Who Is Afraid of CRP? Elevated Preoperative CRP Levels Might Attenuate the Increase in Inflammatory Parameters in Response to Lung Cancer Surgery

Dynamic risk factors for complex regional pain syndrome after distal radius fracture surgery: multivariate analysis and prediction

BACKGROUND

Distal radius fractures are a common orthopedic injury, particularly prevalent among elderly and osteoporotic patients. Although surgical treatment effectively restores fracture alignment and stabilizes the bone, Complex Regional Pain Syndrome (CRPS) can occur as a postoperative complication, severely impacting patients' rehabilitation and quality of life. Therefore, assessing the risk factors for postoperative CRPS is crucial for early clinical intervention, aiming to improve recovery outcomes and overall patient well-being.

OBJECTIVE

This study aims to dynamically evaluate the risk factors for CRPS following distal radius fracture surgery through a retrospective analysis. The goal is to provide scientific evidence for early clinical identification and intervention.

METHODS

A retrospective analysis was conducted on 191 adult patients who underwent distal radius fracture surgery between January 2021 and December 2022, comprising 89 males and 102 females, with an average age of 59.7 ± 11.6(18-75) years. Baseline and follow-up data, including demographic information, clinical characteristics, and psychological assessments, were collected. Descriptive statistics, univariate, and multivariate logistic regression analyses were used to identify independent risk factors and assess their dynamic changes over time.

RESULTS

Age, gender, occupation, fracture type, surgical method, osteoporosis, pain score (VAS), functional disability score (DASH), anxiety score (GAD-7), depression score (PHQ-9), physical therapy, and occupational therapy significantly affected the incidence of CRPS. Age and VAS scores were consistent risk factors. Female gender, internal fixation surgery, and high DASH scores posed higher risks in the early postoperative period but decreased over time. Occupation and fracture type were more significant in the mid to late postoperative period. Psychological factors were most significant in the midterm, while physical and occupational therapy were protective factors early on.

CONCLUSION

The occurrence of CRPS is the result of many factors. Elderly patients, females, and manual laborers had higher risks, with complex fractures and internal fixation surgery patients showing increased risk later on. Osteoporotic patients had higher risks in the mid to late postoperative period. VAS, DASH, GAD-7, and PHQ-9 scores were significantly associated with CRPS. Early physical and occupational therapy can effectively prevent CRPS, but further research is needed to evaluate their long-term effects.

The Significant Role of Alcohol in the Relationship between C-Reactive Protein and Self-Reported Osteoarthritis

BACKGROUND

Despite the known inflammatory nature of osteoarthritis (OA) and the established role of C-reactive protein (CRP) as an inflammation marker, the influence of alcohol consumption on the CRP-OA relationship remains uncertain, with previous research providing conflicting results.

OBJECTIVES

This study aims to examine the potential moderating effect of alcohol on the association between CRP concentrations and self-reported OA.

METHODS

We conducted a cross-sectional study involving 50,259 participants, all data collected from NHANES between 2005-2010 and 2015-2018. A multivariable logistic regression model was used to analyze the relationship between CRP and OA.

RESULTS

We found a nonsignificant positive association between CRP concentration and prevalence of self-reported OA after adjusting for covariates in the raw dataset or 5 multiple imputed datasets. In the stratified analysis by alcohol drinking, for every 10 mg/L higher in CRP concentration, the prevalence of self-reported OA was higher by 13 % in nondrinkers (P = 0.007, adjusted for covariates). Conversely, for every 10 mg/L higher in CRP concentration, the prevalence of self-reported OA was lower by 59 % in drinkers (P = 0.005, adjusted for covariates). Furthermore, we discovered that the directions of the association between CRP concentrations (10 mg/L) and prevalence of self-reported OA [odds ratio (OR) < 1 in the drinking subgroup and OR > 1 in the no-drinking subgroup] were stable in both the main and sensitivity analyses. The significant interaction between CRP concentration and alcohol drinking on the prevalence of self-reported OA was shown in most of our analyses (P-interaction < 0.05).

CONCLUSION

Alcohol consumption may be an interaction factor between CRP and self-reported OA. To our knowledge, our findings are the first to highlight the importance of incorporating analysis of alcohol consumption differences into future studies of CRP and self-reported OA.

C-Reactive Protein as a Prognostic Biomarker for Gynecologic Cancers: A Meta-Analysis

Background

The prognostic role of CRP (C-reactive protein) in gynecological tumors has been previously reported in individual studies, but whether CRP can be used as a separate potential prognostic factor has not been systematically reviewed. The purpose of this research is to determine if there is a link between CRP levels and the prognosis of gynecological cancer patients.

Methods

A systematic search was carried out to find the literature evaluating the predictive role of CRP in the prognosis of gynecological cancer patients. For the purpose of determining the relationship between CRP and clinicopathological characteristics, the pooled odds ratio (OR) was calculated. A hazard ratio (HR) with a 95% confidence interval (CI) was used to determine differences in overall survival (OS), disease-free survival (DFS), or progression-free survival (PFS) between patients with low and high CRP levels.

Results

A total of 19 studies, including 4062 patients, were analyzed retrospectively. The FIGO stage was related to the CRP level (OR = 0.43, 95% CI: 0.19-1.00). Age, lymph node metastasis, and histological grade were not associated with CRP level (OR = 0.93, 95% CI: 0.69-1.25; OR = 0.91, 95% CI: 0.65-1.28; OR = 0.74, 95% CI: 0.52-1.05). Worse OS (HR = 1.40, 95% CI: 1.23-1.57), DFS (HR = 1.20, 95% CI: 1.12-1.28), and PFS (HR = 1.57, 95%CI: 1.23-1.91) were associated with elevated CRP levels, as shown by the pooled results. Subgroup analysis was performed according to cancer type (endometrial cancer: HR = 1.15, 95% CI: 1.02-1.28; ovarian cancer: HR = 1.67, 95% CI: 1.03-2.31; cervical cancer: HR = 1.42, 95% CI: 1.19-1.64), multivariate value (HR = 1.22, 95% CI: 1.10-1.33), and age (HR = 1.50, 95% CI: 1.28-1.72). Significant correlations were observed between CRP and OS.

Conclusions

CRP may be utilized as a prognostic indicator for a variety of gynecologic malignancies, including cervical cancer, ovarian cancer, endometrial cancer, and vulvar cancer.

Perioperative statin medication impairs pulmonary outcome after abdomino-thoracic esophagectomy

Background

Although surgery is the curative option of choice for patients with locally advanced esophageal cancer, morbidity, especially the rate of pulmonary complications, and consequently mortality of patients undergoing abdomino-thoracic esophagectomy remain unacceptably high. Causes for developing post-esophagectomy pulmonary complications are trauma to the lung and thoracic cavity as well as systemic inflammatory response. Statins are known to influence inflammatory pathways, but whether perioperative statin medication impacts on inflammatory response and pulmonary complication development after esophagectomy had not been investigated, yet.

Methods

Retrospective analysis and propensity score matching of patients, who either received perioperative statin medication [statin( +)] or not [statin( −)], with regard to respiratory impairment (PaO₂/FiO₂ < 300 mmHg), pneumonia development, and inflammatory serum markers after abdomino-thoracic esophagectomy.

Results

Seventy-eight patients who underwent abdomino-thoracic esophagectomy for cancer were included into propensity score pair-matched analysis [statin( +): n = 26 and statin( −): n = 52]. Although no differences were seen in postoperative inflammatory serum markers, C-reactive protein values correlated significantly with the development of pneumonia beyond postoperative day 3 in statin( −) patients. This effect was attenuated under statin medication. No difference was seen in cumulative incidences of respiratory impairment; however, significantly higher rate (65.4% versus 38.5%, p = 0.0317, OR 3.022, 95% CI 1.165–7.892) and higher cumulative incidence (p = 0.0468) of postoperative pneumonia were seen in statin( +) patients, resulting in slightly longer postoperative stay on intensive care unit (p = 0.0612) as well as significantly prolonged postoperative in-hospital stay (p = 0.0185).

Conclusions

Development of pulmonary complications after abdomino-thoracic esophagectomy is multifactorial but frequent. The establishment of preventive measures into the perioperative clinical routine is mandatory for an improved patient outcome. Perioperative medication with statins might influence pneumonia development in the highly vulnerable lung after abdomino-thoracic esophagectomy. Perioperative interruption of statin medication might be beneficial in appropriate patients; however, further clinical trials and translational studies are needed to prove this hypothesis.

Negative regulation of ATP-induced inflammasome activation and cytokine secretion by acute-phase proteins: A mini review

The expression of the acute-phase reactants C-reactive protein (CRP), α1-antitrypsin (AAT), and secretory leukocyte protease inhibitor (SLPI), is induced in response to inflammation by pro-inflammatory mediators, including interleukin-1β. It is conceivable that acute-phase proteins exert protective functions, when the integrity of an organism is challenged by pathogens or trauma, which result in uncontrolled release of endogenous damage-associated molecular patterns like Toll-like receptor agonists and ATP. Acute-phase proteins can enhance or down-modulate immunity against infections or protect the host against damage caused by over-shooting effector functions of the immune system. CRP is mainly regarded as a pro-inflammatory opsonizing agent that binds to bacteria and damaged host cells thereby contributing to their inactivation and elimination. AAT and SLPI are well known for their anti-protease activity, which protects the lung extracellular matrix against degradation by proteases that are released by activated neutrophil granulocytes. In addition, there is growing evidence, that CRP, AAT, and SLPI can control the biosynthesis, maturation, and secretion of pro-inflammatory cytokines. The purpose of this narrative mini review is to summarize these anti-inflammatory functions with a focus on the negative control of the ATP-induced, inflammasome-dependent secretion of interleukin-1β by monocytes. CRP-, AAT- and SLPI-mediated control of interleukin-1β release involves the activation of unconventional nicotinic acetylcholine receptors that inhibits the ionotropic function of the ATP receptor P2X7. Apart from other functions, CRP, AAT, and SLPI seem to be central elements of systemic negative feedback loops that protect the host against systemic hyperinflammation, barrier dysfunction, and death by multiple organ damage.

Efficacy of multi-groove silicone drains in single-port video-assisted thoracoscopic lung cancer surgery and their effect on C-reactive protein: a single-center experience

Background

The purpose of this study was to systematically evaluate the effectiveness and safety of a multi-groove silicone drain in single-port video-assisted thoracoscopic lung cancer surgery and its effect on postoperative serum C-reactive protein (CRP) levels.

Methods

We retrospectively analyzed 122 surgical cases who underwent standard lobectomy and lymph node dissection for primary lung cancer between May 2020 and December 2020. A total of 62 patients received 19-F multi-groove silicone drains (experimental group) and 60 patients received 24-F conventional chest drains (control group). According to the different thoracic drainage approaches, the clinical efficacy in the perioperative period, postoperative complications, and postoperative serum CRP levels were compared between the 2 groups.

Results

In this study, thoracic drainage volume, the average visual analog scale (VAS) pain scores in incisions, the rate of primary healing at the site of incisions, and the pulmonary infection rate in the multi-groove silicone drain group were significantly lower than those in the conventional chest drain group (P<0.05), but there was no significant difference in the average hospital stay time, arrhythmia rates, and chest tube removal time between the 2 groups. At postoperative day 1, the levels of serum CRP in the 2 groups were further increased (P>0.05), and the comparison between the 2 groups showed that the levels of serum CRP in the multi-groove silicone drain group at 72 h after the operation were significantly lower than those in the conventional drain group (P<0.05).

Conclusions

Our results showed that a multi-groove silicone drain is feasible and relatively safe in single-port video-assisted thoracoscopic lung cancer surgery for most patients. However we should take cautious in those patients with higher susceptibility of postoperative active bleeding. In patients undergoing lung cancer surgery in the clinical treatment process, the use of a multi-groove silicone drain can improve the quality of life of patients. Due to a small number of included studies and unclear bias, the above results should be verified by high-quality, large-sample randomized controlled studies.

Keywords

Video-assisted thoracoscopic lung cancer surgery; multi-groove silicone drains; conventional chest drains

Changes of inflammatory factors in patients after resection of lung adenocarcinoma with propofol and etomidate

OBJECTIVE

This research was designed to investigate the changes of inflammatory factors in patients after resection of lung adenocarcinoma with propofol versus etomidate.

METHODS

A total of 104 patients who underwent resection of lung adenocarcinoma in our hospital were divided into a propofol group (group A, n=50) and an etomidate group (group B, n=54). The levels of CRP and IL-6 at different time points and the changes of blood gas indexes at 10 min before and after operation were observed in both groups. Their pain score and quality of life score were compared. Besides, we observed the wake-up time, tracheal extubation time and the incidence of adverse reactions.

RESULTS

The anesthesia recovery and tracheal extubation time in group B were shorter than those in group A (P<0.05). After 10-minutes of spontaneous breathing, PaO₂ and SaO₂ in group B were higher than those in group A (P<0.05), and PaCO₂ was lower (P<0.05); compared with group A. The incidence of adverse reactions and the levels of inflammatory factors in group B were lower than those in group A after operation (both P<0.05). The quality of life of patients in group B after operation was better than that in group A (P<0.05). There was no marked difference in VAS scores between groups.

CONCLUSION

Etomidate has better anesthetic effect than propofol in lung adenocarcinoma resection, leading to better stabilization of the vital signs of patients and it also has higher safety.