Roles of the Ratio of C-Reactive Protein to Serum and Pericardial Fluid Albumin Levels in Predicting in-Hospital Mortality in Patients Undergoing Pericardiocentesis

Abstract Background Coronavirus disease has heterogeneous clinical features; however, the reasons for the heterogeneity are poorly understood. This study aimed to identify clinical phenotypes according to patients’ temperature trajectory. Method A retrospective review was conducted in five tertiary hospitals in Hubei Province from November 2019 to March 2020. We explored potential temperature-based trajectory phenotypes and assessed patients’ clinical outcomes, inflammatory response, and response to immunotherapy according to phenotypes. Results A total of 1580 patients were included. Four temperature-based trajectory phenotypes were identified: normothermic (Phenotype 1); fever, rapid defervescence (Phenotype 2); gradual fever onset (Phenotype 3); and fever, slow defervescence (Phenotype 4). Compared with Phenotypes 1 and 2, Phenotypes 3 and 4 had a significantly higher C-reactive protein level and neutrophil count and a significantly lower lymphocyte count. After adjusting for confounders, Phenotypes 3 and 4 had higher in-hospital mortality (adjusted odds ratio and 95% confidence interval 2.1, 1.1–4.0; and 3.3, 1.4–8.2, respectively), while Phenotype 2 had similar mortality, compared with Phenotype 1. Corticosteroid use was associated with significantly higher in-hospital mortality in Phenotypes 1 and 2, but not in Phenotypes 3 or 4 (p for interaction < 0.01). A similar trend was observed for gamma-globulin. Conclusions Patients with different temperature-trajectory phenotypes had different inflammatory responses, clinical outcomes, and responses to corticosteroid therapy.

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Erysipelas Complicated with Acute Exudative Pericarditis

Medicina ◽

10.3390/medicina56110571 ◽

2020 ◽

Vol 56 (11) ◽

pp. 571

Author(s):

Akvilė Gečaitė ◽

Aušra Vainalavičiūtė ◽

Daiva Emilija Rekienė ◽

Laima Jankauskienė ◽

Albinas Naudžiūnas

Keyword(s):

Troponin I ◽

Epigastric Pain ◽

White Blood Cells ◽

Pericardial Fluid ◽

C Reactive Protein ◽

St Segment Elevation ◽

Pericardial Cavity ◽

Reactive Protein ◽

St Segment ◽

The Face

Erysipelas is a common skin infection of the upper dermis. Its most common complications are local; these include abscess formation, skin necrosis, etc. In the present article, we introduce a case of a 75-year-old patient with erysipelas of the face complicated with acute exudative pericarditis. The patient came to Kaunas Clinical Hospital complaining of extreme fatigue and fever, oedema of the left side of the face, and erythema typical for erysipelas. The patient also felt sternum and epigastric pain, especially during breathing, and dyspnoea. Heart work was rhythmic 100 bpm; blood pressure was 142/70 mmHg. Pericardial friction rub was heard over the left sternal border. There were no alterations in other systems. In the electrocardiogram, concave ST segment elevation in leads II, III, and aVF was identified. In addition, during hospitalisation, the patient experienced atrial fibrillation paroxysm, which was treated with amiodarone intravenously. The blood test showed C-reactive protein: 286 mg/L; white blood cells: 20 × 109/L; troponin I was within the normal range. During echocardiography, pericardial fluid in pericardial cavity was identified. As no changes in troponin I were observed, according to the ST segment elevation, the woman was diagnosed with erysipelas of the left side of the face complicated with acute exudative pericarditis. Antibacterial treatment of cephalosporins was administered. After the treatment, C-reactive protein decreased to 27.8 mg/L; whereas, in the electrocardiogram, the return of the ST segment to the isoline was observed, and pericardial fluid resorbed from the pericardial cavity. To the best of the authors’ knowledge, this case is a rare combination of erysipelas complicated with acute exudative pericarditis.

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Impact of Early C-Reactive Protein/Albumin Ratio on Intra-Hospital Mortality Among Patients with Spontaneous Intracerebral Hemorrhage

Journal of Clinical Medicine ◽

10.3390/jcm9041236 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1236 ◽

Cited By ~ 2

Author(s):

Michael Bender ◽

Kristin Haferkorn ◽

Michaela Friedrich ◽

Eberhard Uhl ◽

Marco Stein

Keyword(s):

Regression Analysis ◽

Intracerebral Hemorrhage ◽

Hospital Mortality ◽

Cox Regression ◽

Spontaneous Intracerebral Hemorrhage ◽

C Reactive Protein ◽

Albumin Ratio ◽

Cox Regression Analysis ◽

Reactive Protein ◽

The Impact

Objective: The impact of increased C-reactive protein (CRP)/albumin ratio on intra-hospital mortality has been investigated among patients admitted to general intensive care units (ICU). However, it was not investigated among patients with spontaneous intracerebral hemorrhage (ICH). This study aimed to investigate the impact of CRP/albumin ratio on intra-hospital mortality in patients with ICH. Patients and Methods: This retrospective study was conducted on 379 ICH patients admitted between 02/2008 and 12/2017. Blood samples were drawn upon admission and the patients’ demographic, medical, and radiological data were collected. The identification of the independent prognostic factors for intra-hospital mortality was calculated using binary logistic regression and COX regression analysis. Results: Multivariate regression analysis shows that higher CRP/albumin ratio (odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.193–2.317, p = 0.003) upon admission is an independent predictor of intra-hospital mortality. Multivariate Cox regression analysis indicated that an increase of 1 in the CRP/albumin ratio was associated with a 15.3% increase in the risk of intra-hospital mortality (hazard ratio = 1.153, 95% CI = 1.005–1.322, p = 0.42). Furthermore, a CRP/albumin ratio cut-off value greater than 1.22 was associated with increased intra-hospital mortality (Youden’s Index = 0.19, sensitivity = 28.8, specificity = 89.9, p = 0.007). Conclusions: A CRP/albumin ratio greater than 1.22 upon admission was significantly associated with intra-hospital mortality in the ICH patients.

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C-Reactive Protein and Ferritin Are Associated With Organ Dysfunction and Mortality in Hospitalized Children

Clinical Pediatrics ◽

10.1177/0009922819837352 ◽

2019 ◽

Vol 58 (7) ◽

pp. 752-760 ◽

Cited By ~ 13

Author(s):

Christopher M. Horvat ◽

Jamie Bell ◽

Sajel Kantawala ◽

Alicia K. Au ◽

Robert S. B. Clark ◽

...

Keyword(s):

High Risk ◽

Hospital Mortality ◽

Organ Dysfunction ◽

Risk Groups ◽

Hospitalized Children ◽

Inpatient Mortality ◽

C Reactive Protein ◽

Cut Points ◽

Cut Point ◽

Reactive Protein

Our objective was to determine if C-reactive protein (CRP) and ferritin values alone and in combination are associated with mortality among hospitalized children. All hospitalized patients at our institution with a CRP or ferritin assay in 2015 and 2016 were included. Area under the receiver operating curves (AUROC) were examined, optimal cut-points determined, and patients were stratified into low-, intermediate-, or high-risk groups based on elevation of zero, one, or both biomarkers. A total of 14 928 CRP and 653 ferritin values were obtained, with both obtained for 172 patients. AUROC for maximum CRP value was 0.76 (0.68-0.85) with a cut-point of 7.1 mg/dL for in-hospital mortality and 0.90 (0.83-0.98) for maximum ferritin with a cut-point of 373 ng/mL. Elevation of both ferritin and CRP was associated with the highest inpatient mortality (21.7%) and greatest organ dysfunction, followed by either biomarker alone. Additional prospective study of these biomarkers in combination is warranted.

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Procalcitonin and C-reactive protein in pericardial fluid for postmortem diagnosis of sepsis

International Journal of Legal Medicine ◽

10.1007/s00414-012-0692-8 ◽

2012 ◽

Vol 126 (4) ◽

pp. 567-572 ◽

Cited By ~ 14

Author(s):

Bettina Schrag ◽

Katia Iglesias ◽

Patrice Mangin ◽

Cristian Palmiere

Keyword(s):

Pericardial Fluid ◽

C Reactive Protein ◽

Postmortem Diagnosis ◽

Reactive Protein

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Analysis of C-Reactive Protein and Biochemical Parameters in Pericardial Fluid

Yonsei Medical Journal ◽

10.3349/ymj.2006.47.3.372 ◽

2006 ◽

Vol 47 (3) ◽

pp. 372 ◽

Cited By ~ 9

Author(s):

Turan Ege ◽

Melih Hulusi US ◽

Mustafa Cikirikcioglu ◽

Cavidan Arar ◽

Enver Duran

Keyword(s):

Biochemical Parameters ◽

Pericardial Fluid ◽

C Reactive Protein ◽

Reactive Protein

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Mortality Predictors in Severe COVID-19 Patients from an East European Tertiary Center: A Never-Ending Challenge for a No Happy Ending Pandemic

Journal of Clinical Medicine ◽

10.3390/jcm11010058 ◽

2021 ◽

Vol 11 (1) ◽

pp. 58

Author(s):

Amalia-Stefana Timpau ◽

Radu-Stefan Miftode ◽

Antoniu Octavian Petris ◽

Irina-Iuliana Costache ◽

Ionela-Larisa Miftode ◽

...

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Poor Prognosis ◽

Survival Rates ◽

C Reactive Protein ◽

Happy Ending ◽

Factors Associated ◽

Reactive Protein ◽

Tertiary Center ◽

D Dimer

(1) Background: There are limited clinical data in patients from the Eastern European regions hospitalized for a severe form of Coronavirus disease 2019 (COVID-19). This study aims to identify risk factors associated with intra-hospital mortality in patients with COVID-19 severe pneumonia admitted to a tertiary center in Iasi, Romania. (2) Methods: The study is of a unicentric retrospective observational type and includes 150 patients with severe COVID-19 pneumonia divided into two subgroups, survivors and non-survivors. Demographic and clinical parameters, as well as comorbidities, laboratory and imaging investigations upon admission, treatments, and evolution during hospitalization were recorded. First, we sought to identify the risk factors associated with intra-hospital mortality using logistic regression. Secondly, we assessed the correlations between D-Dimer and C-reactive protein and predictors of poor prognosis. (3) Results: The predictors of in-hospital mortality identified in the study are D-dimers >0.5 mg/L (p = 0.002), C-reactive protein >5mg/L (p = 0.001), and heart rate above 100 beats per minute (p = 0.001). The biomarkers were also significantly correlated the need for mechanical ventilation, admission to intensive care unit, or multiple organ dysfunction syndrome. By area under the curve (AUC) analysis, we noticed that both D-Dimer (AUC 0.741) and C-reactive protein (AUC 0.707) exhibit adequate performance in predicting a poor prognosis in patients with severe viral infection. (4) Conclusions: COVID-19′s outcome is significantly influenced by several laboratory and clinical factors. As mortality induced by severe COVID-19 pneumonia is considerable, the identification of risk factors associated with negative outcome coupled with an early therapeutic approach are of paramount importance, as they may significantly improve the outcome and survival rates.

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Comparison of C-reactive protein levels between antemortem serum and postmortem serum and pericardial fluid

Journal of Forensic and Legal Medicine ◽

10.1016/j.jflm.2020.101968 ◽

2020 ◽

Vol 73 ◽

pp. 101968

Author(s):

Shojiro Takasu ◽

Sari Matsumoto ◽

Saki Kodama ◽

Kana Sakamoto ◽

Kimiharu Iwadate

Keyword(s):

Pericardial Fluid ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein

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The prognostic and risk-stratified value of neutrophil–lymphocyte count ratio in Chinese patients with community-acquired pneumonia

European Journal of Inflammation ◽

10.1177/1721727x17702150 ◽

2017 ◽

Vol 15 (1) ◽

pp. 22-27 ◽

Cited By ~ 1

Author(s):

Ting Yang ◽

Chun Wan ◽

Hao Wang ◽

Jiangyue Qin ◽

Lei Chen ◽

...

Keyword(s):

Hospital Mortality ◽

Lymphocyte Count ◽

Pneumonia Severity Index ◽

Severity Index ◽

Serum Levels ◽

Community Acquired Pneumonia ◽

C Reactive Protein ◽

Pneumonia Severity ◽

Reactive Protein ◽

Count Ratio

Community-acquired pneumonia is a common disease associated with high mortality. This retrospective study examined whether the neutrophil–lymphocyte count ratio (NLR), already widely used as an index of inflammation, can be used to predict in-hospital mortality of adults with community-acquired pneumonia. Clinical characteristics, CURB-65 and pneumonia severity index score of pneumonia severity, NLR, serum levels of C-reactive protein and procalcitonin, and in-hospital mortality were analyzed for 318 consecutive adults with community-acquired pneumonia admitted to West China Hospital between July 2012 and December 2013. The ability of NLR and other parameters to predict in-hospital mortality was assessed using receiver operating characteristic (ROC) curves. Results showed that NLR increased with increasing CURB-65 ( P < 0.05) and pneumonia severity index ( P < 0.05), and NLR correlated positively with serum levels of C-reactive protein (r = 0.239, P < 0.05) and procalcitonin (r = 0.211, P < 0.05). The median value of NLR was significantly higher among patients who died in hospital (11.96) than among those who were alive at the end of hospitalization (4.19, P < 0.05). Based on a cut-off NLR of 7.12, this index predicted in-hospital mortality with a sensitivity of 82.61% and specificity of 72.20% (area under ROC curve, 0.799). Predictive power was greater for the combination of NLR and serum levels of C-reactive protein and procalcitonin. These results suggest that NLR may be useful for predicting prognosis in Chinese adults with community-acquired pneumonia, and it may work better in combination with traditional markers.

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Comparative Survival Analysis of Immunomodulatory Therapy for COVID-19 ‘Cytokine Storm’: A Retrospective Observational Cohort Study

10.1101/2020.06.16.20126714 ◽

2020 ◽

Cited By ~ 1

Author(s):

Sonali Narain ◽

Dimitre G. Stefanov ◽

Alice S. Chau ◽

Andrew G. Weber ◽

Galina Marder ◽

...

Keyword(s):

Lactate Dehydrogenase ◽

Hospital Mortality ◽

Standard Of Care ◽

P Value ◽

Cytokine Storm ◽

C Reactive Protein ◽

Reactive Protein ◽

Treatment Standard ◽

Observational Cohort ◽

Retrospective Observational Cohort Study

AbstractBackgroundCytokine storm is a marker of COVID-19 illness severity and increased mortality. Immunomodulatory treatments have been repurposed to improve mortality outcomes.MethodsWe conducted a retrospective analysis of electronic health records across the Northwell Health system. COVID-19 patients hospitalized between March 1, 2020 and April 15, 2020, were included. Cytokine storm was defined by inflammatory markers: ferritin >700ng/mL, C-reactive protein >30mg/dL, or lactate dehydrogenase >300U/L. Patients were subdivided into six groups -no immunomodulatory treatment (standard of care) and five groups that received either corticosteroids, anti-interleukin 6 (IL-6) antibody (tocilizumab) or anti-IL-1 therapy (anakinra) alone or in combination with corticosteroids. The primary outcome was hospital mortality.ResultsThere were 3,098 patients who met inclusion criteria. The most common comorbidities were hypertension (40-56%), diabetes (32-43%) and cardiovascular disease (2-15%). Patients most frequently met criteria with high lactate dehydrogenase (74.8%) alone, or in combination, followed by ferritin (71.4%) and C-reactive protein (9.4%). More than 80% of patients had an elevated D-dimer. Patients treated with a combination of tocilizumab and corticosteroids (Hazard Ratio [HR]: 0.459, 95% Confidence Interval [CI]: 0.295-0.714; p<0.0001) or corticosteroids alone (HR: 0.696, 95% CI: 0.512-0.946; p=0.01) had improved hospital survival compared to standard of care. Corticosteroids and tocilizumab was associated with increased survival when compared to corticosteroids and anakinra (HR: 0.612, 95% CI: 0.391-0.958; p-value=0.02).ConclusionsWhen compared to standard of care, corticosteroid and tocilizumab used in combination, or corticosteroids alone, was associated with reduced hospital mortality for patients with COVID-19 cytokine storm.

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