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Xu T, Wang L, Wu S, Zhou F, Huang H. Utility of a Simple Scoring System in Differentiating Bacterial Infections in Cases of Fever of Unknown Origin. Clin Infect Dis 2020; 71:S409-S415. [PMID: 33367576 DOI: 10.1093/cid/ciaa1520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Infectious disease is the leading cause of fever of unknown origin (FUO). Serum inflammatory markers historically used to diagnose bacterial infection have sufficient diagnostic sensitivity but low specificity. This study aimed to develop a simple scoring system for differentiating bacterial infections from other causes of early-stage FUO. METHODS This study included a retrospective cohort of patients presenting with FUO at the Huashan Hospital (January 2014 to June 2017). The diagnostic utility of serum inflammatory markers for bacterial infection was evaluated using the receiver operating characteristic (ROC) curve analysis. Relevant markers were subsequently measured prospectively in a separate cohort of FUO patients (December 2017 to May 2019). A scoring system was based on inflammatory markers and other test results. RESULTS Bacterial infection was identified in 34% of patients in the retrospective cohort. The area under the ROC curve (AUC) was 0.644 (95% confidence interval [CI], .595-.693) for C-reactive protein, 0.624 (95% CI, .573-.675) for procalcitonin, and 0.646 (95% CI, .595-.697) for serum ferritin (SF) in diagnosing bacterial infection. Bacterial infection was found in 29% of cases in the prospective cohort. A model based on serum amyloid A (SAA) and SF levels and neutrophil percentage yielded an AUC of 0.775 (95% CI, .695-.854). Validation analysis indicated lower probability (<15%) of bacterial infection for patients with a score <16.5 points. CONCLUSIONS A scoring system based on SAA and SF levels and neutrophil percentage can help distinguish bacterial infection from other causes of FUO, potentially reducing antibiotic use.
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Affiliation(s)
- Teng Xu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, Shanghai, China
| | - Li Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, Shanghai, China
| | - Shi Wu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, Shanghai, China
| | - Fenfen Zhou
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, Shanghai, China
| | - Haihui Huang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, Shanghai, China
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Lee SC, Kim SJ, Yu MH, Lee KJ, Cha YS. Uses of Inflammatory Markers for Differentiation of Intrahepatic Mass-Forming Cholangiocarcinoma from Liver Abscess: Case-Control Study. J Clin Med 2020; 9:jcm9103194. [PMID: 33019760 PMCID: PMC7599997 DOI: 10.3390/jcm9103194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pyogenic liver abscess (LA) is difficult to distinguish from intrahepatic mass-forming cholangiocarcinoma (IMCC) in the emergency department (ED). We evaluated the predictive ability of white blood cells (WBC) and C-reactive protein (CRP) levels, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and delta neutrophil index (DNI) in LA and IMCC in the ED. METHODS Forty patients with IMCC between January 2011 and December 2018 were included in this study. For each patient with IMCC, two control patients with LA were enrolled based on matching age and sex,-i.e., 80 patients with LA. RESULTS Inflammatory markers, including WBC, PLR, NLR, DNI, and CRP were significantly higher in the LA group than in the IMCC group. For both groups, the area under the curve (AUC) of the initial CRP value was significantly higher (AUC: 0.909) than that of the initial serum WBC count, PLR, and DNI levels. On multivariable logistic regression analysis with inflammatory markers, serum CRP (odds ratio, 1.290; 95% confidence interval, 1.148-1.449, p < 0.001) was the only significant predictor for differentiation between the LA and IMCC groups. CONCLUSION Serum CRP may be a potential inflammatory marker to differentiate IMCC from LA in the ED.
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Affiliation(s)
- Sun Chul Lee
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (S.C.L.); (S.J.K)
| | - Sun Ju Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (S.C.L.); (S.J.K)
| | - Min Heui Yu
- SENTINEL (Severance ENdocrinology daTa scIeNcE pLatform) Team, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Kyong Joo Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
- Correspondence: (K.J.L.); (Y.S.C.)
| | - Yong Sung Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (S.C.L.); (S.J.K)
- Correspondence: (K.J.L.); (Y.S.C.)
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Samuel L, Szanton SL, Fedarko NS, Simonsick EM. Leveraging naturally occurring variation in financial stress to examine associations with inflammatory burden among older adults. J Epidemiol Community Health 2020; 74:892-897. [PMID: 32665370 DOI: 10.1136/jech-2020-213807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/27/2020] [Accepted: 06/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Financial strain is associated with earlier disability and mortality, but causal links are underexplored, partly because it is unethical to randomise people to financial stress. This study leverages naturally occurring random variation in days since monthly Social Security payment arrival among older adults to test associations with inflammatory biomarkers. METHODS Biomarker data, including tumour necrosis factor (TNF)-α, interleukin (IL)-6 and C reactive protein (CRP), was collected from 2155 non-working healthy adults aged 70-79 years, participating in the Health, Aging and Body Composition Study. Days since payment arrival was independent of all demographic, socioeconomic or health characteristics measured in this study. Restricted cubic spline models estimated associations separately for each week of the month, stratified by financial strain status (interaction term p value for TNF-α model <0.05). RESULTS Among financially strained older adults, more days since payment arrival was associated with higher TNF-α levels during the first week of the month (coefficient=0.102). Associations with IL-6 and CRP differed depending on the degree of financial strain (interaction term p values <0.05). Those with low, but not high, strain had lower levels of IL-6 (coefficient=-0.152) and CRP (coefficient=-0.179) during the first week. CONCLUSIONS Days since monthly payments were associated with inflammatory cytokines among older adults who have difficulty making ends meet financially and associations depended on financial strain severity, suggesting that results are attributable to monthly variation in financial stress. Future research should examine whether more frequent Social Security disbursement would modify financial strain and inflammatory biomarkers.
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Affiliation(s)
- Laura Samuel
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Neal S Fedarko
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Nakamura K, Ogura K, Nakano H, Naraba H, Takahashi Y, Sonoo T, Hashimoto H, Morimura N. C-reactive protein clustering to clarify persistent inflammation, immunosuppression and catabolism syndrome. Intensive Care Med 2020; 46:437-443. [PMID: 31919541 DOI: 10.1007/s00134-019-05851-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Among patients surviving treatment in intensive care units (ICU), some cases exist for which inflammation persisted with prolonged hospital stays, referred as persistent inflammatory, immunosuppressed, catabolic syndrome (PIICS). C reactive protein (CRP) is regarded as the most important marker for PIICS. Nevertheless, the applicable cut-off of CRP for PIICS has never been described in the literature. METHODS Data of patients admitted to the ICU/Emergency ward from May 2015 through June 2019 were analyzed retrospectively. Using K-means clustering, a 14-day CRP transition dataset was analyzed and categorized finally into 7 classes: 4 PIICS classes and 3 non-PIICS classes. Outcomes and the other PIICS characteristics were evaluated. RESULTS From all 5513 admitted patients, this study examined data of 539 patients who had been admitted for more than 14 days, and for whom 14 day CRP transition analysis could be performed. By the CRP transitions of 7 categorized classes, the CRP cut-off for PIICS was regarded as 3.0 mg/dl on day 14. The Barthel Index at discharge, albumin, and total lymphocyte counts on day 14 were significantly lower in PIICS classes than those of non-PIICS classes. Creatinine kinase, antithrombin activity and thrombomodulin on admission were regarded as independent risk factors for PIICS. CONCLUSIONS Among patients with prolonged hospital stay, the PIICS population had elevated CRP, but lower Barthel Index, albumin, and total lymphocyte counts. The criterion of day 14 CRP for PIICS should be 3.0 mg/dl.
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Affiliation(s)
- Kensuke Nakamura
- Department of Emergency and Critical Care MHiedicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki, 317-0077, Japan.
| | - Kentaro Ogura
- Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan.,TXP Medical Co. Ltd, 3-13 Nihonbashiyokoyamacho, Chuo-ku, Tokyo, 103-0003, Japan
| | - Hidehiko Nakano
- Department of Emergency and Critical Care MHiedicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki, 317-0077, Japan
| | - Hiromu Naraba
- Department of Emergency and Critical Care MHiedicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki, 317-0077, Japan
| | - Yuji Takahashi
- Department of Emergency and Critical Care MHiedicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki, 317-0077, Japan
| | - Tomohiro Sonoo
- Department of Emergency and Critical Care MHiedicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki, 317-0077, Japan.,TXP Medical Co. Ltd, 3-13 Nihonbashiyokoyamacho, Chuo-ku, Tokyo, 103-0003, Japan
| | - Hideki Hashimoto
- Department of Emergency and Critical Care MHiedicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki, 317-0077, Japan
| | - Naoto Morimura
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
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Abolhassani AR, Schuler G, Kirchberger MC, Heinzerling L. C-reactive protein as an early marker of immune-related adverse events. J Cancer Res Clin Oncol 2019; 145:2625-2631. [PMID: 31492984 DOI: 10.1007/s00432-019-03002-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/09/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Immune checkpoint inhibitors (ICIs) are effective against a wide variety of cancers. However, they also induce a plethora of unique immune-related adverse events (irAEs). Since for many organ systems symptoms can be unspecific, differential diagnosis with progression of disease or infection may be difficult. C-reactive protein (CRP) has been suggested as a marker for infection. The purpose of this study was to evaluate the diagnostic value of CRP in differentiating infectious causes from autoimmune side effects induced by ICIs. METHODS In order to investigate the role of CRP in irAEs, we screened our patient data base. Only events with full infectious workup were included. In total 88 events of irAEs in 37 melanoma patients were analyzed. CRP levels before and during irAEs were evaluated. Statistical analyses were conducted using the Chi-square test for categorical variables. RESULTS At the onset of irAE, CRP rose in 93% of cases to a mean of 52.7 mg/L (CI 35.1-70.3) from 8.4 mg/L at baseline (normal < 5 mg/L) (P < 0.0001). Other causes of CRP elevation including infectious diseases were excluded, and procalcitonin (PCT) levels were normal in 92% of events. Importantly, in 42% of cases CRP elevations preceded clinical symptoms. CONCLUSION CRP elevation can predict the onset of irAEs in patients treated with ICIs in the absence of infectious disease.
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Affiliation(s)
- Amir-Reza Abolhassani
- Department of Dermatology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Gerold Schuler
- Department of Dermatology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Michael Constantin Kirchberger
- Department of Dermatology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Lucie Heinzerling
- Department of Dermatology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.
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Klang E, Kopylov U, Eliakim R, Rozendorn N, Yablecovitch D, Lahat A, Ben-Horin S, Amitai MM. Diffusion-weighted imaging in quiescent Crohn's disease: correlation with inflammatory biomarkers and video capsule endoscopy. Clin Radiol 2017; 72:798.e7-798.e13. [PMID: 28506799 DOI: 10.1016/j.crad.2017.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 03/05/2017] [Accepted: 04/04/2017] [Indexed: 02/08/2023]
Abstract
AIM To investigate the role of restricted diffusion in quiescent Crohn's disease (CD) patients and its association with inflammatory biomarkers and endoscopic disease. MATERIAL AND METHODS Fifty-two quiescent CD patients prospectively underwent magnetic resonance enterography (MRE) and video capsule endoscopy (VCE) and were tested for the inflammatory biomarkers, faecal calprotectin (FCP) and C-reactive protein (CRP). Restricted diffusion in the distal ileum was qualitatively (absence/presence) and quantitatively (apparent diffusion coefficient [ADC]) assessed by two readers. The VCE-based Lewis score was calculated for the distal ileum. Restricted diffusion sensitivity and specificity for VCE ulcerations were assessed for patients with elevated (>100 μg/g) or normal (<100 μg/g) FCP. Receiver operating characteristic (ROC) curve was used to assess the ability of ADC to identify patients with concurrent VCE ulceration and elevated FCP. RESULTS The sensitivity and specificity of restricted diffusion for patients with VCE ulceration were higher in patients with elevated FCP (reader 1: 71.4%, 80%, reader 2: 76.2%, 100%, respectively) compared to patients with normal FCP (reader 1: 46.2%, 61.5%; reader 2: 15.4%, 76.9%, respectively). The ADC had a high diagnostic accuracy for identifying patients that had concurrent VCE ulceration and elevated FCP (reader 1: AUC=0.819, reader 2: AUC=0.832). CONCLUSION In quiescent CD patients, the presence of restricted diffusion is suggestive of an active inflammation, associated with elevated FCP. Thus, DWI may serve as a clinical tool in the follow-up of these patients, implying subclinical inflammatory flares.
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Affiliation(s)
- E Klang
- Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat Gan, Israel; Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - U Kopylov
- Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - R Eliakim
- Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - N Rozendorn
- Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat Gan, Israel; Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - D Yablecovitch
- Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - A Lahat
- Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - S Ben-Horin
- Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - M M Amitai
- Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat Gan, Israel; Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel
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