1
|
Rabbi MF, Ahmed MN, Patowary MSA, Huq SR, Razzaque SMA, Arafat HM, Nahar T, Iktidar MA. Pleural fluid adenosine deaminase to serum C-reactive protein ratio for diagnosing tuberculous pleural effusion. BMC Pulm Med 2023; 23:349. [PMID: 37715196 PMCID: PMC10504718 DOI: 10.1186/s12890-023-02644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) may occasionally show similar cytological and biochemical picture including ADA. In such cases, differentiating TPE and MPE is challenging and needs histopathology of pleural tissue which may involve invasive procedures. The present study aims to evaluate the diagnostic accuracy of pleural fluid ADA to serum CRP (ADA/CRP) ratio to discriminate between tuberculous and malignant pleural effusion. In addition, we investigated whether the ratio ADA/CRP adds diagnostic value to ADA. METHODS This cross-sectional study was conducted in the National Institute of Diseases of the Chest and Hospital (NIDCH), Mohakhali, Dhaka, from July 2021 to February 2022 on diagnosed patients of TPE and malignant pleural effusion MPE. A receiver operating characteristic curve (ROC) was constructed for identifying TPE. The added value of the ADA/CRP ratio to ADA was evaluated using the net reclassification improvement (NRI) and integrated discrimination improvement (IDI). A value of p < 0.05 was considered statistically significant for all tests. RESULTS Fifty-nine patients were enrolled in this study, of which 31 had TPE, and 28 had MPE. Pleural fluid ADA to serum CRP ratio and pleural fluid ADA level was significantly higher in patients with TPE, but there was no significant difference in serum CRP levels between patients with TPE and MPE. At cut off value of > 1.25, pleural fluid ADA to serum CRP ratio had a sensitivity of 93.8%, specificity of 85.2%, and positive and negative predictive values were 88.2% and 92% respectively, in the diagnosis of TPE and area under ROC curve (AUC) was 0.94. The NRI and IDI analyses revealed added diagnostic value of ADA/CRP to ADA. CONCLUSION This study shows that the ADA/CRP ratio improves the diagnostic usefulness of ADA for TPE.
Collapse
Affiliation(s)
- Mohammad Fazle Rabbi
- National Institute of Diseases of the Chest and Hospital, Dhaka, 1212, Bangladesh
| | - Mushfiq Newaz Ahmed
- National Institute of Diseases of the Chest and Hospital, Dhaka, 1212, Bangladesh
| | | | | | - S M Abdur Razzaque
- National Institute of Diseases of the Chest and Hospital, Dhaka, 1212, Bangladesh
| | - Hossain Md Arafat
- National Institute of Cancer Research and Hospital, Dhaka, 1212, Bangladesh
| | - Tasnuva Nahar
- Mugda Medical College Hospital, Dhaka, 1214, Bangladesh
| | - Mohammad Azmain Iktidar
- Directorate General of Health Services, Dhaka, Bangladesh.
- School of Research, Chattogram, Bangladesh.
| |
Collapse
|
2
|
Supiyev A, Karlsson R, Wang Y, Koch E, Hägg S, Kauppi K. Independent role of Alzheimer's disease genetics and C-reactive protein on cognitive ability in aging. Neurobiol Aging 2023; 126:103-112. [PMID: 36965205 DOI: 10.1016/j.neurobiolaging.2023.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/31/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
Apolipoprotein E (APOE) ε4, the strongest genetic risk factor for late onset Alzheimer's disease (LOAD), has been associated with cognitive decline independent from AD pathology, but the role for other LOAD risk genes in normal cognitive aging is less studied. We examined the effect of APOE ε4 and several different polygenic risk scores (PRS) for LOAD on cognitive level and decline in aging, using longitudinal data from the UK Biobank. While PRS-LOAD including all variants (except APOE) predicted cognitive level, APOE ε4 and PRS-LOAD based on 17 non-APOE gene variants with strong association to AD (p < 5e-8) predicted age-related decline in verbal numeric reasoning. The effect on decline were partly driven by 4 variants involved in the immune system. Those variants also predicted serum levels of the inflammatory marker C-reactive protein (CRP), but CRP did not mediate the effect on decline. Those findings suggest genetic variations in immune functions play a role in aspects of cognitive aging that may be independent of LOAD pathology as well as systemic inflammation measured by CRP.
Collapse
Affiliation(s)
- Adil Supiyev
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
| | - Robert Karlsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Yunzhang Wang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Elise Koch
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway; Department of Integrative Medical Biology, Umeå Universitet, Biologihuset, Umeå, Sweden
| | - Sara Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Karolina Kauppi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Department of Integrative Medical Biology, Umeå Universitet, Biologihuset, Umeå, Sweden
| |
Collapse
|
3
|
Praz C, Gubbiotti L, Buia G, Chapus V, Dunet J, Grandhomme F, Michon J, Rochcongar G, Hulet C. Value of the synovial C-reactive protein test in the diagnosis of total hip and knee periprosthetic joint infections: A case-control study. Orthop Traumatol Surg Res 2021; 107:102903. [PMID: 33775885 DOI: 10.1016/j.otsr.2021.102903] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The diagnosis of periprosthetic joint infection (PJI) can be challenging and rests on several principles. The use of diagnostic biomarkers, such as the synovial C-Reactive Protein (CRP), seems promising. The purpose of this study was to determine whether synovial CRP was a more discriminating test than serum CRP for the diagnosis of hip and knee PJI. MATERIALS AND METHODS In total, 194 patients were included in this single center prospective study: 42 primary arthroplasties (control group [CG]), 111 revisions for aseptic prosthesis (aseptic revision group [ARG]), and 41 revisions for septic prosthesis (septic revision group [SRG]) based on the Musculoskeletal Infection Society (MSIS) criteria. RESULTS The serum and synovial CRP levels were significantly higher in the SRG than the other two groups (SRG serum CRP=75.6mg/L vs. ARG serum CRP=6mg/L and CG serum CRP=2.7mg/L, p<0.001; SRG synovial CRP=31.5mg/L vs. CG synovial CRP=2.6mg/L and ARG synovial CRP=1.7mg/L, p<0.001). The positive likelihood ratios (LR+) were very similar for both the synovial CRP cut-off value of 4.4mg/L (LR+=7.04; sensitivity [Se] 82.5%, specificity [Sp] 88.3%) and the serum CRP cut-off value of 9mg/L (LR+=6.3; Se 87.5%, Sp 86.1%). CONCLUSION This study showed that synovial CRP testing was not more discriminating than serum CRP in the diagnosis of hip and knee PJI. A serum CRP level greater than 9mg/L was a sign of PJI. LEVEL OF EVIDENCE III; case-control study.
Collapse
Affiliation(s)
- César Praz
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France.
| | - Laura Gubbiotti
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Geoffrey Buia
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Valentin Chapus
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Julien Dunet
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Frederique Grandhomme
- Secteurs biochimie et hormonologie, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Jocelyn Michon
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Goulven Rochcongar
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Christophe Hulet
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| |
Collapse
|
4
|
Baboudjian M, Gondran-Tellier B, Di Bisceglie M, Abdallah R, Michel F, Sichez PC, Al-Balushi K, Akiki A, Gaillet S, Delaporte V, Karsenty G, Lechevallier E, Guieu R, Boissier R. The prognostic value of serum procalcitonin in acute obstructive pyelonephritis. World J Urol 2020; 39:1583-1589. [PMID: 32671605 DOI: 10.1007/s00345-020-03353-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the prognostic value of procalcitonin (PCT) in the occurrence of infectious complications in the management of acute obstructive pyelonephritis (AOP) compared with other biological parameters (leucocyte count, C-reactive protein [CRP]). METHODS We conducted a retrospective study including patients who were treated for AOP and performed serum PCT tests in our center between January 1, 2017 and December 31, 2017. Upper urinary tract obstruction was confirmed by either ultrasound or CT urography. Clinical examinations and laboratory tests including leukocyte count, CRP, urine and blood cultures, and serum PCT measurements were performed in the emergency unit. Treatment included early renal decompression using indwelling ureteral stents or nephrostomy and empiric antibiotic therapy. The primary endpoint was occurrence of severe sepsis (SS), a composite criterion including urosepsis and/or septic shock and/or admission to the intensive care unit (ICU) and/or death. RESULTS A total of 110 patients (median age: 61 years) were included, of whom 56.3% were female. SS occurred in 39 cases (35.4%). Multivariate regression analysis showed that serum PCT (OR 1.08; 95% CI 1.03-1.17; p = 0.01), CRP (OR 1.007; 95% CI 1.001-1.015; p = 0.03), and diabetes mellitus (OR 5.1; 95% CI 1.27-27.24; p = 0.04) were independent predictors for SS. Serum PCT was the biological marker associated with the highest accuracy to predict SS (ROC 0.912 (95% CI 0.861-0.962) and was superior to CRP (p < 0.001): the sensitivity and specificity of PCT to predict SS were 95% and 77%, respectively, with a serum PCT cutoff value of 1.12 µg/L. CONCLUSIONS PCT levels > 1.12 µg/L could help physicians to identify high-risk patients who could benefit from early and aggressive management in collaboration with intensive care specialists.
Collapse
Affiliation(s)
- Michael Baboudjian
- Department of Urology and Kidney Transplantation, Conception University Hospital, APHM, Aix-Marseille University, Marseille, France
| | - Bastien Gondran-Tellier
- Department of Urology and Kidney Transplantation, Conception University Hospital, APHM, Aix-Marseille University, Marseille, France
| | - Mathieu Di Bisceglie
- Department of Urology and Kidney Transplantation, Conception University Hospital, APHM, Aix-Marseille University, Marseille, France
| | - Rony Abdallah
- Department of Urology and Kidney Transplantation, Conception University Hospital, APHM, Aix-Marseille University, Marseille, France
| | - Floriane Michel
- Department of Urology and Kidney Transplantation, Conception University Hospital, APHM, Aix-Marseille University, Marseille, France
| | - Pierre Clement Sichez
- Department of Urology and Kidney Transplantation, Conception University Hospital, APHM, Aix-Marseille University, Marseille, France
| | - Khalid Al-Balushi
- Department of Urology and Kidney Transplantation, Conception University Hospital, APHM, Aix-Marseille University, Marseille, France
| | - Akram Akiki
- Department of Urology and Kidney Transplantation, Conception University Hospital, APHM, Aix-Marseille University, Marseille, France
| | - Sarah Gaillet
- Department of Urology and Kidney Transplantation, Conception University Hospital, APHM, Aix-Marseille University, Marseille, France
| | - Veronique Delaporte
- Department of Urology and Kidney Transplantation, Conception University Hospital, APHM, Aix-Marseille University, Marseille, France
| | - Gilles Karsenty
- Department of Urology and Kidney Transplantation, Conception University Hospital, APHM, Aix-Marseille University, Marseille, France
| | - Eric Lechevallier
- Department of Urology and Kidney Transplantation, Conception University Hospital, APHM, Aix-Marseille University, Marseille, France
| | - Régis Guieu
- Laboratory of Biochemistry and Molecular Biology, La Timone University Hospital, APHM, Aix-Marseille University, Marseille, France
| | - Romain Boissier
- Department of Urology and Kidney Transplantation, Conception University Hospital, APHM, Aix-Marseille University, Marseille, France. .,Department of Urology and Renal Transplantation, Conception University Hospital, APHM, Aix-Marseille University, Marseille, France.
| |
Collapse
|
5
|
Fu J, Ni M, Li H, Li X, Chai W, Zhou Y, Hao L, Chen J. The proper timing of second-stage revision in treating periprosthetic knee infection: reliable indicators and risk factors. J Orthop Surg Res 2018; 13:214. [PMID: 30157882 PMCID: PMC6114879 DOI: 10.1186/s13018-018-0885-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/06/2018] [Indexed: 11/15/2022] Open
Abstract
Background Two-stage revision is the standard procedure for periprosthetic knee infection. But when to perform the second-stage is still under debate. We attempt to search the reliable indicators, risk factors, and proper timing for the second-stage revision. Methods We reviewed and followed 81 infected total knee arthroplasty patients who underwent two-stage revision from January 2010 to January 2014. Our cohort included 56 males and 25 females, all patients were confirmed as PJI with the same phenotypic cultures. The average age was 64.8 ± 8.21 (range 36–78) months. The mean follow-up time was 46.5 ± 17.6 (range 12–72) months after the second-stage surgeries. The diagnostic parameters including serum C-reaction protein, erythrocyte sedimentation rate, and intraoperative frozen section at the time of re-implantation were analyzed. The spacer detention time and antibiotic treatment time were compared. Results Ten of them went through failed first- or second-stage surgeries. The overall success rate was 87.7%. The intraoperative frozen section is a good indicator at the time of re-implantation; the sensitivity and specificity is 90 and 83.1%. Serum CRP and ESR showed poor diagnostic value at time of re-implantation. Atypical pathogen infection, positive FS, and previous sinus were high-risk factors for failure of two-stage revision. Spacer detention time between 12 and 16 weeks had higher success rate than over 16 weeks. Conclusion The proper timing of re-implantation should be combined with disappearance of clinical symptoms and negative intraoperative FS with spacer detention time at 12 to 16 weeks.
Collapse
Affiliation(s)
- Jun Fu
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, 100853, China
| | - Ming Ni
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, 100853, China
| | - Heng Li
- Department of Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
| | - Xiang Li
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, 100853, China
| | - Wei Chai
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, 100853, China
| | - Yonggang Zhou
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, 100853, China
| | - Libo Hao
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, 100853, China
| | - Jiying Chen
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, 100853, China.
| |
Collapse
|