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Mengozzi M, Kirkham FA, Girdwood EER, Bunting E, Drazich E, Timeyin J, Ghezzi P, Rajkumar C. C-Reactive Protein Predicts Further Ischemic Events in Patients With Transient Ischemic Attack or Lacunar Stroke. Front Immunol 2020; 11:1403. [PMID: 32733466 PMCID: PMC7358589 DOI: 10.3389/fimmu.2020.01403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/01/2020] [Indexed: 11/13/2022] Open
Abstract
Patients who have experienced a first cerebral ischemic event are at increased risk of recurrent stroke. There is strong evidence that low-level inflammation as measured by high sensitivity C-reactive protein (hs-CRP) is a predictor of further ischemic events. Other mechanisms implicated in the pathogenesis of stroke may play a role in determining the risk of secondary events, including oxidative stress and the adaptive response to it and activation of neuroprotective pathways by hypoxia, for instance through induction of erythropoietin (EPO). This study investigated the association of the levels of CRP, peroxiredoxin 1 (PRDX1, an indicator of the physiological response to oxidative stress) and EPO (a neuroprotective factor produced in response to hypoxia) with the risk of a second ischemic event. Eighty patients with a diagnosis of lacunar stroke or transient ischemic attack (TIA) were included in the study and a blood sample was collected within 14 days from the initial event. Hs-CRP, PRDX1, and EPO were measured by ELISA. Further ischemic events were recorded with a mean follow-up of 42 months (min 24, max 64). Multivariate analysis showed that only CRP was an independent predictor of further events with an observed risk (OR) of 1.14 (P = 0.034, 95% CI 1.01–1.29). No association was observed with the levels of PRDX1 or EPO. A receiver operating curve (ROC) determined a cut-off CRP level of 3.25 μg/ml, with a 46% sensitivity and 81% specificity. Low-level inflammation as detected by hs-CRP is an independent predictor of recurrent cerebrovascular ischemic events.
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Affiliation(s)
- Manuela Mengozzi
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Frances A Kirkham
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Esme E R Girdwood
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Eva Bunting
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Erin Drazich
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Jean Timeyin
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Pietro Ghezzi
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Chakravarthi Rajkumar
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom.,Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
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Reindl M, Tiller C, Holzknecht M, Lechner I, Henninger B, Mayr A, Brenner C, Klug G, Bauer A, Metzler B, Reinstadler SJ. Association of Myocardial Injury With Serum Procalcitonin Levels in Patients With ST-Elevation Myocardial Infarction. JAMA Netw Open 2020; 3:e207030. [PMID: 32539151 PMCID: PMC7296390 DOI: 10.1001/jamanetworkopen.2020.7030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Myocardial tissue injury due to acute ST-elevation myocardial infarction (STEMI) initiates an inflammatory response that leads to a release of systemic inflammatory biomarkers, including C-reactive protein (CRP) and white blood cells, consequently reducing the usefulness of these routine biomarkers for identifying concomitant infections. The clinical role of procalcitonin (PCT), a promising marker of bacterial infection, to detect concomitant infection in acute STEMI is unknown, mainly because it is unclear whether myocardial injury per se induces systemic PCT release. OBJECTIVE To investigate the release of serum PCT in the acute setting of STEMI (24 and 48 hours after primary percutaneous coronary intervention) and to elucidate any associations with myocardial injury markers through a comprehensive assessment by cardiac magnetic resonance (CMR) imaging. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study conducted between 2016 and 2018 included 141 consecutive patients with STEMI treated with primary percutaneous coronary intervention. Concentrations of PCT, high-sensitivity CRP (hs-CRP), and high-sensitivity cardiac troponin T (hs-cTnT) and white blood cell counts were measured serially 24 and 48 hours after infarct. EXPOSURES Acute STEMI and primary percutaneous coronary intervention. MAIN OUTCOMES AND MEASURES The association of PCT and typical inflammatory marker levels with CMR-determined myocardial damage was assessed. Infarct size, extent of microvascular obstruction, and occurrence of intramyocardial hemorrhage as determined by CMR within the first week following STEMI were also evaluated. RESULTS In total, 141 patients with STEMI (117 men [83%]) having a median age of 56 years (interquartile range, 50-66 years) were included. The median PCT concentration was 0.07 μg/L (interquartile range, <0.06-0.11 μg/L) 24 hours after intervention and 0.07 μg/L (interquartile range, <0.06-0.09 μg/L) 48 hours after intervention. Whereas hs-CRP and hs-cTnT levels and white blood cell counts were significantly correlated with CMR markers of myocardial damage at both 24 and 48 hours after intervention, the PCT level showed no significant correlation with infarct size (at 24 hours: r = 0.07; P = .40; at 48 hours: r = 0.13; P = .12) or with microvascular obstruction (at 24 hours: r = -0.03; P = .75; at 48 hours: r = 0.09; P = .30). Furthermore, PCT levels at 24 hours (odds ratio, 1.25; 95% CI, 0.63-2.48; P = .52) and 48 hours (odds ratio, 1.56; 95% CI, 0.72-3.41; P = .26) were not significantly associated with the presence of intramyocardial hemorrhage. CONCLUSIONS AND RELEVANCE In the acute phase after percutaneous coronary intervention for STEMI, circulating PCT levels remained unassociated with the extent of myocardial and microvascular tissue damage as visualized by CMR imaging.
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Affiliation(s)
- Martin Reindl
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Christina Tiller
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Magdalena Holzknecht
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Ivan Lechner
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Henninger
- University Clinic of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Brenner
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Gert Klug
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Axel Bauer
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Metzler
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Sebastian J. Reinstadler
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
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Nomura N, Saito K, Ikeda M, Yuasa S, Pastore M, Chabert C, Kono E, Sakai A, Tanaka H, Ikemoto T, Takubo T. Evaluation of the Microsemi CRP, an automated hematology analyzer for rapid 3-part WBC differential and CRP using whole blood. Int J Lab Hematol 2014; 37:466-73. [DOI: 10.1111/ijlh.12312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Affiliation(s)
- N. Nomura
- HORIBA Medical; MiyanohigashiKisshoin; Minami-ku Kyoto Japan
| | - K. Saito
- HORIBA Ltd; Tokyo Office: Kanda-Awaji cho; Kanda Chiyoda-ku Tokyo Japan
| | - M. Ikeda
- HORIBA Medical; MiyanohigashiKisshoin; Minami-ku Kyoto Japan
| | - S. Yuasa
- HORIBA Medical; MiyanohigashiKisshoin; Minami-ku Kyoto Japan
| | - M. Pastore
- HORIBA ABX; Parc Euromédecine; Montpellier Cedex 4 France
| | - C. Chabert
- HORIBA ABX; Parc Euromédecine; Montpellier Cedex 4 France
| | - E. Kono
- Department of Central Laboratory; Osaka Medical College Hospital; Daigaku-machi Takatsuki Japan
| | - A. Sakai
- Department of Central Laboratory; Osaka Medical College Hospital; Daigaku-machi Takatsuki Japan
| | - H. Tanaka
- Department of Central Laboratory; Osaka Medical College Hospital; Daigaku-machi Takatsuki Japan
| | - T. Ikemoto
- Department of Central Laboratory; Osaka Medical College Hospital; Daigaku-machi Takatsuki Japan
| | - T. Takubo
- Department of Central Laboratory; Osaka Medical College Hospital; Daigaku-machi Takatsuki Japan
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Erturk A, Cure E, Parlak E, Cure MC, Yuce S, Kizilkaya B. Serum resistin levels may be new prognostic factor of crimean-congo hemorrhagic fever. Int J Clin Exp Med 2014; 7:3536-42. [PMID: 25419394 DOI: pmid/25419394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 09/20/2014] [Indexed: 02/07/2023]
Abstract
Crimean-Congo hemorrhagic fever (CCHF) virus can cause potentially fatal infections in humans. During this disease, cytokines are intensive released. Resistin which is a good marker of inflammation is an adipocytokine released from adipose tissue. We aimed to investigate whether serum resistin level in patients with CCHF has a prognostic value in predicting recovery time. Twenty men and 22 women (a total of 42 CCHF patients) and a similar age group of 40 healthy individuals (16 men and 24 women) were included in the study. Hematologic tests, serum resistin level, C-reactive protein (CRP) and others biochemical values of all the two group subjects were evaluated. Multivariate logistic regression analysis was performed. Resistin level of patients with CCHF was higher than the controls (1252.6±864.7 ng/ml vs. 824.1±224.6 ng/ml, p=0.003). There was strongly association among recovery time, increased resistin level (p < 0.001), prothrombin time (PT) (p < 0.001), INR (p < 0.001), decreased white blood cell count (WBC) (p=0.012) and lower platelet counts (p=0.007). Serum resistin level is significantly elevated in CCHF patients. Resistin level may be a good prognostic factor to predict recovery time in patients with CCHF.
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Affiliation(s)
- Ayse Erturk
- Department of Infectious Disease, School of Medicine, Recep Tayyip Erdogan University Rize, Turkey
| | - Erkan Cure
- Department of Internal Medicine, School of Medicine, Recep Tayyip Erdogan University Rize, Turkey
| | - Emine Parlak
- Department of Infectious Disease, School of Medicine, Ataturk University Erzurum, Turkey
| | - Medine Cumhur Cure
- Department of Biochemistry, School of Medicine, Recep Tayyip Erdogan University Rize, Turkey
| | - Suleyman Yuce
- Department of Internal Medicine, School of Medicine, Recep Tayyip Erdogan University Rize, Turkey
| | - Bayram Kizilkaya
- Department of Internal Medicine, School of Medicine, Recep Tayyip Erdogan University Rize, Turkey
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Hariharan S, Pillai G, McIntosh D, Bhanji Z, Culmer L, Harper-McIntosh K. Prescribing patterns and utilization of antimicrobial drugs in a tertiary care teaching hospital of a Caribbean developing country. Fundam Clin Pharmacol 2009; 23:609-15. [PMID: 19656207 DOI: 10.1111/j.1472-8206.2009.00713.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study aimed to evaluate the prescribing practices and utilization of antimicrobials in a tertiary care teaching hospital of a Caribbean developing country. A prospective observational cohort study was undertaken for a period of 12 weeks in the general wards and the intensive care unit (ICU) of the hospital. Demographic data, diagnoses on admission, antimicrobials prescribed, dosage and duration, route of administration, leukocyte count and microbiological culture and sensitivity reports were recorded. Hospital length of stay and final outcome were recorded. The usage was determined in terms of prescribed daily dose and the total costs of antimicrobials were calculated. Of 889 patients admitted, 335 (37.7%) received 22 different antimicrobial drugs. Overall, 67% of the prescriptions adhered to the hospital protocol. Median length of stay in the hospital was 7 days. Skin and soft tissue infections were the most common diagnoses for which antimicrobials were prescribed. Amoxicillin-clavulanate was the most common (32%) antimicrobial used. Eighty-nine percent of the antimicrobials were given through the intravenous route. Sixty percent of the patients received two antimicrobials, 26% received three, and 14% of patients were prescribed four or more antimicrobials during their stay at the hospital. There was significantly higher inappropriate choice of antimicrobials in ICU when compared with general wards (Mantel-Haenszel Odds Ratio 3.3; 95% Confidence Intervals 1.4, 7.7). Prescribing patterns did not strictly adhere to the hospital antimicrobial protocol. There is a need for monitoring and control of antimicrobial prescription.
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Affiliation(s)
- Seetharaman Hariharan
- Anaesthesia and Intensive Care Unit, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad, West Indies.
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Outpatient antibiotic use and assessment of antibiotic guidelines in Chinese children's hospitals. Eur J Clin Pharmacol 2008; 64:821-8. [PMID: 18458895 DOI: 10.1007/s00228-008-0489-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Accepted: 03/16/2008] [Indexed: 10/22/2022]
Abstract
PURPOSE Our aim was to investigate outpatient antibiotic use and assess the impacts of intervention in five Chinese children's hospitals from 2002 to 2006. METHODS The Anatomical Therapeutical Chemical Classification/Defined Daily Doses and Drug Utilization 90% methodologies were used. We also analyzed the relationship between antibiotic consumption and resistant rate in one of the hospitals. RESULTS The overall antibiotic consumption decreased during the intervention period in some hospitals, and the variation in use between hospitals was also reduced. A decrease in penicillins and first-generation cephalosporins, and an increase in third-generation cephalosporins as well as in the combinations of penicillins and beta-lactamase inhibitors were observed. In addition, an increasing resistance to antibiotics was a concern due to antibiotic overconsumption. CONCLUSIONS The intervention had effects on the overall antibiotic use in outpatients. However, over the span of 5 years, there was a decrease in the use of narrow-spectrum antibiotics and an increase in broad-spectrum antibiotics.
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Ren YF, Malmstrom HS. Rapid quantitative determination of C-reactive protein at chair side in dental emergency patients. ACTA ACUST UNITED AC 2007; 104:49-55. [PMID: 17482849 DOI: 10.1016/j.tripleo.2007.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Revised: 12/22/2006] [Accepted: 01/01/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The objective of this study was to quantitatively determine, at chair side, the serum C-reactive protein (CRP) levels in dental emergency patients. STUDY DESIGN Quantitative CRP test was performed at chair side in 40 patients with acute alveolar abscess (AAA), acute periodontal abscess (APA), and alveolar osteitis (AO) at the time of dental emergency treatment and 1 week after. CRP levels were compared between groups and before and after treatments using ANOVA and Fisher's Exact tests. RESULTS Serum CRP levels were greater than 5 mg/L in 30 (75%) of the 40 patients. At 1-week follow-up, the decline in CRP levels was evident in the AAA group (P < .05), but not statistically significant in the APA and AO groups (P > .05). CONCLUSION Serum CRP levels are often elevated in patients with odontogenic infections and postoperative complications. Rapid reduction in serum CRP levels was likely to occur following successful treatment of AAA, but less likely to occur in APA and AO.
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Affiliation(s)
- Yan-Fang Ren
- University of Rochester, Eastman Dental Center, Rochester, NY 14620, USA.
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Takemura Y, Ishida H, Saitoh H, Kure H, Kakoi H, Ebisawa K, Kure M. Economic consequence of immediate testing for C-reactive protein and leukocyte count in new outpatients with acute infection. Clin Chim Acta 2005; 360:114-21. [PMID: 15964561 DOI: 10.1016/j.cccn.2005.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Revised: 03/18/2005] [Accepted: 04/10/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND There have been few well-designed studies that assess the cost-effectiveness of near-patient immediate testing. METHODS We analyzed the economic outcome of immediate testing for C-reactive protein (CRP) and white blood cell count (WBC) in 305 new outpatients with acute infections. Patients were randomized into two groups: 147 patients were tested immediately for CRP and WBC before the physician's initial consultation (advance testing), and 154 patients were not subjected to advance testing. The subsequent prescribing decision and the drug/testing/personnel costs were compared between the groups. RESULTS In the advance-testing group, the initial consultation was followed by a total of 84 prescriptions of oral antibiotics, against 158 in the other group. Comparing the total costs of oral and parenteral antibiotics between the two groups, a 30% reduction was achieved with advance testing ( yen105,830 vs. yen151,102). However, the savings were largely offset by frequent prescription of newer, expensive influenza neuraminidase inhibitors. Advance testing also significantly reduced additional laboratory use. More frequent urgent testing increased personnel costs in the non-advance-testing group. Overall, total cost was somewhat higher in the advance-testing group ( yen1,028,827 vs. yen984,105). CONCLUSIONS The cost per antibiotic prescription reduced with advance testing was yen604 (approximately 5.8 US dollars) in our clinical setting. Judicious use of antivirals and introduction of a simple CRP test kit would improve cost-effectiveness.
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Affiliation(s)
- Yuzuru Takemura
- Department of Laboratory Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
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Takemura Y, Ebisawa K, Kakoi H, Saitoh H, Kure H, Ishida H, Kure M. Antibiotic selection patterns in acutely febrile new outpatients with or without immediate testing for C reactive protein and leucocyte count. J Clin Pathol 2005; 58:729-33. [PMID: 15976341 PMCID: PMC1770720 DOI: 10.1136/jcp.2004.024356] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Excessive use of broad spectrum antibiotics is related to the spread of drug resistant bacterial strains in the community. AIM/METHODS The effects of immediate testing for C reactive protein (CRP) and white blood cell count (WBC) on physicians' choices of antibiotic was investigated in patients with acute infection. Acutely febrile new outpatients were randomised into two groups: group 1 (147 patients) underwent CRP and WBC testing before initial consultation (advance testing). Prescriptions were compared with those in group 2 (no advance testing; 154 patients). RESULTS In non-pneumonic acute respiratory tract infections, 61 (58%) and 122 (91%) of group 1 and 2 patients were prescribed antibiotics, respectively. Cefcapene pivoxil (third generation cephalosporin) and amoxicillin were the most frequently chosen drugs for group 1 and 2, respectively. Total prescriptions of newer, extended spectrum antibiotics (cefcapene pivoxil and clarithromycin (advanced macrolide)) were reduced by 25% in group 1, although they increased in rate (41 (67%) v 55 (45%) prescriptions) because of the decreased prescription of amoxicillin. In group 1, cefcapene pivoxil was preferentially selected when WBC values were greater than 9 x 10(9)/litre. Prescription shifted to macrolides (mainly clarithromycin) in patients without leucocytosis. Patient treatment outcome did not significantly differ between the two groups. CONCLUSIONS The availability of CRP and WBC data during initial consultation greatly reduced prescription of amoxicillin, but had a lesser effect on newer, potent, broad spectrum antibiotics.
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Affiliation(s)
- Y Takemura
- Department of Laboratory Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
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