Especially in rare and aggressive cancer types, such as ULMS, reliable prognostic parameters are of particular interest. Studies investigating clinical prognostic parameters such as tumor stage or histological grade inpatientswith ULMS have shown inconsistent results. On the one hand a report from Kapp et al. showed an independent influence of tumor stage and histologic grade on survival whereas Hoang et al. did not describe an influence of tumor grade on patient’s survival. Zivanovic et al. showed that FIGO stage does not perform well in terms of predicting overall survival (OS) inpatientswith ULMS [4–6]. C-reactiveprotein (CRP) is a readily available and cheap laboratory parameter, that is widely used in clinical routine as the most important acute phase serumprotein to monitor infection. Besides being induced inthe acute phase of inflammatory response, CRP has been shown to be elevated inpatientswith a variety of cancer types and an association with prognosis was found. In particular elevated CRP serumlevels have been associated with impaired survival inpatients suffering from gynae- cologic malignancies including cervical, ovarian, and endometrial cancer [7–9]. In addition several studies investigated the clinical significance of CRP serumlevelsin soft tissue sarcoma . Therefore, this study set out to evaluate whether pre-treatment CRP serumlevels might be used as novel prognostic parameter inpatientswith ULMS.
Postoperative infectious complications are one ofthe most important problems in surgical treatment of colorectal cancer (CRC), being present in up to 40% ofpatients 1 . Leakage of ana- stomosis created during surgical treatment is the most severe treatment complication, posing dilemmas for surgeons as to the prevention, early detection, and appropriate further treatment. Not only that it significantly impacts postoperative morbidity and mortality 2, 3 , quality of life 4 , prolongs length of hospital stay and increases treatment costs 2, 5 , but is largely correlated with local recurrence rates and reduced tumor-specific survival ofpatients 6 . The reported leak rate varies, between 3% to 19%, depending on the definition 2, 3, 7–9 . It is more common after rec- tal surgery, between 8% and 14% 3, 8, 10, 11 , compared to the co- lon, ranging from 3% to 7% 12, 13 . Early detection of this, potentially most dangerous complication, inthe absence of clear clinical manifestations, would make possible early introduction of appropriate therapeutic measures intended to alleviate or eli- minate adverse effects. The possibility of anticipating a postope- rative course without complications inthe era of adoption ofthe Enhanced Recovery After Surgery (ERAS) 14 protocol, is of sig- nificance with regard to earlier patient discharge and shorter length of hospital stay.
mechanisms regulating PCT levelsin these diseases. CRP is an acute phase inflammatory protein and used as a common clinical inflammatory marker. Serum CRP levelsin normal healthy individuals are extremely low but can significantly increase during stress conditions. In this study, PCT and CRP levelsin adult HSP patientswith GI involvement were higher compared to patients without GI involvement. Among thepatientswith GI involvement, those with GI bleeding had even higher PCT and CRP levels. A positive correlation between PCT and CRP in HSP patientswith GI involvement and GI bleeding was observed. It is worth noting that the elevated PCT levels were minor, with a median value below the threshold for systemic bacterial infections (0.5ng/ml). Our findings were partially consistent withthe study conducted in children with HSP. The authors in that study found that mild elevated serum PCT le - vels were significantly associated with GI bleeding but not CRP 20 . The difference between the two studies may
Deep venous thrombosis (DVT) is a common surgical complication in cancer patients and evidence that inflammation plays a role inthe occurrence of DVT is increasing. We studied a population of cancer patientswith abdominal malignancies withthe aim of investigating whether thelevelsof circulating inflammatory cytokines were associated with postoperative DVT, and to determine thelevelsin DVT diagnoses. TheserumlevelsofC-reactiveprotein (CRP), interleukins (IL)-6 and IL-10, nuclear transcription factor-kB (NF-kB) and E-selectin (E-Sel) were determined in 120 individuals, who were divided into 3 groups: healthy controls, patientswith and patients without DVT after surgery for an abdominal malignancy. Data were analyzed by ANOVA, Dunnet’s T3 test, chi-square test, and univariate and multivariate logistic regression as needed. The CRP, IL-6, NF- kB, and E-Sel levelsinpatientswith DVT were significantly higher than those inthe other groups (P,0.05). The IL-10 level was higher inpatientswith DVT than in controls but lower than inpatients without DVT. Univariate analysis revealed that CRP, IL-6, NF-kB, and E-Sel were statistically associated withthe risk of DVT (OR=1.98, P=0.002; OR=1.17, P=0.000; OR=1.03, P=0.042; and OR=1.38, P=0.003; respectively), whereas IL-10 had a protective effect (OR=0.94, P=0.011). Multivariate analysis showed that E-Sel was an independent risk factor (OR=1.41, P=0.000). Thus, this study indicated that an increased serum level of E-Sel was associated with increased DVT risk in postoperative patientswith abdominal malignancy, indicating that E-Sel may be a useful predictor of diagnosis of DVT.
Forty-eight patients, who were hospitalized and treated withthe diagnosis of PE inthe Pulmonary Diseases Clinic of our hospital between December 2014 and December 2015 were enrolled inthe study. Patients who did not have any clinical signs of infec- tion (such as fever, cough, or sputum) or high laboratory param- eters (such as C-reactiveprotein and procalcitonin) and whose patient charts were available for investigation, were included inthe study. Following approval ofthe local ethics committee, patients’ charts were retrospectively analyzed via the digital archive system. Their demographic data (age, gender, medi- cal history), duration of hospital stay, comorbidities, chronic treatments administered, and the units in which they had been followed-up for acute phase and maintenance embolism treat- ments (clinic/intensive care unit) were recorded. Thepatients were classiied as low mortality (stable hemodynamic status and absence of right ventricular dysfunction); intermediate mortality risk group (stable hemodynamic status and presence of right ventricular dysfunction in radiological or laboratory in- vestigations); and high mortality (unstable hemodynamic sta- tus), according to the Turkish Thoracic Society 2015 Consensus Report on Diagnosis and Treatment of Pulmonary Thromboem- bolism. Patientswith low mortality risk were named as Group 1, and patients having intermediate-low, intermediate-high, and high risks were joined into one group and named as Group 2. The hemogram results ofpatients who had no identiied infec- tions, obtained at the time of diagnosis and as part of discharge from the hospital were retrospectively evaluated. The routine hemogram parameters, white blood cell count (WBC), neutro- phil and lymphocyte counts were recorded together withthe mean platelet volume (MPV). By dividing the neutrophil count by the lymphocyte count, the neutrophil lymphocyte ratio, which is one ofthe nonselective inlammatory markers, was calculated.
The most significant finding ofthe current study was the changes in sensitivity, specificity, and consequently PPV and NPV of CRP in AA diagnosis, which corresponded to the main objective of this study. Higher sensitivity was observed with increasing BMI (91.3% in subjects with obesity, 84.3% in overweight BMI, and 69.3% in lean/normal BMI subjects); however, this increase in sensitivity is of course at the expense of specificity test loss. This finding is understandable, since, as discussed above, CRP is increased at baseline levelsin individuals with obesity, even without an appendicitis diagnosis. However, surgeon’s questions regarding the patient with abdominal pain, such as “Is this appendicitis or not?”, or “Should I operate or not?”, are better supported by stronger specificity. Stronger specificity will show that a normal test suggests against AA diagnosis, or, seen differently, how much ofthe test change actually is due to AA, despite obesity as a confounding variable. Therefore, high CRP values in subjects with obesity should be less appreciated than in a normal BMI subject, due to the risk to incur in a false positive case.
19 artigos encontrados na busca original protein was chosen for combination withthe terms acute coronary syndromes, myocardial infarction, and unstable angina, resulting in a total of three combinations of two terms connected by the preposition AND. After reading ofthe titles and summaries retrieved, the studies withthe following characteristics were selected: prospective cohort design ofpatientswith non-ST elevation ACS, and assessment oftheprognosticvalueofC-reactiveprotein, as measured by a high-sensitivity method at the moment of hospital admission.
ABSTRACT: Ischemic stroke is one ofthe most common causes of death worldwide and is most often caused by thrombotic processes. The study was based on 50 patientswith ischemic stroke; coming to SGDRIMSR, Amritsar. In this study the level of hsCRP was estimated which is one ofthe risk factors in cases of acute ischemic stroke and the relationship between its levels and the short term prognosis was evaluated. Patientswith history of acute infection or injury inthe past 10-14 days before admission, suffering from Diabetes Mellitus, Pregnancy/Nursing Mothers, with Acute Liver disease, with history of Rheumatoid Arthritis, Osteoarthritis or malignancy, with history of skeletal muscle disease, with heart disease which could have led to embolism such as atrial fibrillation or Valvular disease, with thyroid or renal dysfunction were excluded from the study. It was concluded that acute ischemic stroke had higher circulating serum high sensitive CRP and the high sensitive CRP levels was maximum after 2 days ofthe stroke. Short term unfavorable prognosis seems to be associated with elevated serum high sensitive CRP levelsinpatientswith ischemic stroke in our study.
A decline inthe release of acute phase reactants by the liver is observed postopera- tively in non-uremic elderly patients under- going major abdominal surgery (16). In these patientsthe decreased release of liver-syn- thesized acute phase reactants was associ- ated with an impairment of hepatocyte func- tion. Inthe present study, HCV+ patients tended to have lower hsCRP levels compared to HCV- patients. This finding agrees with several lines of evidence previously reported inthe literature. Stevens et al. (17) showed that CRP levels were significantly higher in HCV- patients compared to HCV+ patients. Shima et al. (18) compared the expression of CRP by immunohistochemical analysis in HCV+ patients and inpatientswith hepatitis B and concluded that the intensity of CRP expression inpatientswith hepatitis B was closely associated withthe progression ofthe disease but this finding was not repro- duced in HCV+ patients. Finally, Lin et al. (19) evaluated non-uremic cirrhotic patients regarding the elevation of CRP in response to bacterial infection and showed that a higher CRP cut-off value had to be applied to detect these episodes. Inthe present study, the presence of a significant difference inthe hsCRP/IL-6 ratio in HCV+ patients might indicate that hepatocellular injury could af- fect CRP production in HCV+ HD patients, although no difference in IL-6 levels could be detected between HCV+ and HCV- patients. It remains controversial whether alter- ations in Th cell subpopulations contribute to the pathogenesis and clinical characteristics of chronic hepatitis C (20). Th1 and Th2 cells are involved inthe response to various stimuli, such as infection, CKD and HD itself (21). More recently, it has been debated if a shift inthe balance between the Th2 and Th1 immune responses may play a role inthe progress of chronic hepatitis (15,22). Re- cently, in a study on non-renal HCV+ and HCV- patientswith Sjögren syndrome, an
Forty-seven patients on regular hemodi- alysis for at least 3 months, all dialyzed with a cellulose tri-acetate membrane, represent- ing 94% ofthe total patientsofthe unit, were studied before the water system change. Eight patients were excluded because of obvious inflammatory activity either at the initial or at the final evaluation. Reasons for exclusion were having a central venous cath- eter, urinary tract infections, respiratory in- fections, infected skin ulcers, and colecystitis. Sixteen patients eventually died for several reasons and were also excluded. Three to 6 months after the change inthe purification system, 23 patients were reevaluated. De- mographic, clinical and laboratory data and the water parameters were recorded on both occasions. Nutritional evaluation was also performed using subjective global assess- ment (SGA) (16-18). Blood was collected from each patient before a hemodialysis session for serum albumin, CRP, interleukin- 6 (IL-6), and tumor necrosis factor-alpha (TNF-α) determination. High sensitivity CRP was determined by nephelometry and the cytokines were determined by ELISA (R&D Systems, Inc., Minneapolis, MN, USA).
vasospasm. Furthermore, the elevated CRP levels were associated with worse clinical outcome, as expressed in GOS. Our strict inclusion criteria minimized the inluence of other confounding factors such as systemic infection or concomitant systemic conditions, and statistical analysis is compelling to deine the inluence of CRP levels on vasospasm occurrence and neurological inal outcomes. Unfortunately, the clinical signiicance of elevated serum CRP measurements inpatients sustaining aSAH is confounded by the fact that most of these patients may have other concomitant systemic infections or pathological conditions that could potentially result in increased CRP serum concentrations. Additionally, the surgical manipulation in these patients could inluence the systemic CRP levels.
Chagas disease is a public health problem worldwide. The availability of diagnostic tools to predict the development of chronic Chagas cardiomyopathy is crucial to reduce morbidity and mortality. Here we analyze theprognosticvalueof adenosine deaminase serum activity (ADA) and C-reactiveproteinserumlevels (CRP) in chagasic individuals. One hundred and ten individuals, 28 healthy and 82 chagasic patients were divided according to disease severity in phase I (n = 35), II (n = 29), and III (n = 18). A complete medical history, 12-lead electrocardiogram, chest X-ray, and M-mode echocardiogram were performed on each individual. Diagnosis of Chagas disease was confirmed by ELISA and MABA using recombinant antigens; ADA was determined spectrophotometrically and CRP by ELISA. The results have shown that CRP and ADA increased linearly in relation to disease phase, CRP being significantly higher in phase III and ADA at all phases. Also, CRP and ADA were positively correlated with echocardiographic parameters of cardiac remodeling and with electrocardiographic abnormalities, and negatively with ejection fraction. CRP and ADA were higher inpatientswith cardiothoracic index ≥ 50%, while ADA was higher inpatientswith ventricular repolarization disturbances. Finally, CRP was positively correlated with ADA. In conclusion, ADA and CRP are prognostic markers of cardiac dysfunction and remodeling in Chagas disease.
We also investigated markers of systemic inflamma- tion, including C-reactiveprotein and SAA, and correlated them with COPD. Some studies have demonstrated el- evated C-reactiveproteinlevelsin COPD during exacer- bations, indicating the possible presence of infection (10,38), and in stable COPD patients (39,40), and elevated SAA levelsin asthma. No expressive increase inC-reac- tive protein was observed, a finding that might be ex- plained by the fact that the population consisted of stable severe patients. Curiously, SAA and C-reactiveprotein, even within the reference values ofthe kit, were found to be more elevated in group 2, withthe increase in SAA being significant when compared to group 1.
Objectives: Our aim was to evaluate the relationship between serumC-reactiveprotein (CRP) levels and the neurological prognosis and development of vasospasm inpatientswith aneurysmal subarachnoid hemorrhage (aSAH). Methods: Eighty-two adult patientswith aSAH diagnoses were prospectively evaluated. Glasgow Coma Scale (GCS) score, Hunt and Hess grade, Fisher grade, cranial CT scans, digital sub- traction angiography studies and daily neurological examinations were recorded. Serial serum CRP measurements were obtained daily be- tween admission and the tenth day. Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRS) were used to assess the prognosis. Results: Serum CRP levels were related to severity of aSAH. Patientswith lower GCS scores and higher Hunt and Hess and Fisher grades presented statistically significant higher serum CRP levels. Patientswith higher serum CRP levels had a less favorable prognosis. Conclu- sions: Increased serum CRP levels were strongly associated with worse clinical prognosis in this study.
Materials and Methods: In this semi experimental study, thirty female patientswith at least one coronary artery stenosis (more than70%) were chosen and divided into two groups of aerobic training (n=15) and control (n=15). Blood samples were obtained at the beginning and end ofthe study to measure brain natriuretic peptide (BNP) and C-reactiveprotein (CRP) levels. The aerobic group cycled on a stationary ergometer for three sessions per week (period of eight weeks). The control group did not receive any exercise. Each exercise session included a10-minute warm-up, a 15-minute or more aerobic training program and a 5-minute cool-down. Inthe warm-up and cool-down stages, running, walking and stretching activities were used. During the first week of training, subjects exercised for 15 minutes at 55-60% of their target heart rates. Each week, exercise duration extended by five minutes, while the intensity was unchanged.
Inthe study group, MMP-3 levels were associated and were an independent predictor for the progressi- on of structural damage. Any increase in MMP-3 by 1 ng/ml elevated the likelihood of cartilage damage de- terioration by 4%. These results did not depend on BMI, treatment or polyarticular involvement. Based on these data, a ROC curve was constructed which set a valueof 40.8 ng/ml as the boundary between the pro- gressors and the non-progressors. Therefore, the pre- dictive valueofserum MMP-3 levels for subsequent structural changes suggests that MMP-3 alone or in combination with other prognostic biomarkers may be used as a surrogate indicator for KOA patientswith more rapid progression of cartilage damage. Theoreti- cally, patientswith higher levelsof MMP-3 should be treated more aggressively inthe early stages ofthe di - sease in order to conserve cartilage.
Low-grade inflammation is most likely not the pre- dominant causal factor of decreased fitness in DM because subjects in our sample had DM and CRP levels that were within the normal range. However, previous studies have reported elevated plasma CRP levelsin subjects with DM (3,10). Smoking status and character- istics, such as duration of smoking, pack-years smoked, and duration of abstinence from smoking, are important factors, but not usually controlled in studies that evaluate the influence of inflammatory markers and cardiorespira- tory fitness and pulmonary function (24). These factors per se are closely associated with various markers of inflammation, including CRP, in men (25). In this study, current smoking status and a past history of smoking were exclusion criteria to minimize this confounder. However, we cannot exclude the influence of other possible confounders, such as the use of medications. It is impossible to estimate their effects, if any, particularly during exercise. In any case, it is known that medications commonly used by diabetic individuals, such as hypogly- cemic drugs, angiotensin-converting enzyme inhibitors, and simvastatin can potentially affect CRP levels (26-28). On the other hand, high CRP levels have been observed in diabetic patients treated with oral hypoglycemic drugs and/or insulin (29). In addition, diabetic individuals evaluated in previous studies that found correlations between CRP and fitness or pulmonary function were Table 3. Pulmonary function test parameters.
Blood samples were collected immediately before initializing EC, T 0; in 10 minutes, T 10; and in 30 minutes, T 30 . Plasma TBARS levels were measured according to the method of Buege & Aust  and Lapenna et al. [9,10]. Briefly, 0.5 ml of ethylene diamine tetra-acetic acid plasma was added to a reaction mixture (1.0 ml) formed by equal parts of 15% trichloroacetic acid, 0.25 N hydrochloric acid, and 0.375% thiobarbituric acid, plus 2.5 mM butylated hydroxytoluene and 0.1 ml of 8.1% sodium dodecyl sulfate, followed by 30 min heating at 95ºC; pH valueofthe analytical reaction mixture was about 0.9. Butylated hydroxytoluene was used to prevent lipid peroxidation during heating. After cooling, the chromogen was extracted with n-butanol and read spectrophotometrically at 532 nM. CReactiveProtein (Bioclin ® , High-sensitive CReactiveProtein K079) was
METHODS: Forty-seven elderly Brazilian subjects ( ≥ 65 years old) with LDL cholesterol (LDL-c) ≥ 130 mg/dL were randomly assigned, in a double-blinded manner, to receive either placebo (n = 23) or 20 mg/day of atorvastatin (n = 24) for 4 weeks. Exclu- sion criteria included diabetes, serious hypertension, obesity, steroid use, hormone replacement, and statin use within the previous six months. All patients underwent clinical examinations, laboratory tests (glucose, lipids, liver enzymes, creatine phosphokinase and high sensitivity C-reactiveprotein) and assessment of vasomotor function by high-resolution ultrasound examination ofthe brachial artery (flow-mediated dilation and sublingual nitrate), both before and after treatment.
Despite the presence of signiicantly higher serumlevelsinthepatientswith abdominal sepsis, the accuracy ofthe CRP values for the diferential diagnosis between pulmonary and abdominal sepsis could not be deinitively established in this study. he main limitation was the retrospective nature ofthe analysis, withthe loss of a large number of measurements. Furthermore, the CRP levels could not be correlated with surgical trauma because this information had not been evaluated and because the procedures or complications that could have interfered withthe CRP kinetics were not identiied inthe medical records. However, studies conducted in ideal scenarios to assess the real signiicance ofthe CRP in discriminating the infection site (with all ofthe possible variables controlled) would have little applicability at the bedside. herefore, other markers, such as procalcitonin and IL-6, should be investigated in future studies.