Chemokine/Cytokine Levels Correlate with Organ Involvement in PR3-ANCA-Associated Vasculitis

Background: ANCA-associated vasculitis (AAV) is a rare small vessel disease characterized by multi-organ involvement. Biomarkers that can measure specific organ involvement are missing. Here, we ask whether certain circulating cytokines and chemokines correlate with renal involvement and if distinct cytokine/chemokine patterns can differentiate between renal, ear/nose/throat, joints, and lung involvement of AAV. Methods: Thirty-two sets of Birmingham vasculitis activity score (BVAS), PR3-ANCA titers, laboratory marker, and different cytokines were obtained from 17 different patients with AAV. BVAS, PR3-ANCA titers, laboratory marker, and cytokine concentrations were correlated to different organ involvements in active AAV. Results: Among patients with active PR3-AAV (BVAS > 0) and kidney involvement we found significant higher concentrations of chemokine ligand (CCL)-1, interleukin (IL)-6, IL21, IL23, IL-28A, IL33, monocyte chemoattractant protein 2 (MCP2), stem cell factor (SCF), thymic stromal lymphopoietin (TSLP), and thrombopoietin (TPO) compared to patients without PR3-ANCA-associated glomerulonephritis. Patients with ear, nose, and throat involvement expressed higher concentrations of MCP2 and of the (C-X-C motif) ligand-12 (CXCL-12) compared to patients with active AAV and no involvement of these organs. Conclusion: We identified distinct cytokine patterns for renal manifestation and for ear, nose and throat involvement of PR3-AAV. Distinct plasma cytokines might be used as non-invasive biomarkers of organ involvement in AAV.

Evaluation of neutrophil to lymphocyte ratio in predicting the prognosis of Crimean–Congo haemorrhagic fever

Crimean–Congo haemorrhagic fever (CCHF) is a severe form of haemorrhagic fever identified in parts of Africa, Asia, Eastern Europe and the Middle East. CCHF continues to be a justifiable cause of concern for people in rural areas where the disease is endemic. A total of 151 patients, diagnosed with CCHF, were evaluated retrospectively. The demographic characteristics of these patients and the relationship between the neutrophil–lymphocyte ratio (NLR) at admission and survival were examined. There were 21 (13.9%) deaths. There was no relationship between age, gender and mortality, but elevated neutrophil–lymphocyte ratio (NLR) on admission was statistically associated with mortality. NLR is a laboratory marker that can be studied even in medical centres with limited facilities and may be helpful in predicting the clinical course of the disease.

ROLE OF HYPERBILIRUBINEMIA, ELEVATED CREACTIVE PROTEIN AND LEUCOCYTE COUNT AS A PREDICTIVE FACTOR FOR APPENDICEAL PERFORATION IN ACUTE APPENDICITIS

Background: Appendiceal perforation in patients with acute appendicitis may cause a variety of potentially life-threatening complications. Escherichia coli endotoxin has been shown to impact physiological bile flow in vivo. This had led to the theory that hyperbilirubinemia and elevated CRP in patients with appendicitis may have a predictive potential for the preoperative diagnosis of appendiceal perforation. Objectives: The aim of this retrospective study was to investigate the diagnostic value of hyperbilirubinemia and elevated CRP as a preoperative laboratory marker for appendiceal perforation in patients with acute appendicitis. Thus a new marker for appendiceal perforation would be welcomed. Thus, the need for the study is to conclude whether the Serum Bilirubin or CRP can be considered as a new laboratory marker to aid in the diagnosis of Appendicular Perforation. Materials and methods: All patients admitted with clinical diagnosis of "Acute Appendicitis" or "Appendicular Perforation" and undergoing surgery in General Surgery Dept in Tertiary Care Teaching Hospital were taken as Subjects for this study. The primary data for this study were the blood investigations of the patients. 200 patients with concerned consent and meeting the inclusion criteria were included in the study. The necessary clinical and lab details were obtained in a prewritten format. The intraoperative findings were noted and documented precisely. Upon completion of data collection the preoperative bilirubin levels of the perforated and uncomplicated groups wereOther clinical and lab parameters obtained during the study were compared between the two groups. All parameters were subjected to statistical analysis and evaluated critically. Results: A total of 200 patients participated in the study. Of the 200 patients studied 132 patients were males and 68 patients were females. The youngest patient was 13 years old and the oldest 64 years. Among all the patients operated with a diagnosis of Acute Appendicitis 92 were found to have a perforated appendix, and 108 were found to have a non-perforated appendix. It was observed that among 92 patients with perforated appendix 86 patients showed a raised CRP levels and 58 patients had a raised Bilirubin levels. However in case of non-perforated cases it was found that among the 108 cases 82 patients had a raised CRP levels and 36 patients showed raised bilirubin levels. Conclusion: Hence Logistic Regression technique revealed that the C- reactive protein and Hyperbilirubinemia can be used to predict the appendicular perforation preoperatively and that their roles are comparable and that there is no definitive advantage of one over the other for the same.

A Novel Laboratory Marker for Hepatosteatosis: Mean Platelet Volume to Lymphocyte Count Ratio

Objective: Hepatosteatoz (HS), karaciğerde en az %5 kuru ağırlığa denk gelecek şekilde yağ birikmesidir. Sadece Ortalama trombosit hacmi (MPV) değil, aynı zamanda ortalama trombosit hacmi/lenfosit oranı (MPVLR) metabolik ve enflamatuvar durumların bir belirteci olarak bildirilmektedir. Bu çalışmamızda hepatosteatozlu hastaların MPVLR değerini, sağlıklı kontrol grubuyla karşılaştırmayı amaçladık. Ayrıca CRP ile MPVLR arasındaki korelasyonu araştırdık. Yöntem: Kurumumuz iç hastalıkları polikliniklerine 2018 Aralık-2019 Aralık tarihleri arasında başvuran HS’lu hastalar çalışmaya alındı. MPVLR, MPV/Lenfosit formülü ile hesaplandı. Bulgular: HS ve kontrol gruplarının medyan MPVLR değeri sırasıyla %4.3 (2.1) ve %3.6 (1.7) idi (p<0.001). HS ve kontrol gruplarının medyan CRP değeri sırasıyla 3.6 (4.9) mg/L ve 0.4 (0.2) mg/L idi (p<0.001). MPVLR, CRP ile pozitif ve güçlü bir korelasyona sahipti (r=0.64, p<0.001). Buna karşın, MPVLR ile LDL kolesterol, ALT ve trigliserit arasında korelasyon yoktu. Sonuç: Komorbiditesi bulunmayan HS’lu hastalarda artmış MPVLR değeri, hekimler için HS açısından uyarıcı olmalıdır. CRP ile MPVLR arasındaki güçlü pozitif korelasyon, MPVLR’nin de güvenilir bir inflamatuvar belirteç olduğunu düşündürmektedir.

Abstract 17103: Elevated NT-proBNP Level is Not a Prognostic Marker for Patients Hospitalized With SARS-CoV-2 Infection

Introduction: NT-proBNP is a widely available and frequently utilized laboratory marker in patients with congestive heart failure. Its availability and use as a surrogate marker for elevated ventricular filling pressures and ventricular strain that frequently manifests as shortness of breath makes it an attractive laboratory marker to triage patients with SARS-CoV-2 infection. Hypothesis: Elevated NT-proBNP is correlated with higher mortality and/or rate of major adverse cardiovascular events (MACE) in patients admitted with SARS-CoV-2 infection. Methods: A retrospective analysis was performed on 225 patients admitted for SARS-CoV-2 infection at a major metropolitan hospital located in the Southwestern United States from the period of March 2020 to May 2020. NT-proBNP levels were recorded in 117 patients (52.7%) on admission. Elevated NT-proBNP was defined as: above 450 pg/ml in patients less than 50 years old, above 900 pg/ml if 50 to 75 years old, and above 1,800 pg/ml if above 75 years old. The primary endpoint was a composite of MACE and mortality during hospitalization. MACE was defined as stroke, myocardial infarction, DVT or PE and shock requiring vasopressor support. Two-sample Wilcoxon rank-sum (Mann-Whitney) test, Pearson’s chi square test and Fisher’s exact test were utilized for data analysis. Results: Of the 117 SARS-CoV-2 positive patients that had admission NT-proBNP levels available for analysis, 23 (19.66%) met age-adjusted criteria for elevated NT-proBNP. There was no significant correlation between elevated NT-proBNP levels and MACE (p = 0.482) or mortality (p = 0.737) in patients with SARS-CoV-2 infections. There was no statistical difference in total length of stay (p-value = 0.6384) or ICU admission (p-value = 0.354) between those with elevated admission NT-proBNP and those without. Conclusions: An elevated NT-proBNP at time of admission does not significantly correlate with higher rates of MACE, hospital length of stay, ICU admission, and mortality in patients admitted with SARS-CoV-2 infection.

Diagnostic Power of Galectin-3 in Rheumatic Diseases

Background: The purpose of our study was to assess the diagnostic power of galectin-3 and compare its between rheumatic diseases and with routinely used tests such as CRP and ESR. Methods: Eighty-two patients with rheumatoid arthritis (RA), 49 patients with systemic sclerosis (SSc), and 18 patients with systemic lupus erythematosus (SLE) were enrolled in this study. The control group comprised 30 healthy controls. Serum galectin-3 concentration was measured using immunochemical method. Results: The galectin-3 concentration were significantly elevated in the RA, SSc, and SLE in comparison to the controls (p = 0.000, p = 0.000, p < 0.001; respectively). However, there were no significant differences in the serum galectin-3 levels between rheumatic diseases (H = 0.395, p = 0.821). In RA and SSc patients, galectin-3 positively correlated with erythrocyte sedimentation rate (R = 0.332, p = 0.004; R = 0.384, p = 0.009; respectively). ROC analysis revealed that galectin-3 had an excellent diagnostic power in RA (AUC = 0.911) and SSc (AUC = 0.903) and very good for SLE (AUC = 0.859). Conclusion: We concluded that diagnostic power of serum galectin-3 is as great as CRP and ESR in rheumatic diseases and it can be a very good laboratory marker in RA and SSc patients and a useful tool in the diagnosis of SLE.

Criteria for assessing renal allograft dysfunction

The significance of the glomerular filtration rate calculated by the Cockcroft - Gault formula as one of the highly sensitive criteria for assessing renal allograft dysfunction is substantiated. The study demonstrated that in the group of patients with an increased level of daily proteinuria there is a significantly lower level of serum creatine in comparison with the group of patients with a normal level of daily proteinuria. Moreover, in patients with a normal level of daily proteinuria, there are significantly higher values of glomerular filtration rate calculated by the Cockcroft - Gault formula, compared with patients with an increased level of daily proteinuria. Thus, it is shown that the level of serum creatinine currently used in clinical practice, as a laboratory marker of renal allograft dysfunction, does not allow to detect impaired renal allograft function at the earliest possible date. It has been demonstrated that the glomerular filtration rate calculated by the Cockcroft - Gault formula is a highly sensitive and specific laboratory marker of renal transplant dysfunction. Determining the glomerular filtration rate calculated by the Cockcroft - Gault formula makes it possible to diagnose renal allograft dysfunction at the earliest stages, which will significantly improve the survival of the transplanted kidney due to timely changes in patient management tactics and correction of immunosuppressive therapy.