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Levinson T, Shenhar-Tsarfaty S, Grupper A, Witztum T, Berliner S, Shtark M. Inflammation-Associated Tubulopathy in Patients with Acute Bacterial Infections. Int J Gen Med 2024; 17:2691-2699. [PMID: 38883704 PMCID: PMC11178074 DOI: 10.2147/ijgm.s452068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/09/2024] [Indexed: 06/18/2024] Open
Abstract
Background Acute kidney injury associated with the underlying inflammatory process of an acute bacterial infection affects patient morbidity and mortality. Clinicians use creatinine and estimated glomerular filtration rate (EGFR) to assess this renal injury, however, these measures may lag behind and change only once significant kidney injury has occurred. Neutrophil gelatinase-associated lipocalin (NGAL) is up-regulated by inflammation and infection and may serve as an early detection biomarker of kidney injury. Methods Patients hospitalized with bacterial infections were assessed demographically, clinically and had their creatinine levels, EGFR and inflammatory biomarker levels, including urinary NGAL measured. Findings were compared between controls and patients across different EGFRs. Results Fifty-one participants were included in the study. Among this cohort, 31 suffered bacterial infection. Inflammatory biomarkers including urinary NGAL were found to be higher in the infection group compared to the control group. Urinary NGAL level was significantly higher across all EGFRs of patients diagnosed with infection, including those with normal EGFR. Conclusion Urinary NGAL identifies early kidney damage associated with bacterial infection even at normal EGFR and alerts the treating physician to undertake the necessary measures to mitigate the renal injury.
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Affiliation(s)
- Tal Levinson
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Internal Medicine H, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shani Shenhar-Tsarfaty
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine C, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ayelet Grupper
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Organ Transplantation Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Witztum
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine D, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shlomo Berliner
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine E, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Moshe Shtark
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clinical Laboratory Services, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Poddar NK, Khan A, Fatima F, Saxena A, Ghaley G, Khan S. Association of mTOR Pathway and Conformational Alterations in C-Reactive Protein in Neurodegenerative Diseases and Infections. Cell Mol Neurobiol 2023; 43:3815-3832. [PMID: 37665407 DOI: 10.1007/s10571-023-01402-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023]
Abstract
Inflammatory biomarkers have been very useful in detecting and monitoring inflammatory processes along with providing helpful information to select appropriate therapeutic strategies. C-reactive protein (CRP) is a nonspecific, but quite useful medical acute inflammatory biomarker and is associated with persistent chronic inflammatory processes. Several studies suggest that different levels of CRP are correlated with neurological disorders such as Alzheimer's disease (AD). However, dynamics of CRP levels have also been observed in virus/bacterial-related infections leading to inflammatory responses and this triggers mTOR-mediated pathways for neurodegeneration diseases. The biophysical structural transition from CRP to monomeric CRP (mCRP) and the significance of the ratio of CRP levels on the onset of symptoms associated with inflammatory response have been discussed. In addition, mTOR inhibitors act as immunomodulators by downregulating the expression of viral infection and can be explored as a potential therapy for neurological diseases.
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Affiliation(s)
- Nitesh Kumar Poddar
- Department of Biosciences, Manipal University Jaipur, Jaipur-Ajmer Express Highway, Dehmi Kalan, Near GVK Toll Plaza, Jaipur, Rajasthan, India, 303007.
| | - Arshma Khan
- Department of Biotechnology, Invertis University, Bareilly, Uttar Pradesh, India, 243123
| | - Falak Fatima
- Amity Institute of Biotechnology, Amity University, Uttar Pradesh, Noida, India, 201301
| | - Anshulika Saxena
- Department of Biosciences, Manipal University Jaipur, Jaipur-Ajmer Express Highway, Dehmi Kalan, Near GVK Toll Plaza, Jaipur, Rajasthan, India, 303007
| | - Garima Ghaley
- Department of Biosciences, Manipal University Jaipur, Jaipur-Ajmer Express Highway, Dehmi Kalan, Near GVK Toll Plaza, Jaipur, Rajasthan, India, 303007
| | - Shahanavaj Khan
- Department of Medical Lab Technology, Indian Institute of Health and Technology (IIHT), Deoband, Saharanpur, Uttar Pradesh, India, 247554.
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Cohen N, Feigin E, Berliner S, Zeltser D, Witztum T, Goldiner I, Shtark M, Shenhar-Tsarfaty S, Ziv-Baran T, Matsri S, Hashavia E. Early signaling of inflammation in patients following traumatic injury with accurately estimated time of injury by profiling C-reactive protein levels. Clin Chim Acta 2023; 550:117580. [PMID: 37778680 DOI: 10.1016/j.cca.2023.117580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Despite its widespread use, the precise dynamics of CRP response in clinical practice remain poorly defined. We employed a novel quadratic model to explore the time-course analysis of CRP values in trauma patients with known precise time of injury. METHODS Relevant data on all adult patients admitted to our hospital following traumatic incidents between January 1st 2010 to December 31, 2020 were retrospectively collected. Those with a documented time of injury and who underwent CRP evaluation within the first 24 h since injury were studied. RESULTS Based on the findings from our annual health check-up center, we established a reference upper normal CRP value of 12.99 mg/L. Within the first 7 h after injury, the CRP levels of 8-9% of the 1545 study patients exceeded the reference threshold. The proportion of patients with CRP levels > 12.99 mg/L increased to 18.5% at 8-9 h later and rose sharply to 91.6% at 22-24 h later. Our quadratic model yielded the equation: CRP = 5.122-0.528xTime + 0.139xTime 2. It accounted for > 40% of the variance in CRP levels (R2 = 42.4%). CONCLUSIONS Clear and prominent CRP elevations following atraumatic event are detected only 9-12 h following the insult. This novel finding has crucial implications for accurate CRP assessment of inflammatory responses to physical injuries.
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Affiliation(s)
- Neta Cohen
- Emergency Department, Tel Aviv Sourasky Medical Center, Tel Aviv-Sourasky Medical Center, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eugene Feigin
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Israel; Departments of Internal Medicine C", D" and E", Tel Aviv Sourasky Medical Center, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Berliner
- Departments of Internal Medicine C", D" and E", Tel Aviv Sourasky Medical Center, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Zeltser
- Emergency Department, Tel Aviv Sourasky Medical Center, Tel Aviv-Sourasky Medical Center, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Witztum
- Departments of Internal Medicine C", D" and E", Tel Aviv Sourasky Medical Center, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilana Goldiner
- Division of Clinical Laboratories, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Moshe Shtark
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Israel; Division of Clinical Laboratories, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Shani Shenhar-Tsarfaty
- Departments of Internal Medicine C", D" and E", Tel Aviv Sourasky Medical Center, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sher Matsri
- Departments of Internal Medicine C", D" and E", Tel Aviv Sourasky Medical Center, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Hashavia
- Division of Trauma, Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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C-Reactive Protein Velocity (CRPv) as a New Biomarker for the Early Detection of Acute Infection/Inflammation. Int J Mol Sci 2022; 23:ijms23158100. [PMID: 35897672 PMCID: PMC9330915 DOI: 10.3390/ijms23158100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/17/2022] [Accepted: 07/19/2022] [Indexed: 01/08/2023] Open
Abstract
C-reactive protein (CRP) is considered a biomarker of infection/inflammation. It is a commonly used tool for early detection of infection in the emergency room or as a point-of-care test and especially for differentiating between bacterial and viral infections, affecting decisions of admission and initiation of antibiotic treatments. As C-reactive protein is part of a dynamic and continuous inflammatory process, a single CRP measurement, especially at low concentrations, may erroneously lead to a wrong classification of an infection as viral over bacterial and delay appropriate antibiotic treatment. In the present review, we introduce the concept of C-reactive protein dynamics, measuring the velocity of C-reactive protein elevation, as a tool to increase this biomarker’s diagnostic ability. We review the studies that helped define new metrics such as estimated C-reactive protein velocity (velocity of C-reactive protein elevation from symptoms’ onset to first C-reactive protein measurement) and the measured C-reactive protein velocity (velocity between sequential C-reactive protein measurements) and the use of these metrics in different clinical scenarios. We also discuss future research directions for this novel metric.
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Meilik R, Ben-Assayag H, Meilik A, Berliner S, Zeltser D, Shapira I, Rogowski O, Goldiner I, Shenhar-Tsarfaty S, Wasserman A. Sepsis Related Mortality Associated with an Inflammatory Burst in Patients Admitting to the Department of Internal Medicine with Apparently Normal C-Reactive Protein Concentration. J Clin Med 2022; 11:jcm11113151. [PMID: 35683538 PMCID: PMC9181046 DOI: 10.3390/jcm11113151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Patients who are admitted to the Department of Internal Medicine with apparently normal C-reactive protein (CRP) concentration impose a special challenge due the assumption that they might not harbor a severe and potentially lethal medical condition. Methods: A retrospective cohort of all patients who were admitted to the Department of Internal Medicine with a CRP concentration of ≤31.9 mg/L and had a second CRP test obtained within the next 24 h. Seven day mortality data were analyzed. Results: Overall, 3504 patients were analyzed with a mean first and second CRP of 8.8 (8.5) and 14.6 (21.6) mg/L, respectively. The seven day mortality increased from 1.8% in the first quartile of the first CRP to 7.5% in the fourth quartile of the first CRP (p < 0.0001) and from 0.6% in the first quartile of the second CRP to 9.5% in the fourth quartile of the second CRP test (p < 0.0001), suggesting a clear relation between the admission CRP and in hospital seven day mortality. Conclusions: An association exists between the quartiles of CRP and 7-day mortality as well as sepsis related cause of death. Furthermore, the CRP values 24 h after hospital admission improved the discrimination.
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Affiliation(s)
- Ronnie Meilik
- Department of Internal Medicine “C”, “D”, & “E”, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel; (R.M.); (H.B.-A.); (S.B.); (D.Z.); (I.S.); (O.R.); (A.W.)
| | - Hadas Ben-Assayag
- Department of Internal Medicine “C”, “D”, & “E”, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel; (R.M.); (H.B.-A.); (S.B.); (D.Z.); (I.S.); (O.R.); (A.W.)
| | - Ahuva Meilik
- Clinical Performances Research and Operational Unit, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel;
| | - Shlomo Berliner
- Department of Internal Medicine “C”, “D”, & “E”, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel; (R.M.); (H.B.-A.); (S.B.); (D.Z.); (I.S.); (O.R.); (A.W.)
| | - David Zeltser
- Department of Internal Medicine “C”, “D”, & “E”, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel; (R.M.); (H.B.-A.); (S.B.); (D.Z.); (I.S.); (O.R.); (A.W.)
| | - Itzhak Shapira
- Department of Internal Medicine “C”, “D”, & “E”, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel; (R.M.); (H.B.-A.); (S.B.); (D.Z.); (I.S.); (O.R.); (A.W.)
| | - Ori Rogowski
- Department of Internal Medicine “C”, “D”, & “E”, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel; (R.M.); (H.B.-A.); (S.B.); (D.Z.); (I.S.); (O.R.); (A.W.)
| | - Ilana Goldiner
- Laboratory Medicine, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel;
| | - Shani Shenhar-Tsarfaty
- Department of Internal Medicine “C”, “D”, & “E”, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel; (R.M.); (H.B.-A.); (S.B.); (D.Z.); (I.S.); (O.R.); (A.W.)
- Correspondence:
| | - Asaf Wasserman
- Department of Internal Medicine “C”, “D”, & “E”, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel; (R.M.); (H.B.-A.); (S.B.); (D.Z.); (I.S.); (O.R.); (A.W.)
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Wright MA. Septic arthritis of the wrist and the hand: - An Emergency department case study. Int Emerg Nurs 2022; 62:101150. [PMID: 35240452 DOI: 10.1016/j.ienj.2022.101150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 01/07/2022] [Accepted: 01/29/2022] [Indexed: 11/19/2022]
Abstract
Joint pain is a common presentation in the Emergency department. There are countless potential causes for pain and swelling in a joint. Septic arthritis is a true joint emergency as it can lead to rapid, irreversible destruction of the joint. If not diagnosed early this infection can lead to considerable functional deficit. Our case is unique in that our patient presented to the Emergency department requesting referral to the fracture clinic for continued management of a suspected scaphoid bone fracture but was found to have Neisseria gonorrhoea causing septic arthritis of the joint. This case highlights the importance of accurate history taking, clinical examination and assessment of the patients presenting with joint pain.
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Affiliation(s)
- Mary A Wright
- Emergency Department, Redcliffe Hospital, Redcliffe, Queensland, Australia.
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Ozger H, Senol E. Use of infection biomarkers in the emergency department. Turk J Emerg Med 2022; 22:169-176. [PMID: 36353385 PMCID: PMC9639740 DOI: 10.4103/2452-2473.357347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
The use of infection biomarkers in the emergency department is discussed in terms of their possible contributions to diagnostic-prognostic uncertainties, appropriate antibiotic treatments, and triage and follow-up planning. Procalcitonin (PCT), C-reactive protein (CRP), proadrenomedullin (proADM), and presepsin are among the most discussed infection biomarkers for use in the emergency department. Due to the variable sensitivity results and cutoff values, there are insufficient data to recommend the widespread use of CRP and procalcitonin (PCT) for the diagnosis and prognosis of infection in the emergency department. However, these biomarkers can be used for appropriate antibiotic use in selected infection groups, such as community-acquired pneumonia, especially to reduce unnecessary antibiotic prescribing. With its prognostic superiority over other biomarkers and its contribution to prognostic score systems in community-acquired pneumonia (CAP), proADM can be used to predict hospitalization, preferably within the scope of clinical studies. Although presepsin has been shown to have some advantages over other biomarkers to rule out sepsis, there are insufficient data for its clinical use in the emergency department.
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8
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Bernstein D, Coster D, Berliner S, Shapira I, Zeltser D, Rogowski O, Adler A, Halutz O, Levinson T, Ritter O, Shenhar-Tsarfaty S, Wasserman A. C-reactive protein velocity discriminates between acute viral and bacterial infections in patients who present with relatively low CRP concentrations. BMC Infect Dis 2021; 21:1210. [PMID: 34863104 PMCID: PMC8643010 DOI: 10.1186/s12879-021-06878-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 11/15/2021] [Indexed: 11/12/2022] Open
Abstract
Background To assess the utility of C-reactive protein (CRP) velocity to discriminate between patients with acute viral and bacterial infections who presented with relatively low CRP concentrations and were suspected of having a bacterial infection. Methods We analyzed a retrospective cohort of patients with acute infections who presented to the emergency department (ED) with a relatively low first CRP measurement (CRP1) ≤ 31.9 mg/L and received antibiotics shortly after. We then calculated C-reactive protein velocity (CRPv), milligram per liter per hour, for each patient based on CRP1 and the second CRP value (CRP2) measured within the first 24 h since admission. Finally, we compared CRPv between patients with bacterial and viral infections. Results We have presently analyzed 74 patients with acute bacterial infections and 62 patients with acute viral infections at the mean age of 80 and 66 years respectively, 68 male and 68 female. CRP1 did not differ between both groups of patients (16.2 ± 8.6 and 14.8 ± 8.5 for patients with viral and bacterial infections respectively, p value = 0.336). However, the CRP2 was significantly different between the groups (30.2 ± 21.9 and 75.6 ± 51.3 for patients with viral and bacterial infections respectively, p-value < 0.001) and especially the CRPv was much higher in patients with acute bacterial infections compared to patients with acute viral infections (0.9 ± 1.2 and 4.4 ± 2.7 respectively, p-value < 0.001). Conclusion CRPv and CRP2 are useful biomarkers that can discriminate significantly between patients who present with acute bacterial and viral infections, and relatively low CRP concentration upon admission who were suspected of having a bacterial infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06878-y.
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Affiliation(s)
- Daniel Bernstein
- Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Dan Coster
- Blavatnik School of Computer Science, Tel-Aviv University, Tel-Aviv, Israel
| | - Shlomo Berliner
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel
| | - Itzhak Shapira
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel
| | - David Zeltser
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel
| | - Ori Rogowski
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel
| | - Amos Adler
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ora Halutz
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Tal Levinson
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel. .,Infectious Diseases Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
| | - Omri Ritter
- Department of Emergency Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Shani Shenhar-Tsarfaty
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel
| | - Asaf Wasserman
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel
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Feigin E, Levinson T, Berliner S, Zeltser D, Itzhak S, Shenhar-Tsarfaty S, Egoz E, Meilik A, Goldiner I, Rogowski O, Wasserman A. Patients who are admitted to the Department of Internal Medicine with a very low C-reactive protein concentration. EUR J INFLAMM 2021. [DOI: 10.1177/20587392211047303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction C-reactive protein (CRP) is a marker commonly used in clinical practice as a reference for the inflammatory activity in vivo. Low levels are often associated with good health and lower risk for adverse outcomes. Patients and methods We examined medical records of the last 6 years, of all patients admitted for hospitalization in internal medicine wards who had the first CRP measurement below ≤ 0.03 mg/L (detection limit). Diagnosis criteria and 7 days’ survival were reviewed. Results Out of 61,590 total admissions to internal medicine wards, three hundred and thirteen patients had CRP equal to or lower than 0.03 mg/L (0.5%). Second CRP measurement revealed gradual increment up to 10.8 ± 35.4 mg/L. Four patients died within 7 days from admission. Discussion Presentation to the internal medicine department with a very low concentration of CRP is highly unusual, but it does not exclude the existence of significant acute morbidities. Clinicians should take additional CRP tests before any conclusion is considered regarding the presence or absence of an inflammatory response.
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Affiliation(s)
- Eugene Feigin
- Departments of Internal Medicine C", D" and E", Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tal Levinson
- Departments of Internal Medicine C", D" and E", Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shlomo Berliner
- Departments of Internal Medicine C", D" and E", Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Zeltser
- Departments of Internal Medicine C", D" and E", Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shapira Itzhak
- Departments of Internal Medicine C", D" and E", Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shani Shenhar-Tsarfaty
- Departments of Internal Medicine C", D" and E", Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Egoz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clinical Performances Research and Operational Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ahuva Meilik
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clinical Performances Research and Operational Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ilana Goldiner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clinical Laboratory Services, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ori Rogowski
- Departments of Internal Medicine C", D" and E", Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Wasserman
- Departments of Internal Medicine C", D" and E", Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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The superiority of 72 h leukocyte descent over CRP for mortality prediction in patients with sepsis. Clin Chim Acta 2020; 514:34-39. [PMID: 33333041 DOI: 10.1016/j.cca.2020.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/27/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Detection of an eventful course in the early days of sepsis treatment is clinically relevant. The white blood cell count (WBCC) and C-reactive protein (CRP) are used in daily practice to monitor the intensity of the inflammatory response associated with sepsis. It is not entirely clear which of the two might better discriminate the outcomes of patients with sepsis. METHODS 30-day mortality was assessed in a cohort of patients who were hospitalized with sepsis in the departments of Internal Medicine in a tertiary medical center. Admission and 72-hour time points were analyzed to discriminate between patients with increased versus decreased 30 days mortality risk. RESULTS The study included 195 patients. Higher 72 h CRP, WBCC, neutrophil counts and neutrophils to lymphocyte ratio were associated with increased mortality (p < 0.02). Baseline WBCC and CRP failed to discriminate between patients who died and those who survived (AUC = 0.551, 0.479). In multivariate analysis of the 72 h tests, higher WBCC count (OR = 1.12, 95%CI 1.05-1.20, p = 0.001), was associated with increased mortality whereas CRP was not (OR = 1.004, 95%CI 0.998-1.01, p = 0.146). CONCLUSION Patients who presented a 72-hour leukocyte descent had a better outcome and in this regard, WBCC was superior to 72-hour CRP in predicting 30 days mortality.
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