The Impact of Intramuscular Depot Betamethasone Injection (Diprospan) on Patients with Fibromyalgia and Normal C-Reactive Protein Levels

Introduction: Intramuscular depot betamethasone treatment had resulted in a significant improvement among fibromyalgia patients with elevated C-reactive protein (C-RP) levels. Here, we wanted to evaluate the same regimen of treatment among fibromyalgia patients with normal C-RP levels. These patients represent the overwhelming majority of fibromyalgia patients. Patients and Methods: Consecutive patients with fibromyalgia attending the outpatient rheumatology clinic, with normal C-RP level and negative serology, who had failed different medical treatment, were asked to participate in our study. All patients have qualified the American College of Rheumatology (ACR) criteria from 2010. After consent, patients had an intra-muscular injection of 14 mg depot betamethasone at the gluteal area. Just prior to the injection, 1 week and 1 month later, patients were interviewed by phone and asked to answer the Fibromyalgia Revised Questionnaire (FIQR). Wilcoxon’s signed ranked test was used to compare the results 1 week and 1 month following the injection, compared to the base line scores. Results: Seventeen (17) patients completed the study. Favorable effects were seen regarding 13 out of 19 parameters one week following the injection, including functional parameters, mood and anxiety, tenderness to touch and intolerance to noise and light. No significant favorable effect was seen 1 month following the injection except for one parameter: ability of walking for twenty minutes. Conclusions: IM depot betamethasone injection had very limited and transient favorable effects on fibromyalgia patients with normal C-RP levels. Such a treatment is not a recommended modality of routine treatment, among fibromyalgia patients with normal C-RP levels.

Correlation between C-reactive Protein and Morphology of Aortic Intramural Hematoma on CT Angiography

Objectives To investigate the morphologic characteristics of intramural hematoma(IMH)on CT angiography(CTA),and evaluate the possible correlation of serum C-reactive protein(CRP)with morphologic characteristics of IMH.Material and Methods Forty-two patients who were initially diagnosed as IMH by aortic CTA and also had serum CRP examination on the same day of CTA were enrolled in this retrospective study,including 30 males and 12 females,with the mean age of 61±14 years old.The volumetric CT data were retrospectively processed and analyzed on post-processing workstation.Based on the thickness of IMH and the length-area curve,the crosssectional area of true lumen and total vessel were measured,the hematoma-vessel ratio(HVR)was calculated.Imaging characteristics were compared between patients who had pathological elevated CRP(>0.8 mg/dl)and those did not.Spearman correlation analyses of CRP level and morphological characteristics of IMH were performed,and the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic validity of CRP.Results Of all 42 IMH patients,the mean serum CRP was 3.94±4.71 mg/dl,and the mean HVR was 46.7%±14.2%.HVR in patients with elevated CRP was significantly higher than those with normal CRP(49.7%±15.0%vs.40.7%±10.5%,P=0.030).HVR was mildly correlated with CRP in all patients(r=0.48,P<0.001).CRP levels differed neither between patients with Stanford type A and B(P=0.207),nor between patients with and without intimal disruption(P=0.230).To discriminate HVR>47%(the mean value),the area under curve(AUC)were 0.700(95%CI:0.535-0.865)for CRP at a cutoff point of 3.55 mg/dl,with a sensitivity of 54.5%and a specificity of 90.0%.Conclusion CRP was mildly correlated with the severity of cross-sectional hematoma area of IMH,but not with Stanford types and the presence of intimal disruption.

Combined Effects of Family History of Cardiovascular Disease and Serum C-reactive Protein Level on the Risk of Stroke: A 9.2-year Prospective Study among Mongolians in China

Objective We aimed to evaluate the combined effect of a family history of cardiovascular disease（CVD） and high serum C‐reactive protein（CRP） on the stroke incidence in an Inner Mongolian population in China. Methods A prospective cohort study was conducted from June 2002 to July 2012, with 2,544 participants aged 20 years and over from Inner Mongolia, China. We categorized participants into four groups based on the family history of CVD and CRP levels. Results We adjusted for age; sex; smoking; drinking; hypertension; body mass index; waist circumference; and blood glucose, triglycerides, low‐density lipoprotein cholesterol, and high‐density lipoprotein cholesterol levels. Compared with the group with no family history of CVD/low CRP levels, the group with family history of CVD/high CRP levels had a hazard ratio（HR） of 1.78 [95% confidence interval（CI）, 1.03‐3.07; P = 0.039] of stroke, and an HR of 2.14（95% CI, 1.09‐4.20; P = 0.027） of ischemic stroke. The HRs of hemorrhagic stroke for the other three groups were not statistically significant（all P 〉 0.05）. Conclusion Participants with both a family history of CVD and high CRP levels had the highest stroke incidence, suggesting that high CRP levels may increase stroke risk, especially of ischemic stroke, among individuals with a family history of CVD.

Elevated Homocysteine and C-reactive Protein Levels Independently Predict Worsening Prognosis after Stroke in Chinese Patients

Increased plasma total homocysteine (tHcy) and high sensitivity C-reactive protein (hsCRP) levels are independent risk factors for cardiovascular disease.However, the predictive value of tHcy in combination with hsCRP in patients with stroke is not known.To determine the relationship between tHcy and hsCRP, we enrolled 291 patients with first-onset stroke (196 ischemic and 95 hemorrhagic).Plasma tHcy and hsCRP levels were measured and subsequent vascular events and deaths were determined over a 5-year period.Using the arbitrary cutoff for tHcy (【18 μmol/L and ≥18 μmol/L) and hsCRP (【1 mg/L, 1-3 mg/L and 】3 mg/L), the patients were divided into 6 groups.Survival analysis showed that the probability of death or new vascular events during a 5-year follow-up increased according to tHcy and hsCRP levels (P【0.01).The relative risk (RR) of death or new vascular events was 4.67 (95% CI, 1.96 to 11.14, P=0.001) in patients with high tHcy (≥18 μmol/L) and hsCRP (】3 mg/L) compared with those with low tHcy (【18 μmol/L) and hsCRP (【1 mg/L).The increased tHcy level (≥18 μmol/L) combined with increased hsCRP level (】3 mg/L) was still significantly associated with the risk of death or new vascular events (RR, 4.10, 95% CI, 1.61 to 10.45, P=0.003) even when adjusted for other risk factors at inclusion.The combination of increased tHcy and hsCRP levels had a stronger predictive value than increased hsCRP alone or increased tHcy level alone.Further studies are required to evaluate the potential decrease in risks associated with lowering both Hcy and hsCRP levels in patients that present with both increased tHcy and hsCRP.

Predictive value of C-reactive protein/albumin ratio in acute pancreatitis

BACKGROUND:Serum C-reactive protein(CRP) increases and albumin decreases in patients with inflammation and infection.However,their role in patients with acute pancreatitis is not clear.The present study was to investigate the predictive significance of the CRP/albumin ratio for the prognosis and mortality in acute pancreatitis patients.METHODS:This study was performed retrospectively with 192 acute pancreatitis patients between January 2002 and June 2015.Ranson scores,Atlanta classification and CRP/albumin ratios of the patients were calculated.RESULTS:The CRP/albumin ratio was higher in deceased patients compared to survivors.The CRP/albumin ratio was positively correlated with Ranson score and Atlanta classification in particular and with important prognostic markers such as hospitalization time,CRP and erythrocyte sedimentation rate.In addition to the CRP/albumin ratio,necrotizing pancreatitis type,moderately severe and severe Atlanta classification,and total Ranson score were independent risk factors of mortality.It was found that an increase of 1 unit in the CRP/albumin ratio resulted in an increase of 1.52 times in mortality risk.A prediction value about CRP/albumin ratio >16.28 was found to be a significant marker in predicting mortality with 92.1% sensitivity and 58.0% specificity.It was seen that Ranson and Atlanta classification were higher in patients with CRP/albumin ratio >16.28 compared with those with CRP/albumin ratio ≤16.28.Patients with CRP/albumin ratio >16.28 had a 19.3 times higher chance of death.CONCLUSION:The CRP/albumin ratio is a novel but promising,easy-to-measure,repeatable,non-invasive inflammationbased prognostic score in acute pancreatitis.

The Role of High-sensitivity C-reactive Protein, Interleukin-6 and Cystatin C in Ischemic Stroke Complicating Atrial Fibrillation

This study examined the role of high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6) and cystatin C in ischemic stroke complicating atrial fibrillation (AF) and the relationship of systemic inflammation with this disease in order to identify AF patients who are at high risk of stroke and need optimal anticoagulant therapy.A total of 103 AF patients, simple (n=75) or complicated by ischemic stroke (n=28), and 112 control subjects were recruited.IL-6 level was detected by using enzyme linked immunosorbent assay.Cystatin C and hsCRP levels were measured by means of a particle-enhanced immunonephelometric assay.The results showed that the AF patients had higher levels of hsCRP (P=0.004), IL-6 (P=0.000), and cystatin C (P=0.000) than control subjects.Plasma hsCRP level was increased in the AF patients with ischemic stroke as compared to the patients with simple AF (P=0.036).The AF patients who had the level of hsCRP exceeding 3.83 mg/L were at a higher risk than those with hsCRP level lower than 3.83 mg/L (P=0.030).After adjusting for other factors, cystatin C remained positively associated with IL-6 (r=0.613) and hsCRP (r=0.488).It was concluded that hsCRP is positively correlated with ischemic stroke complicating AF and may be a risk factor independent of other risk factors for AF.Elevated cystatin C level is also indicative of the increased risk of AF.

Clinical signif icance of C-reactive protein values in antibiotic treatment for pyogenic liver abscess

AIM:To investigate the clinical signifi cance of C-reactive protein (CRP) values in determining the endpoint of antibiotic treatment for liver abscess after drainage. METHODS: The endpoints of antibiotic treatment in 46 patients with pyogenic liver abscess after complete percutaneous drainage were assessed by performing a retrospective study. After complete percutaneous drainage, normal CRP values were considered as the endpoint in 18 patients (experimental group), and normal body temperature for at least 2 wk were considered as the endpoints in the other 28 patients (control group). RESULTS:The duration of antibiotic treatment after complete percutaneous drainage was 15.83 ± 6.45 d and 24.25 ± 8.18 d for the experimental and the control groups, respectively (P=0.001), being significantly shorter in the experimental group than in the control group. The recurrence rate was 0% for both groups.However, we could not obtain the follow-up data about 3 patients in the control group. CONCLUSION: CRP values can be considered as an independent factor to determine the duration of the antibiotic treatment for pyogenic liver abscess after complete percutaneous drainage.

Impact of clinical and procedural factors upon C reactive protein dynamics following transcatheter aortic valve implantation

AIM: To determine the effect of procedural and clinical factors upon C reactive protein(CRP) dynamics following transcatheter aortic valve implantation(TAVI).METHODS: Two hundred and eight consecutive patients that underwent transfemoral TAVI at two hospitals(Imperial, College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom and San Raffaele Scientific Institute, Milan, Italy) were included. Daily venous plasma CRP levels were measured for up to 7 d following the procedure(or up to discharge). Procedural factors and 30-d safety outcomes according tothe Valve Academic Research Consortium 2 definition were collected. RESULTS: Following TAVI, CRP significantly increased reaching a peak on day 3 of 87.6 ± 5.5 mg/d L, P < 0.001. Patients who developed clinical signs and symptoms of sepsis had significantly increased levels of CRP(P < 0.001). The presence of diabetes mellitus was associated with a significantly higher peak CRP level at day 3(78.4 ± 3.2 vs 92.2 ± 4.4, P < 0.001). There was no difference in peak CRP release following balloonexpandable or self-expandable TAVI implantation(94.8 ± 9.1 vs 81.9 ± 6.9, P = 0.34) or if post-dilatation was required(86.9 ± 6.3 vs 96.6 ± 5.3, P = 0.42), however, when pre-TAVI balloon aortic valvuloplasty was performed this resulted in a significant increase in the peak CRP(110.1 ± 8.9 vs 51.6 ± 3.7, P < 0.001). The development of a major vascular complication did result in a significantly increased maximal CRP release(153.7 ± 11.9 vs 83.3 ± 7.4, P = 0.02) and there was a trend toward a higher peak CRP following major/lifethreatening bleeding(113.2 ± 9.3 vs 82.7 ± 7.5, P = 0.12) although this did not reach statistical significance. CRP was not found to be a predictor of 30-d mortality on univariate analysis. CONCLUSION: Careful attention should be paid to baseline clinical characteristics and procedural factors when interpreting CRP following TAVI to determine their future management.

Changes of plasma C-reactive protein in patients with craniocerebral injury before and after hyperbaric oxygenation: A randomly controlled study

Changes of plasma C-reactive protein in patients with craniocerebral injury before and after hyperbaric oxygenation： A randomly controlled study BACKGROUND： Plasma inflammatory factor, such as C-reactive protein, whose content is regarded as a sensitively pathological marked protein and quantitative indexes of central nervous system injury, has been paid more and more attention in clinic. OBJECTIVE： To observe the effects and clinical significance of C-reactive protein in patients with craniocerebral injury after hyperbaric oxygenation. DESIGN： Randomized controlled study. SETTING： Departments of Neurosurgery, Laboratory and Hyperbaric Oxygen, the Second Affiliated Hospital, Medical College of Shantou University. PARTICIPANTS： A total of 60 patients with craniocerebral injury were selected from Department of Neurosurgery, the Second Affiliated Hospital, Medical College of Shantou University from October 2006 to April 2007. There were 37 males and 23 females and the mean age was 26 years. All subjects were certainly diagnosed as history of craniocerebral injury. Patients hospitalized at 24 hours after injury, Glasgow Coma Score ranged from 3 to 12 points, and all patients were certainly diagnosed with CT or MR scanning. Patients and their relatives provided confirmed consent. All the subjects were randomly divided into hyperbaric oxygenation group and control group with 30 in each group. METHODS： Patients in the control group were treated with routinely neurosurgical therapy after hospitalization; however, based the same basic treatment in the control group, patients in the hyperbaric oxygenation group received hyperbaric oxygenation by using iced-wheel four-door 2-cabin air-compression chamber （made in Yantai） from 24 hours to 10 days after operation or injury. After entering the cabin, patients who had a clear consciousness breathed the oxygen by using face mask; contrarily, patients directly breathed the oxygen. Therapeutic project： Expression was increased for about 15–20 minutes, maintained for about 70–80 minutes, and decreased for 20 minutes. Otherwise, pressure was maintained from 0.2 to 0.25 MPa. Hyperbaric oxygenation took an hour for once a day and 10 times were regarded as a course. Venous blood was collected before treatment and on the next day of the first course end. Content of C-reactive protein in plasma was measured with immune turbidimetry in hyperbaric oxygenation group; in addition, content of C-reactive protein in plasma was directly measured with the same method at the corresponding time in the control group. If the content was less or equal to 8 mg/L, it was regarded as normal value. Effects of the two groups were evaluated based on Glasgow Coma Score before and after treatment. MAIN OUTCOME MEASURES： Content of plasma C-reactive protein and Glasgow Coma Score in the two groups before and after treatment. RESULTS： All 60 patients were involved in the final analysis. ① Content of plasma C-reactive protein： The two contents were obviously higher than normal value after craniocerebral injury. There was no significant difference in the two groups before treatment （P 〉 0.05）, but both contents were decreased after treatment, and there was significant difference between HBOT group and control group after treatment （t =4.756, P 〈 0.01）. In addition, there was significant difference in hyperbaric oxygen therapy group before and after treatment （t =5.236, P 〈 0.01）. ② Glasgow Coma Score： There was no significant difference in the two groups before treatment （P 〉 0.05）, but scores were increased in both groups after treatment （t =9.92, 2.51, P 〈 0.01, 0.05）; on the other hand, therefore, there was significant difference between the two groupsafter treatment （t =9.21, P 〈 0.01）. CONCLUSION： Hyperbaric oxygenation can remarkably decrease content of plasma C-reactive protein in patients with craniocerebral injury at the phase of stress.

Combined Effects of A Body Shape Index and Serum C-reactive Protein on Ischemic Stroke Incidence among Mongolians in China

Objective We aimed to evaluate the combined effects of a high body shape index(ABSI) and a high serum C-reactive protein(CRP) level on the incidence of ischemic stroke in a Mongolian population in China. Methods A prospective cohort study was conducted among 2,589 participants from June 2002 to July 2012 in Inner Mongolia, China. The participants were categorized into 4 groups according to their level of ABSI and CRP. Cox proportional hazards models were used to assess the hazard ratios(HRs) and 95% confidence intervals(CIs) for ischemic stroke among all groups. Results The multivariate adjusted HRs(95% CI) of ischemic stroke for high ABSI and high CRP level were 1.46(0.89-2.39) and 1.63(0.95-2.79), respectively. Compared with the low ABSI/low CRP level group, the multivariate adjusted HRs(95% CI) of ischemic stroke in the low ABSI/high CRP, high ABSI/low CRP, and high ABSI/high CRP groups were 1.04(0.46-2.35), 1.06(0.58-1.95) and 2.52(1.27-5.00), respectively. The HR of ischemic stroke for the high ABSI/high CRP level group was the highest and most statistically significant. Conclusion We found that participants with simultaneously high ABSI and high CRP levels had the highest risk of ischemic stroke in the Mongolian population. Our findings suggest that the combination of high ABSI and high CRP levels may increase the risk of ischemic stroke.

Elevated levels of inflammatory cytokines and high-sensitivity C-reactive protein in periodontitis patients in Kosovo: A pilot study

The following article has been retracted due to the investigation of complaints received against it. The Editorial Board found that the same contents have been published in another journal at the same time. The scientific community takes a very strong view on this matter, and the Open Journal of Stomatology treats all unethical behavior such as plagiarism seriously. This paper published in Vol.3 No.1 32-38, 2013 has been removed from this site. Title: Elevated levels of inflammatory cytokines and high-sensitivity C-reactive protein in periodontitis patients in Kosovo: A pilot study Authors: Zana Sllamniku-Dalipi, Hasan Mehmeti, Fatmir Dragidella, Ferit Kocani, Metush Disha, Kastriot Meqa, Luljeta Begolli, Gramos

Prognostic role of C-reactive protein in prostate ：ancer： a systematic review and meta-analysis

Several studies have reported that C-reactive protein （CRP）, an inflammation biomarker, may be associated with the prognosis of prostate cancer （PCa）. The objective of this systematic review is to summarize the predictive role of CRP for survival in PCa as reported in previous studies. Related studies were identified, and evaluated for quality through multiple search strategies. Data was collected from studies comparing overall and cancer-specific survival （CSS） in patients with elevated CRP levels and those having lower levels. However, for progression-free survival （PFS）, data were collected according to the log of CRP. The hazard ratio （HR） and its 95% confidence interval （Cl） were used to assess the strength of associations. A total of nine studies （n = 1,497） were evaluated in this meta-analysis （five for overall survival （OS）, four for CSS and two for PFS）. For OS and PFS, the pooled HR of CRP was statistically significant at 1.51 （95% Cl, 1.28-1.79） and 1.50 （95% Cl, 1.25-1.81）, respectively. For CSS, the pooled HR was 1.91 （95% CI, 1.36-2.69） with higher CRP expression in PCa, which strongly indicates poorer survival in PCa. This study demonstrates that CRP may have a critical prognostic value in patients with prostatic cancer.

The prognostic value of serum C-reactive protein-bound serum amyloid A in early-stage lung cancer

Background:Elevated levels of serum C-reactive protein(CRP) have been reported to have prognostic significance in lung cancer patients.This study aimed to further identify CRP-bound components as prognostic markers for lung cancer and validate their prognostic value.Methods:CRP-bound components obtained from the serum samples from lung cancer patients or healthy controls were analyzed by differential proteomics analysis.CRP-bound serum amyloid A(CRP-SAA) was evaluated by coimmunoprecipitation(IP).Serum samples from two independent cohorts with lung cancer(retrospective cohort,242patients;prospective cohort,222 patients) and healthy controls(159 subjects) were used to evaluate the prognostic value of CRP-SAA by enzyme-linked immunosorbent assay.Results:CRP-SAA was identified specifically in serum samples from lung cancer patients by proteomic analysis.CRP binding to SAA was confirmed by co-IP in serum samples from lung cancer patients and cell culture media.The level of CRP-SAA was significantly higher in patients than in healthy controls(0.37 ± 0.58 vs.0.03 ± 0.04,P < 0.001).Elevated CRP-SAA levels were significantly associated with severe clinical features of lung cancer.The elevation of CRPSAA was associated with lower survival rates for both the retrospective(hazard ration[HR]= 2.181,95%confidence interval[CI]= 1.641-2.897,P < 0.001) and the prospective cohorts(HR = 2.744,95%CI = 1.810-4.161,P < 0.001).Multivariate Cox analysis showed that CRP-SAA was an independent prognostic marker for lung cancer.Remarkably,in stages l-ll patients,only CRP-SAA,not total SAA or CRP,showed significant association with overall survival in two cohorts.Moreover,univariate and multivariate Cox analyses also showed that only CRP-SAA could be used as an independent prognostic marker for early-stage lung cancer patients.Conclusion:CRP-SAA could be a better prognostic marker for lung cancer than total SAA or CRP,especially in earlystage patients.

Changes of serum high sensitive C-reactive protein in patients with acute cerebral infarction

BACKGROUND： Serum high sensitive C-reactive protein （hs-CRP）, which regards as a high sensitive mark of systemic inflammatory response syndrome, can provide a lot of valuable information for the treatment and prognosis of cerebrovascular disease. OBJECTIVE： To observe the differences of blood glucose, lipid, homocysteine and previous disease history among patients with acute cerebral infarction at various levels of hs-CRP and compare changes of hs-CRP of patients with various degrees of neurologic impairment. DESIGN： Contrast observation. SETTING： Department of Neurology, Shenzhou Hospital, Shenyang Medical College. PARTICIPANTS： A total of 102 patients with acute cerebral infarction were selected from Department of Neurology, Shenzhou Hospital of Shenyang Medical College from February 2005 to September 2006, including 55 males and 47 females aged from 55 to 86 years. All accepted patients met the diagnostic criteria of cerebral infarction established by the Fourth National Cerebrovascular Disease Academic Meeting and were diagnosed with CT or MRI examination. All patients provided the confirmed consent. Based on clinical criteria of neurologic impairment established by the Fourth National Cerebrovascular Disease Academic Meeting, patients were randomly divided into mild group （0 - 15 points, n =46）, moderate group （16 - 30 points, n =38） and severe group （31 - 45 points, n =18）. In addition, based on hs-CRP level within 72 hours, patients were divided into normal group （hs-CRP ≤3 mg/L, n =53） and increasing group （hs-CRP 〉 3 mg/L, n =-49）. METHODS： ① 2 mL venous blood was selected from hospitalized patients in the next morning to separate serum. Quantitative measurement of hs-CRP was dealt with Latex Enhnced Turbidimetric Immunoassay （LETIA）. ②Fasting venous blood was colleted from hospitalized patients in the next morning to measure numeration of white blood cells, fibrinogen, blood glucose, total cholesterol （TC）, triacylglycerol （TG）, high density lipoprotein cholesterol （HDL-C）, low density lipoprotein cholesterol （LDL-C） and homocysteine. ③Measurement data were compared with t test or analysis of variance. MAIN OUTCOME MEASURES： ①Comparisons of serum biochemical indexes among patients with various levels of hs-CRP; ②comparisons of risk factors among patients with various levels of hs-CRP; ③comparisons of levels of hs-CRP among patients with various degrees of clinical neurologic impairment. RESULTS： A total of 102 patients were involved in the final analysis. ①Plasma fibrinogen and numeration of leucocytes were more in the increasing group than those in the normal group （t =4.39, 3.54, P 〈 0.01）; while, there were no significant differences of blood glucose, TC, TG, HDL-C, LDL-C and homocysteine between the two groups （P 〉 0.05）. ② Percentage of patients with hypertension and diabetes mellitus （DM） was higher in the increasing group than the normal group （ Х^2=3.98, 4.23, P 〈 0.05）; while, percentage of patients with smoking in the increasing group was not significantly different from that of patients in the normal group （P 〉 0.05）. ③Level of hs-CRP of patients with severe neurologic impairment was higher than that of patients with moderate neurologic impairment （t =2.273, P 〈 0.05）; that of patients with moderate neurologic impairment was higher than that of patients with mild neurologic impairment （t =2.586, P 〈 0.05）; that of patients with severe neurologic impairment was obviously higher than that of patients with mild neurologic impairment （t = 4.913, P 〈 0.01）. CONCLUSION： ① With the increase of hs-CRP, plasma fibrinogen and numeration of leucocytes of patients with acute cerebral infarction is increased, especially, they are increased remarkably among patients who have history of diabetes mellitus and hypertension. ②Increase of level of hs-CRP can be regarded as one of marks to evaluate severity of acute stroke.

C-reactive protein as a predictor of malignant ventricular arrhythmias in non-ST elevation myocardial infarction

Objective To investigate whether C-reactive protein (CRP) is a biomarker of malignant ventricular arrhythmias (MVA) occurring in non-ST elevation myocardial infarction (NSTEMI) patients with Global Registry of Acute Coronary events (GRACE) scores < 140. Methods A total of 1450 NSTEMI patients were included in this study. Hs-CRP blood levels were measured via a turbidimetric immunoassay after confirming the diagnosis of NSTEMI with GRACE scores < 140. Results Consistent with prior studies, the MVA occurrence rate in our cohort was 6.7%, and patients with MVA exhibited a reduced left ventricular ejection fraction (46.1%± 6.9% vs. 61.5%± 8.7%, P = 0.032), a higher incidence of Killip classification > 1 (34.1% vs. 24.2%, P < 0.001), an increased surgical revascularization rate (34.1% vs. 9.7%, P < 0.001), and increased mortality (16.5% vs. 5.8%, P < 0.001). Serum hs-CRP levels were higher (P = 0.003) in NSTEMI patients with MVA, and this increase appeared unrelated to other clinical parameters. The C-statistic to discriminate MVA was 0.82 (95% CI: 0.74–0.89). Using receiver operating characteristics analysis, we optimized a cutoff point of 16 mL/L, and the sensitivity and specificity were 95% and 61%, respectively;the positive predictive value was 20% and the negative predictive value was 99%. Conclusions An hs-CRP assay is a potential MVA biomarker in low-risk NSTEMI patients with GRACE scores < 140. If validated in prospective studies, hs-CRP may offer a low-cost supplementary strategy for risk stratification for NSTEMI patients.

Obstructive sleep apnea syndrome and cardiovascular disease: The influence of C-reactive protein

Obstructive sleep apnea syndrome(OSAS) is a common medical condition, associated with atherosclerosis and cardiovascular disease(CVD). The underlying pathophysiologic mechanisms of this association have not been completely understood and may be multifactorial in origin. A number of studies suggest that inflammatory processes have emerged critical in the pathogenesis of CVD in OSAS. A range of circulating inflammatory molecules has been identified and measured, with a view to assess inflammation and predict vascular damage risk, such as plasma cytokines, adhesion molecules, and C-reactive protein(CRP). CRP is a relevant marker worthy of further study, because not only is elevated in patients with OSAS, but also is rapidly becoming a risk factor for cardiac disease. Furthermore, in selected OSAS patients, aggressive treatment of the disorder may lead to retarding or even improvement of CVD progression. However, still there is a debate on the true correlation between CRP and OSAS, as well as the clinical effect of any reduction after OSAS treatment. Further research is required to define those OSAS patients who will have a considerable reduction with treatment, as well as to understand the significance of the interaction between cardiovascular risk factor and CRP reduction in patients with OSAS.

C-reactive Protein Level,Apolipoprotein B-to-apolipoprotein A-1 Ratio,and Risks of Ischemic Stroke and Coronary Heart Disease among Inner Mongolians in China

Objective We aimed to investigate the cumulative effect of high CRP level and apolipoprotein B-to-apolipoprotein A-1（ApoB/ApoA-1） ratio on the incidence of ischemic stroke（IS） or coronary heart disease（CHD） in a Mongolian population in China.Methods From June 2003 to July 2012,2589 Mongolian participants were followed up for IS and CHD events based on baseline investigation.All the participants were divided into four subgroups according to C-reactive protein（CRP） level and ApoB/ApoA-1 ratio.Cox proportional hazard models were used to estimate the hazard ratios（HRs） and 95% confidence intervals（CIs） for the IS and CHD events in all the subgroups.Results The HRs（95% CI） for IS and CHD were 1.33（0.84-2.12）,1.14（0.69-1.88）,and 1.91（1.17-3.11） in the ‘low CRP level with high ApoB/ApoA-1＇,‘high CRP level with low ApoB/ApoA-1＇,and ‘high CRP level with high ApoB/ApoA-1＇ subgroups,respectively,in comparison with the ‘low CRP level with low ApoB/ApoA-1＇ subgroup.The risks of IS and CHD events was highest in the ‘high CRP level with high ApoB/ApoA-1＇ subgroup,with statistical significance.Conclusion High CRP level with high ApoB/ApoA-1 ratio was associated with the highest risks of IS and CHD in the Mongolian population.This study suggests that the combination of high CRP and ApoB/ApoA-1 ratio may improve the assessment of future risk of developing IS and CHD in the general population.

C-reactive protein and diabetic retinopathy in Chinese patients with type 2 diabetes mellitus

AIM：To investigate the relationship between Creactive protein（CRP）and diabetic retinopathy（DR）in a cohort of Chinese patients with type 2 diabetes mellitus（T2DM）.·METHODS：Community-based observational cohort study.There were 1131 participants recruited from November 2009 to September 2011 in Desheng community in urban Beijing.Patients diagnosed T2DM were recruited and underwent a standardized evaluation consisting of a questionnaire,ocular and anthropometric examinations and laboratory investigation.The presence and severity of DR were assessed by seven fields 30°color fundus photographs.Subjects were then classified into groups with no DR,any DR,or vision-threatening DR.CRP was analyzed from serum of study subjects.·RESULTS：A total of 1007 patients with T2DM were included for analysis,including 408（40.5%）men and 599（59.5%）women.The median CRP level was 1.5 mg/L for women and 1.1 mg/L for men（=0.004,OR 0.37,95%CI0.18-0.74）.After adjusting for possible covariates,higher levels of CRP were associated with lower prevalence of any DR（=0.02,OR 0.55,95%CI 0.35-0.89）,but not associated with vision-threatening DR（=0.62,OR 0.78,95%CI 0.28-2.14）.After stratification by sex,the inverse association between CRP and DR was found to be statistically significant in men（=0.006,OR 0.35,95%CI0.16-0.73）,but not in women（=0.58,OR 0.88,95%CI0.29-1.16）.·CONCLUSION：The data drawn from a Chinese population with T2DM suggest that increasing CRP levels may be inversely associated with development of DR.

Significance of Fractional Exhaled Nitric Oxide Combined with Serum Procalcitonin and C-Reactive Protein in Evaluation of Elderly Asthma

Bronchial asthma is a common chronic airway inflammatory disease. Asthma is associated with high mortality, especially in the elderly patients. Repeated exacerbations cause disease progression. Therefore, identifying the onset of acute elderly asthma as soon as possible and giving the effective treatment is crucial to improve the prognosis. This study was to investigate the significance of fractional exhaled nitric oxide （FeNO） combined with serum procalcitonin （PCT） and C-reactive protein （CRP） in the evaluation of elderly asthma. A total of 120 elderly patients with an acute attack of asthma from July, 2010 to May, 2012 were studied. On presentation, FeNO, serum PCT and CRP concentrations were measured and sputum culture was also performed. The elderly patients were re-evaluated when they had returned to their stable clinical state. The elderly patients were classified into two groups： positive bac- terial culture group （A） and negative bacterial culture group （B）. The results showed that： （1） In patients with an acute exacerbation of asthma, 48 （40%） patients had positive sputum bacterial culture and 72 （60%） had negative sputum bacterial culture. （2） The levels of FeNO in patients with acute exacerbation of asthma were significantly higher than in those with no acute exacerbation state （63.8±24.6 vs. 19±6.5 ppb, P〈0.05）. There was no significant difference in FeNO between group A and group B （P〉0.05）. （3） The levels of PCT and CRP in group A patients with an acute exacerbation of asthma were significantly higher （P〈0.05） than in group B （for PCT： 27.46±9.32 vs. 7.85±3.52 ng/mL; for CRP： 51.25±11.46 vs. 17.11±5.87 mg/L, respectively）. When they had returned to stable clinical state, the levels of PCT and CRP in group A were decreased significantly （P〈0.05）, and those in group B had no significant change （P〉0.05） when compared with the exacerbation group. There were no significant differences in the levels of PCT and CRP between the two groups in non-acute exacerbation state （/9〉0.05）. These results suggest that the increase in FeNO indicates the acute exacerbation of asthma, and the elevation of serum PCT and CRP levels may be associated with bacterial infection.

Linking inflammation and thrombosis:Role of C-reactive protein

C-reactive protein(CRP) is a biomarker of inflammation.Increased plasma levels of CRP are associated with an increased risk of myocardial infarction.However,the correlation between plasma CRP concentration and atherosclerotic plaque burden is poor.Based on these observations,it has been hypothesized that CRP increases the risk of myocardial infarction by promoting thrombosis.This article reviews available data that link enhanced CRP expression to increased risk of thrombosis,with a focus on the effects of CRP on hemostasis,platelet function,and fibrinolysis.Overall,the available data support the hypothesis that CRP is an important mechanistic link between inflammation and throm bosis.