The C-Reactive Protein/Albumin Ratio and Complete Blood Count Parameters as Indicators of Disease Activity in Patients with Takayasu Arteritis

Characteristics of scrotal involvement in IgA vasculitis: Relationship with disease activity and inflammatory markers

Immunoglobulin A (IgA) vasculitis is a common systemic vasculitis in children, involving the skin, joint, gastrointestinal tract and kidneys. Scrotal involvement is a less common manifestation in the course of IgA vasculitis, which alters disease management. The purpose of this study was to present the characteristics of patients with IgA vasculitis with scrotal involvement and to compare patients with and without scrotal involvement. We also aimed to investigate the relationship between scrotal involvement and disease activity and inflammatory markers. This medical record review study was conducted in 234 male patients under the age of 18 years who were diagnosed with IgA vasculitis and followed for at least 6 months in the Pediatric Rheumatology Clinic. Demographic characteristics, clinical findings, laboratory findings, and pediatric vasculitis activity score (PVAS) of IgA vasculitis patients were recorded. CRP to albumin ratio (CAR), platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) were calculated using the patients' complete blood count parameters and C reactive protein (CRP) levels. Two hundred thirty four male patients with IgA vasculitis were included in the study. Scrotum involvement was detected in 34 (14.5%) of patients. The mean age at diagnosis of 34 patients with scrotal involvement was 7.37 (4.41-8.43) years. Of the 34 patients, 15 had scrotal pain, swelling and rash, 12 had scrotal pain and swelling, and 2 had only scrotal swelling. Two (5.9%) patients had penile involvement with scrotal involvement. Patients were divided into two groups as those with scrotal involvement (n = 34, 10.2%) and those without (n = 200, 89.8%). Local edema, widespread skin involvement, hematuria, penile involvement, PVAS and CAR were significantly higher in IgA patients with scrotal involvement than in those without (p < 0.001, p < 0.001, p = 0.019, p = 0.001, p < 0.001, and p = 0.004, respectively).

CONCLUSION

Widespread purpura, local edema, penile involvement and hematuria are more common in patients with scrotal involvement than those without. PVAS and some systemic inflammatory markers such as CAR may be helpful in predicting scrotal involvement.

WHAT IS KNOWN

• IgA vasculitis is the most common type of vasculitis in childhood and scrotal involvement is very rare during the course of the disease. • PVAS is a scoring system used to measure the severity of childhood vasculitis.

WHAT IS NEW

• PVAS might be promising surrogate tool for predicting scrotal involvement in patients with IgA vasculitis.

The association of C-reactive protein to albumin ratio wıth lichen planus

OBJECTIVE

In some diseases associated with inflammation, the C-reactive protein-to-albumin ratio can be used as a biomarker of inflammation. Since lichen planus is a chronic inflammatory disease, our study aimed to investigate the relationship between C-reactive protein-to-albumin ratio and disease activity and whether it plays a role in determining disease prognosis, and compare them with those in subjects without lichen planus.

METHODS

This is a case-control study. Demographic data, clinical features, and laboratory measures, including neutrophil, lymphocyte, eosinophil, platelet counts, neutrophile-to-lymphocyte ratio, erythrocyte sedimentation rate, C-reactive protein, albumin, and C-reactive protein-to-albumin ratio were statistically compared between patients with lichen planus (n=61) and controls (n=64).

RESULTS

Albumin and erythrocyte sedimentation rate (p<0.001), C-reactive protein (p=0.017), C-reactive protein-to-albumin ratio (p=0.016), and neutrophile-to-lymphocyte ratio (p=0.02) were significantly higher in the patient group than in the control group. C-reactive protein-to-albumin ratio (p=0.003, OR 1.2), neutrophile-to-lymphocyte ratio (p=0.02, OR 1.4), and erythrocyte sedimentation rate (p=0.003, OR 1.1) were effective in differentiating patients from the healthy group. Erythrocyte sedimentation rate>4.5 mm/h, C-reactive protein-to-albumin ratio>0.6, and neutrophile-to-lymphocyte ratio>1 were useful in showing disease activity, of which C-reactive protein-to-albumin ratio has the best value with 92% sensitivity. C-reactive protein-to-albumin ratio has a sensitivity of 100% and is more effective and sensitive than other markers in distinguishing between mild and severe groups and between single and multiple involvement.

CONCLUSION

Elevated C-reactive protein-to-albumin ratio levels may be considered a potential marker for lichen planus. It may be highly sensitive to follow-up of systemic inflammation and disease activity in patients with lichen planus. However, further prospective studies may confirm the association between C-reactive protein-to-albumin ratio and lichen planus.

PCT-to-albumin ratio and CRP-to-albumin ratio as predictors of febrile neutropenia complications: a prospective observational trial

PURPOSE

This study aimed to determine whether procalcitonin-to-albumin ratio (PAR) and C-reactive protein-to-albumin ratio (CAR) can be alternatives to the Multinational Association for Supportive Care in Cancer (MASCC) risk index score in predicting bacteriemia, septicemia, death during FN, and 28-day mortality, in patients with febrile neutropenia (FN).

METHODS

This is a prospective observational study that included 185 participants with FN. Clinical and laboratory findings like PAR and CAR were analyzed, and their ability to predict FN complications was investigated.

RESULTS

From the included population, the 91 subjects (49.46%) had low-risk FN with MASCC risk index ≥ 21. Sixteen participants (8.70%) had bacteremia, and eight developed septicemia (4.89%). Before resolving FN, 15 people died, and in total 33 died within 28 days of diagnosis. The ROC curve analysis indicates that the CAR (p = 0.0008921) better predicts mortality during FN, and the PAR (p = 0.0003535) better predicts bacteremia. Incorporating CAR values into the MASCC risk index predicts mortality by as much as 33.33% more precisely than the MASCC risk index alone. The CAR values > 2.74 were an independent predictor of 28-day mortality (OR = 3.70; 95% CI = 1.08-13.02; p = 0.0376).

CONCLUSION

The study results suggest that PAR and CAR can be leveraged as valuable prognostic tools in predicting bacteremia, septicemia, mortality during FN, and 28-day mortality in patients with FN.

The relationship of disease severity with C-reactive protein/albumin ratio and hematological parameters in patients with rosacea

This study aims to investigate the effectiveness of the C-reactive protein/albumin ratio (CAR) and parameters derived from complete blood counts as indicators of inflammatory activity in patients with rosacea and to evaluate their association with disease severity. This retrospective cross-sectional study included 90 rosacea patients classified into three groups based on the Investigator Global Assessment (IGA) score: 30 with mild, 30 with moderate, and 30 with severe disease, along with 30 healthy controls. There were no significant differences between the patient and control groups in terms of gender (%31.1 vs. %30 male) and age (41.92 ± 10.70 years vs. 41.07 ± 11.92 years). In rosacea patients, neutrophil (P = 0.0004), lymphocyte (P = 0.031), platelet (P = 0.041), monocyte (P = 0.003), CRP (P < 0.0001), and CAR (P < 0.0001) levels were significantly higher. The AUC value for CAR was 0.83, with a cut-off value of 0.91; sensitivity was 66.67%, and specificity was 96.67%. Significant differences were observed among the three patient groups classified by rosacea severity for neutrophil (P < 0.0001), lymphocyte (P = 0.011), monocyte (P = 0.0001), CRP (P < 0.0001), albumin (P < 0.0001), CAR (P < 0.0001), neutrophil/lymphocyte ratio (NLR) (P = 0.004), and lymphocyte/monocyte ratio (LMR) (P = 0.021). Patients with rhinophyma had higher neutrophil (P = 0.005) and NLR (P = 0.019) levels. Those with ocular involvement had higher CRP (P = 0.003) and CAR (P = 0.002) levels, while albumin (P = 0.024) levels were lower. This study is the first to examine the relationship between CAR, rosacea severity, and different clinical types. Based on our findings, we believe that CAR and other hematological parameters can be used to assess the severity of rosacea and monitor various clinical types.

Blood Cell Ratio Combinations for Diagnosing Periprosthetic Joint Infections: A Preliminary Study

Background

Periprosthetic joint infection (PJI) is a serious complication following total joint arthroplasty (TJA), which requires prompt and accurate diagnosis for effective management. Many biomarkers have been used for PJI diagnosis; however, the identification of the most effective inflammatory biomarker combination for optimal diagnostic accuracy may be poorly reported.

Methods

In this prospective, multi-center study, a total of 269 individuals undergoing knee or hip revision arthroplasty were recruited and subsequently categorized based on 2018 ICM PJI criteria into two groups: 93 with periprosthetic joint infection (PJI) and 176 with aseptic failure (AF). Various preoperative biomarkers were analyzed and compared, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil-to-lymphocyte ratio (NLR), CRP-to-albumin ratio (CAR), CRP-Albumin-lymphocyte ratio (CALLR), platelet-to-lymphocyte ratio (PLR), platelet-to-albumin ratio (PAR), and neutrophil-to-albumin ratio (NAR). The diagnostic performance of these biomarkers was evaluated using ROC curve analysis and the area under the curve (AUC). Additionally, the Youden index was used to determine optimal threshold values, and positive predictive value (PPV) and negative predictive value (NPV) were calculated to evaluate diagnostic precision.

Results

In the PJI group, levels of PAR, CAR, and CALLY were notably higher compared to the AF group, reaching statistical significance (P < 0.05). PAR and CAR were confirmed to have high diagnostic values, with AUC values of 0.779 and 0.718, respectively. CALLY exhibited moderate diagnostic effectiveness, with an AUC of 0.647. When PAR was combined with CRP and ESR, sensitivity and specificity notably improved to 93.8% and 92.5%, respectively. However, subgroup analysis revealed no significant differences in combined inflammatory biomarker levels between the two groups.

Conclusion

PAR and CAR prove to be effective combined inflammatory biomarkers for PJI diagnosis, whereas other markers exhibited limited diagnostic utility for PJI.

Variable temocillin protein binding and pharmacokinetics in different clinical conditions: Implications for target attainment

AIMS

The beta-lactam antibiotic temocillin is increasingly used to treat extended-spectrum beta-lactamase (ESBL-producing) strains; however, its protein binding is complex. This study aims to predict unbound temocillin concentrations in various participant groups to determine its impact on the probability of target attainment (PTA) and to improve dosing recommendations.

METHODS

The plasma pharmacokinetics were analysed using non-linear mixed-effects modelling. Data from individuals in four groups: healthy volunteers (HV), urinary tract infection patients (UTI), ventriculitis patients and sepsis-ICU patients were included. Simulations were performed to compare the PTA for different dosing regimens and participant-groups.

RESULTS

A two-compartment protein-binding model best fitted the 1085 concentrations (543 unbound, 542 total). Temocillin clearance was influenced by creatinine clearance, serum albumin (ALB) and C-reactive protein (CRP). For 2 g q8h intermittent infusion, the PTAs at an MIC of 16 mg/L were 2.3%, 39.5%, 10.0% and 72.5%, for HV, UTI, ventriculitis and sepsis-ICU patients, respectively. The effects of the covariates on the PTA were simulated for two example patients with intermittent infusion: the PTAs at an MIC of 8 mg/L for a sepsis-ICU patient (CRP 300 mg/L, albumin 15 g/L) and a mild-UTI patient (CRP 30 mg/L, albumin 35 g/L) were 94.3% and 62.4%, respectively. Continuous infusion consistently outperformed intermittent infusion in achieving the desired pharmacodynamic target (time above MIC).

CONCLUSIONS

Our study underscores the significant variation in temocillin clearance and unbound fractions among different participant groups, challenging the efficacy of traditional 2 g q12h dosing. For patients with enhanced renal function and lower inflammation, continuous infusion emerges as a more effective strategy to achieve optimal target attainment.

Prognostic factors associated with acute retinal necrosis treated non-surgically

OBJECTIVES

To analyse the prognostic factors for visual acuity in acute retinal necrosis (ARN) patients treated non-surgically.

METHODS

The clinical data of ARN patients who visited our hospital from January 2010 to January 2023 were retrospectively analysed.

RESULTS

Twenty-four patients (29 eyes) were included. Aqueous humour samples were collected from 20 out of 29 eyes, and PCR confirmed that 85% (17/20) of the eyes had VZV infection, 10% (2/20) had CMV infection, and 5% (1/20) had HSV infection. All patients were treated with intravenous antiviral agents. Intravitreal ganciclovir and oral corticosteroids were given according to the patients' wishes. A comparison of visual acuity at the time of first identification of inactive ARN with that at the first visit revealed that 16 (55.2%) eyes improved and 13 (44.8%) did not improve. Logistic regression analysis revealed that risk factors for failure to improve vision after treatment included retinal detachment (odds ratio [OR],33.75; 95% CI, 3.245-351.067; P = 0.003), necrotising retinitis involving the posterior pole (odds ratio [OR],8.167; 95% CI, 1.297-51.403, P = 0.025), and arteritis involving the large retinal arteries (odds ratio [OR],9.167; 95% CI, 1.493-56.297; P = 0.017). The VZV viral load in the aqueous humour at initial presentation was significantly associated with visual prognosis (r = 0.688, P = 0.013), retinal detachment (τ = 0.597, P = 0.021) and the extent of retinal necrosis (τ = 0.57, P = 0.027). The neutrophil to lymphocyte ratio (NLR) of VZV-infected patients at first presentation was significantly correlated with the prognosis of visual acuity (r = 0.616, P = 0.033) and retinal detachment (τ = 0.728, P = 0.004).

CONCLUSIONS

High NLR and viral DNA copy number in the aqueous humour at the initial presentation, as well as subsequent retinal detachment, necrotising retinitis involving the posterior pole, and arteritis involving the large retinal arteries were risk factors for poor visual prognosis in VZV-infected ARN patients.

Exploring the predictive factors in the gastrointestinal involvement of patients with immunoglobulin A vasculitis

BACKGROUND

Immunoglobulin A vasculitis (IgAV), the most common systemic vasculitis in children, typically presents with gastrointestinal (GI) symptoms in about half of cases. This study aimed to analyze the clinical and laboratory findings of patients with IgAV regarding GI involvement.

METHODS

We compared the GI involvement data of the patients diagnosed with IgAV.

RESULTS

Of the 210 patients (60.5% female and 39.5% male), 101 had GI involvement, with abdominal pain being the predominant symptom (n=98). White blood cell, neutrophil, monocyte, and platelet counts, C-reactive protein, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were significantly elevated in patients with GI involvement (p<0.001, p<0.001, p=0.01, p=0.005, p=0.002, p<0.001, p=0.03, p=0.001, p<0.001, p<0.001, respectively). The cutoff values for SII (>1035.7), SIRI (>1.65), NLR (>2.73), and MLR (>0.28) were determined, yielding respective sensitivities of 46%, 59%, 47%, and 53%, specificities of 83.1%, 69.1%, 81.3%, and 71.9%. Corresponding areas under the curve were 0.658, 0.668, 0.649, and 0.634, respectively (all p<0.001).

CONCLUSION

Although IgAV is a self-limiting disease, GI involvement can lead to serious consequences. Systemic inflammatory indices such as SII and SIRI may be indicative in identifying patients with GI involvement.

CAR, mGPS and hs-mGPS: What is among them the best gero-biomarker for age-related diseases? And for what clinical application?

The identification of biomarkers linked to the onset, progression, and prevention of age-related diseases (ARD), in the era of personalized medicine, represents the best goal of geroscience. Geroscience has the fundamental role of exploring and identifying the biological mechanisms of aging to suggest interventions capable of stopping/delaying the many pathological conditions and disabilities related to age. Therefore, it has become its key priority, as well as that of clinical practice and research, based on identifying and validating a range of biomarkers, geromarkers, which can be used to diagnostic, prognostic, or predictive clinical purposes. Indeed, geromarkers have, the potential to predict ARD trajectories and facilitate targeted interventions to slow down the related disabilities. Here our attention is paid to the inflammatory indexes (CAR, mGPS, hs-mGPS) linked to the relationship between the plasma levels of two inflammatory analytes, the typical positive protein of the acute phase, and the negative one, i.e. c-reactive protein (CRP) and albumin, respectively. These indexes allow us to understand the magnitude of the two main mechanisms predicted to influence the aging process, including inflammation and immunosenescence, as well as the degree of ARD severity. Evidence on their relationship with ARD is widely reported and discussed, to understand which can represent the best ARD geromarker, and its clinical application.

Evaluation of serum neopterin levels in severe COVID-19 patients: An observational study

In patients with coronavirus disease (COVID-19), a massive inflammatory response is a significant cause of morbidity and mortality. Inflammatory markers are prognostic indicators of disease severity and the ultimate clinical outcome. Several studies have demonstrated a correlation between serum levels of neopterin, which can be an immune system marker, disease severity, and poor outcomes in COVID-19 patients. Our study aimed to determine the diagnostic significance of neopterin in conjunction with routinely measured inflammatory markers in patients with severe COVID-19. Serum neopterin, C-reactive protein (CRP), albumin levels, and complete blood count were determined in 39 patients with severe COVID-19 and 30 healthy individuals. Demographic characteristics, serum neopterin levels, and other laboratory data were compared between patients and healthy volunteers and statistically analyzed. High neopterin levels were observed in patients with severe COVID-19 compared to healthy volunteers. Furthermore, albumin levels were decreased, while CRP levels were increased in patients, statistically significantly. Also, positive correlations were shown between serum neopterin levels and serum CRP levels, while negative correlations were shown between serum neopterin levels and serum albumin levels. Systemic inflammation markers, CRP/albumin ratio, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio were significantly higher, while lymphocyte/monocyte ratio was also significantly lower in patients with severe COVID-19 than in healthy volunteers. However, serum neopterin levels were not linked to the CRP/albumin ratio, the neutrophil/lymphocyte ratio, or the platelet/lymphocyte ratio. On the other hand, they were linked negatively to the lymphocyte/monocyte ratio. Our findings highlight the association between high neopterin levels and patients with severe COVID-19. Neopterin is correlated with traditional inflammatory biomarkers and may indicate general immune and inflammatory activation in patients with severe COVID-19.

Effector CD4+ T-cell subsets in Takayasu arteritis-differences between the peripheral blood and the aorta

Takayasu arteritis (TAK) is a granulomatous vasculitis that affects large arteries. T cells are important in TAK pathophysiology as these cells orchestrate granulomatous infiltration in arteries. This study aims to evaluate effector CD4+ T cells in the peripheral blood and the aortic wall of TAK patients and to analyze associations with disease activity and therapy. We performed a longitudinal study including 30 TAK patients and 30 controls. CD3+ T cells, CD3+CD4- T cells, CD4+ T cells, and Th1, Th2, and Th17 cells were evaluated in peripheral blood by flow cytometry, and the expression of CD4, CD8, Tbet, GATA-3, and RORγT was analyzed in the aorta of six patients by immunohistochemistry. TAK patients presented lower CD3+ T cells and CD4+ T cells (P = 0.031 and P = 0.039, respectively) than controls. Patients with active disease and those in remission had higher proportions of Th17 cells than controls (P = 0.016 and P = 0.004, respectively). Therapy for TAK did not result in significant differences concerning CD4+ effector T-cell subpopulations. Disease duration correlated with the number and percentage of Th2 cells (rho = -0.610 and rho = -0.463, respectively) and with Th17 cells (rho = -0.365 and rho = -0.568). In the aorta, the expression of CD8 was higher than CD4, whereas GATA-3, Tbet, and RORγT were expressed in this order of frequency. In conclusion, TAK patients present an increased Th17 response in the peripheral blood regardless of disease activity, whereas in the aortic tissue CD8 cells and the Th2 response were predominant.

Red Blood Cell Distribution Width to Albumin Ratio for Predicting Type I Cardiorenal Syndrome in Patients with Acute Myocardial Infarction: A Retrospective Cohort Study

Purpose

Red blood cell distribution width to albumin ratio (RAR) is a novel inflammatory biomarker that independently predicts adverse cardiovascular events and acute kidney injury. This study aimed to assess the predictive value of RAR for cardio-renal syndrome type I (CRS-I) risk in acute myocardial infarction (AMI) patients.

Patients and methods

This study retrospectively enrolled 551 patients who were definitively diagnosed as AMI between October 2021 and October 2022 at the Affiliated Zhongda Hospital of Southeast University. Participants were divided into two and four groups based on the occurrence of CRS-I and the quartiles of RAR, respectively. Demographic data, laboratory findings, coronary angiography data, and drug utilization were compared among the groups. Logistic regression and receiver operating characteristic curve (ROC) analysis were performed to identify independent risk factors for CRS-I and evaluated the predictive value of RAR for CRS-I.

Results

Among the cohort of 551 patients, 103 (18.7%) developed CRS-I. Patients with CRS-I exhibited significantly elevated RAR levels compared to those without the condition, and the incidence of CRS-I correlated with escalating RAR. Univariate and multivariate logistic regression analyses identified RAR as an independent risk factor for CRS-I. ROC curves analysis demonstrated that RAR alone predicted CRS-I with an area under the curve (AUC) of 0.683 (95% CI=0.642-0.741), which was superior to the traditional inflammatory marker C-reactive protein (CRP). Adding the variable RAR to the model for predicting the risk of CRS-I further improved the predictive value of the model from 0.808 (95% CI=0.781-0.834) to 0.825 (95% CI=0.799-0.850).

Conclusion

RAR is an independent risk factor for CRS-I, and high levels of RAR are associated with an increased incidence of CRS-I in patients with AMI. RAR emerges as a valuable and readily accessible inflammatory biomarker that may play a pivotal role in risk stratification in clinical practice.

Review of the Predictive Value of Biomarkers in Sepsis Mortality

Sepsis is a leading cause of mortality among severely ill individuals, primarily due to its potential to induce fatal organ dysfunction. For clinicians, it is vital to have appropriate indicators, including the physiological status and personal experiences of patients with sepsis, to monitor the condition and assess prognosis. This approach aids in preventing the worsening of the illness and reduces mortality. Recent guidelines for sepsis focus on improving patient outcomes through early detection and timely treatment. Nonetheless, identifying severe cases and predicting their prognoses remain challenging. In recent years, there has been considerable interest in utilising the C-reactive protein (CRP)/albumin ratio (CAR) to evaluate the condition and forecast the prognosis of patients with sepsis. This research concentrates on the significance of CAR in the pathological process of sepsis, its association with prognosis, and the latest developments in employing procalcitonin, lactic acid, CRP, and other potential biomarkers. The CAR, with its predictive value for sepsis prognosis and mortality, is increasingly used as a clinical biochemical marker in diagnosing and monitoring patients with sepsis.

Are monocyte-to-HDL and C-reactive protein-to-albumin ratios useful for the diagnosis and follow-up of Takayasu arteritis?

OBJECTIVE

In this study, we aimed to investigate the role of erythrocyte sedimentation rate, C-reactive protein, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, red blood cell distribution width, mean platelet volume, monocyte/HDL ratio, and C-reactive protein/albumin ratio in the diagnosis and treatment follow-up of active and remission Takayasu arteritis patients compared with healthy control group.

METHODS

This is a retrospective case-control study in which 56 Takayasu arteritis patients and 40 age- and sex-matched healthy control were included. The blood values of Takayasu arteritis patients were analyzed during their active period and post-treatment remission periods, after comparing them with the healthy control. Furthermore, all parameters were evaluated by receiver operating characteristic analysis.

RESULTS

Erythrocyte sedimentation rate, C-reactive protein, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, monocyte/HDL ratio, and C-reactive protein/albumin ratio values were significantly higher in active Takayasu arteritis patients compared with healthy control and remission Takayasu arteritis groups. In the receiver operating characteristic analysis performed in active Takayasu arteritis and Takayasu arteritis patients in remission, C-reactive protein had the highest power to indicate disease activity, followed by C-reactive protein/albumin ratio, erythrocyte sedimentation rate, and monocyte/HDL ratio. When Takayasu arteritis in remission was compared with the healthy control, a significant difference was found between erythrocyte sedimentation rate, C-reactive protein, red blood cell distribution width, and C-reactive protein/albumin ratio, while no significant difference was found between monocyte/HDL ratio values.

CONCLUSION

C-reactive protein/albumin ratio and red blood cell distribution width can be used in the diagnosis of Takayasu arteritis, and C-reactive protein/albumin ratio, red blood cell distribution width, and monocyte/HDL ratio measurements can be used in the follow-up. As C-reactive protein/albumin ratio is more powerful than C-reactive protein in differentiating the Takayasu arteritis group from the healthy control group, evaluation of C-reactive protein/albumin ratio together with albumin instead of evaluation of C-reactive protein alone when diagnosing the disease may help us to obtain more accurate results in daily practice.

Prediction models for postoperative recurrence of non-lactating mastitis based on machine learning

OBJECTIVES

This study aims to build a machine learning (ML) model to predict the recurrence probability for postoperative non-lactating mastitis (NLM) by Random Forest (RF) and XGBoost algorithms. It can provide the ability to identify the risk of NLM recurrence and guidance in clinical treatment plan.

METHODS

This study was conducted on inpatients who were admitted to the Mammary Department of Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine between July 2019 to December 2021. Inpatient data follow-up has been completed until December 2022. Ten features were selected in this study to build the ML model: age, body mass index (BMI), number of abortions, presence of inverted nipples, extent of breast mass, white blood cell count (WBC), neutrophil to lymphocyte ratio (NLR), albumin-globulin ratio (AGR) and triglyceride (TG) and presence of intraoperative discharge. We used two ML approaches (RF and XGBoost) to build models and predict the NLM recurrence risk of female patients. Totally 258 patients were randomly divided into a training set and a test set according to a 75%-25% proportion. The model performance was evaluated based on Accuracy, Precision, Recall, F1-score and AUC. The Shapley Additive Explanations (SHAP) method was used to interpret the model.

RESULTS

There were 48 (18.6%) NLM patients who experienced recurrence during the follow-up period. Ten features were selected in this study to build the ML model. For the RF model, BMI is the most important influence factor and for the XGBoost model is intraoperative discharge. The results of tenfold cross-validation suggest that both the RF model and the XGBoost model have good predictive performance, but the XGBoost model has a better performance than the RF model in our study. The trends of SHAP values of all features in our models are consistent with the trends of these features' clinical presentation. The inclusion of these ten features in the model is necessary to build practical prediction models for recurrence.

CONCLUSIONS

The results of tenfold cross-validation and SHAP values suggest that the models have predictive ability. The trend of SHAP value provides auxiliary validation in our models and makes it have more clinical significance.

A meta-analysis on first-trimester blood count parameters-is the neutrophil-to-lymphocyte ratio a potentially novel method for first-trimester preeclampsia screening?

Objective

Meta-analysis focusing on the role of first-trimester neutrophil-to-lymphocyte ratio (NLR) in the prediction of preeclampsia.

Data sources

PubMed, Scopus, Web of Science, Cochrane Library, and Embase databases were queried from inception up to December 31, 2022.

Study eligibility criteria

The study included all types of original research that was conducted in humans and values of NLR were measured during the first trimester, among patients who later developed preeclampsia, compared to the values of control groups.

Study appraisal and synthesis methods

Two reviewers independently performed data abstraction and quality appraisal, and disagreements were resolved by consensus and, if necessary, by the opinion of a third reviewer. During the analysis, PRISMA and MOOSE guidelines were followed. All statistical analyses were made with R.

Results

For the research on the predictive role of NLR values in the first trimester for preeclampsia, a total of 6 studies were selected for analysis, covering 2,469 patients. The meta-analysis revealed a 95% confidence interval (CI) for the effect size of 0.641 to 1.523, with a prediction interval of 0.027 to 2.137.

Conclusion

Based on the analysis, NLR is a promising biochemical marker for future pieces of research that try to find new screening methods for first-trimester preeclampsia. We encourage other researchers to examine NLR's predictive value combined with other markers in preeclampsia screening, this way being able to find new and affordable protocols for first-trimester preeclampsia screening.

Systematic review registration

identifier CRD42023392663.

Importance of the C-Reactive Protein to Albumin Ratio in the Diagnosis and Prognosis of Mycosis Fungoides

INTRODUCTION

The C-reactive protein to albumin ratio (CAR) lately has demonstrated as a prognostic factor and an indicator of disease activity, severity and prognosis in solid organ malignancies and inflammatory diseases. However, the effects of CAR have not been investigated in mycosis fungoides (MF) patients yet.

OBJECTIVES

This study aimed to determine the potential role of CAR as a diagnostic and a prognostic indicator in MF.

METHODS

We retrospectively investigated the electronic medical records of 97 patients with MF admitted to the Dermatology Clinic of Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital between January 2014 and December 2020. In total, 60 patients with MF were enrolled in the study. CAR was evaluated, patient and control group. Also, the other clinicopathological factors including age, lactate dehydrogenase, stage of disease, beta-2-microglobulin levels, and sedimentation levels were evaluated.

RESULTS

The median value of CAR was 0.85 (0.10-7.51) in the patient group, whereas it was 0.39 (0.0-1.11) in the control group (P < 0.001). Patients with disease progression (N = 16, 13M, 3 F) had a median value of CAR 0.84 (0.10-7.51) and the median value of CAR (N = 44) was 0.86 (0.12-4.57) in the group of patients with stable disease. The CAR value had no prognostic significance (P > 0.05).

CONCLUSIONS

There is no association between the CAR and progression in the stage in MF patients. But the CAR is significantly higher in patients with MF than in the control group. The CAR can be a guide for us in cases where we have difficulty in diagnosing.

Value of C-reactive protein/albumin ratio in predicting the development of preoperative oxygenation impairment in patients with Stanford type-B acute aortic dissection

Objectives

We aimed to assess the predicting value of C-reactive protein (CRP)/albumin ratio (CAR) in the development of Oxygenation impairment (OI) in the patients with Stanford type-B acute aortic dissection (AAD).

Methods

This study included 133 patients (age = 58.8 ± 12.0 years, median age = 61 years, Male/Female = 117/16) diagnosed as Stanford type-B AAD accompanied by hypertension from July 2012 to May 2020. Clinical data were retrospectively extracted from the database. The patients in this study were divided into OI group (oxygenation index ≤ 200) and non-OI group (oxygenation index > 200). Clinical characteristics in both groups were compared, and predicting value of CAR in the development of OI was assessed.

Results

Patients in OI group had higher peak body temperature (37.94 ± 0.62 vs. 37.67 ± 0.51 ℃, P =.010), higher levels of serum CRP (41.74 ± 27.71 vs 15.21 ± 19.66 mg/L, P =.000) and plasma B-type natriuretic peptide (292.14 ± 251.11 vs 179.80 ± 241.27 ng/L, P =.016), lower levels of albumin (34.00 ± 5.14 vs 37.72 ± 5.24 g/L, P =.000), and higher CAR (1.27 ± 0.89 vs 0.41 ± 0.53, P =.000). In multivariate regression analysis, CAR (odds ratio: 5.215, 95 % CI: 2.682; 10.137, P =.000) and the peak body temperature (odds ratio: 2.905, 95 % CI: 1.255; 6.724, P =.013) could significantly predict the OI development. The AUC for CAR was 0.831 (95 % CI: 0.756-0.907). An optimal cutoff value for CAR for predicting OI was ≥ 0.70, with a sensitivity of 67.5 % and a specificity of 88.2 %.

Conclusions

Compared with CRP or albumin alone, the CAR might be a more accurate marker in predicting OI development in Stanford type-B AAD.

Platelet count as a potential predictor in refractory Takayasu arteritis

Platelet parameters have been recognized as important markers for disease severity in various types of diseases. The aim of our study was to investigate whether platelet count could be used as a potential predictor of refractory Takayasu arteritis (TAK). In this retrospective study, fifty-seven patients were selected as development data group to identify the associated risk factors and potential predictors of refractory TAK. Ninety-two TAK patients were included in the validation data group to verify the predictive value of platelet count for refractory TAK. Refractory TAK patients had higher levels of platelet (PLT) than non-refractory TAK patients (305.5 vs. 272.0 × 109/L, P = 0.043). For PLT, the best cut-off value was 296.5 × 109/L to predict refractory TAK. Elevated PLT (> 296.5 × 109/L) was found to be statistically related to refractory TAK (OR [95%CI] 4.000 [1.233-12.974], p = 0.021). In the validation data group, the proportion of refractory TAK in patients with elevated PLT was significantly higher than that in patients with non-elevated PLT (55.6% vs. 32.2%, P = 0.037). The 1-, 3- and 5-year cumulative incidence of refractory TAK were 37.0%, 44.4% and 55.6% in patients with elevated PLT, respectively. Elevated PLT (p = 0.035, hazard ratio (HR) 2.106) was identified as a potential predictor of refractory TAK. Clinicians should pay close attention to platelet levels in patients with TAK. For TAK patients with PLT greater than 296.5 × 109/L, closer monitoring of the disease and comprehensive assessment of disease activity are recommended to be alert to the occurrence of refractory TAK.

The role of plateletcrit in Takayasu arteritis: A potential biomarker for disease activity and 6-month treatment response

OBJECTIVES

To determine the role of plateletcrit as a potential biomarker for disease activity and treatment response in Takayasu arteritis (TAK).

METHODS

Totally, 215 newly diagnosed TAK patients were consecutively enrolled. Demographic data, clinical manifestations, laboratory and imaging examinations, and treatment strategy were recorded at baseline and at each visit during the 6-month treatment period. Normal plateletcrit (0.1%-0.4%) and hyper-plateletcrit (>0.4%) observed at baseline were used as group criteria.

RESULTS

At baseline, the overall plateletcrit was 0.32 (0.24-0.38)%, with a normal and high level observed in 172 (80.00%) and 43 (20.00%) patients, respectively. Baseline plateletcrit was significantly higher in patients with active disease and associated with inflammatory biomarkers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin (IL)-6 (all p < .01). At 6 months, complete remission was achieved in 171 (79.53%) patients, and a significant decrease in plateletcrit was observed in these cases (p < .01). Patients with a normal baseline plateletcrit were more likely to achieve complete remission compared to those with a high baseline plateletcrit (HR = 4.65, 95% CI: 2.38-19.08, p < .01). In addition, ESR (p = .01) and IL-6 (p = .02) levels were still higher in patients with a high baseline plateletcrit at 6 months. Progression of vascular lesions was indicated in 18 (8.37%) patients at 6 months, and these patients also had significantly higher baseline plateletcrit (p = .03).

CONCLUSION

Plateletcrit levels were positively related to disease activity and inflammatory index in TAK. Importantly, patients with high baseline plateletcrit levels may show a worse treatment response at 6 months.

Development and validation of diagnostic and activity-assessing models for relapsing polychondritis based on laboratory parameters

Background

Relapsing polychondritis (RP) as a rare autoimmune disease is characterized by recurrent inflammation of the organs containing cartilage. Currently, no biomarkers have been integrated into clinical practice. This study aimed to construct and evaluate models based on laboratory parameters to aid in RP diagnosis, assess activity assessment, and explore associations with the pathological process.

Methods

RP patients and healthy controls (HCs) were recruited at the Peking Union Medical College Hospital from July 2017 to July 2023. Clinical data including Relapsing Polychondritis Disease Activity Index (RPDAI) score and laboratory tests were collected. Differences in laboratory data between RP patients and HCs and active and inactive patients were analyzed.

Results

The discovery cohort (cohort 1) consisted of 78 RP patients and 94 HCs. A model based on monocyte counts and neutrophil to lymphocyte ratio (NLR) could effectively distinguish RP patients from HCs with an AUC of 0.845. Active RP patients exhibited increased erythrocyte sedimentation rate, complement 3, platelet to lymphocyte ratio (PLR), NLR, and C-reactive protein to albumin ratio (CAR) compared with stable patients, which were also positively correlated with RPDAI. Notably, CAR emerged as an independent risk factor of disease activity (OR = 4.422) and could identify active patients with an AUC of 0.758. To confirm the reliability and stability of the aforementioned models, a replication cohort (cohort 2) was enrolled, including 79 RP patients and 94 HCs. The monocyte-combined NLR and CAR showed a sensitivity of 0.886 and 0.577 and a specificity of 0.830 and 0.833 in RP diagnosis and activity prediction, respectively. Furthermore, lower natural killer cell levels in RP patients and higher B-cell levels in active patients may contribute to elucidating the pathological mechanisms of disease occurrence and exacerbation.

Conclusions

The utilization of laboratory parameters provides cost-effective and valuable markers that can assist in RP diagnosis, identify disease activity, and elucidate pathogenic mechanisms.

Role of Systemic Immune-Inflammatory Index in Predicting the Development of In-Hospital Malignant Ventricular Arrhythmia in Patients With ST-Elevated Myocardial Infarction

Many complications can be observed after ST-elevation myocardial infarction (STEMI). The systemic immune-inflammatory index (SII) is a sensitive indicator of the inflammatory state, and this parameter may also be associated with cardiovascular diseases. In this study, we investigated the relationship between malignant ventricular arrhythmias (MVA) development and SII in STEMI patients. A total of 1708 STEMI patients were included in the study. Propensity score matching (PSM) analysis was performed. Patients were divided into 2 groups according to the development of MVA, and predictors of MVA development were investigated. After the PSM analysis, the mean age of 158 patients was 61.6 years, and 68.4% were male. In the univariate analysis, neutrophil count, SII, C-reactive protein (CRP), albumin, and CRP/albumin ratio (CAR) were associated with the development of MVA; while in the regression analysis, CAR and SII was found to be independent predictors of the development of MVA. In this study, we demonstrated that SII is a better independent predictor than other inflammatory parameters for predicting the development of MVA. This index may be useful in clinical use.

Red Blood Cell Distribution Width: A Potential Inexpensive Marker for Disease Activity in Patients with Rheumatic Diseases; Scoping Review

Background

Rheumatic diseases encompass a diverse group of autoimmune disorders that affect the joints and connective tissues. The red blood cell distribution width (RDW) has been widely investigated as an inflammatory marker. This scoping review aimed to explore the potential utility of RDW as an inexpensive marker for disease activity in patients with rheumatic diseases. By summarizing the available evidence, we aimed to determine whether RDW can serve as a reliable and accessible indicator of disease activity in these patients.

Methods

A comprehensive search was systematically performed across electronic databases, encompassing PubMed, Embase, and Web of Science. Studies have explored the relationship between RDW and disease activity in rheumatic diseases. Data extraction focused on the study characteristics, methodologies, and findings related to RDW as a disease activity marker.

Results

After removing duplicates, the initial search yielded 25 relevant studies. These studies encompassed a variety of rheumatic diseases, with rheumatoid arthritis being the most frequently studied condition. The association between RDW and disease activity was assessed by using various disease activity indices and clinical parameters. While some studies have reported a significant correlation between elevated RDW and disease activity, others have yielded inconclusive results.

Conclusion

From this review, we concluded that RDW is an inexpensive potential marker for the evaluation of disease activity in rheumatic diseases. RDW is promising as an inexpensive and readily available marker; however, its clinical utility in assessing disease activity in rheumatic conditions warrants more rigorous investigation through well-designed prospective studies.

Utility of neutrophil/albumin ratio and C-reactive protein/albumin ratio as novel inflammatory markers in Behcet's disease

INTRODUCTION AND OBJECTIVES

Behcet's disease (BD) is an autoimmune systemic inflammatory disease, and its exact pathogenesis is unknown. There are currently no specific tests to evaluate the disease activity of BD, making its management more difficult. This study aims to determine the neutrophil/albumin ratio (NAR) and C-reactive protein (CRP) to albumin ratio (CAR) and investigate their associations with clinical findings in patients with BD and to determine optimum cutoff levels of CAR and NAR.

METHODS

The study included 75 consecutively recruited patients with BD with a mean age of 33.29±6.23 years and disease duration of 7.21±4.64 years, as well as 75 healthy participants. Clinical characteristics and laboratory data were obtained. Disease activity was assessed using the BD current activity form score (BDCAF).

RESULTS

NAR and CAR were elevated in patients with BD compared with those of healthy controls (NAR: 1.08±0.34 vs. 0.607±0.06, CAR: 2.49±1.73 vs. 0.39±0.142; p<0.0001), as well as in active BD versus inactive BD. Both NAR and CAR were significantly correlated with CRP, active uveitis, and BDCAF score (p≤0.05). In patients with active BD, the cutoff value of NAR was >0.9744 (sensitivity: 89.74%, specificity: 80.56%), while that of CAR was >2.04 (sensitivity: 74.36%, specificity: 83.33%).

CONCLUSIONS

NAR and CAR are both elevated in patients with BD and may contribute to its active state. NAR and CAR can be feasible and inexpensive markers for predicting BD activity.

Comparative Evaluation of Peripheral Blood Neutrophil to Lymphocyte Ratio, Serum Albumin to Globulin Ratio and Serum C-Reactive Protein to Albumin Ratio in Dogs with Inflammatory Protein-Losing Enteropathy and Healthy Dogs

Few routinely available biomarkers are clinically useful in assessing dogs with inflammatory protein-losing enteropathy caused by immunosuppressive-responsive enteropathy (IRE-PLE). Only the neutrophil to lymphocyte ratio (NLR) has been studied, while no information exists on the use of the albumin to globulin ratio (AGR) and C-reactive protein to albumin ratio (CRP/ALB). We aimed to evaluate the clinical significance of the NLR, AGR and CRP/ALB in a population of dogs with IRE-PLE. The medical records of 53 IRE-PLE dogs were reviewed at the time of diagnosis (T0) and 1 month after the initiation of immunosuppressants (T1). A control group of 68 healthy dogs was used for comparison. At T0, the median values of the NLR and AGR of sick dogs were significantly higher and lower than those of healthy dogs, respectively. With the increase in the chronic enteropathy activity index, AGR and CRP/ALB significantly decreased and increased, respectively. At T1, NLR and AGR significantly increased, while CRP/ALB significantly decreased. NLR, AGR and CRP/ALB did not differ significantly between dogs classified as responders and nonresponders according to the chronic enteropathy activity index. Further studies are needed to provide more information on this subject.

Evaluation of the serum C-reactive protein-albumin ratio and its relationship with disease severity IN alopecia areata: A prospective case-control study

BACKGROUND

Alopecia areata (AA) is an autoimmune and inflammatory disease characterized by localized or diffuse non-scarring hair loss. The serum C-reactive protein (CRP)/albumin ratio (CAR) is a novel inflammatory marker and a significant prognostic indicator in several diseases.

AIM

We aimed to explore CAR in AA patients and healthy controls and analyze the possible correlation between CAR and disease severity.

METHOD

The present study was conducted with 65 eligible AA patients and 65 age- and gender-matched healthy controls. Disease severity was analyzed based on the Severity of Alopecia Tool (SALT) score. The CAR score was calculated by dividing serum CRP by the albumin content in both patient and healthy control groups.

FINDINGS

56.9% of the patients were male and 43.1% were female, and the mean age was 31.93 ± 9.67. The patient group' mean CAR level (0.42 ± 0.3) was statistically higher than that of the healthy controls (0.07 ± 0.04), (p < 0.05). There were positive correlations between disease severity, CAR (r = 0.65; p < 0.01), and CRP (r = 0.66; p < 0.01), while the correlation between disease severity and albumin was negative (r = -0.56; p < 0.01). In the receiver operating characteristic analysis conducted on disease severity, the area under the curve was 0.16 for albumin, 0.92 for CRP, and 0.95 for CAR. The optimum CAR for AA severity was 0.38 with 87% sensitivity and 92% specificity.

CONCLUSION

In the study, we determined that the CAR was higher in AA patients when compared to the control group, and the elevation was associated with disease severity. The present study findings demonstrated that alopecia areata was associated with systemic inflammation, and CAR is a useful inflammatory marker in AA patients.

The neutrophil: A key resourceful agent in immune‐mediated vasculitis

The term "vasculitis" refers to a group of rare immune-mediated diseases characterized by the dysregulated immune system attacking blood vessels located in any organ of the body, including the skin, lungs, and kidneys. Vasculitides are classified according to the size of the vessel that is affected. Although this observation is not specific to small-, medium-, or large-vessel vasculitides, patients show a high circulating neutrophil-to-lymphocyte ratio, suggesting the direct or indirect involvement of neutrophils in these diseases. As first responders to infection or inflammation, neutrophils release cytotoxic mediators, including reactive oxygen species, proteases, and neutrophil extracellular traps. If not controlled, this dangerous arsenal can injure the vascular system, which acts as the main transport route for neutrophils, thereby amplifying the initial inflammatory stimulus and the recruitment of immune cells. This review highlights the ability of neutrophils to "set the tone" for immune cells and other cells in the vessel wall. Considering both their long-established and newly described roles, we extend their functions far beyond their direct host-damaging potential. We also review the roles of neutrophils in various types of primary vasculitis, including immune complex vasculitis, anti-neutrophil cytoplasmic antibody-associated vasculitis, polyarteritis nodosa, Kawasaki disease, giant cell arteritis, Takayasu arteritis, and Behçet's disease.

Outcome Measures and Biomarkers for Disease Assessment in Takayasu Arteritis

Takayasu arteritis (TAK) is a less common large vessel vasculitis where histopathology of involved arteries is difficult to access except during open surgical procedures. Assessment of disease activity in TAK, therefore, relies on surrogate measures. Clinical disease activity measures such as the National Institutes of Health (NIH) score, the Disease Extent Index in TAK (DEI.TAK) and the Indian TAK Clinical Activity Score (ITAS2010) inconsistently associate with acute phase reactants (APRs). Computerized tomographic angiography (CTA), magnetic resonance angiography (MRA), or color Doppler Ultrasound (CDUS) enables anatomical characterization of stenosis, dilatation, and vessel wall characteristics. Vascular wall uptake of 18-fluorodeoxyglucose or other ligands using positron emission tomography computerized tomography (PET-CT) helps assess metabolic activity, which reflects disease activity well in a subset of TAK with normal APRs. Angiographic scoring systems to quantitate the extent of vascular involvement in TAK have been developed recently. Erythrocyte sedimentation rate and C-reactive protein have a moderate performance in distinguishing active TAK. Numerous novel biomarkers are under evaluation in TAK. Limited literature suggests a better assessment of active disease by combining APRs, PET-CT, and circulating biomarkers. Validated damage indices and patient-reported outcome measures specific to TAK are lacking. Few biomarkers have been evaluated to reflect vascular damage in TAK and constitute important research agenda.

Red cell distribution width, eosinophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio can predict the development of infection and the number of antibiotics used in elderly patients undergoing revision total knee arthroplasty

Introduction: We aimed to evaluate the relationship between complete blood parameters reported to be associated with inflammation and development of complications, length of hospital stays and the number of antibiotics used in elderly patients undergoing revision total knee arthroplasty (rTKA). Material and Method: Our retrospective study was conducted in a single center and included 72 older patients who underwent rTKA operations. We recorded patients’ firs day preoperative, first day postoperative and 45th day postoperative whole blood parameters. Results: It was found that the development of postoperative infection and the number of antibiotics used were higher in patients with low preoperative Hb values and high platelet-to-lymphocyte ratio (PLR) rates. In patients with high RDW value and high eosinophil-lymphocyte ratio (ELR) one day after surgery, both the development of infection (P=0.002, P=0.002) and the number of antibiotics used during follow-up were found to be significantly higher ​(P

Longitudinal monitoring of circulating immune cell phenotypes in large vessel vasculitis

Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are two types of primary large vessel vasculitis (LVV). LVV is an intractable, rare disease with a high relapse rate. Disease progression in asymptomatic patients is an important issue in the clinical management of LVV. Useful biomarkers associated with clinical phenotypes, disease activity, and prognosis may be present in peripheral blood. In this review, we focused on peripheral leukocyte counts, surface markers, functions, and gene expression in LVV patients. In particular, we explored longitudinal changes in circulating immune cell phenotypes during the active phase of the disease and during treatment. The numbers and phenotypes of leukocytes in the peripheral blood were different between LVV and healthy controls, GCA and TAK, LVV in active versus treatment phases, and LVV in treatment responders versus non-responders. Therefore, biomarkers obtained from peripheral blood immune cells may be useful for longitudinal monitoring of disease activity in LVV.

Combination of serological biomarkers and clinical features to predict mucosal healing in Crohn's disease: a multicenter cohort study

PURPOSE

Mucosal healing (MH) has become the treatment goal of patients with Crohn's disease (CD). This study aims to develop a noninvasive and reliable clinical tool for individual evaluation of mucosal healing in patients with Crohn's disease.

METHODS

A multicenter retrospective cohort was established. Clinical and serological variables were collected. Separate risk factors were incorporated into a binary logistic regression model. A primary model and a simple model were established, respectively. The model performance was evaluated with C-index, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Internal validation was performed in patients with small intestinal lesions.

RESULTS

A total of 348 consecutive patients diagnosed with CD who underwent endoscopic examination and review after treatment from January 2010 to June 2021 were composed in the derivation cohort, and 112 patients with small intestinal lesions were included in the validation cohort. The following variables were independently associated with the MH and were subsequently included into the primary prediction model: PLR (platelet to lymphocyte ratio), CAR (C-reactive protein to albumin ratio), ESR (erythrocyte sedimentation rate), HBI (Harvey-Bradshaw Index) score and infliximab treatment. The simple model only included factors of PLR, CAR and ESR. The primary model performed better than the simple one in C-index (87.5% vs. 83.0%, p = 0.004). There was no statistical significance between these two models in sensitivity (70.43% vs. 62.61%, p = 0.467), specificity (87.12% vs. 80.69%, p = 0.448), PPV (72.97% vs. 61.54%, p = 0.292), NPV (85.65% vs. 81.39%, p = 0.614), and accuracy (81.61% vs. 74.71%, p = 0.303). The primary model had good calibration and high levels of explained variation and discrimination in validation cohort.

CONCLUSIONS

This model can be used to predict MH in post-treatment patients with CD. It can also be used as an indication of endoscopic surveillance to evaluate mucosal healing in patients with CD after treatment.

C-Reactive Protein to Albumin Ratio and Albumin to Fibrinogen Ratio in Rheumatoid Arthritis Patients

Objective: the albumin to fibrinogen ratio (AFR) and the C-reactive protein (CRP) to albumin ratio (CAR) have been proposed as markers of systemic inflammation. The goal of this study was to differentiate rheumatoid arthritis (RA) patients from healthy people and to study the association between AFR/CAR and DAS28 in RA.

Patients and methods. A case control study including 30 RA patients and 30 healthy controls was performed. Fibrinogen, albumin, CRP and erythrocyte sedimentation rate (ESR) were measured. We calculated CAR and AFR in each group and compared them. Correlations of AFR, and CAR with disease activity were examined. Receiver operation characteristic (ROC) curves of AFR and CAR were also used to detect cutoffs for disease activity assessment.

Results and discussion. CAR was higher while AFR was lower in RA patients than in control group. ROC curve analyses showed that CAR can be used to detect disease activity of RA at cut off 2.66 with sensitivity 81.3% and specificity 64.3% with an area under the curve (AUC) 0.78. So, CAR was a fair parameter to discriminate disease activity among RA patients. AFR has AUC 0.62, sensitivity 87.5% and specificity 42.9% at cutoff value 5.96. So, in our group AFR was a poor indicator to discriminate disease activity among RA patients.

Conclusion. AFR and CAR have been recently proposed as inflammatory markers for assessment of disease activity in RA. AFR and CAR are simple, and inexpensive biomarkers, they also can be rapidly evaluated. CAR was found to be a fair parameter to depict disease activity in RA patients. AFR poorly depicted RA activity.

Relationship Between C-Reactive Protein/Serum Albumin Ratio, Neutrophil/Lymphocyte Ratio, and ANCA-Associated Vasculitis Activity: A Retrospective Single Center Cohort Study

Objectives

To evaluate the role of C-reactive protein/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), and mean platelet volume (MPV) in newly diagnosed AAV patients and examine their clinical significance.

Methods

Data from 79 untreated newly diagnosed AAV patients were collected and 76 health examination subjects were included in the healthy control group. All clinical characteristics of AAV patients were extracted from their medical records. The NLR, CAR, and MPV levels of AAV patients and the healthy controls were compared and the correlation between these markers and clinical characteristics was analyzed. Patients were then divided into two groups based on the 2003 Birmingham Vasculitis Activity Score (BVAS). The correlation between NLR, CAR, and MPV and disease activity was analyzed and their effects on the cumulative survival rate were analyzed.

Results

Compared with the healthy control group, elevated CAR, NLR, and MPV were observed in AAV patients. CAR (r = 0.701, P < 0.0001) and NLR (r = 0.369, P < 0.05) were positively correlated with the BVAS while MPV did not show any significant correlation (P = 0.85). The optimal cutoff value for disease activity evaluation using CAR was 0.80 (sensitivity: 85% and specificity: 82%, P < 0.05). The optimal cutoff value for disease activity evaluation using NLR was 5.15 (sensitivity: 66% and specificity: 72%, P < 0.05). Kaplan–Meier survival analysis revealed that the all-cause mortality rate was higher in patients with CAR ≥ 0.8 than in patients with CAR < 0.8 (P < 0.05). Patients with low NLR also showed a lower cumulative survival rate (P < 0.05).

Conclusions

NLR and CAR can reflect the inflammatory response and disease activity in AAV patients, while MPV is not significantly correlated with disease activity in AAV patients. The all-cause mortality rate was higher in patients with high CAR and NLR than in patients with low CAR and NLR.

The Relation Between C-Reactive Protein-Albumin Ratio and Carotid Intima-Media Thickness in Psoriasis

Psoriasis vulgaris is associated with an increased risk of atherosclerosis. The C-Reactive Protein-to-Albumin Ratio (CAR) has received increasing attention as an independent prognostic factor for inflammatory diseases. The carotid intima-media thickness (cIMT) is a predictor of atherosclerosis. We assessed the correlation between CAR and cIMT in patients with psoriasis vulgaris. We enrolled 147 participants (72 with psoriasis vulgaris and 75 controls). Disease severity was assessed using the "Psoriasis Area Severity İndex (PASI)." Patient and control groups were similar with regard to gender, age, and body mass index (BMI). cIMT was measured in both the left and the right common carotid arteries. CAR values were higher in patients with psoriasis compared with controls (0.93 (0.06-4.32) vs 0.51 (0.10-2.99), p < .001). The patients with psoriasis had a significantly greater cIMT compared with control subjects. (0.53 (0.42-0.65) vs 0.50 (0.41-0.65) mm, p = .03). PASI scores were positively correlated with CAR values (r = 0.532, p < .001). A positive correlation between cIMT and CAR was found in patients with psoriasis vulgaris (r = 0.463, p < .001). CAR is an easily derived reproducible marker that could prove useful for assessing the inflammatory status of patients with psoriasis in clinical practice. CAR may also prove useful as a cardiovascular risk marker in these patients.

Effect of disease duration on the association between C-reactive protein-albumin ratio and endoscopic activity in ulcerative colitis

Background

A simple serum biomarker for clinical outcome in patients with ulcerative colitis (UC) remains an unmet need. Some studies have shown an association between C-reactive protein (CRP)-albumin ratio (CAR) and prognosis in patients with inflammatory bowel disease (IBD), but evidence regarding the association between CAR and UC remains limited. We evaluated the association between CAR and clinical outcome in Japanese patients with UC.

Methods

Subjects were 273 Japanese patients with UC. Clinical remission was defined as absence of both abnormally high stool frequency (< 3 per day) and rectal bleeding. Mucosal healing (MH) was defined as Mayo endoscopic subscore (MES) 0. Moderate to severe endoscopic activity was defined as MES 2–3. Subjects were divided according to CAR into tertiles (low, moderate, and high).

Results

The proportions of patients with clinical remission, MH, and moderate to severe endoscopic activity were 57.9%, 26.0%, and 37.0%, respectively. High CAR was significantly positively associated with moderate to severe endoscopic activity but not MH or clinical remission after adjustment (adjusted odds ratio [OR] 2.18 [95% confidence interval (CI) (1.11–4.35)], p for trend 0.023), but only in patients with long disease duration (> 7 years) (adjusted OR 2.95 [95% CI (1.06–8.79)], p for trend 0.023). CAR was not associated with clinical remission or MH.

Conclusions

CAR may be significantly positively associated with moderate to severe endoscopic activity but not clinical remission or MH in Japanese patients with UC. In patients with long UC duration, CAR might be a useful serum marker for disease activity.

MRI diagnosis of Takayasu arteritis in a young woman

Takayasu arteritis is a rare type of chronic, granulomatous vasculitis, characterized by inflammation of blood vessels of large caliber, such as the aorta, and its branches. Clinical presentation varies, depending on the severity of symptoms. Onset may be gradual, however at times, presentation may be acute, and life threatening. Herein, we present the case of a 29-year-old female, 3 months post-op, following a right carotid artery stenting procedure. The patient presented with nonspecific symptoms of malaise, arthralgia, and blurry vision. Clinical presentation and imaging findings were consistent with Takayasu's Arteritis.

Three new inflammatory markers C reactive protein to albumin ratio, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio correlated with relapsing polychondritis disease activity index

OBJECTIVE

The novel inflammatory markers C-reactive protein to albumin ratio (CAR), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) were associated with the disease activity of many autoimmune diseases. The aim of this study was to evaluate the association of these new inflammatory indexes with relapsing polychondritis disease activity index (RPDAI).

METHODS

The data of relapsing polychondritis (RP) patients hospitalized between 2004 and 2020 at Peking Union Medical College Hospital were collected. One of the exclusive criteria was that RP patients overlapped with other diseases. Another was the RP patients with incomplete data. A total of 170 RP patients and 170 healthy controls (HCs) were included. The association of new inflammatory makers with RPDAI was assessed by Spearman's correlation analysis.

RESULTS

Compared to HCs, the CAR, NLR, and PLR were significantly higher in RP patients (both p < 0.001). The CAR, NLR, PLR, erythrocyte sedimentation rate and neutrophil counts in peripheral blood positively correlated with RPDAI. Blood albumin, lymphocyte count, hemoglobin (Hb) negatively correlated with RPDAI. The association of CAR, NLR, and PLR with RPDAI was demonstrated by Spearman's correlation analysis.

CONCLUSION

The novel inflammatory markers CAR, NLR and PLR were associated with RPDAI. Key Points • This is the first research to explore the association of CAR, NLR, and PLR with disease activity in patients with RP • CAR, NLR, and PLR are positively correlated with RPDAI • CAR, NLR, and PLR might be the potential predictors of disease activity in RP.

Relationship between C-reactive Protein/Albumin Ratio and Subclinical Inflammation in Patients with Familial Mediterranean Fever

Background Familial Mediterranean Fever (FMF), which is characterised by recurrent episodes of fever with serositis, is associated with ongoing inflammation without clinical findings during attack-free periods, leading to amyloidosis, the most important complication of FMF. The objective of this study was to investigate the C-reactive protein/albumin ratio (CAR) as a marker to identify subclinical inflammation in symptom-free FMF children and compare the CAR with other systemic inflammatory markers such as mean platelet volume (MPV), red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR).

Material and Methods We included 100 patients and 70 healthy subjects. Hospital records were obtained to collect data on laboratory findings and genetic mutations.

Results We found that the CAR levels of our FMF patients were significantly higher than those of the control group. We also evaluated that the CAR values had a higher area-under-the-curve value than the other systemic inflammation parameters including CRP, MPV, RDW, NLR, PLR based on Receiver-Operating Characteristics (ROC) analysis.

Conclusion It is important to identify subclinical inflammation in FMF patients with simple, reliable, easily accessible markers to avoid amyloidosis. Although the CAR might be used to assess subclinical inflammation in paediatric FMF patients, the prognostic value of CAR is not superior to CRP. Merging CRP and albumin into a single index thus provides no additional benefit in detecting subclinical inflammation in FMF.

Predictive value of C-reactive protein to albumin ratio as a biomarker for initial and repeated intravenous immunoglobulin resistance in a large cohort of Kawasaki disease patients: a prospective cohort study

BACKGROUND

Intravenous immunoglobulin (IVIG) resistance prediction is one pivotal topic of interests in Kawasaki disease (KD). This study aimed to prospectively investigated the value of C-reactive protein-to-albumin (CAR) in predicting both initial and repeated IVIG resistance in patients with KD, and to test the hypothesis that CAR was more valuable or accurate than either C-reactive protein (CRP) or albumin (ALB) alone in IVIG resistance prediction.

METHOD

A prospective cohort study involving 550 patients with KD was conducted. The clinical and laboratory data were compared between IVIG-response group and IVIG-resistance group. Multivariate logistic regression analysis was performed to identify the independent risk factors of initial/repeated IVIG resistance. Receiver operating characteristic (ROC) curves analysis was applied to assess the validity of CAR, CRP and ALB in predicting both initial and repeated IVIG resistance.

RESULTS

CAR was significantly higher in IVIG non-responders and was identified as independent risk factor for both initial and repeated IVIG resistance in KD. The best cut-off value of CAR for initial and repeated IVIG resistance prediction was 2.07 and 3.34, with a corresponding sensitivity of 0.610 and 0.548, a specificity of 0.552 and 0.813, respectively. The value of CAR was not better than either CRP or ALB alone for both initial and repeated IVIG resistance prediction.

CONCLUSION

A higher CAR was an independent risk factor for both initial and repeated IVIG resistance. However, similar with that of CRP or ALB, the predictive value of CAR was not good enough for both initial and repeated IVIG resistance prediction in KD.

C-Reactive Protein/Albumin and Neutrophil/Albumin Ratios as Novel Inflammatory Markers in Patients with Schizophrenia

OBJECTIVE

Peripheral biomarker studies in schizophrenia are insufficient to correspond to whether inflammatory markers are trait- or state-related. The main objective of this study was to compare novel biomarkers C-reactive protein/albumin ratio (CAR), neutrophil/albumin ratio (NAR), and complete blood count-derived inflammatory markers; neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), red-cell distribution width (RDW), and mean platelet volume (MPV) between patients with acutely exacerbated and remitted schizophrenia and healthy controls.

METHODS

Anonymous data of a total of 618 patients with schizophrenia (179 in remission, 439 with acute exacerbation) and 445 psychiatrically and medically healthy subjects admitted to outpatient units were included. One-way ANOVA with Tukey's HSD post-hoc test, Pearson's correlation test, receiver operating characteristic analysis, and binomial logistic regression analysis were performed.

RESULTS

CAR, NAR, NLR, PLR, MLR, RDW, MPV values were found higher in patients with schizophrenia than in healthy subjects. Except for NAR (p=0.007), none of the markers differed between acute exacerbation and remission. As a cut-off value of CAR, 0.388 differentiated patients with schizophrenia from controls (sensitivity 81%, specificity 81%). CAR, NAR, and MPV significantly predicted the diagnosis of schizophrenia.

CONCLUSION

CAR and NAR are reliable biomarkers of inflammation and a combination of inflammatory markers including CAR and NAR could be used to reflect the increased inflammatory status in schizophrenia, regardless of relapse or remission.

The Relationship between C-Reactive Protein/Albumin Ratio and Disease Activity in Patients with Inflammatory Bowel Disease

Objectives

The aims of this study were to evaluate the C-reactive protein/albumin ratio (CRP/ALB), inflammatory markers, and parameters from the complete blood count (CBC) in patients with inflammatory bowel disease (IBD) and their associations with disease activity.

Methods

A total of 876 IBD patients, composed of 275 patients with ulcerative colitis (UC) and 601 patients with Crohn's disease (CD), were included in this retrospective study, and the serum C-reactive protein (CRP), albumin (ALB), erythrocyte sedimentation rate (ESR), and CBC parameters were measured. To explore the disease activity, the Mayo score and Crohn disease activity index were used to assess UC and CD patients, respectively.

Results

The CRP/ALB ratio, CRP, ESR, platelet to lymphocyte ratio (PLR), red blood cell distribution width (RDW), and neutrophil to lymphocyte ratio (NLR) levels in active IBD patients were significantly higher than those in inactive IBD patients, whereas ALB and lymphocyte to monocyte ratio (LMR) levels were significantly decreased (P < 0.001). The receiver operating characteristic analysis showed that the optimum cut-off values of the CRP/ALB ratio for active UC and CD were 0.18 and 0.43, with sensitivities of 67.8% and 75.8% and specificities of 86.7% and 92.0%, respectively. Multivariable logistic analysis revealed that after adjusting for these inflammatory markers (ESR, NLR, PLR, and LMR), the CRP/ALB ratio was a statistically significant parameter capable of differentiating the disease activity of UC and CD.

Conclusions

This study indicated that the CRP/ALB ratio was closely related to the IBD disease activity. Compared with CBC parameters, the CRP/ALB ratio had a higher discriminative capacity for active IBD.

Serum C-Reactive Protein/Albumin Ratio in Rheumatoid Arthritis and its Relationship With Disease Activity, Physical Function, and Quality of Life

Objectives

This study aims to evaluate the relationship between C-reactive protein (CRP)/albumin ratio (CAR) and disease activity, quality of life (QoL), and physical function in rheumatoid arthritis (RA).

Patients and methods

A total of 121 RA patients (22 males, 99 females; mean age 57.6±11.2 years; range, 32 to 85 years) applying to Ankara University School of Medicine Rheumatology Outpatient Clinic between January 2019 and February 2019 were included in this cross-sectional study. The inclusion criteria were fulfilling the American College of Rheumatology/European League Against Rheumatism 2010 RA classification criteria, being over 18 years and accepting to participate in the study. Demographic and clinical parameters including serum erythrocyte sedimentation rate (ESR), CRP and albumin levels were recorded. Disease activity was measured using Disease Activity Score 28 (DAS28)-ESR. General health, fatigue, and pain were questioned by means of a 100 mm visual analog scale (VAS). The QoL was assessed with the Rheumatoid Arthritis Quality of Life (RAQoL) Questionnaire. The functional status was determined using the Health Assessment Questionnaire (HAQ).

Results

Rheumatoid factor (RF) was positive in 56.2% of the patients. The median ESR was 19.0 mm/hour [interquartile range (IQR): 19.5] and median CRP was 5.6 (IQR: 9) mg/L. The median CAR was 1.3 (IQR: 2.1) and median DAS 28-ESR was 3.6 (IQR: 1.5). There was a significant but weak correlation between CAR and DAS28-ESR [p<0.001, Spearman's correlation coefficient (rs)=0.327]. Moreover, CAR was positively correlated with ESR, CRP, and VAS physician's global assessment (p<0.001, rs=0.497; p<0.001, rs=0.987, p<0.001, rs=0.401, respectively). However, no correlation was observed between CAR, HAQ, and RAQoL. In the RF positive group, there was a significant but weak correlation between CAR and RF titers (p=0.016, rs=0.292).

Conclusion

We observed a positive but weak correlation between CAR and DAS28-ESR, ESR, and the RF titer. Further studies are warranted to investigate the role of CAR in RA.

C-Reactive Protein to Albumin Ratio for Predicting Coronary Artery Lesions and Intravenous Immunoglobulin Resistance in Kawasaki Disease

Background: C-reactive protein (CRP) to albumin ratio (CRP/Alb) has emerged as a novel marker of inflammation, but few studies have evaluated the role of CRP/Alb ratio in Kawasaki disease (KD). Coronary artery lesions (CAL) in children with KD is a major acquired heart disease. We aimed to assess the association between CRP/Alb ratio and CAL formation in children with KD. Methods: This retrospective study enrolled children diagnosed with KD and divided them into two groups, KD with CAL and KD without CAL. We compared the difference in gender, age, laboratory data, intravenous immunoglobulin (IVIG) resistance rate, and incidence of CAL between the two groups. Multivariable logistic regression analysis was used to assess the independent risk factors of CAL. We adopted receiver operating characteristic (ROC) curve analysis to determine the predictive ability of CRP/Alb ratio in predicting CAL. Results: In total, 410 KD patients were reviewed, with 143 in the KD with CAL group and 267 in the KD without CAL group. KD children with CAL had a higher CRP/Alb ratio than those without CAL (3.14 ± 3.17 vs. 2.12 ± 2.04, p < 0.001). Multivariable logistic regression analysis demonstrated that male gender (OR = 3.222, p < 0.001), incomplete KD (OR = 1.968, p = 0.031), greater platelet count (OR = 1.004, p < 0.001), higher CRP (OR = 0.982, p = 0.048), and higher CRP/Alb ratio (OR = 1.994, P = 0.016) were all independent risk factors for predicting CAL. KD children with a high CRP/Alb ratio (≥2.94) had a higher incidence rate of CAL and IVIG resistance than those with a low CRP/Alb ratio (<2.94) (49.6 vs. 28.7%, p < 0.001 and 11.6 vs. 3.5%, p = 0.001, respectively). Conclusions: This report is the first to show the role of CRP/Alb ratio in KD children. CRP/Alb ratio can serve as a novel predicting marker for CAL formation and IVIG resistance in KD.

Misunderstandings Between Platelets and Neutrophils Build in Chronic Inflammation

Regulated hemostasis, inflammation and innate immunity entail extensive interactions between platelets and neutrophils. Under physiological conditions, vascular inflammation offers a template for the establishment of effective intravascular immunity, with platelets providing neutrophils with an array of signals that increase their activation threshold, thus limiting collateral damage to tissues and promoting termination of the inflammatory response. By contrast, persistent systemic inflammation as observed in immune-mediated diseases, such as systemic vasculitides, systemic sclerosis, systemic lupus erythematosus or rheumatoid arthritis is characterized by platelet and neutrophil reciprocal activation, which ultimately culminates in the generation of thrombo-inflammatory lesions, fostering vascular injury and organ damage. Here, we discuss recent evidence regarding the multifaceted aspects of platelet-neutrophil interactions from bone marrow precursors to shed microparticles. Moreover, we analyse shared and disease-specific events due to an aberrant deployment of these interactions in human diseases. To restore communications between the pillars of the immune-hemostatic continuum constitutes a fascinating challenge for the near future.

An aptasensor based on the microscopic enumeration of encoding gold nanoparticles for the detection of C-reactive protein

C-reactive protein (CRP) is a crucial clinical biomarker for inflammatory and cardiovascular diseases. Therefore, the sensitive, selective and convenient detection of CRP is of great significance. Using gold nanoparticles (AuNPs) and combining the specific interaction between an aptamer and CRP, we developed a simple and convenient assay for CRP detection. The aptamer-based probe was fabricated through the hybridization of CRP-aptamer immobilized on magnetic beads (MBs) to a short complementary DNA (cDNA) chain attached to AuNPs to form a MB–Aptamer–AuNP sandwich structure. Upon the addition of CRP, aptamer–cDNA dehybridization occurred due to the strong interaction between CRP and the aptamer, resulting in the release of AuNPs, which were subjected to DFM imaging and subsequently counted using the MATLAB program. The number of AuNPs was therefore positively correlated to the concentration of CRP and a detection limit as low as 2.71 nM was achieved. The current approach could also exclude the disturbance of other proteins, including thrombin, IgG, Lys and BSA. In addition, the concentration of CRP detected was in good agreement with the amount cast in bovine and mouse serum, indicating that the proposed probe is robust and accurate, and it is very promising for practical applications where CRP detection is necessary. The current strategy is also promising for the detection of other proteins where a suitable aptamer is selected.

An aptasensor based on the displacement of encoding AuNPs by analyte molecules was presented. Combined with magnetic separation and DFM imaging, the number of displaced AuNPs was counted, which was correlated to the concentration of the CRP.