Pancreatic cancer survival prediction via inflammatory serum markers

Background For prognostic evaluation of pancreatic ductal adenocarcinoma (PDAC), the only well-established serum marker is carbohydrate antigen CA19-9. To improve the accuracy of survival prediction, we tested the efficacy of inflammatory serum markers. Methods A preoperative serum panel comprising 48 cytokines plus high-sensitivity CRP (hs-CRP) was analyzed in 173 stage I–III PDAC patients. Analysis of the effect of serum markers on survival utilized the Cox regression model, with the most promising cytokines chosen with the aid of the lasso method. We formed a reference model comprising age, gender, tumor stage, adjuvant chemotherapy status, and CA19-9 level. Our prognostic study model incorporated these data plus hs-CRP and the cytokines. We constructed time-dependent ROC curves and calculated an integrated time-averaged area under the curve (iAUC) for both models from 1 to 10 years after surgery. Results Hs-CRP and the cytokines CTACK, MIF, IL-1β, IL-3, GRO-α, M-CSF, and SCF, were our choices for the prognostic study model, in which the iAUC was 0.837 (95% CI 0.796–0.902), compared to the reference model’s 0.759 (95% CI 0.691–0.836, NS). These models divided the patients into two groups based on the maximum value of Youden’s index at 7.5 years. In our study model, 60th percentile survival times were 4.5 (95% CI 3.7–NA) years (predicted high-survival group, n = 34) and 1.3 (95% CI 1.0–1.7) years (predicted low-survival group, n = 128), log rank p < 0.001. By the reference model, the 60th percentile survival times were 2.8 (95% CI 2.1–4.4) years (predicted high-survival group, n = 44) and 1.3 (95% CI 1.0–1.7) years (predicted low-survival group, n = 118), log rank p < 0.001. Conclusion Hs-CRP and the seven cytokines added to the reference model including CA19-9 are potential prognostic factors for improved survival prediction for PDAC patients.

Association of LpPLA2 with coronary artery disease a hospital-based case control study

Coronary artery disease (CAD) in Asian-Indians is characterised by an earlier onset and more severe disease when compared to Western populations. It is estimated that about 20% of patients presenting with an acute coronary syndrome do not have any of the conventional risk factors for CAD. To assess the risk posed by each of the newer risk factors; alongside conventional risk factors namely diabetes, hypertension, dyslipidaemia for coronary artery disease and to compare the relative risk in a case-control design. Department of Cardiology, XXX Institute of Medical sciences (XXX). Case control study design. Cases are as any individual with coronary artery disease and controls included patients with non-coronary conditions. Dependant variable: coronary artery disease (CAD); Independent variables: Lp PLA2, Lp(a), Apo(a), Apo(b), Ratio (Apo B/Apo A); Other predictors- diabetes mellitus, hypertension, dyslipidaemia, tobacco use Categorical variables were presented as frequencies and percentages. Chi-square test and binary logistic regression analysis was used to study the comparison and association of the categorical risk factors with the disease status, respectively. Software used was SPSS version 20.0. A total of 253 participants aged between 19 and 90 years; 140 cases and 113 controls were enrolled in this study. Except for the hs-CRP level, alcohol consumption and LDL, all the other risk factors were seen significantly associated with the coronary artery disease; dyslipidaemia (10.8, 95% CI 3.29-35.37), gender- male (4.68, 95% CI 2.12-10.30), diabetes mellitus (3.3, 95% CI 1.6 -6.77), lipoprotein(a) more than 30mg% (2.34, 95% CI 1.06-5.15) and hypertension (2.48, 95% CI 1.14-5.39). Conventional risk factors namely diabetes, hypertension and dyslipdaemia showed a statistically significant association with CAD while from among the biochemical markers the association was statistically significant only for Lp(a) when compared both between cases and controls and also in cases &#60; age 50 years. The other biochemical risk factors namely Lp-PLA2, Apo(A1) and Apo(b) showed a weak degree of association with CAD. In the present study we analyse the role of inflammatory mediators of CAD (hs-CRP, Lp-PLA2), pro-thrombotic markers [Lp(a)] alongside the lipid fractions apoB, apo A and their ratio to assess which of these biochemical markers predisposed one to CAD through assessment of the relative risk.

Association of level of IL-6, IL-10, IL-18, tumour necrosis factor-α with rheumatic mitral stenosis and subsequent pulmonary hypertension

Background: Objective of the study was to provide insight on the immune response in patients of rheumatic heart disease, mitral stenosis and evaluation of various cytokines in pulmonary hypertension secondary to rheumatic heart disease.Methods: Total 163 subjects, more than 18 year of age, were enrolled in this study. 84 subjects with rheumatic mitral stenosis (group A) diagnosed on two-dimensional echocardiography (2D echo) and 79 normal healthy volunteers (group B). Patients with mitral stenosis were further divided into subgroups based on severity of mitral stenosis [mitral valve area (MVA >1 cm2 and MVA <1 cm2) (subgroup Aa and Ab)] and presence or absence of pulmonary hypertension [pulmonary arterial systolic pressure (PASP >36 mm Hg) (subgroup Ac and Ad)]. Interleukins IL-6, IL-10, IL-18, tumour necrosis factor alpha (TNF-α) and high-sensitivity C-reactive protein (hs-CRP) levels were assessed in both groups.Results: Mean IL-6, IL-10, IL-18, TNF-α and hs-CRP in group A and group B was 6.57±3.53 and 2.73±1 (p≤0.001), 8.185±2.8 and 3.51±0.86 (p≤0.001), 136.31±89.0 and 47.96±9.76 (p≤0.001), 21.26±18.59 and 5.36±3.57 (p≤0.001), 4.69±6.3 and 2.63±2.22 (p≤0.008) respectively. On subgroup analysis mean TNF-α in subgroup Aa was 20.71±16.84, while in subgroup Ab was 7.56±1.93 (p≤0.001). Mean IL-10 in subgroup Ac and Ad was 8.74±3.29 and 7.47±1.82, respectively. Differences in levels of other cytokines in these subgroups were not found statistically significant.Conclusions: This study finds increased IL-6, IL-10, IL-18, TNF-α and hs-CRP levels in subjects with rheumatic mitral stenosis. Subjects with severe mitral stenosis had increased TNF-α levels. Subjects of mitral stenosis having pulmonary hypertension had increased IL-10 levels.

Korelasi antara High Sensitivity C-Reactive Protein dengan Kadar Glukosa Darah dan Profil Lipid pada Mahasiswa Obesitas Fakultas Farmasi Universitas Pancasila

Obesitas merupakan keadaan dimana terjadi ketidaknormalan atau kelebihan akumulasi lemak dalam tubuh yang disimpan dalam jaringan adiposa. Keadaan obesitas akan mempengaruhi sekresi adiponektin. C-reactive protein merupakan suatu globulin yang disintesis oleh hepatosit, produksi CRP ini diinduksi oleh interleukin-6, interleukin-1 dan tumor necrosis factor α, yang kemudian akan disekresi ke dalam darah. Tujuan dari penelitian ini adalah untuk mengetahui hubungan antara inflamasi dengan gangguan metabolisme karbohidrat dan metabolisme lipid serta mendapatkan data kadar High Sensitivity C-Reactive Protein sebagai penanda inflamasi, Kadar glukosa darah untuk menilai gangguan metabolisme glukosa, sedangkan kolesterol, trigliserida, LDL untuk menilai gangguan metabolisme lipid dan mengetahui hubungan antara High Sensitivity C-Reactive Protein dengan glukosa darah dan profil lipid (kolesterol total, trigliserida dan LDL) pada mahasiswa obesitas Fakultas Farmasi Universitas Pancasila. Penelitian ini dilakukan menggunakan metode observasional dengan rancangan penelitian cross sectional dengan pengambilan data secara consecutive sampling dimana peneliti melalukan pengukuran terhadap indikator obesitas (berat badan, tinggi badan, lingkar pinggang) kadar C-Reactive Protein (CRP) dan profil lipid. Uji statisitik yang digunakan dalam penelitian ini adalah Kolmogorov smirnov, Leaven test dan Spearman. Karakteristik responden berdasarkan parameter indeks massa tubuh didapatkan sebesar 27.54 kg/m2. Distribusi frekuensi pada parameter jenis kelamin yang paling banyak dengan jenis kelamin perempuan sebanyak 74,1%. Rerata lingkar perut sebesar 91.97 cm. Diketahui rata-rata 48,1% mahasiswa obesitas fakultas farmasi mengalami hiperglikemia, 48,1% mengalami hiperkoleterolemia, 37% hipertrigliseridemia, 88,9% hiperbetalipoprotenemia dan 29,6% mahasiswa memiliki kadar hs-CRP > 3 mg/L. Terdapat hubungan bermakna antara hs-CRP dan indeks massa tubuh (r = 0.503 dan p = 0.007) serta didapatkan juga hubungan bermakna antara indeks massa tubuh dan tekanan darah diastolik (r= 0.506 dan p = 0.007). Dapat disimpulkan bahwa indeks massa tubuh (IMT) berkolerasi dengan hs-CRP dan tekanan darah diastolik.

Using Machine Learning to Evaluate the Role of Microinflammation in Cardiovascular Events in Patients With Chronic Kidney Disease

BackgroundLipid metabolism disorder, as one major complication in patients with chronic kidney disease (CKD), is tied to an increased risk for cardiovascular disease (CVD). Traditional lipid-lowering statins have been found to have limited benefit for the final CVD outcome of CKD patients. Therefore, the purpose of this study was to investigate the effect of microinflammation on CVD in statin-treated CKD patients.MethodsWe retrospectively analysed statin-treated CKD patients from January 2013 to September 2020. Machine learning algorithms were employed to develop models of low-density lipoprotein (LDL) levels and CVD indices. A fivefold cross-validation method was employed against the problem of overfitting. The accuracy and area under the receiver operating characteristic (ROC) curve (AUC) were acquired for evaluation. The Gini impurity index of the predictors for the random forest (RF) model was ranked to perform an analysis of importance.ResultsThe RF algorithm performed best for both the LDL and CVD models, with accuracies of 82.27% and 74.15%, respectively, and is therefore the most suitable method for clinical data processing. The Gini impurity ranking of the LDL model revealed that hypersensitive C-reactive protein (hs-CRP) was highly relevant, whereas statin use and sex had the least important effects on the outcomes of both the LDL and CVD models. hs-CRP was the strongest predictor of CVD events.ConclusionMicroinflammation is closely associated with potential CVD events in CKD patients, suggesting that therapeutic strategies against microinflammation should be implemented to prevent CVD events in CKD patients treated by statin.

ỐI TƯƠNG QUAN GIỮA NỒNG ĐỘ HS-CRP VỚI MỘT SỐ CHỈ SỐ XÉT NGHIỆM HÓA SINH LIÊN QUAN TRÊN BỆNH NHÂN ĐÁI THÁO ĐƯỜNG TYP 2

Mở đầu: Tình trạng viêm kéo dài gây nên các biến chứng mạch máu trong bệnh đái tháo đường. Nếu không được kiểm soát và điều trị kịp thời bệnh nhân có thể tàn phế, tử vong. Xét nghiệm hs-CRP máu như một chỉ dấu sinh học hữu ích của tình trạng viêm mạch mạn tính, nhằm hỗ trợ chẩn đoán, theo dõi điều trị và phát hiện biến chứng một cách hiệu quả cho bệnh nhân đái tháo đường typ 2. Mục tiêu: Khảo sát mối liên quan giữa nồng độ hs-CRP máu với các chỉ số xét nghiệm hóa sinh (glucose máu đói, HbA1c, lipid máu) trên bệnh nhân đái tháo đường typ 2. Đối tượng: 238 người chia 2 nhóm: Nhóm bệnh gồm 118 bệnh nhân đái tháo đường typ 2 và nhóm chứng gồm 120 người bình thường khỏe mạnh, có độ tuổi và giới tính tương đương với nhóm bệnh. Phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang có đối chứng. Bệnh nhân được khám lâm sàng, khai thác tiền sử, bệnh sử, lấy máu tĩnh mạch lúc đói định lượng nồng độ hs-CRP, glucose, HbA1c, cholesterol toàn phần, LDL-C, HDL-C và triglyceride. Chẩn đoán đái tháo đường typ 2 theo tiêu chuẩn của ADA 2020. Kết quả: Nồng độ trung bình hs-CRP máu (mg/L) của nhóm bệnh và nhóm chứng lần lượt là 3,9 ± 1,7 so với 1,7 ± 1,1mg/L (p<0.001). Sự khác biệt này có ý nghĩa thống kê. Bệnh nhân có nồng độ hs-CRP ở các mức độ nguy cơ cao và nguy cơ trung bình đối với bệnh tiểu đường typ 2 rất phổ biến (99,2%). Trong đó, tỷ lệ phần trăm bệnh nhân ở các mức cao, trung bình và thấp lần lượt là 72,9; 26,3 và 0,8. Nồng độ hs-CRP máu tương quan thuận với glucose, HbA1c, cholesterol toàn phần, LDL-C và triglyceride, tương quan nghịch với HDL-C. Kết luận: Nồng độ trung bình hs-CRP máu của người mắc đái tháo đường typ 2 cao hơn người không mắc đái tháo đường typ 2. Có mối tương quan thuận và có ý nghĩa thống kê giữa hs-CRP với glucose, HbA1c, cholesterol toàn phần, LDL-C và triglyceride, tương quan nghịch với HDL-C.

Inflammatory Cytokines, Adipocytokines, and Th17/Treg Balance in Patients with Nonalcoholic Fatty Liver Disease following Administration of Dahuang Zhechong Pills

Objectives. The occurrence and development of nonalcoholic fatty liver disease (NAFLD) is related to lipid peroxidation, imbalance of inflammatory response factors, and immune function disorder. This study was conducted with the purpose of investigating the expression levels of inflammatory cytokines and adipocytokines and Th17/Treg balance in NAFLD patients treated with Dahuang Zhechong pills (DHZCPs). Methods. The study recruited 100 NAFLD patients who were then arranged into the test group and control group. Patients in the test group were treated with DHZCPs, while patients in the control group were untreated. Peripheral TH17 and Treg cells were detected by flow cytometry, and peripheral IL-17, IL-10, hs-CRP, and TNF-α expression levels were determined by enzyme-linked immunosorbent assay (ELISA) methods. The concentrations of ghrelin, leptin, and adiponectin were quantitatively examined. Results. The levels of TC, TG, ALT, and AST were declined but the level of HDL-C was increased in NAFLD patients treated with DHZCPs compared with untreated patients ( P < 0.05 ). The ratio of Th17/Treg in NAFLD patients treated with DHZCPs was (1.52 ± 0.21), which was significantly lower than (2.39 ± 0.45) of untreated patients ( P < 0.05 ). The levels of IL-17, hs-CRP, and TNF-α were lower, but the level of IL-10 was higher in NAFLD patients treated with DHZCPs than that in untreated patients ( P < 0.05 ). The expression levels of ghrelin and adiponectin in NAFLD patients treated with DHZCPs were evidently higher than those in untreated patients ( P < 0.01 ), and the expression level of leptin in NAFLD patients treated with DHZCPs was evidently lower than that in untreated patients ( P < 0.01 ). Conclusions. Administration of DHZCPs regulates the immune function of NAFLD patients by keeping Th17/Treg balance and affecting the levels of inflammatory cytokines and adipocytokines.

Association between baseline and changes in high-sensitive C-reactive protein and metabolic syndrome: a nationwide cohort study and meta-analysis

Background We aimed to prospectively evaluate the associations between the baseline and changes in high-density C-reactive protein (hs-CRP) and incident metabolic syndrome (MetS) in China and update the evidence based on a meta-analysis of cohort studies in different populations. Methods Data from the China Health and Retirement Longitudinal Study among adults aged 45 years or older were analyzed. Participants who were recruited in the study in 2011–2012 without MetS and successfully followed up to 2015–2016 were included in our final analysis. Logistic regressions were applied to examine the prospective associations of baseline and changes in hs-CRP with incident MetS and estimate corresponding odds ratios (ORs) and 95% confidence intervals (95% CIs). A meta-analysis was conducted to synthesize effect estimates from our findings and other cohort studies on this topic. Results Among 4,116 participants, 535 developed MetS after a 4-year follow-up. Compared with the participants with hs-CRP in the lowest quartile, those with hs-CRP in the second, third, and highest quartiles had higher odds of MetS, with multivariable-adjusted ORs (95% CIs) of 1.51 (1.12, 2.06), 1.50 (1.11, 2.04), and 1.83 (1.37, 2.47). For the hs-CRP changes, ORs (95% CIs) were 3.24 (2.51, 4.02), 3.34 (2.56, 4.38), and 3.34 (2.54, 4.40) respectively. One unit (log of 1 mg/L) increase in hs-CRP was associated with 23% higher risk of MetS (OR 1.23; 95% CI 1.10, 1.38). In a meta-analysis of 6 cohort studies, the pooled relative risk for MetS was 1.63 (1.38, 1.93) for the highest versus lowest level of hs-CRP. In addition, the pooled relative risk for MetS was 1.29 (1.05, 1.59) for each unit increase of hs-CRP after log-transformation. Conclusions Both higher baseline hs-CRP and longitudinal hs-CRP increases were associated with higher risks of incident MetS. Individuals with high hs-CRP levels may need to be closely monitored for future risk of MetS.

Correlation Analysis of Acute Coronary Syndrome with Serum IL-18, MMP-9, hs-CRP, and Plasma FIB

Aim. This study attempted to investigate the diagnostic value of interleukin-18 (IL-18), matrix metalloproteinase-9 (MMP-9), high-sensitivity C-reactive protein (hs-CRP), and fibrinogen (FIB) in acute coronary syndrome (ACS) and their correlation with the degree of vascular lesions. Materials and Methods. Altogether 206 patients with coronary heart disease admitted to our hospital were selected as research objects, including 136 patients with ACS (group A), 70 patients with stable angina pectoris (SAP) (group B), and 60 patients with noncoronary heart disease who had normal coronary angiography during the same period were selected as group C. The levels of IL-18, MMP-9, and hs-CRP in the serum were detected by enzyme-linked immunosorbent assay (ELISA), and the level of FIB in plasma was detected by automatic coagulation analyzer. Results. Serum IL-18, MMP-9, hs-CRP, and plasma FIB levels in group A were significantly higher than those in group B and group C ( p < 0.05 ). ROC curve and multivariate logistic regression showed that the sensitivity and specificity of combined diagnosis of ACS with serum IL-18, MMP-9, hs-CRP, and plasma FIB were 86.03% and 95.71%, respectively. Serum IL-18, MMP-9, hs-CRP, and plasma FIB were positively correlated with Gensini grading ( p < 0.001 ). Serum IL-18, MMP-9, hs-CRP, and plasma FIB levels were positively correlated ( p < 0.001 ). Conclusion. The combined detection of serum IL-18, MMP-9, hs-CRP, and plasma FIB has good diagnostic value for ACS, and these index levels are positively correlated with the degree of vascular lesions.