Neck Circumference Predicts Mortality in Hospitalized COVID-19 Patients

We aimed to determine whether neck circumference predicts mortality among hospitalized COVID-19 patients with respiratory failure. We performed a prospective multicenter (Italy and Brasil) study carried out from March to December 2020 on 440 hospitalized COVID-19 patients with respiratory failure. Baseline neck circumference was measured. The study outcome was 30- and 60-days mortality. Female and male participants were classified as “large neck” when exceeding fourth-quartile. Patients had a median age of 65 years (IQR 54–76), 68% were male. One-quarter of patients presented with grade-1 or higher obesity. The median neck circumference was 40 cm (IQR 38–43): 38 cm (IQR 36–40) for female and 41 cm (IQR 39–44) for male subjects. “Large neck” patients had a significantly higher prevalence of hypertension (63 vs. 48%), diabetes (33 vs. 19%), obesity (26 vs. 14%), and elevated C-reactive protein (CRP) (98 vs. 88%). The cumulative mortality rate was 13.1% (n = 52) and 15.9% (n = 63) at 30 and 60 days, respectively. After adjusting for age, BMI, relevant comorbidities, and high C-reactive protein to albumin ratio, “large neck” patients showed a significantly increased risk of death at 30- (adjusted HR 2.50; 95% CI 1.18–5.29; p = 0.017) and 60-days (adjusted HR 2.26; 95% CI 1.14–4.46; p = 0.019). Neck circumference is easy to collect and provides additional prognostic information to BMI. Among hospitalized COVID-19 patients with respiratory failure, those with large neck phenotype had a more than double risk of death at 30 and 60 days.

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The prognostic efficacy of beta2-microglobulin in acute pulmonary embolism

Acute Medicine Journal ◽

10.52964/amja.0655 ◽

2017 ◽

Vol 16 (2) ◽

pp. 52-59

Author(s):

Sotirios Kakavas ◽

◽

Aggeliki Papanikolaou ◽

Evangelos Balis ◽

Evgenios Metaxas ◽

...

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

C Reactive Protein ◽

Reactive Protein ◽

Risk Of Death ◽

Increased Risk ◽

Preliminary Study ◽

Wbc Count ◽

A Prospective Study ◽

Acute Pe

Our aim was to prospectively assess the prognostic value of beta2- microglobulin (b2-M) in patients with acute pulmonary embolism (PE). We conducted a prospective study of 109 patients admitted in a pulmonary clinic due to acute PE. A panel of inflammatory markers including b2-M white blood cell (WBC) count and C-reactive protein (CRP) was determined for each patient. In this preliminary study, baseline b2-M levels significantly correlated with the impairment of oxygenation and with all the parameters that are used for the early risk stratification of patients. In multivariate analysis, patients’ age and baseline b2-M levels were significantly associated with an increased risk of death. These findings require further prospective validation.

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Biomarkers Associated with Death After Initiating Treatment for Tuberculosis and HIV in Patients with Very Low CD4 Cells

Pathogens and Immunity ◽

10.20411/pai.v3i1.235 ◽

2018 ◽

Vol 3 (1) ◽

pp. 46 ◽

Cited By ~ 1

Author(s):

Fred Richard Sattler ◽

Daniel Chelliah ◽

Xingye Wu ◽

Alejandro Sanchez ◽

Michelle A. Kendall ◽

...

Keyword(s):

Proportional Hazards ◽

Cox Proportional Hazards ◽

C Reactive Protein ◽

Retrospective Case ◽

Reactive Protein ◽

Risk Of Death ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

Treatment Naïve ◽

Low Bmi

Background: The risk of short-term death for treatment naive patients dually infected with Mycobacterium tuberculosis and HIV may be reduced by early anti-retroviral therapy. Of those dying, mechanisms responsible for fatal outcomes are unclear. We hypothesized that greater malnutrition and/or inflammation when initiating treatment are associated with an increased risk for death.Methods: We utilized a retrospective case-cohort design among participants of the ACTG A5221 study who had baseline CD4 < 50 cells/mm3. The case-cohort sample consisted of 51 randomly selected participants, whose stored plasma was tested for C-reactive protein, cytokines, chemokines, and nutritional markers. Cox proportional hazards models were used to assess the association of nutritional, inflammatory, and immunomodulatory markers for survival.Results: The case-cohort sample was similar to the 282 participants within the parent cohort with CD4 < 50 cells/mm3. In the case cohort, 7 (14%) had BMI < 16.5 (kg/m2) and 17 (33%) had BMI 16.5-18.5(kg/m2). Risk of death was increased per 1 IQR width higher of log10 transformed level of C-reactive protein (adjusted hazard ratio (aHR) = 3.42 [95% CI = 1.33-8.80],P = 0.011), interferon gamma (aHR = 2.46 [CI = 1.02-5.90], P = 0.044), MCP-3 (3.67 [CI = 1.08-12.42], P = 0.037), and with IL-15 (aHR = 2.75 [CI = 1.08-6.98], P = 0.033) and IL-17 (aHR = 3.99 [CI = -1.06-15.07], P = 0.041). BMI, albumin, hemoglobin, and leptin levels were not associated with risk of death.Conclusions: Unlike patients only infected with M. tuberculosis for whom malnutrition and low BMI increase the risk of death, this relationship was not evident in our dually infected patients. Risk of death was associated with significant increases in markers of global inflammation along with soluble biomarkers of innate and adaptive immunity.

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Low Intracellular Water, Overhydration, and Mortality in Hemodialysis Patients

Journal of Clinical Medicine ◽

10.3390/jcm9113616 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3616

Author(s):

Carolina Gracia-Iguacel ◽

Emilio González-Parra ◽

Ignacio Mahillo ◽

Alberto Ortiz

Keyword(s):

Proportional Hazards ◽

Hemodialysis Patients ◽

Cox Proportional Hazards ◽

Intracellular Water ◽

C Reactive Protein ◽

Reactive Protein ◽

Risk Of Death ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

Over Time

Background: In hemodialysis patients, extracellular water (ECW) overload predicts all-cause and cardiovascular mortality. The primary aim of the present study was to analyze changes in post-dialysis (i.e., following removal of excess ECW) ECW, intracellular water (ICW), and the overhydration (OH) parameter over time. Additionally, the association of these parameters with mortality was explored. Patients and methods: Prospective study of prevalent hemodialysis patients (n = 124) followed for a median of 20 (interquartile range (IQR) 8–31) months. In three visits, inflammation (C-reactive protein) and post-dialysis fluid status (bioimpedance, BIS) were assessed. Results: During follow-up, the overhydration (OH) parameter increased (−0.696 ± 1.6 vs. 0.268 ± 1.7 L; p = 0.007) at the expense of a decrease in intracellular water (ICW) (19.90 ± 4.5 vs. 18.72 ± 4.1 24 L; p = 0.006) with a non-significant numerical increase in ECW/ICW ratio (0.795 ± 0.129 vs. 0.850 ± 0.143; p = 0.055). Baseline ICW positively correlated with muscle mass and energy intake and negatively with C-reactive protein and it was lower in those who died than in survivors (15.09 ± 2.36 vs. 18.87 ± 4.52 L; p = 0.004). In Kaplan–Meier analysis, patients with low baseline ICW (≤17 L) and high ECW/ICW ratio (≥0.84) were at an increased risk of death. Baseline ICW was also associated with the risk of death in adjusted Cox proportional hazards models (HR 0.62 (0.40–0.98) p = 0.04). Conclusions: In hemodialysis patients, the post-dialysis OH parameter increased over time while ICW decreased, without changes in ECW. Low baseline post-dialysis ICW correlated with muscle wasting and inflammation and was an independent risk factor for mortality.

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Prospective Study of High-Sensitivity C-Reactive Protein as a Determinant of Mortality: Results from the MONICA/KORA Augsburg Cohort Study, 1984–1998

Clinical Chemistry ◽

10.1373/clinchem.2007.100271 ◽

2008 ◽

Vol 54 (2) ◽

pp. 335-342 ◽

Cited By ~ 105

Author(s):

Wolfgang Koenig ◽

Natalie Khuseyinova ◽

Jens Baumert ◽

Christa Meisinger

Keyword(s):

Chronic Diseases ◽

Cancer Mortality ◽

High Sensitivity ◽

Medical Attention ◽

C Reactive Protein ◽

Middle Aged ◽

Cox Regression Analysis ◽

Reactive Protein ◽

Risk Of Death ◽

Increased Risk

Abstract Background: C-reactive protein (CRP), an exquisitely sensitive systemic marker of inflammation, has emerged as an independent predictor of cardiovascular diseases (CVD). Because other chronic diseases are also associated with an inflammatory response, we sought to assess the association of high-sensitivity CRP (hsCRP) with total and cause-specific mortality in a large cohort of middle-aged men. Methods: We measured hsCRP at baseline in 3620 middle-aged men, randomly drawn from 3 samples of the general population in the Augsburg area (Southern 0Germany) in 1984–85, 1989–90, and 1994–95. Outcome was defined as all deaths, fatal CVD, fatal coronary heart disease (CHD) including sudden cardiac deaths, and cancer deaths. Results: During an average follow-up of 7.1 years, 408 deaths occurred (CVD 196, CHD 129, cancer 127). In multivariable Cox regression analysis, subjects with hsCRP >3 mg/L at baseline showed an almost 2-fold increased risk to die vs those with hsCRP <1 mg/L [hazard ratio (HR) 1.88, 95% CI 1.41–2.52]. HRs were 2.15 (95% CI 1.39–3.34) for fatal CVD, 1.74 (1.04–2.92) for fatal CHD, and 1.65 (1.01–2.68) for cancer mortality. In contrast, neither total nor HDL cholesterol significantly predicted all-cause or cancer mortality, and cholesterol had only modest effects on CVD mortality. Conclusions: Our results suggest that increased circulating hsCRP concentrations are associated with an increased risk of death from several widespread chronic diseases. Persistently increased hsCRP is a sensitive and valuable nonspecific indicator of an ongoing disease process that deserves serious and careful medical attention.

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Elevated baseline C-reactive protein is associated with increased risk of death and myocardial infarction at one year following percutaneous coronary intervention

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(03)80149-3 ◽

2003 ◽

Vol 41 (6) ◽

pp. 34-35

Author(s):

Joel P. Reginelli ◽

David S. Lee ◽

Derek P. Chew ◽

Ivan P. Casserly ◽

Kent Dauterman ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

C Reactive Protein ◽

Reactive Protein ◽

Risk Of Death ◽

Increased Risk ◽

Percutaneous Coronary ◽

One Year

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P1597 Additional prognostic information of C-reactive protein to TIMI risk score in patients with ST-elevation myocardial infarction

European Heart Journal ◽

10.1016/s0195-668x(03)94735-x ◽

2003 ◽

Vol 24 (5) ◽

pp. 292

Author(s):

M ZAIRIS

Keyword(s):

Myocardial Infarction ◽

Risk Score ◽

St Elevation Myocardial Infarction ◽

C Reactive Protein ◽

Prognostic Information ◽

Reactive Protein ◽

St Elevation ◽

Timi Risk Score

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Faculty Opinions recommendation of Elevated maternal C-reactive protein and increased risk of schizophrenia in a national birth cohort.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718470282.793502246 ◽

2014 ◽

Author(s):

Driss Moussaoui ◽

Adil Khoubila

Keyword(s):

Birth Cohort ◽

C Reactive Protein ◽

Reactive Protein ◽

Increased Risk

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Clinical characteristics and risk factors for mortality in COVID-19 inpatients in Birjand, Iran: a single-center retrospective study

European Journal of Medical Research ◽

10.1186/s40001-021-00553-3 ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Ghodsiyeh Azarkar ◽

Freshteh Osmani

Keyword(s):

Risk Factors ◽

Platelet Count ◽

Protein Level ◽

Clinical Characteristics ◽

Single Center ◽

C Reactive Protein ◽

Reactive Protein ◽

Risk Of Death ◽

Survivor Group ◽

Epidemiological Characteristics

Abstract Background The coronavirus disease 2019(COVID-19) has affected mortality worldwide. The Cox proportional hazard (CPH) model is becoming more popular in time-to-event data analysis. This study aimed to evaluate the clinical characteristics in COVID-19 inpatients including (survivor and non-survivor); thus helping clinicians give the right treatment and assess prognosis and guide the treatment. Methods This single-center study was conducted at Hospital for COVID-19 patients in Birjand. Inpatients with confirmed COVID-19 were included. Patients were classified as the discharged or survivor group and the death or non-survivor group based on their outcome (improvement or death). Clinical, epidemiological characteristics, as well as laboratory parameters, were extracted from electronic medical records. Independent sample T test and the Chi-square test or Fisher’s exact test were used to evaluate the association of interested variables. The CPH model was used for survival analysis in the COVID-19 death patients. Significant level was set as 0.05 in all analyses. Results The results showed that the mortality rate was about (17.4%). So that, 62(17%) patients had died due to COVID-19, and 298 (83.6%) patients had recovered and discharged. Clinical parameters and comorbidities such as oxygen saturation, lymphocyte and platelet counts, hemoglobin levels, C-reactive protein, and liver and kidney function, were statistically significant between both studied groups. The results of the CPH model showed that comorbidities, hypertension, lymphocyte counts, platelet count, and C-reactive protein level, may increase the risk of death due to the COVID-19 as risk factors in inpatients cases. Conclusions Patients with, lower lymphocyte counts in hemogram, platelet count and serum albumin, and high C-reactive protein level, and also patients with comorbidities may have more risk for death. So, it should be given more attention to risk management in the progression of COVID-19 disease.

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C-Reactive Protein and All-Cause Mortality in a Large Hospital-Based Cohort

Clinical Chemistry ◽

10.1373/clinchem.2007.091959 ◽

2008 ◽

Vol 54 (2) ◽

pp. 343-349 ◽

Cited By ~ 62

Author(s):

Claudia Marsik ◽

Lili Kazemi-Shirazi ◽

Thomas Schickbauer ◽

Stefan Winkler ◽

Christian Joukhadar ◽

...

Keyword(s):

Hospital Admission ◽

Acute Phase ◽

Cox Regression ◽

Disease Risk ◽

C Reactive Protein ◽

Reactive Protein ◽

Increased Risk ◽

All Cause Mortality ◽

Low Sensitivity

Abstract Background: C-reactive protein (CRP), an acute-phase protein, is a sensitive systemic marker of inflammation and acute-phase reactions. Testing CRP concentrations at hospital admission may provide information about disease risk and overall survival. Methods: All first-ever transmittals to the department of medical and chemical laboratory diagnostics for determination of low-sensitivity CRP (n = 274 515, 44.5% male, median age 51 years) between January 1991 and July 2003 were included [median follow-up time: 4.4 years (interquartile range, 2.3–7.4 years)]. The primary endpoint was all-cause mortality. Multivariate Cox regression adjusted for sex and age was applied for analysis. Results: Compared to individuals within the reference category (CRP <5 mg/L), hazard ratios (HR) for all-cause mortality increased from 1.4 (5–10 mg/L category) to 3.3 in the highest category (>80 mg/L, all P <0.001). CRP was associated with various causes of death. The relation of CRP to cancer death was stronger than to vascular death. Younger patients with increased CRP had relatively far worse outcome than older patients (maximal HR: ≤30 years: 6.7 vs >60 years: 1.7–3.7). Interestingly, both short- and long-term mortality were associated with increasing CRP concentrations (>80 mg/L: HR 22.8 vs 1.4). Conclusion: Measurement of low-sensitivity CRP at hospital admission allowed for the identification of patients at increased risk of unfavorable outcome. Our findings indicate that close attention should be paid to hospitalized patients with high CRP not only because of very substantial short-term risk, but also long-term excess risk, the basis for which needs to be determined.

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