Is C-reactive protein to albumin ratio an indicator of poor prognosis in Bell's palsy?

Review of the Predictive Value of Biomarkers in Sepsis Mortality

Sepsis is a leading cause of mortality among severely ill individuals, primarily due to its potential to induce fatal organ dysfunction. For clinicians, it is vital to have appropriate indicators, including the physiological status and personal experiences of patients with sepsis, to monitor the condition and assess prognosis. This approach aids in preventing the worsening of the illness and reduces mortality. Recent guidelines for sepsis focus on improving patient outcomes through early detection and timely treatment. Nonetheless, identifying severe cases and predicting their prognoses remain challenging. In recent years, there has been considerable interest in utilising the C-reactive protein (CRP)/albumin ratio (CAR) to evaluate the condition and forecast the prognosis of patients with sepsis. This research concentrates on the significance of CAR in the pathological process of sepsis, its association with prognosis, and the latest developments in employing procalcitonin, lactic acid, CRP, and other potential biomarkers. The CAR, with its predictive value for sepsis prognosis and mortality, is increasingly used as a clinical biochemical marker in diagnosing and monitoring patients with sepsis.

Depressive disorder and elevated risk of bell's palsy: a nationwide propensity score-weighting study

BACKGROUND

Prior studies have reported a potential relationship between depressive disorder (DD), immune function, and inflammatory response. Some studies have also confirmed the correlation between immune and inflammatory responses and Bell's palsy. Considering that the pathophysiology of these two diseases has several similarities, this study investigates if DD raises the risk of developing Bell's palsy.

METHODS

This nationwide propensity score-weighting cohort study utilized Taiwan National Health Insurance data. 44,198 patients with DD were identified as the DD cohort and 1,433,650 adult subjects without DD were identified as the comparison cohort. The inverse probability of treatment weighting (IPTW) strategy was used to balance the differences of covariates between two groups. The 5-year incidence of Bell's palsy was evaluated using the Cox proportional-hazard model, presenting results in terms of hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

The average age of DD patients was 48.3 ± 17.3 years, and 61.86% were female. After propensity score-weighting strategy, no significant demographic differences emerged between the DD and comparison cohort. The Cox proportional hazards model revealed a statistically significant adjusted IPTW-HR of 1.315 (95% CI: 1.168-1.481) for Bell's palsy in DD patients compared to comparison subjects. Further independent factors for Bell's palsy in this model were age (IPTW-HR: 1.012, 95% CI: 1.010-1.013, p < 0.0001), sex (IPTW-HR: 0.909, 95% CI: 0.869-0.952, p < 0.0001), hypertension (IPTW-HR: 1.268, 95% CI: 1.186-1.355, p < 0.0001), hyperlipidemia (IPTW-HR: 1.084, 95% CI: 1.001-1.173, p = 0.047), and diabetes (IPTW-HR: 1.513, 95% CI: 1.398-1.637, p < 0.0001) CONCLUSION: This Study confirmed that individuals with DD face an elevated risk of developing Bell's palsy. These findings hold significant implications for both clinicians and researchers, shedding light on the potential interplay between mental health and the risk of certain physical health outcomes.

Prognostic Value of Electroneuronography in Severe Cases of Facial Palsy

OBJECTIVE

To examine the prognostic value of electroneuronography (ENoG) in predicting functional recovery in severe cases of acute facial palsy.

METHODS

Patients with severe degrees of facial palsy (initial House-Brackmann [HB] grades IV to VI) with available electrodiagnostic studies conducted 2-4 weeks after symptom onset were reviewed retrospectively. The patients were categorized into "good recovery" and "poor recovery" groups, with the former showing mild to no dysfunction (HB I to III) and the latter exhibiting moderate to severe dysfunction (HB IV to VI) on follow-up evaluation, 2 months after onset. ENoG amplitudes in four facial muscles (frontalis, nasalis, orbicularis oculi, and orbicularis oris), as well as age, sex, affected side, disease etiology, comorbidities, and laboratory findings, were compared between the two groups.

RESULTS

Thirty-seven patients were included. Twenty-nine of the patients showed "good recovery," and eight showed "poor recovery" at 2 months after symptom onset. Univariate analysis yielded no significant difference in age, sex, affected side, disease etiology, comorbidities, and laboratory findings between the two groups. Preserved ENoG amplitudes (individual, average, and trimmed means) were significantly higher in the good recovery group than in the poor recovery group (p<0.005). Sex (p=0.038) and the ENoG of the nasalis muscle, acquired 2-4 weeks from symptom onset (p=0.004), showed significant differences in multivariate regression analysis.

CONCLUSION

This study suggests that the female sex and lower ENoG of the nasalis muscle, acquired 2-4 weeks from symptom onset, have negative prognostic value for the 2-month functional outcome of severe facial palsy cases.

The Comparison of Inflammatory Markers for the Prediction of Recurrence of the Nasal Polyp After Endoscopic Sinus Surgery

During the past decade, several inflammation-based periferic prognostic systems have been reported in the field of chronic rhinosinusitis with nasal polyps (CRSwNP). Recently, C-reactive protein (CRP) and albümin ratio (CAR) showed its impact on a large variety of diseases conditions that cause chronic inflammation. We aimed to compare the inflammatory markers in patients with recurrent and non-recurrent nasal polyps and if a significant inflammatory profile is associated with multiple recurrences. The study concerned 144 patients who underwent FESS for CRSwNP from 2012 to 2017 and had a postoperative follow-up longer than 12 months and 120 healthy individuals. We evaluated the impact of the CAR, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio, eosinophil-to-lymphocyte ratio (ELR) between patients with and without polyp recurrences and control groups. There was a statistically significant difference in CRP, CAR and ELR values between multiple recurrence group and no-recurrence group (p = 0.02; 0.004; 0.019 respectively), mean eosinophil and CRP values, CAR, NLR and ELR was significantly higher in NP patients than control group (p < 0.001). The receiver operating curve analysis showed CAR and ELR as a potential marker of recurrence of NP (AUC = 0.713 and 0.613, respectively p < 0.001). The cutoff values for were 1.03 for CAR and 0.22 for ELR. The mean CRP, CAR and ELR were significantly higher in patients with CRSwNP whose disease recurred after surgery. CAR may be a potential marker to predict the recurrence before endoscopic sinus surgery as well as ELR in CRSwNP disease.

Role of Biomarkers as Prognostic Factors in Acute Peripheral Facial Palsy

Acute peripheral facial palsy (APFP), including Bell's palsy and Ramsay Hunt syndrome, is a disease that affects daily life through facial motor dysfunction, causing psychological problems. Various tests to evaluate prognosis have been studied; however, there are no validated predictive biomarkers to guide clinical decision making. Therefore, specific biomarkers that respond to treatment are required to understand prognostic outcomes. In this review, we discuss existing literature regarding the role of APFP biomarkers in prognosis and recovery. We searched the PubMed, EMBASE, and Cochrane Library databases for relevant papers. Our screening identified relevant studies and biomarkers correlating with the identification of predictive biomarkers. Only studies published between January 2000 and October 2021 were included. Our search identified 5835 abstracts, of which 35 were selected. All biomarker samples were obtained from blood and were used in the evaluation of disease severity and prognosis associated with recovery. These biomarkers have been effective prognostic or predictive factors under various conditions. Finally, we classified them into five categories. There is no consensus in the literature on the correlation between outcomes and prognostic factors for APFP. Furthermore, the correlation between hematologic laboratory values and APFP prognosis remains unclear. However, it is important to identify new methods for improving the accuracy of facial paralysis prognosis prediction. Therefore, we systematically evaluated prognostic and potentially predictive APFP biomarkers. Unfortunately, a predictive biomarker validating APFP prognosis remains unknown. More prospective studies are required to reveal and identify promising biomarkers providing accurate prognosis.

Investigating the correlation between serum albumin level and the prognosis of Bell's palsy

To investigate the correlation between the serum albumin level and the prognosis of patients with Bell's palsy.We retrospectively analyzed the clinical records of 311 inpatients with Bell's palsy (BP) in our hospital between September 2018 and October 2019. The patients were divided into 2 groups: the recovered group (with the House-Brackmann grade ≤ 2) and the unrecovered group (with the House-Brackmann grade > 2), according to the follow-up results within 3 months after discharge. Blood test indicators (white blood cell count, neutrophil-to-lymphocyte ratio, red cell distribution width, serum albumin level, globulin level) and basic clinical data (age, sex, course of the disease, inpatient days, comorbidity of hypertension, diabetes, and hepatitis B) of the 2 groups were compared to explore whether they were correlated with the prognosis of patients with Bell's palsy.The serum albumin level of patients with BP in the unrecovered group was significantly lower than that of the recovered group (medians [interquartile range], 40.75 [38.40, 43.85] vs 44 [42.10, 46.20], P < .001). Multivariate binary logistic regression revealed that serum albumin (odds ratio 0.772, 95% confidence interval 0.711-0.839, P < .001) was a protective factor for BP prognosis.Serum albumin is a protective factor for the prognosis of BP. Although more prospective clinical controlled trials are needed, our study provides valuable and crucial prognostic information for physicians.

Hematologic parameters as predictive markers in pediatric Bell's palsy

PURPOSE

To analyze various hematological parameters in pediatric population with Bell's palsy (BP) and to determine the most valuable parameter as a prognostic marker.

METHODS

Fifty-nine patients with BP under 18 years were enrolled, and patients were divided into three groups: recovery group (49 cases), non-recovery group (10 cases) and controls (65 healthy children). Age, white blood cell (WBC), hemoglobin (Hbg), mean platelet volume (MPV), red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and C-reactive protein-to-albumin ratio (CAR) were determined and compared between groups. Additionally, the receiver operating characteristics (ROC) analysis was carried out, and the most valuable marker to demonstrate the prognosis among these parameters was investigated.

RESULTS

While mean age was found as 10.69 ± 5.76 years, 28 (47.5%) female and 31 (52.5%) male pediatric patients were determined to be followed up due to BP in our hospital. When such parameters age, mean Hbg, MPV and RDW were examined, no significant difference was detected between groups. However, compared controls with recovery and non-recovery groups, WBC, NLR, PLR and CAR were found to be significantly higher, respectively (p < 0.05). Median CAR and NLR values were found to be significantly higher in non-recovery group, compared to those in recovery group (p = 0.001, p = 0.012, respectively). However, when median WBC and PLR were examined between recovery and non-recovery groups, no significant difference was observed (p > 0.05).

CONCLUSION

High NLR and CAR values in pediatric BP may be related to poor prognosis in such patients. CAR, however, is a more valuable parameter than NLR in terms of indicating poor prognosis.

The novel indicators of moderate to severe sleep apnea: fibrinogen to albumin ratio vs. CRP to albumin ratio

PURPOSE

This study aimed at investigating the association of severity of obstructive sleep apnea with the markers of inflammation as fibrinogen to albumin ratio and C-reactive protein to albumin ratio.

METHODS

We included 126 patients admitted to sleep disorders outpatient clinic. We constituted four groups by reference to the apnea-hypopnea index (mild-moderate-severe sleep apnea and control group). We investigated the difference of white blood cell, fibrinogen to albumin ratio, C-reactive protein to albumin ratio, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and hemoglobin among the groups.

RESULTS

Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and hemoglobin did not significantly differ among four groups (p = 0.39, p = 0.06, and p = 0.31, respectively). A significant difference of fibrinogen to albumin ratio and C-reactive protein to albumin ratio was evident among four groups (p < 0.001). Fibrinogen to albumin ratio and C-reactive protein to albumin ratio did not significantly differ between the mild sleep apnea and control groups (p = 0.65, and p = 0.85, respectively), but were significantly greater in moderate sleep apnea group compared with the control group (p < 0.001 and p = 0.001, respectively). Also, fibrinogen to albumin ratio and C-reactive protein to albumin ratio were significantly greater in the severe sleep apnea group compared with the control group (p < 0.001). Fibrinogen to albumin ratio and C-reactive protein to albumin ratio did not significantly differ between the severe sleep apnea and moderate sleep apnea groups (p = 0.49, and p = 0.58, respectively).

CONCLUSION

Higher fibrinogen to albumin ratio and C-reactive protein to albumin ratio may be predictive of inflammation in patients with moderate-to-severe sleep apnea.