ObjectiveTo investigate the clinical value of the C-reactive protein (CRP) ratio (CRP value on postoperative day 3/day 1) as an early predictor of postoperative severe complication after laparoscopic gastrectomy (LG) for gastric cancer.MethodsThis retrospective study examined the relationship between the occurrence of severe complication and the CRP ratio of 259 gastric cancer patients, who underwent LG in the Department of General Surgery of General Hospital of Fuxin Mining Industry Group of Liaoning Health Industry Group from January 2015 to January 2020. According to Clavien-Dindo (CD) grading system, gastric cancer patients were divided into the severe postoperative complication group (n=41, 15.8%) and the non-severe postoperative complication group (n=218, 84.2%). The relationship between CRP ratio and clinicopathologic characteristics of patients and the predictive value of CRP ratio for severe complication were analyzed.ResultsThe optimal cutoff value of CRP ratio of 2.2 offered 63.2% sensitivity, 91.0% specificity, 70.7% positive predictive value, and 85.8% negative predictive value for severe postoperative complication. The area under the receiver operating characteristic curve was 0.766. There had distinct differences (P<0.05) on body mass index, preoperative comorbidity, type of surgery, T stage, and TNM stage between the high CRP ratio group (CRP ratio >2.2, n=60) and the low CRP ratio group (CRP ratio ≤2.2, n=199). Logistic regression showed that preoperative comorbidity [OR=3.624, 95%CI (1.191, 11.206), P=0.023], later of TNM stage [OR=9.037, 95% CI (1.729, 47.226), P=0.009], and CRP ratio >2.2 [OR=20.473, 95%CI (7.948, 52.737), P<0.001] were independent risk factors for postoperative severe complication after LG.ConclusionThere must to be paid enough attention to the CRP ratio >2.2 on the day 1 and 3 after LG, it suggests that there might be a risk of severe postoperative complications.
Objective To evaluate the safety of conversion from external fixation to internal fixation for open tibia fractures. Methods Between January 2010 and December 2014, 94 patients (98 limbs) with open tibia fractures were initially treated with external fixators at the first stage, and the clinical data were retrospectively analyzed. In 29 cases (31 limbs), the external fixators were changed to internal fixation for discomfort, pin tract response, Schantz pin loosening, delayed union or non-union after complete wound healing and normal or close to normal levels of erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and the leucocyte count as well as the neutrophil ratio (trial group); in 65 cases (67 limbs), the external fixators were used as the ultimate treatment in the control group. There was no significant difference in gender, age, side of the limbs, interval from injury to the first debridement, initial pathogenic bacteria, the limbs that skin grafting or flap transferring for skin and soft tissue defect between the two groups ( P>0.05). The incidence of Gustilo type III fractures in the control group was significantly higher than that in the trial group (P=0.000). The overall incidence of infection was calculated respectively in the two groups. The incidence of infection according to different fracture types and whether skin grafting or flap transferring was compared between the two groups. The information of the pathogenic bacteria was recorded in the infected patients, and it was compared with the results of the initial culture. The incidence of infection in the patients of the trial group using different internal fixation instruments was recorded. Results The overall incidences of infection for the trial and control groups were 9.7% (3/31) and 9.0% (6/67) respectively, showing no significant difference (χ2=0.013, P=0.909). No infection occurred in Gustilo type I and type II patients. The incidence of infection for Gustilo type IIIA patients in the trial group and the control group were 14.3% (1/7) and 6.3% (2/32) respectively, showing no significant difference (χ2=0.509, P=0.476); the incidence of infection for type IIIB patients in the two groups were 50.0% (2/4) and 14.3% (2/14) respectively, showing no significant difference (χ2=2.168, P=0.141); and the incidence of infection for type IIIC patients in the two groups were 0 and 16.7% (2/12) respectively, showing no significant difference (χ2=0.361, P=0.548). Of all the infected limbs, only 1 limb in the trial group had the same Staphylococcus Aureus as the result of the initial culture. In the patients who underwent skin grafting or flap transferring, the incidence of infection in the trial and control groups were 33.3% (2/6) and 13.3% (2/15) respectively, showing no significant difference (χ2=1.059, P=0.303). After conversion to internal fixation, no infection occurred in the cases that fixed with nails (11 limbs), and infection occurred in 4 of 20 limbs that fixed with plates, with an incidence of infection of 20%. Conclusion Conversion from external fixation to internal fixation for open tibia fractures is safe in most cases. However, for open tibia fractures with extensive and severe soft tissue injury, especially Gustilo type III patients who achieved wound heal after flap transfer or skin grafting, the choice of secondary conversion to internal fixation should carried out cautiously. Careful pre-operative evaluation of soft tissue status, cautious choice of fixation instrument and meticulous intra-operative soft tissue protection are essential for its safety.
ObjectiveTo investigate the pathogenesis and treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) by detecting the changes of serum interleukin-23 (IL-23) and C-reactive protein (CRP) levels of the OSAHS patients before and after treatment with continuous positive airway pressure (CPAP).MethodsFifty-eight patients with moderate to severe OSAHS diagnosed by polysomnography were recruited as an experimental group, 57 out-patient healthy subjects with matched age, sex and body mass index of the experimental group were enrolled as a control group. The serum concentrations of IL-23 and CRP in the experimental group were detected and compared before and after CPAP application for 3 months. The serum concentrations of IL-23 and CRP in the control group were also measured.ResultsThe serum levels of IL-23 and CRP in the OSAHS patients were significantly higher than those in the normal control subjects (P<0.05). The serum levels of IL-23 and CRP in the OSAHS patients after CPAP treatment were significantly lower than those before CPAP treatment (P<0.05). The serum concentrations of IL-23 and CRP were positively correlated with apnea hypopnea index (r=0.756, r=0.345, P<0.05, respectively), and negatively correlated with mean oxygen saturation (r=–0.715, r=–0.334, P<0.05, respectively).ConclusionsThe serum levels of IL-23 and CRP are positively correlated with the severity of OSAHS. After CPAP treatment, the levels of IL-23 and CRP decrease, which indicates that CPAP treatment may reduce the inflammatory reaction and correct anoxia of OSAHS patients.
ObjectiveTo explore the serum concentrations of complement C1q tumor necrosis factor related protein 5 (CTRP5) in patients with acute exacerbations and stable stage of chronic obstructive pulmonary disease (COPD), and analyze the correlation of CTRP5 with high sensitivity C-reactive protein (hs-CRP) and FEV1/FVC and FEV1%pred.MethodsThirty hospitalized patients with acute exacerbation of COPD and 30 outpatients with stable COPD according with diagnostic criteria and inclusive criteria were sampled successively. At the same time 30 healthy volunteers were selected as normal control. All subjects were measured the concentrations of CTRP5 and hs-CRP in serum and lung function test was performed.ResultsThe serum CTRP5 and hs-CRP concentrations of the acute exacerbation group was higher than those in the stable group and the control group. The serum CTRP5 and hs-CRP concentrations of the stable group was also higher than those of the control group. The FEV1/FVC of the acute exacerbation group was lower than those of the stable group and the control group; and the FEV1/FVC of the stable group was lower than that of the control group. The FEV1%pred of three groups by analysis indicated the difference was statistically significant. Further pairwise comparisons demonstrated that the FEV1%pred of two COPD groups were lower than that of the control group but the FEV1%pred of the acute exacerbation group and stable group was not significantly different. The correlation analysis of the acute exacerbation group and the stable group demonstrated that the levels of serum CTRP5 and hs-CRP were postively correlated and the level of serum CTRP5 was negatively correlated with FEV1/FVC and FEV1%pred.ConclusionsThe level of CTRP5 in serum of COPD patients is increased. No matter in acute exacerbation or stable phase, the level of serum CTRP5 is positively correlated with hs-CRP and negatively correlated with FEV1/FVC and FEV1%pred, which suggests that CTRP5 is involved in the pathogenesis of COPD but the exact mechanism needs further study.
ObjectiveTo investigate the relationship between preoperative C-reactive protein (CRP)/albumin ratio (CAR) and National Institutes of Health (NIH) risk classification in patients with gastric stromal tumors.MethodsClinical data of 108 patients with gastric stromal tumors admitted to the First Affiliated Hospital of Kunming Medical University from February 2010 to November 2016 were retrospectively collected. With the median of CAR as the critical value, patients were divided into high CAR group (CAR>0.048) and low CAR group (CAR≤0.048). Then observed the general clinicopathological characteristics and survival status of patients with higher and lower CAR value.ResultsThere were significant differences in NIH classification, tumor diameter, and mitosis between the high CAR group and low CAR group (P<0.05). Compared with the low CAR group, the tumors in the high CAR group had larger diameter, higher mitotic figure, and higher NIH grade. Survival analysis showed that the prognosis of the low CAR group was better than that of the high CAR group (χ2=15.152, P<0.001).ConclusionsCAR is closely related to the malignant index and NIH risk classification of gastric stromal tumors. It can be used as an index for evaluating the malignant degree of gastric stromal tumors, and it is expected to be an important reference factor for clinical NIH risk classification and prognosis.
Objective To measure the level of circulating endothelial progenitor cells ( EPCs) in peripheral blood of patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) , and to explore the relationship between EPCs and severity markers of the disease and cardiovascular adverse outcome predictors.Methods Forty patients with COPD were recruited, including 27 at acute exacerbation phase and 13 with stable COPD from December 2010 to December 2011. Sixteen healthy nonsmokers were included as controls. Circulating EPCs were isolated by Ficoll density-gradient centrifugation and purified by Magnetic Activated Cell Sorting system. High-sensitivity C-reactive protein ( hsCRP) was estimated by using a latex immunoturbidimetric assay kit, and matrix metalloproteinase-9 ( MMP-9) was measured by enzymelinked immunosorbent assay ( ELISA) . Arterial blood gas analysis and echocardiograph were performed in the AECOPD patients. The correlations between circulating EPCs, lung function, and cardiovascular markers were investigated. Results Circulating EPCs were significantly lower in AECOPD and stable COPD patients compared with the healthy controls [ ( 5.1 ±2.6) ×103 /mL and ( 6.0 ±3.2) ×103 /mL vs. ( 9.0 ±4.3) × 103 /mL, Plt;0. 05] . EPCs had a weak correlation with hsCRP ( P = 0. 033) , but not with MMP-9. In the AECOPD patients, EPC counts were significantly inversely correlated with PASP ( pulmonary artery systolic pressure) and NT-proBNP ( amino-terminal pro-brain natriuretic peptide) levels, and positively with left ventricular ejection fraction. No correlations were found between EPCs and lung function, blood gas, hospital stays or smoking index. Conclusions Circulating EPCs were significantly lower in AECOPD patients compared with healthy controls, in which systemic inflammation might be involved. Decreased EPCs were correlated with cardiac dysfunction in patients with AECOPD, which may account for the increased cardiovascular risk in this population.
Objective To investigate the values of pneumonia severity index ( PSI) , CURB-65,plasma procalcitonin ( PCT) , C-reactive protein ( CRP) measurements for evaluation the severity of healthcare-associated pneumonia ( HCAP) .Methods A retrospective observational study was conducted on 92 hospitalized patients with HCAP admitted between June 2010 and December 2011. They were divided into different groups according to different severity assessment criteria. The variance and correlation of PCT,CRP,WBC and percent of neutrophil ( Neu% ) levels were compared among different groups. ROC curvewas established to analyze PSI, CURB-65, PCT and CRP levels for predicting the motality of HCAP patients.Results In the severe HCAP group, PSI and CURB-65 scoring and serum PCT, CRP, WBC, Neu% levels were significantly higher than those in the non-severe HCAP group( P lt; 0. 05) . In the high-risk HCAP group, PCT, CRP, WBC and Neu% levels were significantly higher than those in the low-risk HCAP group according to the PSI and CURB-65 scoring criteria( P lt;0. 05) .WBC and Neu% levels were also significantly higher than those in the moderate-risk group. PSI and CURB-65 scoring were positively correlated with PCT and CRP levels. PSI scoring gt;120 points or CURB-65 scoring gt;2 points on admission were predictors of mortality. Conclusions PSI and CURB-65 scoring are correlated with severity of HCAP. Combining serum PCT and CRP levels can improve the predictive accuracy of the severity of HCAP.
In recent years, domestic and foreign scholars have carried out extensive research on the prognostic factors of gastric cancer. Among them, non-specific inflammatory markers and nutritional indicators are the most concentrated in gastric cancer. C-reactive protein, as an acute phase protein, has been widely used to diagnose acute and chronic inflammation throughout the body. Prealbumin is a sensitive indicator of nutrition with a shorter half-life, which can quickly reflect the nutritional status of the body. At present, C-reactive protein and prealbumin as sensitive indicators of inflammation and nutrition, have shown certain predictive value in terms of postoperative complications and prognosis of gastric cancer. This article reviews the use of C-reactive protein, prealbumin and their ratios in predicting postoperative complications and prognosis of gastric cancer, aiming to provide a reference for the diagnosis and treatment of patients after gastric cancer.
ObjectiveTo analyze the clinical characteristics of acute pancreatitis (AP) complicated with pulmonary infection and to explore the value of BISAP, APACHEⅡ and CTSI scores combined with C-reactive protein (CRP) in early diagnosis and prognosis of AP complicated with pulmonary infection.MethodsFour hundreds and eighty-four cases of AP treated in the Affiliated Hospital of North Sichuan Medical College from January 2018 to January 2020 were selected. After screening, 460 cases were included as the study object, and the patients with pulmonary infection were classified as the infection group (n=114). Those without pulmonary infection were classified as the control group (n=346). The baseline data, clinical characteristics, laboratory test indexes, length of stay, hospitalization cost, and outcome of the two groups were collected, and the risk factors and early predictive indexes of pulmonary infection in patients with AP were analyzed.ResultsHospitalization days and expenses, outcome, fluid replacement within 24 hours, drinking, smoking, age, APACHEⅡ score, BISAP score, CTSI score, hemoglobin (Hb), albumin (ALB), CRP, procalcitonin (PCT), total bilirubin (TB), lymphocyte count, international standardized ratio (INR), blood glucose, and blood calcium, there were significant differences between the two groups (P<0.05). There were no significant difference in BMI, sex, recurrence rate, fatty liver grade, proportion of patients with hypertension and diabetes between the two groups (P>0.05). The significant indexes of univariate analysis were included in multivariate regression analysis, the results showed that Hb≤120 g/L, CRP≥56 mg/L, PCT≥1.65 ng/mL, serum calcium≤2.01 mmol/L, BISAP score≥3, APACHEⅡ score≥8, CTSI score≥3, and drinking alcohol were independent risk factors of AP complicated with pulmonary infection. The working characteristic curve of the subjects showed that the area under the curve (AUC) of CRP, BISAP score, APACHEⅡ score and CTSI score were 0.846, 0.856, 0.882, 0.783, respectively, and the AUC of the four combined tests was 0.952. The AUC of the four combined tests was significantly higher than that of each single test (P<0.05).Conclusions The CRP level, Apache Ⅱ score, bisap score and CTSI score of AP patients with pulmonary infection are significantly higher, which are closely related to the severity and prognosis of AP patients with pulmonary infection. The combined detection of the four items has more predictive value than the single detection in the early diagnosis and prognosis evaluation of AP complicated with pulmonary infection. Its application in clinic is of great significance to shorten the duration of hospitalization and reduce the cost of hospitalization and mortality.
Objective To explore the association between C-reactive protein (CRP) change and the prognosis of patients with stroke. Methods Individuals who were diagnosed with stroke from the 2011 China Health and Retirement Longitudinal Study (CHARLS) registry were included. The baseline characteristics in 2011, blood tests in 2011 and 2015, and follow-up data in 2018 were collected. The patients were divided into three groups according to their CPR change from 2011 to 2015, and the cut-off values of CRP change were 0 and 5 mg/L. Logistic regression analysis was performed to evaluate the association between CRP change and the risk of death after stroke. Results A total of 1065 participants diagnosed in 2011 were enrolled. There were 383 participants in the CRP decreased group (CRP change ranging from –74.30 to –0.01 mg/L), 584 participants in the CRP stable group (CRP change ranging from 0 to 4.98 mg/L), and 98 participants in the CRP increased group (CRP change ranging from 5.00 to 79.27 mg/L). By 2018, the numbers (rates) of deaths in CRP decreased group, CRP stable group, and CRP increased group were 25 (6.53%), 33 (5.65%), and 13 (13.27%), respectively, and the difference in the mortality among the three groups was statistically significant (P=0.020). Logistic regression analysis showed that the CRP change≥5 mg/L was associated with a higher risk of death after stroke [odds ratio=2.332, 95% confidence interval (1.099, 4.946), P=0.027]. Conclusions Increasing CRP levels over time may indicate an increased risk of death in stroke patients. A 4-year increase in CRP greater than 5 mg/L may be an independent predictor of the risk of long-term death in stroke patients.