There was no correlation between CRP concentrations in mothers and their offspring at birth. The IL-6 values observed in the delivering mothers and in their babies at all three neonatal ages were negatively associated with gestational age. In the immediate postnatal period, IL-6 dynamics for term babies were significantly different from those for near-term babies. Maternal IL-6 concentrations correlated with babies’ IL-6 concentrations only for term deliveries. Apgar score had a significant effect on babies’ IL-6 values at birth. Conclusions: The patterns of CRP and IL-6 responses in the healthy neonate should be taken into account to optimize their use in the diagnosis of early-onset neonatal sepsis.

Comparative Study of Serum Amyloid A Protein and C-Reactive Protein in Disease

1985 ◽  
Vol 68 (2) ◽  
pp. 233-238 ◽  
Author(s):  
C. P. J. Maury
Keyword(s):  
Serum Amyloid A ◽  
Tissue Injury ◽  
Serum Amyloid ◽  
Response To Treatment ◽  
Surgical Trauma ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Amyloid A ◽  
Wide Range ◽  
Serum Amyloid A Protein

1. On the basis of results from 3000 parallel measurements of serum amyloid A protein (SAA) and C-reactive protein (CRP) in various clinical and experimental conditions, the relationship between these proteins was examined and the question of whether measurements of SAA can provide clinically useful information beyond that from CRP assays was evaluated. 2. The concentrations of SAA and CRP showed a close relationship in a wide range of clinical conditions and the general clinical impact of an elevated SAA or CRP level is similar. SAA was, however, more sensitive than CRP in reflecting inflammatory activity, and in some conditions characterized by normal or only slightly elevated CRP concentrations, measurements of SAA concentrations could be used for monitoring disease activity and response to treatment. 3. Marked variation in the ratios of SAA to CRP concentration occurred in response to different stimuli (e.g. surgical trauma/immunological tissue injury), suggesting the existence of independent, disease-specific pathways of regulation for the serum concentrations of SAA and CRP.

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