scholarly journals Severity and prognosis of acute organophosphorus pesticide poisoning are indicated by C-reactive protein and copeptin levels and APACHE II score

2016 ◽  
Vol 11 (3) ◽  
pp. 806-810 ◽  
Author(s):  
XINKUAN WU ◽  
WEI XIE ◽  
YUELEI CHENG ◽  
QINGLONG GUAN
Keyword(s):  
Organophosphorus Pesticide ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Pesticide Poisoning ◽  
C Reactive Protein ◽  
Reactive Protein

scholarly journals C-reactive protein concentration as a risk predictor of mortality in intensive care unit: a multicenter, prospective, observational study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rong Qu ◽  
Linhui Hu ◽  
Yun Ling ◽  
Yating Hou ◽  
Heng Fang ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Inflammatory Markers ◽  
Prospective Observational Study ◽  
Apache Ii ◽  
Apache Ii Score ◽  
C Reactive Protein ◽  
Icu Mortality ◽  
Reactive Protein ◽  
Risk Reclassification ◽  
Multicenter Prospective Observational Study

Abstract Background It is not clear whether there are valuable inflammatory markers for prognosis judgment in the intensive care unit (ICU). We therefore conducted a multicenter, prospective, observational study to evaluate the prognostic role of inflammatory markers. Methods The clinical and laboratory data of patients at admission, including C-reactive protein (CRP), were collected in four general ICUs from September 1, 2018, to August 1, 2019. Multivariate logistic regression was used to identify factors independently associated with nonsurvival. The area under the receiver operating characteristic curve (AUC-ROC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the effect size of different factors in predicting mortality during ICU stay. 3 -knots were used to assess whether alternative cut points for these biomarkers were more appropriate. Results A total of 813 patients were recruited, among whom 121 patients (14.88%) died during the ICU stay. The AUC-ROC values of PCT and CRP for discriminating ICU mortality were 0.696 (95% confidence interval [CI], 0.650–0.743) and 0.684 (95% CI, 0.633–0.735), respectively. In the multivariable analysis, only APACHE II score (odds ratio, 1.166; 95% CI, 1.129–1.203; P = 0.000) and CRP concentration > 62.8 mg/L (odds ratio, 2.145; 95% CI, 1.343–3.427; P = 0.001), were significantly associated with an increased risk of ICU mortality. Moreover, the combination of APACHE II score and CRP > 62.8 mg/L significantly improved risk reclassification over the APACHE II score alone, with NRI (0.556) and IDI (0.013). Restricted cubic spline analysis confirmed that CRP concentration > 62.8 mg/L was the optimal cut-off value for differentiating between surviving and nonsurviving patients. Conclusion CRP markedly improved risk reclassification for prognosis prediction.

scholarly journals APACHE II score, C-reactive protein and Marshall score in acute pancreatitis. Association with admission at critical care unit. A cohort study

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e321-e322
Author(s):  
H. Losada Morales ◽  
A. Troncoso Trujillo ◽  
L. Burgos San Juan ◽  
J. Silva Abarca ◽  
L. Acencio Barrientos ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Critical Care ◽  
Cohort Study ◽  
Critical Care Unit ◽  
Apache Ii ◽  
Apache Ii Score ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Marshall Score

scholarly journals Neutrophil-Lymphocyte Count Ratio Better Predict Prognosis than Conventional Markers in Critical Patients? A Multiple-Centered Retrospective Cohort Study

2020 ◽  
Author(s):  
Tao Zhou ◽  
Nan Zheng ◽  
Xiang Li ◽  
Dongmei Zhu ◽  
YI HAN
Keyword(s):  
Cohort Study ◽  
Critical Illness ◽  
Retrospective Cohort Study ◽  
Lymphocyte Count ◽  
Inflammatory Markers ◽  
Retrospective Cohort ◽  
Apache Ii ◽  
Apache Ii Score ◽  
C Reactive Protein ◽  
Reactive Protein

Abstract Background: Neutrophil-lymphocyte count ratio (NLCR) has been reported as better indicator of bacteremia than procalcitonin (PCT), and better predictor of mortality than C-reactive protein (CRP) in various medical conditions. However, large controversy remains upon this topic. We compared the efficiency of NLCR with conventional inflammatory markers in predicting the prognosis of critical illness. Methods: We performed a multiple-centered retrospective cohort study consisting of 536 ICU patients with outcomes of survival, 28- and 7-day mortality. NLCR was compared with conventional inflammatory markers such as PCT, C-reactive protein (CRP), serum lactate (LAC), white blood cell, neutrophil and severity score APACHE II (Acute Physiology and Chronic Health Evaluation II) to evaluate the predictive value on outcomes of critical illness. Then receiver operating characteristics (ROC) curves were constructed to assess and compare each marker’s sensitivity and specificity respectively. Results: NLCR values were not differential among survival and mortality groups. Meanwhile remarkable differences were observed upon APACHE II score, CRP, PCT and LAC levels among survival and death groups. ROC analysis revealed that NLCR was not competent to predict prognosis of critical illness. The AUROCs of conventional markers such as CRP, PCT, LAC and APACHE II score were more significant in predicting 28- and 7-day mortality. Conclusions: NLCR is not competent and less reliable than conventional markers CRP, PCT, LAC and APACHE II score in assessing severity and in predicting outcomes of critical illness.

scholarly journals C-Reactive Protein Concentration as A Risk Predictor of Mortality in Intensive Care Unit: A Multicenter, Prospective, Observational Study

2020 ◽  
Author(s):  
Rong Qu ◽  
Linhui Hu ◽  
Yun Ling ◽  
Heng Fang ◽  
Huidan Zhang ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Inflammatory Markers ◽  
Prospective Observational Study ◽  
Apache Ii ◽  
Apache Ii Score ◽  
C Reactive Protein ◽  
Icu Mortality ◽  
Reactive Protein ◽  
Risk Reclassification ◽  
Multicenter Prospective Observational Study

Abstract Background: It is not clear whether there is value inflammatory markers for prognosis judgment in the intensive care unit (ICU). We therefore conducted a multicenter, prospective, observational study to evaluate the prognostic role of inflammatory markers.Methods: The clinical and laboratory data of patients at admission, including C-reactive protein (CRP), were collected in four general ICUs from September 1, 2018, to August 1, 2019. Multivariate logistic regression was used to identify factors independently associated with nonsurvival. The area under the receiver operating characteristic curve (AUC-ROC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the effect size of different factors in predicting mortality during ICU stay. 3 knots was used to assess whether alternative cut points for these biomarkers were more appropriate. Results: A total of 813 patients were recruited, among whom 121 patients (14.88%) died during the ICU stay. The AUC-ROC values of PCT and CRP for discriminating ICU mortality were 0.696 (95% confidence interval [CI], 0.650-0.743) and 0.684 (95% CI, 0.633-0.735), respectively. In the multivariable analysis, only APACHE II score (odds ratio, 1.166; 95% CI, 1.129-1.203; P=0.000) and CRP concentration > 62.8 mg/L (odds ratio, 2.145; 95% CI, 1.343-3.427; P=0.001), were significantly associated with an increased risk of ICU mortality. Moreover, the combination of APACHE II score and CRP > 62.8 mg/L significantly improved risk reclassification over the APACHE II score alone, with NRI (0.556) and IDI (0.013). Restricted cubic spline analysis confirmed that CRP concentration >62.8 mg/L was the optimal cut-off value for differentiating between surviving and nonsurviving patients.Conclusion: CRP markedly improved risk reclassification for prognosis prediction.

scholarly journals Procalcitonin and C-reactive Protein Perform Better Than Neutrophil-Lymphocyte Count Ratio on Evaluation of Hospital Acquired Pneumonia

2020 ◽  
Author(s):  
Nan Zheng ◽  
YI HAN
Keyword(s):  
Early Diagnosis ◽  
Roc Curves ◽  
Diagnostic Value ◽  
Apache Ii ◽  
Apache Ii Score ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Discriminant Ability ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Abstract Background: Early diagnosis and severity evaluation are key factors to achieve improved outcomes of hospital acquired pneumonia (HAP). We are constantly in search of more sensitive and specific biomarkers to improve timely diagnosis and survival.Methods: 593 cases of adult patients were enrolled into this retrospective cohort study to determine neutrophil-lymphocyte count ratio (NLCR), procalcitonin (PCT), C-reactive protein (CRP), serum lactate level and APACHE (Acute Physiology and Chronic Health Evaluation) II score at the admission of ICU. Patients were divided into 2 groups according to diagnosis: non-infection and HAP. Discriminant analysis was applied to which marker or what composition of markers performed better regarding to the diagnostic value and severity evaluation. The diagnostic value of each individual biomarker was assessed by construction of receiver operating characteristic (ROC) curves, calculation of the area under each ROC curves (AUROC). Multivariate analysis was also applied to detect most appropriate prognostic factors.Results: Remarkable differences were observed on NLCR, PCT, CRP and APACHE II scores between non-infection and HAP group. Regarding to discriminant ability of severe infection, the AUROC of NLCR (0.56; 95%CI 0.52-0.61) was not comparative with any of other single markers such as PCT (0.63; 95% CI 0.59-0.68), CRP (0.60; 95% CI 0.54-0.67), or APACHE II score (0.68; 95% CI 0.64-0.73). Compared to the single biomarkers, APACHE II score presented higher discriminant ability with greater AUROC. Besides, AUROC of the composite biomarker PCT-CRP-NLCR (0.66; 95% CI 0.61-0.70) was significantly greater than any of the single biomarkers, and its discriminant ability was comparable to APACHE II score.Conclusions: NLCR is not comparable to other single biomarkers such as PCT, CRP, or APACHE II score regarding to diagnosis or to severity evaluation of HAP. Composite biomarkers can prompt early diagnosis and severity evaluation with improved accessibility, especially the composition of PCT-CRP-NLCR.

scholarly journals The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients

2018 ◽  
Vol 7 (10) ◽  
pp. 333 ◽  
Author(s):  
Ji Park ◽  
Kyung Chung ◽  
Joo Song ◽  
Song Kim ◽  
Eun Kim ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Univariate Analysis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Proportional Hazard ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
Cox Proportional Hazard

The C-reactive protein (CRP)/albumin ratio has recently emerged as a marker for poor prognosis or mortality across various patient groups. This study aimed to identify the association between CRP/albumin ratio and 28-day mortality and predict the accuracy of CRP/albumin ratio for 28-day mortality in medical intensive care unit (ICU) patients. This was a retrospective cohort study of 875 patients. We evaluated the prognostic value of CRP/albumin ratio to predict mortality at 28 days after ICU admission, using Cox proportional hazard model and Kaplan-Meier survival analysis. The 28-day mortality was 28.0%. In the univariate analysis, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score (p < 0.001), CRP level (p = 0.045), albumin level (p < 0.001), and CRP/albumin ratio (p = 0.032) were related to 28-day mortality. The area under the receiver operating characteristic (ROC) curve (the area under the ROC curves (AUC)) of CRP/albumin ratio was higher than that of CRP for mortality (0.594 vs. 0.567, p < 0.001). The cut-off point for CRP/albumin ratio for mortality was 34.3. On Cox proportional-hazard regression analysis, APACHE II score (hazards ratio (HR) = 1.05, 95% confidence interval (CI) = 1.04–1.07, p < 0.001) and CRP/albumin ratio (HR = 1.68, 95% CI = 1.27–2.21, p < 0.001 for high CRP/albumin ratio) were independent predictors of 28-day mortality. Higher CRP/albumin ratio was associated with increased mortality in critically ill patients.

scholarly journals The impact of procalcitonin to C-reactive protein ratio (PCR) kinetics as a predictor of mortality in nosocomial bloodstream infections

2020 ◽  
Author(s):  
Ismail Necati Hakyemez ◽  
Turan Aslan ◽  
Bulent Durdu
Keyword(s):  
Logistic Regression ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Blood Stream Infection ◽  
Univariate Analysis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
The Impact

Abstract Background: This study was performed to investigate the combination of serum C-reactive protein (CRP) and procalcitonin (PCT) kinetics as a best marker in predicting mortality in patients with nosocomial blood stream infection (BSI).Methods: We retrospectively reviewed the medical records of patients ≥ 18 years of age with nosocomial BSIs hospitalized in intensive care units during the period from January 2016 to June 2018. Eighty-four patients who met the inclusion criteria were included in the study. Clinical, microbiological and biochemical data were compared in patients who survivors and deaths. Binary logistic regression analyses (backward LR) were used to identify independent risk factors. A receiver operating characteristic (ROC) curve analysis was performed to compare the predictive accuracy. The kinetic changes were expressed as Δ (delta) and defined the as difference between level on day 5 and level at day 1 of BSI.Results: Of the 84 included patients, 46 (58.4%) had survivors and 35 (41.6%) had deaths. In univariate analysis, renal disease (p = 0.007), cardiac disease (p = 0.042), septic shock (p = <0.001), maximum SOFA (p = <0.001) and APACHE-II (p <0.001), ΔCRP (p = 0.004), ΔPCT (p = <0.001), and ΔPCR (p = 0.025) were significantly higher in non-survivors than in survivors. In the logistic regression analysis, APACHE-II score (odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.20-1.78, p <0.001), ΔCRP (OR = 1.18, %95 CI =1.04-1.34, p = 0.009), ΔPCT (OR = 0.87, 95% CI = 0.79-0.95, p = 0.001), and ∆PCR (OR = 36.78, 95% CI = 4.52-299.01, p = 0.001) were independent predictors of 28-day mortality. After a ROC analysis, the AUC of ∆PCR was higher than that of ∆PCT for mortality in ICU patients (0.745 vs. 0.712, p <0.001).Conclusions: The PCR kinetic was a strong independent predictor of mortality in patients with nosocomial BSIs in intensive care units. Especially in patients with CRP and PCT tested together, it is expected to be a fast and rational tool for clinical practice.

scholarly journals Plasma Levels of IL-8 and Microparticle Tissue Factor Activity Are Associated with Mortality in Patients with Primary Influenza A/H1N1 Infection

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3544-3544
Author(s):  
Matthew T. Rondina ◽  
Kohei Tatsumi ◽  
Julie A. Bastarache ◽  
Nigel Mackman
Keyword(s):  
Plasma Levels ◽  
Influenza A ◽  
H1n1 Influenza ◽  
Apache Ii ◽  
Apache Ii Score ◽  
H1n1 Infection ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Influenza A H1n1 ◽  
D Dimer

Abstract Background and Objective: Treatment and triage decisions during influenza remain difficult due to lack of reliable severity of illness predictive score. Influenza A/H1N1 induces the expression and release of tissue-factor bearing microparticles (MP-TF), contributing to a prothrombic milieu. However, there are no studies reporting levels of circulating TF-expressing MPs during the course of human influenza. We sought to determine if MP-TF are an early predictor of mortality in critically ill patients with influenza A/H1N1. Methods: This was a prospective, multicenter, case-cohort pilot study of three academic intensive care units. We prospectively studied 15 patients with primary influenza A/H1N1 that included 7 survivors and 8 non-survivors. For comparison, 27 healthy, medication-free, age- and gender-matched control subjects were also prospectively studied. Plasma was prepared from blood drawn upon ICU admission in influenza patients. MP-TF activity, thrombin-antithrombin complexes (TATc), and D-dimers were measured as markers of activation of coagulation. Plasma cytokine levels were measured on the same blood samples. Patients were followed for the primary outcome of 28-day mortality. Results: The average admission APACHE II score of the influenza patients was 25.5±9.3, 60% of patients had shock, and the 28-day mortality rate was 53.3% (n=8/15). Compared to healthy controls, influenza patients had significantly higher plasma fibrinogen, C-reactive protein (CRP) MP-TF activity, TATc, D-dimer and a prolonged prothrombin time. However, of these procoagulant markers, only MP-TF activity predicted influenza related mortality (5.6±1.2 pg/ml in non-survivors vs. 1.8±0.8 pg/mL in survivors, p < 0.05; Table 1 and Fig. 1A). MP-TF activity, TATc levels, and D-dimer did not correlate with APACHE II score, platelet count, fibrinogen levels, CRP, or age or between patients with severe sepsis versus septic shock. Influenza non-survivors also had significantly higher plasma IL-8 levels compared with survivors (71.8±29.1 pg/ml vs. 17.3±3.7 pg/mL, p < 0.05; Figure 1B). MP-TF activity and IL-8 levels were significantly and positively correlated (r2 = 0.60, P =0.003; Figure 1C). Other cytokines, TATc, and D-dimer were not different between non-survivors and survivors. Conclusions: This study demonstrates that plasma IL-8 and MP-TF activity measured upon admission in patients with severe, primary influenza A/H1N1 infection is associated with subsequent mortality. Thus, these biomarkers may serve as very early prognostic markers for patients with influenza A/H1N1. Table 1. Characteristics of the influenza patients. Laboratory values, coagulation markers, and plasma cytokines were measured within 24 hours of ICU admission. All Influenza A/H1N1 Patients(n=15) Influenza Non-Survivors(n=8) Influenza Survivors(n=7) P value Admission Characteristic Age, years 43.3±11.0 45.8±4.6 40.4±15.5 0.37 Male Gender, n (%) 7 (47%) 3 (38%) 4 (57%) 0.45 Weight, kg 95.5±25.2 86.6±20.9 105.7±27.4 0.15 BMI, kg/m2 33.3±7.2 31.5±5.0 35.4±9.1 0.31 Obesity (BMI³30 kg/m2) 10 (67%) 5 (63%) 5 (71%) 0.71 Tobacco Use, n (%) 4 (27%) 3 (38%) 1 (14%) 0.31 APACHE II Score 25.5±9.3 27.9±9.1 22.9±9.4 0.31 Mechanically Ventilated, n (%) 15 (100%) 8 (100%) 7 (100%) -- Shock, n (%) 9 (60%) 6 (75%) 3 (43%) 0.21 P/F Ratio 83±28 84±34 82±22 0.89 Clinical Outcomes ICU Length of Stay, days 21.9±7.7 23.0±7.9 20.7±7.8 0.58 Duration of Ventilation, days 8.2±1.0 8.5±0.9 7.6±0.9 0.11 Secondary Bacterial Infection, n (%) 5 (33%) 4 (50%) 1 (14%) 0.28 Overt DIC, n (%) 15 (100%) 8 (100%) 7 (100%) -- Laboratory Values Platelets, 103/µL 213±138 154±104 280±150 0.08 White Blood Cells, K/µL 7.3±4.4 8.5±4.9 5.9±3.5 0.28 Hemoglobin, g/dL 11.7±1.9 11.5±2.0 12.0±1.8 0.66 Serum Creatinine, mg/dL 1.1±0.7 1.14±0.74 1.07±0.59 0.84 Coagulation Markers Fibrinogen, mg/dL 571±240 461±253 700±157 0.07 C-reactive Protein, mg/L 11.0±7.6 11.8±7.4 10.2±8.2 0.70 PT, sec 20±7.0 19.2±4.7 20.9±9.3 0.67 aPTT, sec 53.0±22.9 55.1±29.0 50.7±15.0 0.72 MP-TF, pg/mL 3.8±0.9 5.6±1.2 1.8±0.8 < 0.05 TATc, ng/mL 11.8±2.7 14.3±3.5 9.1±4.1 0.35 D-dimer, ng/mL 2439±86 2568±98 2292±134 0.11 Figure 1. MP-TF activity and IL-8 predict mortality in patients with influenza A/H1N1. (A) Plasma levels of MP-TF activity and (B) IL-8 levels in survivors and non-survivors. (C) Correlation between MP TF activity and IL-8 levelsin H1N1 influenza-infected patients (*P <0.05). Figure 1. MP-TF activity and IL-8 predict mortality in patients with influenza A/H1N1. / (A) Plasma levels of MP-TF activity and (B) IL-8 levels in survivors and non-survivors. (C) Correlation between MP TF activity and IL-8 levelsin H1N1 influenza-infected patients (*P <0.05). Disclosures No relevant conflicts of interest to declare.

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