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Wyman M, Dargan D, Kazzazi D, Caddick J, Giblin V. Serum Inflammatory Markers and Amputations in Hand Osteomyelitis: A Retrospective Review of 146 Cases. Hand (N Y) 2023; 18:987-993. [PMID: 35130740 PMCID: PMC10470241 DOI: 10.1177/15589447211066346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The diagnosis of hand osteomyelitis requires correlation of clinical, radiological, and microbiological findings. The role of serum inflammatory markers in diagnosing and prognosticating hand osteomyelitis remains uncertain. We sought to determine the utility of inflammatory markers in the diagnosis and follow-up of hand osteomyelitis, and their ability to predict outcomes, particularly amputation. METHODS We retrospectively reviewed 146 patients diagnosed with hand osteomyelitis and with serum inflammatory marker levels measured after the onset of symptoms and within 14 days either side of diagnosis. Blood results at first presentation including white cell count (WCC), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and C-reactive protein (CRP) were reviewed, and associations with amputations assessed. Follow-up markers taken at 15 to 60 days from diagnosis were analyzed where available. RESULTS Mean WCC and CRP at diagnosis were 9.2 (SD: 4.6) and 30.2 (SD: 42.4) respectively, compared with 8.2 (SD: 3.9) and 30.2 (SD: 42.4) at follow-up. At diagnosis, sensitivity of CRP was 74%, and WCC was 31%. Each marker had a low positive predictive value for amputation at diagnosis (<29%). A rise in CRP between diagnosis and follow-up was associated with an increased risk of amputation compared with a fall in CRP. The finding that WCC and CRP were both normal at diagnosis had a high negative predictive value against amputation (96%). CONCLUSION C-reactive protein has a higher sensitivity than WCC, NLR, and PLR when used as a diagnostic adjunct in hand osteomyelitis. White cell count and CRP both within reference ranges at diagnosis was highly negatively predictive against amputation.
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Affiliation(s)
- Matthew Wyman
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
- The University of Sheffield, UK
| | - Dallan Dargan
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
- The University of Sheffield, UK
| | - Diana Kazzazi
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | | | - Victoria Giblin
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
- The University of Sheffield, UK
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Glatstein M, Salamon L, Soffer GP, Capua T, Scolnik D, Rimon A. C-Reactive Protein and the Outcome of a Pediatric Emergency Department 7 Days Revisit. Pediatr Emerg Care 2022; 38:453-455. [PMID: 35973067 DOI: 10.1097/pec.0000000000002634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pediatric emergency department (PED) return visits represent an important quality of care metric and constitute a patient-centered outcome. C-reactive protein (CRP) is an inflammatory biomarker that is commonly used as screening tool in the PED. In this study, we assessed the clinical outcomes of children whose levels of CRP are 150 mg/L or higher at the initial PED visit and if such levels could be useful in predicting outcomes at a second PED visit. METHODS A historical cohort study of all patients who visited the PED between July 2007 and June 2017 and had a CRP value of 150 mg/L or greater in the setting of a febrile illness. Data of patients with a return visit to the PED within 7 days were assessed for an association between laboratory values, diagnosis and clinical outcome. RESULTS One hundred thirty-six index visits were included in this study. One hundred fifteen (84.6%) of the revisits were discharged after their second visit, and 21 (15.4%) were admitted to the inpatient unit. Admitted patients did not differ from patients who were discharged home in diagnosis and CRP levels, but a difference in white blood cell and absolute neutrophil counts was observed. CONCLUSIONS The intensity of the inflammatory response, as expressed by the high concentrations of CRP in children, does not seem to predict the outcome at a repeat PED visit within 7 days.
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Affiliation(s)
- Miguel Glatstein
- From the Division of Pediatrics Department, Dana-Dwek Children Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lotan Salamon
- From the Division of Pediatrics Department, Dana-Dwek Children Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gili Palnizky Soffer
- From the Division of Pediatrics Department, Dana-Dwek Children Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Capua
- From the Division of Pediatrics Department, Dana-Dwek Children Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dennis Scolnik
- Division of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ayelet Rimon
- From the Division of Pediatrics Department, Dana-Dwek Children Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rhee SM, Kim MS, Kim JD, Ro K, Ko YW, Rhee YG. Hematologic Expression After Shoulder Surgery: Normalization Curve of Serum Inflammatory Markers. Arthroscopy 2021; 37:71-82. [PMID: 32971139 DOI: 10.1016/j.arthro.2020.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the normalization curves of the serologic markers including white blood cell (WBC) count, WBC differential for segmented neutrophil (WBC seg.), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) after elective shoulder surgery and to investigate the hematologic differences among different shoulder surgeries. METHODS Seventy-seven patients underwent arthroscopic rotator cuff repair (RCR, group A), 44 patients had open rotator cuff repair (group B), and 84 patients had shoulder arthroplasty (group C). Peak and normalization times of markers were determined at preoperatively, postoperative day (POD) 1 and 2 days, 1 and 2 weeks, 1, 2, 3, 6 months, and 1 year after surgery. The normal ranges of serologic markers were set to WBC 4000 to10,000/μL, WBC seg. 40% to 60%, ESR 0 to 20 mm/h, and CRP 0 to 0.8 mg/dL. RESULTS Groups reached peak mean WBC count and WBC seg. on POD 1; mean WBC count started decreasing on POD 2 but was within normal value afterwards. Mean WBC seg. decreased to normal value at 1 month postoperatively in group A and B and at 2 months postoperatively in group C. Mean ESR peaked at 2 weeks postoperatively and normalized after 1 month in groups A and B and 3 months in group C. Mean CRP levels peaked on POD 2 in all groups and normalized within 2 weeks postoperatively in groups A and B and 1 month postoperatively in Group C. Normalized values of WBC count, WBC seg., and ESR varied widely. In contrast, CRP showed a consistent undetectable median, upper and lower quartile values less than 0.5 after normalization. Mean serum ESR and CRP values at peak time were significantly greater in group C than in the other groups (P = .001). CONCLUSIONS The mean CRP levels were normalized at 2 weeks after rotator cuff repair and at 1 month after arthroplasties. Unlike the other serologic markers, CRP had consistent normalized values of median, upper and lower quartile afterwards. The peak levels of the inflammatory markers were greater and therefore normalized slower following more invasive surgery. LEVEL OF EVIDENCE Level III, case control study.
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Affiliation(s)
- Sung-Min Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Myung Seo Kim
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University at Gangdong, Seoul, Korea
| | - Jong Dae Kim
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kyunghan Ro
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Young Wan Ko
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Korea.
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Yu JY, Choi WJ, Lee HS, Lee JW. Relationship between inflammatory markers and visceral obesity in obese and overweight Korean adults: An observational study. Medicine (Baltimore) 2019; 98:e14740. [PMID: 30817629 PMCID: PMC6831265 DOI: 10.1097/md.0000000000014740] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Obesity is now considered a state of chronic low-grade inflammation. We investigated the relationship between several inflammatory markers and body composition for identifying patients with an increased risk of visceral obesity and compared the predictive values of inflammatory indices in visceral obesity.Six hundred individuals who received health checkups for obesity-related risk factors in Severance Hospital between January 2008 and March 2017 were included in our study. Serum inflammatory markers, such as white blood cell (WBC), high-sensitivity C-reactive protein (hsCRP), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) levels were assessed. Intra-abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas were measured with computed tomography. We performed analysis of covariance, trend analysis, Steiger's Z tests, and multiple linear regression analysis to investigate associations between abdominal adiposity indices and inflammatory markers.Pearson's correlation analysis revealed a stronger association of VAT with WBC counts (r = 0.157, P < .001) than with levels of NLR (r = 0.108, P = .11; Steiger's Z test, P = .04) and PLR (r = 0.036, P = .39; Steiger's Z test, P = .003). WBC and hsCRP levels linearly increased with VAT area (overall P < .001 and trend P < .001) and VAT/SAT ratio (overall P = .001 and trend P = .002; overall P < .001 and trend P < .001, respectively) but linearly decreased with SAT (overall P = .02 and trend P = .17; overall P = .03 and trend P = .01, respectively). Visceral adipose tissue area was more highly associated with WBC and hsCRP levels than with NLR and PLR. Only VAT area was significantly associated with WBC, hsCRP, and NLR levels after adjusting for confounding variables.We found that VAT, but not SAT area is independently associated with several inflammatory markers. WBC and hsCRP are more strongly correlated with VAT compared with NLR and PLR. Thus, WBC and hsCRP could be useful parameters for identifying individuals at risk for visceral obesity and cardiometabolic diseases.
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Affiliation(s)
- Ju-Yeon Yu
- Department of Family Medicine, Gangnam Severance Hospital
| | - Won-Jun Choi
- Department of Family Medicine, Gangnam Severance Hospital
| | - Hye-Sun Lee
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji-Won Lee
- Department of Family Medicine, Gangnam Severance Hospital
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Ziv-Baran T, Wasserman A, Shteinvil R, Zeltser D, Shapira I, Shenhar-Tsarfaty S, Meilik A, Goldiner I, Rogowski O, Berliner S, Halpern P. C-reactive protein and emergency department seven days revisit. Clin Chim Acta 2018; 481:207-211. [DOI: 10.1016/j.cca.2018.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 03/19/2018] [Indexed: 01/21/2023]
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Hu SY, Lee BJ, Tsai CA, Hsieh MS. Concurrent emphysematous pyelonephritis, cystitis, and iliopsoas abscess from discitis in a diabetic woman. Int J Infect Dis 2016; 51:105-106. [PMID: 27637417 DOI: 10.1016/j.ijid.2016.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 02/08/2023] Open
Affiliation(s)
- Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Nursing, College of Health, National University of Taichung Science and Technology, Taichung, Taiwan.
| | - Bor-Jen Lee
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Che-An Tsai
- Division of Infection, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Shun Hsieh
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, No. 100, Sec. 3, Cheng-Kung Road, Taoyuan 330, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Płotek W, Pielok J, Cybulski M, Samborska R. Emotional processes in patients undergoing coronary artery bypass graft surgeries with extracorporeal circulation in view of selected indicators of the inflammatory condition. Med Sci Monit 2015; 21:105-17. [PMID: 25573296 PMCID: PMC4298257 DOI: 10.12659/msm.892372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The aim of this study was to describe positive and negative emotions in patients undergoing coronary artery bypass graft (CABG) surgeries with extracorporeal circulation and the correlations between emotions and basic indicators of the inflammatory condition: C-reactive protein (CRP) concentration, body temperature, and leukocyte count. Material/Methods Standardized tools were used to select 52 patients (aged 47–63 years, 6 women – 11.5% and 46 men – 88.5%) without dementia or depression. The Positive and Negative Affect Schedule (PANAS) was used to examine positive affect (PA) and negative affect (NA) and the State-Trait Anxiety Inventory (STAI X1 and X2) was used to examine the anxiety level. The patients underwent CABG surgery according to a common anesthesia protocol and for 5 consecutive days they were observed in the ward, where selected indicators of the inflammatory condition were monitored. Results A detailed description of the results of examinations of emotions was presented. The patients with low PA-trait level, high NA-trait level, and high anxiety-trait level (STAI X2) exhibited statistically significantly higher body temperatures than the other patients in the postoperative period. The patients with high NA-trait and anxiety-state levels (STAI X1) had statistically significantly lower CRP levels in the postoperative period than the patients with low NA-trait and anxiety-state levels (STAI X1). Conclusions Patients undergoing CABG operations express both positive and negative affects. The changes in the inflammatory markers are expressed mostly by CRP concentration. There exist relationships between the result of tests assessing emotions and the markers of the inflammatory condition.
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Affiliation(s)
- Włodzimierz Płotek
- Department of Teaching Anaesthesiology and Intensive Therapy, Poznań University of Medical Sciences, Poznań, Poland
| | - Joanna Pielok
- Department of Anaesthesiology and Intensive Care, Stanisław Staszic Specialist Hospital, Piła, Poland
| | - Marcin Cybulski
- Department of Clinical Psychology, Poznań University of Medical Sciences, Poznań, Poland
| | - Regina Samborska
- Department of Cardiac Surgery with Intensive Cardiologic Supervision Wards, Józef Struś General Hospital, Poznań, Poland
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ElKorashy R, El-Sherif R. Gram negative organisms as a cause of acute exacerbation of COPD. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2013.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lazzarotto C, Ronsoni MF, Fayad L, Nogueira CL, Bazzo ML, Narciso-Schiavon JL, de Lucca Schiavon L, Dantas-Corrêa EB. Acute phase proteins for the diagnosis of bacterial infection and prediction of mortality in acute complications of cirrhosis. Ann Hepatol 2013. [PMID: 23813138 DOI: 10.1016/s1665-2681(19)31344-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Bacterial infection is a frequent complication in patients with decompensated liver cirrhosis and is related to high mortality rates during follow-up of these individuals. We sought to evaluate the diagnostic value of C-reactive protein (CRP) and procalcitonin (PCT) in diagnosing infection and to investigate the relationship between these biomarkers and mortality after hospital admission. MATERIAL AND METHODS Prospective study that included cirrhotic patients admitted to the hospital due to complications of the disease. The diagnostic accuracy of CRP and PCT for the diagnosis of infection was evaluated by estimating the sensitivity and specificity and by measuring the area under the receiver operating characteristics curve (AUROC). RESULTS A total of 64 patients and 81 hospitalizations were analyzed during the study. The mean age was 54.31 ± 11.87 years with male predominance (68.8%). Significantly higher median CRP and PCT levels were observed among infected patients (P < 0.001). The AUROC of CRP and PCT for the diagnosis of infection were 0.835 ± 0.052 and 0.860 ± 0.047, respectively (P = 0.273). CRP levels > 29.5 exhibited sensitivity of 82% and specificity of 81% for the diagnosis of bacterial infection. Similarly, PCT levels > 1.10 showed sensitivity of 67% and specificity of 90%. Significantly higher levels of CRP (P = 0.026) and PCT (P = 0.001) were observed among those who died within three months after admission. CONCLUSION CRP and PCT were reliable markers of bacterial infection in subjects admitted due to complications of liver cirrhosis and higher levels of these tests are related to short-term mortality in those patients.
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Affiliation(s)
- César Lazzarotto
- Division of Gastroenterology, Federal University of Santa Catarina, Brasil.
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Markers of lower respiratory tract infections in emergency departments. Multidiscip Respir Med 2013; 8:20. [PMID: 23497669 PMCID: PMC3610129 DOI: 10.1186/2049-6958-8-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/17/2013] [Indexed: 11/12/2022] Open
Abstract
Background Acute respiratory tract infections are the common causes for admission to emergency department. Appropriate diagnosis and initiating treatment on time are important for reducing morbidity and mortality rate due to lower respiratory tract infection (LRTI). The aim of this study is to determine if C-reactive protein (CRP) levels and white blood cells (WBC) count are considerable markers to help rapid diagnosis and prediction of antibiotic need for lower respiratory infections in emergency departments. The relationships between infectious agents and those markers have also been evaluated. Methods Study subjects and control group were selected by defined criteria. Patients were analyzed and assessed for CRP and WBC, sputum Gram stain and culture besides routine laboratory tests and chest X-Rays. Results One hundred and ninety four episodes out of 175 patients were evaluated for the study. CRP level and WBC count were detected significantly higher in patients ofstudy group than in those of control group. Pseudomonas aeruginosa and Haemophilus influenzae were the pathogens most often isolated. Conclusion In conclusion, CRP and WBC sputum are important markers for diagnosis of LRTI at the emergency departments and results of microbiological analysis of respiratory specimens were correlated with these markers. Trial registration Registation number of ethic committee of Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital: 28.04.2006/114
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