Early Detection of Inflammation-Prone STEMI Patients Using the CRP Troponin Test (CTT)

The impact of post-stroke fatigue on inpatient rehabilitation outcomes: An observational study

BACKGROUND

Post-stroke fatigue is a typical complication following stroke. However, existing research primarily focused on its underlying mechanisms, and its impact on rehabilitation outcomes has yet to be uncovered.

OBJECTIVE

This study aims to explore the impact of post-stroke fatigue on rehabilitation outcomes during hospitalization.

METHOD

This was a prospective multicenter observational study including 46 stroke patients receiving comprehensive rehabilitation treatment. Patients' basic information was recorded upon admission and patients' functional independence was assessed with Functional Independence Measure (FIM) both upon admission and discharge. One week after rehabilitation treatment, fatigue, positivity in daily activity, attention, and memory were assessed. Serum biochemical indicators and levels of C-reactive protein (CRP) were assessed weekly following admission. The pain scores were assessed during the first week of hospitalization to calculate the average. Correlation analysis, linear regression and propensity score matching (PSM) were used to analyze the impact of fatigue on FIM scores at discharge and length of hospital stay.

RESULT

The proportion of patients with low fatigue was 39.13% and significant improvement was revealed in FIM scores upon admissions and discharge [(50.67±18.61) vs. (75.13±21.04), P<0.05]. Positivity in daily activity, attention, and age are factors that influence post-stroke fatigue. After PSM, low-fatigue group (Fatigue score< 3) showed significant higher motor function independence at discharge [(54.39 ± 15.42) vs. (41.89 ± 14.90), P<0.05] and shorter hospital stay [(28.54±9.13)d vs. (37.32 ± 9.81)d, P<0.05] than high-fatigue group. There was a significant difference (P<0.05) in level of CRP between the first inpatient week and the third week, with declining trend.

CONCLUSION

Post-stroke fatigue can affect the rehabilitation outcomes regarding motor function independence and length of hospital stay.

Being Eaten Alive: How Energy-Deprived Cells Are Disposed of, Mediated by C-Reactive Protein-Including a Treatment Option

In medicine, C-reactive protein (CRP) has become established primarily as a biomarker, predicting patient prognosis in many indications. Recently, however, there has been mounting evidence that it causes inflammatory injury. As early as 1999, CRP was shown to induce cell death after acute myocardial infarction (AMI) in rats and this was found to be dependent on complement. The pathological effect of CRP was subsequently confirmed in further animal species such as rabbit, mouse and pig. A conceptual gap was recently closed when it was demonstrated that ischemia in AMI or ischemia/hypoxia in the severe course of COVID-19 causes a drastic lack of energy in involved cells, resulting in an apoptotic presentation because these cells cannot repair/flip-flop altered lipids. The deprivation of energy leads to extensive expression on the cell membranes of the CRP ligand lysophosphatidylcholine. Upon attachment of CRP to this ligand, the classical complement pathway is triggered leading to the swift elimination of viable cells with the appearance of an apoptotic cell by phagocytes. They are being eaten alive. This, consequently, results in substantial fibrotic remodeling within the involved tissue. Inhibiting this pathomechanism via CRP-targeting therapy has been shown to be beneficial in different indications.

Association between high-sensitivity C-reactive protein and bleeding in non-ST-segment elevation acute coronary syndrome: A multicentre cohort of Chinese population.. [DOI: 10.21203/rs.3.rs-2241865/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background The association between high-sensitivity C-reactive protein (hs-CRP) and bleeding risk in acute coronary syndrome (ACS) patients remains unclear. This study aimed to examine the association between bleeding events and different hs-CRP levels in patients with non-ST elevation ACS (NSTE-ACS). Methods This study retrospectively included 2583 adults with NSTE-ACS between January 1, 2010, and December 31, 2014, at 5 medical centres in China. The primary outcome was major bleeding, defined by the Bleeding Academic Research Consortium definition (grades 3–5). Results Fifty-three (2.1%) patients experienced major bleeding in the hospital. Patients with hs-CRP levels greater than 8.20 mg/L had the highest incidence of in-hospital major bleeding (25 (3.9%), P < 0.001) compared with the other groups. Multivariable analysis indicated that hs-CRP was an independent factor associated with in-hospital major bleeding (continuous: adjusted OR = 1.01, 95% CI: 1.01–1.02, P < 0.001; quartiles: adjusted OR for quartile 4 (referring to quartile 1) = 3.71, 95% CI: 1.35 ~ 10.23, P = 0.011), which was further confirmed by subgroup analysis and receiver operating characteristic curves. The restricted cubic spline analysis demonstrated an S-shaped association between hs-CRP and major bleeding. During the 5-year follow-up, there was a significantly high risk of bleeding in patients with higher hs-CRP levels. Conclusion Higher hs-CRP level at admission in NSTE-ACS patients is associated with high risk of in-hospital major bleeding. An S-shaped association was found between hs-CRP and bleeding events. Further studies are warranted to optimize antithrombotic drug therapy in high-bleeding risk patients during follow-up.

Cardiac Biomarkers in 2022 – a Vital Tool for Emergency Care

The role of cardiac biomarkers in diagnosing acute myocardial infarction is undoubted. In the 2020 guidelines of the European Society of Cardiology, the measurement of cardiac peptides to gain prognostic information has a class IIa indication in all patients with ACS. In emergency care, ruling out a non-ST elevation myocardial infarction requires documentation of normal levels of cardiac biomarkers, which remain stable or have very small variations within several hours. This review aims to summarize the current knowledge and recent progresses in the field of cardiac biomarker discovery, from their routine use in emergency rooms to their prognostic roles in modern risk assessment tools. Integrated approaches combining cardiac troponin with other biomarkers of ventricular dysfunction or inflammation, or with modern cardiac imaging in emergency care are also presented, as well as the role of modern algorithms for serial troponin measurement in the modern management of emergency departments.

Special Issue “C-Reactive Protein and Cardiovascular Disease: Clinical Aspects”

This Special Issue focuses on the clinical relevance of C-reactive protein [...]