Role of Serum Ferritin, D-Dimer, and C-Reactive Protein Parameters in COVID 19 Severity

Following the epidemics caused by the transmission of the common virus between humans and animals (COVID-19), coronavirus 2 (SARS-CoV-2) is the third and most deadly strain of RNA virus that can cause respiratory, digestive, and nervous system problems, and there are many unknown complications. This study included 170 clinical samples of nasopharyngeal swaps (100 patients and 70 controls for both males and females). RT-PCR was performed, and blood samples were taken for biochemical analyses. They were obtained from Iraqi patients aged 25 to 92 years old. Between November 2021 and March 2022, COVID-19 patients were admitted to Dar al-salam Hospital, Alyarmok Teaching Hospital, and Alshefaa Hospital. AFIAS D-Dimer, AFIAS ferritin, and NycoCard CRP tests were performed on the patients and were classified depending on the severity of their infection (mild or moderate, severe and critical). The results showed a significant increase in ferritin in critically ill patients (545.58 ± 57.71). A significant increase of D-dimer was found with different severity with highly significant in the critical group (3.93 ± 0.79). With varying degrees of severity, a substantial rise in CRP was discovered with highly significant in the critical group (96.27 ± 14.55) between the severity group (p-value <0.001). Also, COVID-19 individuals in the age range (50 - 60) tended to be more severe than younger people, whereas the effect of gender is not significant in any patient group. The biochemical factors, including D-Dimer, ferritin, and CRP, are effective in the disease's occurrence of symptoms and severity.

C-reactive protein isoforms as prognostic markers of COVID-19 severity

C-reactive protein (CRP), an active regulator of the innate immune system, has been related to COVID-19 severity. CRP is a dynamic protein undergoing conformational changes upon activation in inflammatory microenvironments between pentameric and monomeric isoforms. Although pentameric CRP is the circulating isoform routinely tested for clinical purposes, monomeric CRP shows more proinflammatory properties. Therefore, we aimed to determine the potential of monomeric CRP in serum as a biomarker of disease severity in COVID-19 patients (admission to intensive care unit [ICU] and/or in-hospital mortality). We retrospectively determined clinical and biological features as well as pentameric and monomeric CRP levels in a cohort of 97 COVID-19 patients within 72h of hospital admission. Patients with severe disease had higher levels of both pentameric and monomeric CRP. However, multivariate analysis showed increased mCRP but not pCRP to be independently associated to disease severity. Notably, mCRP levels higher than 4000 ng/mL (OR: 4.551, 95% CI: 1.329-15.58), together with number of co-morbidities, low lymphocyte count, and procalcitonin levels were independent predictors of disease severity in the multivariate model. Our results show the potential of mCRP levels as a marker of clinical severity in COVID-19 disease.

Predictive role of selected biomarkers in differentiating gram-positive from gram-negative sepsis in surgical patients: a retrospective study

INTRODUCTION

Patients after major surgery are at high risk of developing sepsis, which is accompanied by elevated serum levels of C-reactive protein (CRP) and procalcitonin (PCT). This study aimed to examine the differences in serum biomarker levels concerning the causative agent of sepsis in surgical patients.

MATERIAL AND METHODS

A retrospective study was carried out in the surgical intensive care unit (ICU) and included 81 septic patients admitted from January 2019 to May 2022, who had positive blood cultures (BC). Serum levels of PCT, CRP, white blood cells (WBC) and platelet counts were recorded on the day of the positive BC and over the following 3 days.

RESULTS

Patients with gram(-) sepsis had significantly higher PCT levels, and lower platelet count compared to patients with gram(+) sepsis. High PCT and low platelets levels in all measurements were a significant predictor of gram(-) isolate with the highest predictive value on the third day after BC sampling, with AUROC 0.821 (95% CI: 0.692-0.950), P = 0.001, and AUROC 0.676 (95% CI: 0.541-0.811), P = 0.02, respectively. In multivariate logistic regression, platelets the day after BC sampling and PCT on the third day made a significant contribution in distinguishing gam(+) from gram(-) BC. Age and high serum CRP levels were significant predictors of poor outcomes.

CONCLUSIONS

PCT and platelets may be useful biomarkers for predicting the causative agent of sepsis in surgical patients.

Added value of CRP to clinical features when assessing appendicitis in children

BACKGROUND

The diagnostic value of C-reactive protein (CRP) for appendicitis in children has not been evaluated in primary care. As biochemical responses and differential diagnoses vary with age, separate evaluation in children and adults is needed.

OBJECTIVES

To determine whether adding CRP to symptoms and signs improves the diagnosis of appendicitis in children with acute abdominal pain in primary care.

METHODS

A retrospective cohort study in Dutch general practice. Data was collected from the Integrated Primary Care Information database between 2010 and 2016. We included children aged 4-18 years, with no history of appendicitis, presenting with acute abdominal pain, and having a CRP test. Initial CRP levels were related to the specialist's diagnosis of appendicitis, and the test's characteristics were calculated for multiple cut-offs. The value of adding CRP to signs and symptoms was analysed by logistic regression.

RESULTS

We identified 1076 eligible children, among whom 203 were referred for specialist evaluation and 70 had appendicitis. The sensitivity and specificity of a CRP cut-off ≥10 mg/L were 0.87 (95%CI, 0.77-0.94) and 0.77 (95%CI, 0.74-0.79), respectively. When symptoms lasted > 48 h, this sensitivity increased to 1.00. Positive predictive values for CRP alone were low (0.18-0.38) for all cut-off values (6-100 mg/L). Adding CRP increased the area under the curve from 0.82 (95%CI, 0.78-0.87) to 0.88 (95%CI, 0.84-0.91), and decision curve analysis confirmed that its addition provided the highest net benefit.

CONCLUSION

CRP adds value to history and physical examination when diagnosing appendicitis in children presenting acute abdominal pain in primary care. Appendicitis is least likely if the CRP value is < 10 mg/L and symptoms have been present for > 48 h.

Correlation of calprotectin serum levels with degrees of endometriosis: A cross-sectional study

Background

Endometriosis is closely associated with delayed diagnosis due to the lack of a definitive and sensitive noninvasive approach. The use of calprotectin in inflammatory process has been demonstrated in various inflammatory diseases. Calprotectin has a significant correlation with high-sensitivity C-reactive protein (hs-CRP) and could be used as an inflammatory marker. No study thus far has evaluated the correlation between calprotectin and endometriosis.

Objective

To determine the correlation of calprotectin with the degree of endometriosis in order to help clinicians in establishing better early detection and management.

Materials and Methods

In this cross-sectional study, 46 women referred to the Cipto Mangunkusumo, Fatmawati, and Persahabatan Hospitals in Jakarta, Indonesia between July 2017 and April 2018 were enrolled, and their blood serum were taken a day before surgery. Calprotectin serum level was treated using the PhicalⓇ ELISA method. After the diagnosis of endometriosis was confirmed through pathological examination, the final diagnosis of endometriosis could be established. The degree of endometriosis was classified according to the revised American Society for Reproductive Medicine (ASRM) classification.

Results

The prevalence of minimal, mild, moderate, and severe degrees of endometriosis were 15.2, 39.1, 34.8, and 10.9%, respectively. The median serum calprotectin levels for minimal, mild, moderate, and severe endometriosis were 138.98, 121.49, 124.16, and 122.82 mg/mL, respectively. No correlation was observed between calprotectin and the degrees of endometriosis (r = –0.16, p = 0.278).

Conclusion

There is no correlation between calprotectin serum levels and the degrees of endometriosis.

[Effects of low-dose dexmedetomidine combined with hydromorphone in postoperative analgesia and on the serum IL-6 and CRP levels of prostate cancer patients]

OBJECTIVE

To explore the effects of low-dose dexmedetomidine (DM) combined with hydromorphone (HM) in postoperative analgesia and on levels of serum interleukin-6 (IL-6) and C-reactive protein (CRP) in PCa patients.

METHODS

Using the random number table, we divided 102 PCa patients undergoing radical prostatectomy from January 2019 to November 2020 into a trial group (n = 51) and a control group (n = 51), the former given HM and the latter low-dose DM + HM for postoperative analgesia. We recorded the postoperative resuscitation time, extubation time and pain, perioperative cognitive function, IL-6 and CRP levels, and drug-related adverse reactions of the patients, and compared them between the two groups.

RESULTS

There was no statistically significant difference in postoperative resuscitation time and extubation time between the two groups of patients (P > 0.05). The frequency of patient-controlled epidural analgesia (PCEA) compressions was lower in the trial than in the control group within 24 hours after surgery (P < 0.05). The Visual Analogue Scale (VAS) scores were higher in both of the groups at 24 hours than at 4, 12, and 48 hours after surgery (P < 0.05), at 12 hours than at 4 and 48 hours (P < 0.05) and at 4 hours than at 48 hours (P < 0.05), but lower in the trial than in the control group at 4, 12 and 24 hours postoperatively (P < 0.05). No statistically significant difference was observed in the scores of the Mini Mental State Evaluation Scale between the two groups of patients (P > 0.05). The levels of IL-6 and CRP were higher in both of the groups at 24 hours after than before and at 4, 12 and 48 hours after surgery (P < 0.05), at 48 hours after than before and at 4 and 12 hours after surgery (P < 0.05), at 12 hours after than before and at 4 hours after surgery (P <0.05), and at 4 hours after than before surgery (P < 0.05), but lower in the trial than in the control group at 4, 12, 24 and 48 hours postoperatively (P < 0.05). There was no statistically significant difference in the total incidence rate of adverse reactions between the two groups (P > 0.05).

CONCLUSIONS

Low-dose dexmedetomidine combined with hydromorphone is a safe and effective option for postoperative analgesia in PCa patients, and it can inhibit the expression of inflammatory factors.

Features of the interconnection of traditional risk factors and il-10 with the activity of the inflammatory process and atherosclerosis development in patients with psoriatic arthritis

OBJECTIVE

The aim: To determine the features of atherosclerotic process, cardiovascular risk in patients with PsA.

PATIENTS AND METHODS

Materials and methods: The study included 42 patients with PsA who did not have atherosclerotic CVD, diabetes, chronic kidney disease and other serious diseases, did not take statins, the comparingl group consisted of 20 patients with psoriasis (PS) and 20 practically healthy individuals who had no signs of rheumatic, infectious and other inflammatory diseases were screened.

RESULTS

Results: It was revealed that in patients with PsA, the severity of the atherosclerotic process is more compared with patients with PS (the RF profiles were the same). The highest levels of C-reactive protein, fibrinogen, uric acid, intima-media complex thickness, atherosclerotic plaque frequency were found in patients in the PsA group, which may indicate a pathogenetic association of additional RF with the development of a more common atherosclerotic process.

CONCLUSION

Conclusions: In the development of the atherosclerotic process in patients with PsA, the pro-traditional risk factors play an important role as the immune-inflammatory factors (CRP, IL-10) and additional risk factors (uric acid).