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Zhang N, Liu Y, Yang C, Li X. Review of the Predictive Value of Biomarkers in Sepsis Mortality. Emerg Med Int 2024; 2024:2715606. [PMID: 38938850 PMCID: PMC11208822 DOI: 10.1155/2024/2715606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/26/2024] [Accepted: 05/11/2024] [Indexed: 06/29/2024] Open
Abstract
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.
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Affiliation(s)
- Nai Zhang
- Department of Emergency, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang 330003, China
| | - Yujuan Liu
- Department of Emergency, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang 330003, China
| | - Chuang Yang
- Department of Emergency, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang 330003, China
| | - Xinai Li
- Department of Respiratory Medicine, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang 330003, China
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Ersal T, Özkocaman V, Pınar İE, Yalçın C, Orhan B, Candar Ö, Çubukçu S, Koca TG, Hunutlu FÇ, Yavuz Ş, Ali R, Özkalemkaş F. Systemic inflammatory indices for predicting prognosis of myelofibrosis. Sci Rep 2023; 13:12539. [PMID: 37532753 PMCID: PMC10397340 DOI: 10.1038/s41598-023-39077-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
The impact of inflammatory markers such as systemic immune-inflammation (SII) index and systemic inflammation response index (SIRI) on myelofibrosis (MF) prognosis was evaluated for the first time in this study. Data from 60 patients diagnosed with MF between March 2011 and September 2022 were retrospectively analyzed. In addition to disease-related markers, the impact of SII and SIRI on prognosis was evaluated. In our study, the overall median survival (OS) was 64 months. OS was significantly shorter in patients older than 65 years, with high ferritin and lymphocyte levels, transfusion dependence at diagnosis, platelet count below 100 × 109/L, Hb level below 8 g/dl, and high risk according to the dynamic international prognostic scoring system (DIPSS)-Plus score. When these variables were included in the multivariate Cox regression model, it was found that being older than 65 years, having a high ferritin value, being at high risk according to the DIPSS-plus score and Hb values below 8 increased the risk of death. Platelet-to-lymphocyte ratio (PLR) and SII index were lower in patients with a fatal outcome. No statistically significant relationship was found between SIRI and mortality. The findings of this study showed that low PLR and high ferritin were associated with poor prognosis in MF. Elevated SII and SIRI, evaluated for the first time in patients with myelofibrosis, did not predict prognosis. Since non-inflammatory variables play a role in the pathogenesis of MF, bone marrow indicators and systemic inflammation indicators derived from hematologic parameters may not be accurate.
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Affiliation(s)
- Tuba Ersal
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, 16059, Bursa, Turkey.
| | - Vildan Özkocaman
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - İbrahim Ethem Pınar
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - Cumali Yalçın
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - Bedrettin Orhan
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - Ömer Candar
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - Sinem Çubukçu
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - Tuba Güllü Koca
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - Fazıl Çağrı Hunutlu
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - Şeyma Yavuz
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - Rıdvan Ali
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - Fahir Özkalemkaş
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, 16059, Bursa, Turkey
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Messerich NM, Uda NR, Volken T, Cogliatti S, Lehmann T, Holbro A, Benz R, Graf L, Gupta V, Jochum W, Demmer I, Rao TN, Silzle T. CRP/Albumin Ratio and Glasgow Prognostic Score Provide Prognostic Information in Myelofibrosis Independently of MIPSS70-A Retrospective Study. Cancers (Basel) 2023; 15:cancers15051479. [PMID: 36900271 PMCID: PMC10000567 DOI: 10.3390/cancers15051479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
In myelofibrosis, the C-reactive protein (CRP)/albumin ratio (CAR) and the Glasgow Prognostic Score (GPS) add prognostic information independently of the Dynamic International Prognostic Scoring System (DIPSS). Their prognostic impact, if molecular aberrations are considered, is currently unknown. We performed a retrospective chart review of 108 MF patients (prefibrotic MF n = 30; primary MF n = 56; secondary MF n = 22; median follow-up 42 months). In MF, both a CAR > 0.347 and a GPS > 0 were associated with a shorter median overall survival (21 [95% CI 0-62] vs. 80 months [95% CI 57-103], p < 0.001 and 32 [95% CI 1-63] vs. 89 months [95% CI 65-113], p < 0.001). Both parameters retained their prognostic value after inclusion into a bivariate Cox regression model together with the dichotomized Mutation-Enhanced International Prognostic Scoring System (MIPSS)-70: CAR > 0.374 HR 3.53 [95% CI 1.36-9.17], p = 0.0095 and GPS > 0 HR 4.63 [95% CI 1.76-12.1], p = 0.0019. An analysis of serum samples from an independent cohort revealed a correlation of CRP with levels of interleukin-1β and albumin with TNF-α, and demonstrated that CRP was correlated to the variant allele frequency of the driver mutation, but not albumin. Albumin and CRP as parameters readily available in clinical routine at low costs deserve further evaluation as prognostic markers in MF, ideally by analyzing data from prospective and multi-institutional registries. Since both albumin and CRP levels reflect different aspects of MF-associated inflammation and metabolic changes, our study further highlights that combining both parameters seems potentially useful to improve prognostication in MF.
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Affiliation(s)
- Nora-Medea Messerich
- Department of Intensive Care, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Narasimha Rao Uda
- Laboratory of Stem Cells and Cancer Biology, Department of Oncology and Hematology, Medical Research Center, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Thomas Volken
- ZHAW School of Health Sciences, Institute of Public Health, 8400 Winterthur, Switzerland
| | - Sergio Cogliatti
- Institute of Pathology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Thomas Lehmann
- Institute of Pathology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
- Clinic for Medical Oncology and Hematology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Andreas Holbro
- Division of Hematology, University Hospital of Basel, University of Basel, 4001 Basel, Switzerland
| | - Rudolf Benz
- Division of Hematology and Oncology, Spital Thurgau AG, 8569 Muensterlingen, Switzerland
| | - Lukas Graf
- Centre for Laboratory Medicine, 9001 St. Gallen, Switzerland
| | - Vikas Gupta
- Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Wolfram Jochum
- Institute of Pathology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Izadora Demmer
- Institute of Pathology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Tata Nageswara Rao
- Laboratory of Stem Cells and Cancer Biology, Department of Oncology and Hematology, Medical Research Center, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
- Institute for Pharmacology, University of Bern, 3012 Bern, Switzerland
| | - Tobias Silzle
- Clinic for Medical Oncology and Hematology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
- Correspondence: ; Tel.: +41-71-494-2922
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Liang-Fonseca J, Geissler K. Significance of C-reactive protein in patients with chronic myelomonocytic leukemia. Wien Med Wochenschr 2023; 173:15-20. [PMID: 36441359 PMCID: PMC9876868 DOI: 10.1007/s10354-022-00981-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 07/14/2022] [Indexed: 11/29/2022]
Abstract
In a retrospective study, we analyzed the prevalence of elevated C‑reactive protein (CRP) serum levels in 148 patients with chronic myelomonocytic leukemia (CMML), their potential prognostic impact, and potential correlations with laboratory features. Normal, up to 10-fold, and more than 10-fold elevated CRP levels were found in 18%, 59%, and 23% of CMML patients, respectively. Using the CRP cutoff value of 10 mg/L of the widely used Glasgow score, high CRP values were associated with inferior survival (13 vs. 39 months, p = 0.014), which retained prognostic significance in multivariate analysis. High CRP values were associated with lower hemoglobin levels. The survival difference between patients with normal (< 5 mg/L) and elevated CRP levels persisted after exclusion of patients with clinical infection. These findings indicate that in CMML patients, the presence of an acute-phase reaction is associated with a poor outcome, independent of clinical infection.
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Affiliation(s)
| | - Klaus Geissler
- Medical School, Sigmund Freud University, Vienna, Austria.
- Department of Internal Medicine V with Hematology, Oncology and Palliative Medicine, Hospital Hietzing, Wolkersbergenstr. 1, 1130, Vienna, Austria.
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Clinical and prognostic significance of C-reactive protein to albumin ratio in hospitalized coronavirus disease 2019 (COVID-19) patients : Data on 2309 patients from a tertiary center and validation in an independent cohort. Wien Klin Wochenschr 2022; 134:377-384. [PMID: 35038003 PMCID: PMC8761839 DOI: 10.1007/s00508-021-01999-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/18/2021] [Indexed: 12/15/2022]
Abstract
C‑reactive protein (CRP) and albumin are inflammation sensitive parameters that are regulated by interleukin‑6 inflammatory pathways. The CRP to albumin ratio (CAR) integrates these two into a potent clinical parameter whose clinical and prognostic association in the context of coronavirus disease 2019 (COVID-19) have not been well defined. We aimed to investigate the clinical and prognostic significance of CAR in the context of COVID-19 infection.We retrospectively analyzed 2309 consecutive COVID-19 patients hospitalized at a tertiary level hospital in the period from March 2020 to March 2021 who had baseline data for a CAR assessment. Findings were validated in an independent cohort of 1155 patients hospitalized from March 2021 to June 2021.The majority of patients (85.8%) had severe or critical COVID-19 on admission. Median CRP, albumin and CAR levels were 91 mg/L, 32 g/L and 2.92, respectively. Higher CAR was associated with a tendency for respiratory deterioration during hospitalization, increased requirement of high-flow oxygen treatment and mechanical ventilation, higher occurrence of bacteriemia, higher occurrence of deep venous thrombosis, lower occurrence of myocardial infarction, higher 30-day mortality and higher postdischarge mortality rates. We defined and validated four CAR prognostic categories (< 1.0, 1.0-2.9, 3.0-5.9 and ≥ 6.0) with distinct 30-day survival. In the series of multivariate Cox regression models we could demonstrate robust prognostic properties of CAR that was associated with inferior 30-day survival independently of COVID-19 severity, age and comorbidities and additionally independently of COVID-19 severity, CURB-65 and VACO index in both development and validation cohorts.The CAR seems to have a good potential to improve prognostication of hospitalized COVID-19 patients.
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Lucijanic M, Krecak I, Galusic D, Sedinic M, Holik H, Perisa V, Moric Peric M, Zekanovic I, Stoos-Veic T, Pejsa V, Kusec R. Higher serum uric acid is associated with higher risks of thrombosis and death in patients with primary myelofibrosis. Wien Klin Wochenschr 2021; 134:97-103. [PMID: 33464403 DOI: 10.1007/s00508-020-01802-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Serum uric acid (SUA) can promote inflammation and is associated with increased cardiovascular morbidity. Primary (PMF) and secondary myelofibrosis (SMF) are myeloproliferative neoplasms characterized by high cellular turnover and substantial risk of thrombosis and death. METHODS We have retrospectively investigated SUA in 173 patients with myelofibrosis (125 PMF; 48 SMF) and 30 controls. RESULTS The PMF patients had significantly higher SUA in comparison to SMF and controls. In both PMF and SMF higher SUA was significantly associated with arterial hypertension and decreased renal function. Among PMF patients, higher SUA was significantly associated with older age, larger spleen, higher white blood cell counts, higher lactate dehydrogenase, lower immunoglobulin G levels, allopurinol use and non-smoking. Among SMF patients, higher SUA was associated with male sex (P < 0.05 for all analyses). In PMF higher SUA was univariately associated with inferior survival (> 427 μmol/L hazard ratio (HR) = 2.22; P = 0.006) and shorter time to thrombosis (> 444 μmol/L HR = 5.05; P = 0.006), which could be shown separately for arterial (> 380 μmol/L; HR = 4.9; P = 0.013) and venous thromboses (> 530 μmol/L; HR = 17.9; P < 0.001). In multivariate analyses, SUA remained significantly associated with inferior survival independent of the Dynamic International Prognostic Staging System and with shorter time to thrombosis independent of age in PMF patients; however, the prognostic significance of SUA was diminished after including serum creatinine in the models. SUA was not prognostic in SMF patients. CONCLUSION The PMF patients present with higher SUA levels, which are associated with features of more advanced disease and higher risks of arterial and venous thrombosis and death.
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Affiliation(s)
- Marko Lucijanic
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia.
- School of Medicine, University of Zagreb, Ul. Salata 3, 10000, Zagreb, Croatia.
| | - Ivan Krecak
- Hematology Department, General Hospital Sibenik, Ul. Stjepana Radića 83, 22000, Sibenik, Croatia
| | - Davor Galusic
- Department of Hematology, University Hospital of Split, Soltanska ul. 1, 21000, Split, Croatia
| | - Martina Sedinic
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia
| | - Hrvoje Holik
- Department of Internal Medicine, "Dr. Josip Bencevic" General Hospital, Ul. Andrije Štampara, 35000, Slavonski Brod, Croatia
| | - Vlatka Perisa
- Department of Hematology, Osijek University Hospital, Ul. Josipa Huttlera 4, 31000, Osijek, Croatia
- Faculty of Medicine, University of Osijek, Ul. Josipa Huttlera 4, 31000, Osijek, Croatia
| | - Martina Moric Peric
- Department of Internal Medicine, General Hospital Zadar, Ul. Boze Pericica 5, 23000, Zadar, Croatia
| | - Ivan Zekanovic
- Department of Internal Medicine, General Hospital Zadar, Ul. Boze Pericica 5, 23000, Zadar, Croatia
| | - Tajana Stoos-Veic
- School of Medicine, University of Zagreb, Ul. Salata 3, 10000, Zagreb, Croatia
- Department of Clinical Cytology and Cytometry, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia
| | - Vlatko Pejsa
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, Ul. Salata 3, 10000, Zagreb, Croatia
| | - Rajko Kusec
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, Ul. Salata 3, 10000, Zagreb, Croatia
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