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While modifying dietary patterns can reduce the effects of inflammation in obesity, less is known about the impact of dietary patterns on inflammation levels in women of different ethnicities. This study investigated the link between dietary patterns and mediators associated with inflammation, such as C-reactive protein (CRP) and white blood cells (WBCs), among obese Hispanic and Non-Hispanic White women. CRP and WBC counts were extracted from the National Health and Nutrition Examination Survey conducted between 2003 and 2010. Based on their recorded responses to two 24 h recall interviews, individuals were grouped into one of three dietary patterns: healthy plant-based, less healthy plant-based, or animal-based. Comparisons were run between obese Hispanic and Non-Hispanic women assigned to the same dietary pattern groups and between dietary pattern groups within ethnic groups. CRP and WBCs increased in obese Non-Hispanics as dietary patterns moved from healthy plant-based to animal-based ( p CRP = 0.002 and p WBC = 0.017). Regardless of the dietary pattern, CRP and WBC expression were similar in Hispanic women. In addition, WBCs were higher in Hispanics compared to Non-Hispanics when both populations adhered to healthy plant and less healthy plant dietary patterns. The results indicate that dietary patterns may influence Hispanics' inflammation differently than Non-Hispanics.

Background: Detection of an eventful course in the early days of sepsis treatment is clinically relevant. The white blood cell count (WBCC) and C-reactive protein (CRP) are used in daily practice to monitor the intensity of the inflammatory response associated with sepsis. It is not entirely clear which of the two might better discriminate the outcomes of patients with sepsis., Methods: 30-day mortality was assessed in a cohort of patients who were hospitalized with sepsis in the departments of Internal Medicine in a tertiary medical center. Admission and 72-hour time points were analyzed to discriminate between patients with increased versus decreased 30 days mortality risk., Results: The study included 195 patients. Higher 72 h CRP, WBCC, neutrophil counts and neutrophils to lymphocyte ratio were associated with increased mortality (p < 0.02). Baseline WBCC and CRP failed to discriminate between patients who died and those who survived (AUC = 0.551, 0.479). In multivariate analysis of the 72 h tests, higher WBCC count (OR = 1.12, 95%CI 1.05-1.20, p = 0.001), was associated with increased mortality whereas CRP was not (OR = 1.004, 95%CI 0.998-1.01, p = 0.146)., Conclusion: Patients who presented a 72-hour leukocyte descent had a better outcome and in this regard, WBCC was superior to 72-hour CRP in predicting 30 days mortality., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: White blood cell (WBC) count and C-reactive protein (CRP) level are the most common markers of inflammation. There is a growing need for point-of-care testing (POCT) of WBC and CRP, and more advances in convenient devices are required. We developed an analyzer-free POCT system for measuring WBC and CRP using a low volume blood sample., Methods: The POCT-WBC is based on the granulocyte esterase assay, while the POCT-CRP is based on the immunochromatographic assay. These kits were examined for precision as well as correlation with currently used popular commercial automated assays. The correlations were clinically analyzed in children with acute infection (n=62; mean age 4.2y). The correlations regarding the monitoring of values were further examined in several follow-up subjects., Results: The POCT-WBC and POCT-CRP kits demonstrated good precision. POCT-WBC exhibited a significantly close correlation with those of the control assay (r=0.94, p<0.05). The results of POCT-CRP also exhibited a significantly close correlation with those of the control assay (r=0.94, p<0.05). In the follow-up study, the results of the respective kits were similar to those of the control assays., Conclusions: The POCT-WBC and POCT-CRP are promising tools for assessing infection in clinical practice., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Introduction: Inflammatory reactions are one of the potential safety concerns that are evaluated in the framework of vaccine safety testing. In nonclinical studies, the assessment of the inflammation relies notably on the measurement of biomarkers. C-reactive protein (CRP) is an acute-phase plasma protein of hepatic origin that could be used for that purpose in toxicity studies with rabbits., Methods: To evaluate the utility of CRP as an additional inflammatory biomarker in adjuvant or vaccine toxicity studies, rabbits were injected on Day 0 with saline, aluminium phosphate, aluminium hydroxide, Adjuvant System (AS)01, AS03, AS15, or diphtheria-tetanus-whole cell pertussis-hepatitis B vaccine (DTPw-HB). Body weights, haematology parameters, CRP and fibrinogen levels were measured daily up to Day 7. Macroscopic changes at the injection site were also evaluated up to Day 7. At Day 7, a histopathological examination of the injection site was performed., Results: Like fibrinogen, CRP levels rapidly increased after the injection of Adjuvant Systems or DTPw-HB, peaking at Day 1, and returning to baseline in less than a week. The magnitude of the CRP increase was consistently higher than that of fibrinogen with a larger fold increase from background, providing a more sensitive evaluation. The number of circulating heterophils was also increased on Day 1 after the injection of Adjuvant Systems or DTPw-HB. The highest increases in CRP levels were observed after the injection of DTPw-HB or AS03, and were also associated with the persistence of mixed inflammatory cell infiltrates (including heterophils) at the injection sites on Day 7. No increases in CRP levels and in circulating heterophils were observed after injection of the aluminium salt adjuvants., Discussion: Our study supports the use of CRP as an accurate biomarker of acute inflammation in rabbits for vaccine toxicity studies and highlights an association between increased CRP levels and the recruitment of heterophils., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Incorporating plyometric exercises (PE) into soccer players' conditioning routines is vital for boosting their performance. Nevertheless, the effects of PE sessions with diverse volume loads on inflammation, oxidative stress, and muscle damage are not yet clearly understood. This study aimed to examine the effects of altering the volume-loads of PE on indicators of oxidative muscle damage and inflammation. The study involved forty young male soccer players who were randomly assigned to three different volume-loads of PE (Low volume-load [100 jumps]: LVL, n = 10; Moderate volume-load [150 jumps]: MVL, n = 10; and High volume-load [200 jumps]: HVL, n = 10) and a control group (CON = 10). The levels of various biomarkers including delayed onset muscle soreness (DOMS), serum lactate dehydrogenase (LDH), creatine kinase (CK), 8-hydroxy-2-deoxyguanosine (8-OHdG), malondialdehyde (MDA), protein carbonyl (PC), leukocytes, neutrophils, interleukin-6 (IL-6), and C-reactive protein (CRP) were measured at different time points. These measurements were taken at rest, immediately after completion of PE, and 24-, 48-, and 72-hours post-PE. The CK, LDH, DOMS, 8-OHdG, MDA, and PC levels were significantly increased (p < 0.05) after the PE protocol, reaching their peak values between 24 to 48 hours post-PE for all the volume-loaded groups. The levels of leukocytes, neutrophils, and IL-6 also increased after the PE session but returned to resting values within 24 hours post-PE. On the other hand, CRP levels increased at 24 hours post-PE for all the treatment groups (p < 0.05). The changes observed in the indicators of muscle damage and inflammation in response to different volume-loads of PE was not significant. However, the HVL and MVL indicated significant differences compared to LVL in the 8-OHdG (at 48-hour) and MDA (at 72-hour). Athletes engaging in higher volume-loads demonstrated more pronounced responses in terms of biochemical variables (specifically, LVL < MVL < HVL); however, these changes were not statistically significant (except 8-OHdG and MDA). [ABSTRACT FROM AUTHOR]

Introduction: Early leakage detection following bariatric procedures is crucial, but a standardized evaluation method is lacking. The aim was to validate the potential benefits of postoperative day 1 (POD1) C-reactive protein (CRP) levels and white blood cell (WBC) counts in distinguishing at-risk patients following Roux-en-Y gastric bypass (RYGB) while considering the impact of obesity-related chronic inflammation. Methods: Retrospective analysis of 261 consecutive patients aged 18–65 years with a body mass index (BMI) of 32.5–50 kg/m2 who underwent primary RYGB between 2017 and 2022. Sequential changes in CRP levels and WBC counts measured 48 h preoperatively and on POD1 morning were collected and compared between patients with/without complications and in patients without complications stratified by preoperative CRP levels. Results: Female patients and those with a higher BMI tended to have higher baseline CRP levels, which were positively related to postoperative CRP. Patients experiencing complications had higher WBC counts and a higher prevalence of WBC counts >14,000/μl (77.8% vs. 25.4%; p<0.001) than those without complications. Baseline CRP ≥ 0.3 mg/dl, a longer operative time, and blood loss >10 ml were significantly more common with WBC counts above 14,000/μl; a reasonable range of change in WBC count (∆WBC) derived from its positive correlation to postoperative WBC count (r=0.6695) may serve as a useful complementary indicator. Conclusion: An individualized CRP threshold setting and integrated interpretation of the WBC count can be more appropriate than using static criteria for differentiating at-risk patients after RYGB. Further studies are needed to validate these findings and determine their generalizability. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the diagnostic value of combined detection of PCT, IL-6, CRP, and WBC in neonatal sepsis. The study selected 50 neonatal sepsis patients treated in Pucheng County Hospital from April 2018 to June 2020 as the patient group, and 50 healthy newborns as the control group. Before treatment, white blood cell count (WBC) was performed on all neonates, and serum PCT, IL-6, and CRP levels were detected by ELISA. After treatment, serum levels of these four biomarkers in the effective/non-effective groups were observed. The results noted higher levels of these four biomarkers in the patient group rather than the control group before treatment, and in the effective group rather than the non-effective group after treatment. ROC analysis found that the area under curve (AUC), specificity and sensitivity of the combined detection were better than those of the single detection. In short, combined detection of these four biomarkers has a high diagnostic value for neonatal sepsis. [ABSTRACT FROM AUTHOR]

Introduction: Periprosthetic joint infections (PJI) following primary arthroplasty continue to be a serious complication, despite advances in diagnostics and treatment. Two-stage revision arthroplasty has been commonly used as the gold standard for the treatment of PJI. However, much discussion persists regarding the interim of the two-stage procedure and the optimal timing of reimplantation. Serology markers have been proposed as defining parameters for a successful reimplantation. The objective of this matched-pair analysis was to assess the role of serum C-reactive protein (CRP) and white blood cell count (WBC) in determining infection eradication and proper timing of reimplantation. We investigated the delta (∆) change in CRP and WBC values prior to both stages of two-stage revision arthroplasty as a useful marker of infection eradication. Methods: We analyzed 39 patients and 39 controls, matched by propensity score matching (BMI, age, ASA-classification), with a minimum follow-up of 24 months and treated with a two-stage revision THA or TKA in our institution. Data of serum CRP and WBC values were gathered at two selected time points: prior to the explantation of the implant (preexplantation) and following the completion of antibiotic treatment regimen, both systemic and with a drug-eluting cement spacer (prereimplantation). Patient records were reviewed electronically for preexisting comorbidities, overall health status, synovial fluid cultures, inflammatory serologies, revision surgeries, and recurrent or persistent infection based on the modified Musculoskeletal Infection Society criteria. Patient demographics, ∆CRP, ∆WBC, and time interval to reimplantation were statistically analyzed using receiver operator curves (ROC), Pearson's correlation coefficient, Levene's test, and Student's t-test. Results: Infection-free patients exhibited higher mean CRP and WBC than did patients who were reinfected at both time points. When comparing preexplantation with prereimplantation values, the median ∆CRP was 9.48 mg/L (interquartile range (IQR) 2.3–36.6 mg/L) for patients who did not develop a reinfection versus 2.74 mg/L (IQR 1.4–14.2 mg/L) for patients who developed reinfection (p = 0.069). The median ∆WBC was 1.5 × 109/L (IQR 0.6–4.0 × 109/L) for patients who remained infection-free versus 1.2 × 109/L (IQR 0.8–2.2 109/L) for patients who developed reinfection (p = 0.072). Analysis of areas under the curve (AUC) using ROC demonstrated poor prediction of persistent infection by ∆CRP (AUC = 0.654) and ∆WBC (AUC = 0.573). Although a highly significant correlation was found between the interim interval and infection persistence (r = 0.655, p < 0.01), analysis using ROC failed to result in a specific threshold time to reimplantation above which patients are at significantly higher risk for reinfection (AUC = 0.507). Conclusion: No association could be determined between the delta change in serum CRP and WBC before and after two-stage revision arthroplasty for PJI and reinfection risk. Even though inflammatory serologies demonstrate a downtrending pattern prior to reimplantation, the role of CRP and WBC in determining the optimal timing of reimplantation seems to be dispensable. Planning a second-stage reimplantation requires assessing multiple variables rather than relying on specific numeric changes in these inflammatory marker values. [ABSTRACT FROM AUTHOR]

Background/Aim: Convalescent plasma (CP) therapy, which includes processing and administering antibody-rich plasma from recovered patients to sick patients, is used for passive immunity in COVID-19 pneumonia patients in addition to antivirals and antibiotics. This study aimed to assess whether CP treatment significantly affects hyperviscosity and COVID-19 prognosis-related blood parameters. Methods: This study was a single-center retrospective cohort study. Ninety-seven patients with COVID-19 polymerase chain reaction (PCR)-positive results and pneumonia observed on thoracic computed tomography (CT) were included. Patients' ferritin, d-dimer, C-reactive protein (CRP), and complete blood count levels before and after CP administration were compared. Results: Ferritin, d-dimer, white blood cell (WBC), neutrophil, and plateletcrit (PCT) levels and the platelet distribution width (PDW) were significantly higher and there was a significant decrease in the CRP level after CP treatment compared to before CP (P < 0.05). Ferritin, d-dimer, and CRP values measured after CP were higher in deceased patients than in survivors (P = 0.001, P = 0.007, and P < 0.001, respectively). Conclusion: Ferritin, d-dimer, WBC, and neutrophil levels, which we expected to decrease on the basis of the COVID-19 prognosis, unfortunately increased, and only CRP levels decreased. However, we found that these increases were more pronounced in patients who died. Considering these prognostic factors, the findings of our study suggest that CP treatment has no effect on the COVID-19 disease course and may lead to a worse prognosis. [ABSTRACT FROM AUTHOR]

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The aim of this study was to investigate the predictive value of peptidyl-prolyl cis-trans isomerase NIMA-interacting 1 (Pin1) with C-reactive protein (CRP) and white blood cell (WBC) count for community-acquired pneumonia (CAP) in infants. A total of 84 hospitalized infants with CAP and 69 healthy infants were included in this study. The clinical manifestations and laboratory assay results of infants were recorded. Serum Pin1 level was estimated by enzyme-linked immunosorbent assay. The median serum Pin1 concentration in infants with CAP was significantly higher than that in controls (1.44 vs. 0.21 ng/mL, P < 0.0001). Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) of the combination Pin1, CRP and WBC (Pin1 + CRP + WBC, 0.943) was higher than Pin1, CRP, WBC alone or the combination of Pin1 and CRP (P < 0.05). The sensitivity of Pin1 + CRP + WBC (94.0%) was higher than that of Pin1, CRP, WBC alone, or any two combined (P < 0.05). Pin1 + CRP + WBC also had a high negative predictive value (91.4%). Moreover, serum Pin1 alone had a high specificity (97.0%) and excellent positive predictive value (96.6%) for infants with CAP, which were higher than WBC, Pin1 and WBC in combination, CRP and WBC in combination, and Pin1 + CRP + WBC (P < 0.05). Therefore, serum Pin 1 was highly expressed in infants with CAP and can singly or in combination with CRP and WBC represent promising novel predictors for infants with CAP. [ABSTRACT FROM AUTHOR]

CRP and WBC are the most widely used markers of inflammation in veterinary clinical diagnosis. Also, PCT is a specific APP marker of bacterial diseases in humans. This study evaluated the levels of PCT, CRP and WBC during postoperative monitoring of bitches undergoing ovariohysterectomy. Thirteen adult clinically healthy female crossbreed dogs aged between 7-24 months were used in the study. Ovariohysterectomy was performed via medial laparotomy using routine procedures. Blood samples were collected from the cephalic vein at 1, 4 and 7 days after surgery (post-op period). Mean serum concentration of PCT, CRP and WBC levels were increased after the surgery. CRP concentrations and WBC counts were increased significantly (p

• Hedonic wellbeing is longitudinally associated with lower WBC count. • Eudemonic wellbeing is longitudinally associated with lower WBC, fibrinogen & CRP. • Associations are independent of depression and other aspects of mental ill-health. • Constant factors e.g. sex, medical history, SES & genetics cannot explain results. • Associations are partly explained by time-varying health-related factors. There is a large literature linking inflammation with mental ill health, but a much smaller literature focusing on mental wellbeing. Specifically, it remains unclear whether mental wellbeing is longitudinally and independently associated with inflammation or only via associated changes in mental ill health. This study used data from 8780 adults aged 50+ in the English Longitudinal Study of Ageing. Hedonic wellbeing (both positive affect and life satisfaction) and eudemonic wellbeing (self-realisation and control-autonomy) were measured at data collection waves 2 (2004/05), 4 (2008/09) and 6 (20012/13), along with measures of C-reactive protein (CRP), fibrinogen and white blood cells (WBC). Fixed effects modelling was performed to identify the longitudinal relationship between wellbeing and inflammation, adjusting for time-varying mental ill health and other identified confounders. Both measured aspects of hedonic wellbeing were associated with lower WBC count, independent of mental ill health. For life satisfaction, this relationship was explained by confounders, whilst for positive affect it persisted. Both measured aspects of eudemonic wellbeing were associated with lower CRP, fibrinogen and WBC, independent of mental ill health. For control-autonomy, this relationship was explained by confounders, whilst for self-realisation it persisted. Results were present in both men and women, although more strongly in men, and were robust to a range of sensitivity analyses. This study builds on the strong literature showing a relationship between mental ill health and inflammation by showing that there is also an apparently independent relationship between mental wellbeing, in particular eudemonic wellbeing, and inflammation that is unexplained by socio-economic or other time-constant factors and in some instances persists independent of time-varying confounders. [ABSTRACT FROM AUTHOR]

Sepsis is the leading causes of morbidity and mortality in critical patients in many intensive care units. There were numerous parameter and biomarkers available to confirm the presence of sepsis. The aim of this study was to determine which one the parameter or biomarkers (white blood cell, CRP,procalcitonin and TNF-α) has a role as an outcome predictor in pediatric sepsis patient. This prospective cohort study was conducted in Pediatric Intensive Care Unit WahidinSudirohusodo hospital fromJanuari 2016untilMay 2017. A total of 108 sepsis patients were included. Plasma specimens were collected at admission, then the patients were being followed up for survived or non-survived. The diagnosis of sepsis is using the International Pediatric Sepsis Consensus 2005 criteria. Serum CRP,Procalcitonin TNF-α were measured using Enzyme Linked Immunosorbent Assay technique. Initial serumprocalcitonin level and TNF-α in non-survived children with septic were very significantly higher than those in the survived groupswith p=0.000 with OR2,46 CI(0,905- 6,697) in procalcitonin and p=0.000 with OR 44,69 CI(5,749-347,36)in TNF-α. The initial serum level of PCT and TNF-α can be used as a predictor outcome of sepsis patient in children. [ABSTRACT FROM AUTHOR]

Background: One of the commonest emergencies in surgical practice (pediatric and general surgery) is acute appendicitis which is associated with acute phase reaction. Diagnosis of acute appendicitis is still a challenging issue for surgeons because lifetime risk of acute appendicitis is high (in some series reach 8%), rate of negative exploration is also high (in some series reach 35%) and complications of acute appendicitis (mainly perforation of appendix) are still high, especially in developing countries (in some series reach 62%). Several modalities have been used for diagnosis of acute appendicitis which include scoring systems (e.g. Alvarado scoring system), imaging techniques (ultrasound and computerized tomography), and laboratory investigations (white blood cell count, neutrophil percentage, C-reactive protein and some other serological markers) in order to improve diagnosis, reduce negative exploration rate and reduce complications rate. The aim of study is to evaluate efficacy of (CRP, WBC count and neutrophil percentage) in diagnosis of acute appendicitis. Patients and methods: The study was conducted at the beginning of January to the end of August 2018. Thirty male patients, whose age between 10-40 years and admitted to emergency department of Kirkuk general hospital and diagnosed clinically as acute appendicitis by same surgeon, were studied. In emergency department, white blood cell count (WBC) and neutrophil percentage (NP) are estimated by same automated analyzer in same laboratory (as part of complete blood count estimation). C- reactive protein (CRP) was estimated qualitatively by latex agglutination technique in same laboratory. Appendicectomy was done by same surgeon and decision was done regarding whether appendix was inflamed or not macroscopically (by same surgeon) and microscopically (by histopathological examination by same histopathologist). Chai-squared test was used to compare between means of variables. Results: There were significant relations between onset of symptoms and results of CRP results, onset of symptoms and end diagnosis, and WBC count and end diagnosis. All other relations were non-significant. Conclusions: Diagnosis of acute appendicitis remains a challenging issue in clinical practice. Frequent clinical examination remains the best method for accurate diagnosis of acute appendicitis. Laboratory investigations can be used as an adjuvant in diagnosis of acute appendicitis.. [ABSTRACT FROM AUTHOR]

Abstract Objective This study explored the association between low-grade inflammation measured using multiple common inflammatory markers and general psychological distress symptoms. Method A total of 68,463 Korean adults were included. White blood cell counts with differential count, fibrinogen, C-reactive protein (CRP), ferritin and rheumatoid factor were measured. General psychological distress symptoms were assessed using 18 questions of psychosocial well-being index short form (PWI-SF). Results Among the eight inflammatory markers measured, WBC count, segmented neutrophil count, monocyte and CRP level were significantly and independently associated with broad psychological symptoms. In contrast, fibrinogen and ferritin showed a weak association with limited number of items. No significant association was detected with lymphocyte and RF. Conclusion General psychological distress symptoms were associated with multiple inflammatory markers in Korean adults. The association patterns differed by the types of inflammatory markers. Additional investigation into the relationship between general inflammatory markers and diverse psychological distress symptoms is warranted. [ABSTRACT FROM AUTHOR]

Aims Immunological mechanisms may play a role in symptomatology of patients with a psychotic disorder. Besides metabolic problems and medication use, inflammatory processes that may occur due to the disorder may cause increased inflammatory markers and concurrent psychiatric symptoms. The aim of this study is to investigate whether levels of C-reactive protein (CRP) and white blood cell count (WBC) are related to positive and negative symptoms of psychotic disorders, and whether age, gender, duration of illness, smoking behavior, haloperidol equivalents, mediation use, body mass, and metabolic syndrome affect this relation. Methods CRP and WBC values of 2123 patients with a psychotic disorder were related to positive and negative symptoms measured with a psychiatric interview. CRP was analyzed by survival analysis accounting for detection limit and WBC by linear mixed model analysis. In case of a significant association, the confounding factors were added to the model. Results Both WBC and CRP were related to both positive and negative symptoms, even after correction for age, gender, smoking, use of medication and metabolic problems. Of the covariates, gender, metabolic problems, smoking and statins also showed a strong association with inflammatory markers. Conclusions This study in a large patient-group confirmed that inflammatory markers are related to psychotic disorders, particularly negative symptoms. Future studies could use more precise measures of inflammatory markers and measure symptomatic state at specific moments in illness progression. [ABSTRACT FROM AUTHOR]

Purpose: Idiopathic orbital inflammation (IOI) and orbital cellulitis can present similar clinical features, and the diagnoses of these two disorders are sometimes confused. The purpose of the present study was to determine whether or not inflammatory markers in the blood can be useful to differentiate between IOI and orbital cellulitis in cases with acute eyelid erythema and edema.Subjects and methods: In this retrospective single-institute study, we reviewed the medical records spanning the past 10 years at the Department of Ophthalmology, Osaka Medical College Hospital, Takatsuki, Osaka, Japan, and found 45 cases, with patients >15 years of age, with presumed IOI. Their blood samples were obtained within 5 days after the onset of IOI. Of those cases, 15 patients (10 males, 5 females, mean age of 56.9 years; range 38–76 years) presented acute eyelid erythema and edema, and were initially misdiagnosed as orbital cellulitis. Thus, inflammatory markers in the blood (ie, white blood cells [WBCs] and C-reactive protein [CRP]) of those 15 patients were analyzed with 17 patients (10 males, 7 females) having orbital cellulitis. The receiver operating characteristic curve analysis was performed to determine the optimal cut-off values. Results: The mean ± standard error (SE) levels of the WBC were 6.80±0.70×10³/µL in the IOI patients, and 8.54±0.91×10³/µL in the orbital cellulitis patients, and no significant differences were observed (P=0.15, Student's t-test). However, the mean ± SE levels of CRP were 1.04±0.43 mg/dL in the IOI patients, yet were significantly increased to 4.65±1.21 mg/dL in the orbital cellulitis patients (P=0.01, Student's t-test). The area under the curve value was 0.80 and the optimal cut-off value was 0.43 for orbital cellulitis, with sensitivity and specificity being 82% and 73%, respectively. Conclusion: The findings of this study indicate that CRP may be useful in distinguishing patients with idiopathic orbital inflammation from those with orbital cellulitis. [ABSTRACT FROM AUTHOR]

• Bacteremia in hospitalized patients requires prompt administration of appropriate antibiotic therapy. • Various inflammatory biomarkers are used to aid in deciding if antibiotic treatment is warranted. • Low concentrations of inflammatory markers can mislead clinicians into thinking there isn't an infection. • CRP velocity is shown to be superior to CRP alone and WBC in predicting bacteremia. Examining the usefulness of C-reactive protein velocity (CRPv) as an early biomarker for the presence of bacteraemia in patients presenting to the Department of Emergency Medicine with acute infection/inflammation and suspected bacteraemia. A retrospective study examining a cohort of patients who presented to the E.R and in whom blood cultures were taken. CRPv was calculated as the difference in mg/hour/litter between two consecutive CRP tests performed within 12 h. 256 patients were included in the cohort. Using CRPv in patients who at first presented with a relatively low (17.9 ≤ mg/L 1st quartile) CRP concentration, we found an AUC of 0.808 ± 0.038 (p < 0.001) for the presence of positive versus negative blood cultures (what is AUC?). This was better than the AUC that was obtained when the WBC for the same purpose. CRPv may be a useful biomarker in the identification of patients with suspected bacteremia and a low CRP-a challenging situation for clinicians who may underestimate the severity of illness in this patient group. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the diagnostic efficiency of human neutrophil lipocalin (HNL) in bacterial infections in children. This study included 49 pediatric patients with bacterial infections, 37 patients with viral infections, 30 patients with autoimmune diseases (AID) and 41 healthy controls (HCs). HNL, procalcitonin (PCT), C-reactive protein (CRP), white blood cell (WBC) and neutrophil counts were detected in the initial diagnosis and the following days. In the patients with bacterial infections, the levels of HNL, PCT, CRP, WBC and neutrophils were significantly increased than that of disease controls and HCs. The dynamic of these markers was monitored during antibiotic treatment. The level of HNL was decreased rapidly in patients with effective treatment, but maintained at high levels in deteriorated patients according to the clinical progression. HNL detection is an effective biomarker to identify bacterial infections from viral infections and other AIDs, and has potential value to evaluate the effect of antibiotic treatment in pediatric patients. [ABSTRACT FROM AUTHOR]

Objective: The metabolic syndrome is highly prevalent in patients with schizophrenia, and is associated with a state of chronic, low-grade inflammation. We investigated relationships between total and differential white blood cell (WBC) counts, inflammatory markers, adipokines and the metabolic syndrome in patients with schizophrenia.Method: For subjects with available data from the baseline/screening visit of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial, WBC counts, inflammatory markers, and adipokines were investigated as predictors of the metabolic syndrome (and its components), using linear and binary logistic regression models, controlling for potential confounding effects of age, sex, race, smoking, fasting status, alcohol, and illicit drug use.Results: After controlling for potential confounders, blood CRP, interleukin-6, and leptin were significant predictors of all five individual components of the metabolic syndrome (as both continuous and categorical outcome measures). Furthermore, total WBC (OR=2.31, 95% CI 1.58-3.41, p<0.01) and lymphocyte (OR=2.51, 95% CI 1.75-3.60, p<0.01) counts were the strongest predictors of current metabolic syndrome.Conclusions: Our findings provide the strongest evidence to date that measurement of total and differential WBC counts are germane to the clinical care of patients with schizophrenia, and that inflammation and adipokines are associated with metabolic disturbance in these patients. [ABSTRACT FROM AUTHOR]

Background: Blood culture is necessary for appropriate management of clinically severe pneumonia in children under five years of age. However, in limited resource countries it might be unduly costly and waste of valuable time because of the high negative culture rate. Objectives: This study aims to identify clinical and laboratory parameters that potentially predict a positive blood culture in cases of severe pneumonia. Materials and Methods: A hospital based study, enrolled 189 cases satisfying the WHO definition of severe pneumonia. Age, gender, clinical history, physical examination, temperature, complete blood count, C-reactive protein, blood culture and Chest X Ray for all the patients were recorded. Results: Forty one patients had positive blood culture giving a prevalence of 21.7%. All variables were used in a dichotomous manner. White Blood Count (WBC) more than 20 000, very high C-reactive protein (C-RP ≥8mg/L) and Temperature more than 40oC, had a positive predictive value of 46.1%, 44.3% and 40.0% respectively for a positive culture as well as a Negative Predictive Value of 91.1%, 91.6% and 91.7% respectively. The WBC more than 20 000 and temperature above 40oC had a significant association with a positive blood culture. Their adjusted Odds Ratios were 3.9 (95% CI: 1.4-10.90) and 3.1 (95% CI: 1.2-8.4) respectively. This was not the case for C-RP (Odds Ratio=2.2, 95% CI: 0.7-2.2) or positive Chest X Ray (Odds Ratio=1.5, 95% CI: 0.6-3.6). Conclusion and Recommendation: Temperature of more than 40oC, Very high C-RP and WBC of more than 20 000 are good indicators of a potential positive blood culture. It is therefore recommended that further research be undertaken to refine these predictors as screening tools before resorting to blood culture. It is also recommended that antibiotic treatment may be initiated on the basis of the high temperature and WBC, while waiting for the culture results. [ABSTRACT FROM AUTHOR]

Background: Neonatal septicaemia diagnosis based on clinical features alone is non-specific leading to the initiation of unnecessary antibiotic treatment posing a danger of increased antibiotic resistance. In the present study the utility of serial qualitative C-reactive protein (CRP) assay and white blood cells count (WBC) in the diagnosis of neonatal septicaemia was investigated using blood culture as gold standard. Methods: A total of 305 neonates admitted at Bugando Medical Centre (BMC) neonatal units between September 2013 and April 2014 were enrolled. Demographic and clinical data were collected using standardized data collection tool. Blood specimens were collected for blood culture, WBC count and qualitative CRP assay. Results: Of 305 neonates; 224 (73.4%) were ≤ 72 hrs of age and 91(29.8%) had low birth weight. The positive CRP assay was observed in 67 (22.0%), 80 (26.2%) and 88 (28.9%) of neonates on day 1, 2 and 3 respectively; with any CRP positive occurred in 104 (34.1%) of neonates. The sensitivities of CRP assay in the diagnosis of septicaemia using culture as gold standard on day 1, 2, 3 and any positive were 40.4%, 53.2%, 54.8% and 62.9% respectively. While specificities were 82.7%, 80.7%, 77.8% and 73.3% respectively. Higher sensitivity of 75% was observed when CRP was used to diagnose gram negative septicaemia compared to 50% that was observed in the diagnosis of gram positive septicaemia. WBC count of ≥13 × 109 /L had sensitivity and specificity of 64.5% and 66.7% respectively with area under the curve of 0.694. When the any positive CRP and WBC of ≥13 × 109 /L were used the sensitivity increased to 90.3% with specificity of 50%. Neonates with septicaemia due to gram negative bacteria were significantly found to have higher rates of positive CRP than neonates with gram positive septicaemia and with negative culture (p < 0.001, OR 8.2, 95 CI; 2.9-26). Conclusion: In place where blood culture is limited neonates having clinical features of neonatal sepsis with positive qualitative CRP assay and increased WBC should urgently be initiated on appropriate sepsis management in order to reduce morbidity and mortality associated with neonatal sepsis. [ABSTRACT FROM AUTHOR]

Abstract: The metabolic syndrome is highly prevalent in patients with schizophrenia, and is associated with a state of chronic, low-grade inflammation. Schizophrenia is also associated with increased inflammation, including aberrant blood levels of pro-inflammatory cytokines and high-sensitivity C-reactive protein (hsCRP). The purpose of this study is to investigate the relationship between total and differential white blood cell (WBC) counts, hsCRP, and the metabolic syndrome in patients with schizophrenia and related non-affective psychoses. Fifty-nine inpatients and outpatients age 18–70 with non-affective psychotic disorders and 22 controls participated in this cross-sectional study. Subjects had a fasting blood draw between 8 and 9am for glucose, lipids, total and differential WBC counts, and hsCRP. Vital signs and anthropometric measures were obtained. Patients with non-affective psychosis and the metabolic syndrome had significantly higher total WBC counts, monocytes, and hsCRP levels than patients without the metabolic syndrome (p ⩽0.04 for each). In binary logistic regression analyses, after controlling for potential confounding effects of age, race, sex, age at first hospitalization for psychosis, parental history of diabetes, smoking, and psychotropic medications, total WBC count, monocytes, and hsCRP were significant predictors of metabolic syndrome in patients (p ⩽0.04 for each). hsCRP was also a significant predictor of increased waist circumference and triglycerides in patients (p ⩽0.05 for each). Our findings suggest that measurement of total and differential WBC counts and hsCRP blood levels may be germane to the clinical care of patients with schizophrenia and related disorders, and support an association between inflammation and metabolic disturbance in these patients. [Copyright &y& Elsevier]

Objective To re-evaluate the prognostic and predictive significance of the preoperative white blood cell ( WBC) count and C-reactive protein ( CRP) that independently predicts patient prognosis and to determine optimal threshold values for CRP., Patients and Methods From 1996 to 2005, 327 patients with surgery for clear cell renal cell carcinoma were retrospectively evaluated., Cox proportional hazard models were used, adjusted for the effects of tumour stage, size, Fuhrman grade and Karnofsky index, to evaluate the prognostic significance of WBC count and CRP and to identify threshold values., Identified thresholds were correlated with clinicopathological parameters and used to estimate cancer-specific survival., To prove any additional predictive accuracy of the identified threshold it was compared with a clinicopathological base model using the Harrell concordance index (c-index)., Results In univariable analyses WBC count was a significant prognostic marker at a concentration of 9.5/μ L (hazard ratio [ HR] 1.83) and 11.0/μ L ( HR 2.09) and supported CRP values of 0.25 mg/d L ( HR 6.47, P < 0.001) and 0.5 mg/d L ( HR 7.15, P < 0.001) as potential threshold values., If adjusted by the multivariable models WBC count showed no clear breakpoint, but a CRP value of 0.25 mg/d L ( HR 2.80, P = 0.027) proved to be optimal., Reduced cancer-specific survival was proved for CRP 0.25 mg/d L (median 69.9 vs 92.3 months). Median follow-up was 57.5 months with 72 (22%) tumour-related deaths., The final model built by the addition of CRP 0.25 mg/d L did not improve predictive accuracy (c-index 0.877) compared with the clinicopathological base model (c-index 0.881) which included TNM stage, grading and Karnofsky index., Conclusions Multivariable analyses revealed that an optimal breakpoint of CRP at a value of 0.25 mg/d L was best to stratify patients at risk of cancer-specific mortality, but CRP 0.25 mg/d L added no additional information in the prediction model., Therefore we cannot recommend measuring CRP as the traditional parameters of TNM stage, grading and Karnofsky index are already of high predictive accuracy. [ABSTRACT FROM AUTHOR]

Background: Inflammation has been shown to play a role in atherosclerosis and acute coronary syndrome. This study was carried out to evaluate the relationship between baseline white blood cell (WBC) count and C-reactive protein (CRP) with angiographic severity of coronary artery disease in patients with acute coronary syndrome and to identify those subsets of patients with acute coronary syndrome who may need to undergo invasive or conservative strategies. Method: A total of 100 patients with acute coronary syndrome including unstable angina, non-ST elevated myocardial infarction & ST elevated myocardial infarction were evaluated in National Institute of Cardiovascular Disease (NICVD), Dhaka with a view to correlate angiographic findings, C-reactive protein and WBC count. Results: This study observed that either raised WBC count or raised CRP independently and combination of both WBC count and CRP elevation were significantly associated with more severe coronary artery disease. Either raised WBC count or raised CRP or combination of raised WBC count and CRP were significant predictor of multivessel disease and high stenosis score. Conclusion: Elevation of WBC count and CRP in patients with acute coronary syndrome are associated with severe coronary disease. WBC count and CRP can be used as a new and even simpler tool for risk stratification in acute coronary syndrome. [ABSTRACT FROM AUTHOR]

Two cases of subcutaneous soft tissue infection in 30 RA patients treated with tocilizumab are reported. In both patients, local redness, swelling, and heat were observed around the affected site. WBC spikes and such local findings were suggested to be clinically useful for the early detection of low-grade subcutaneous infection in RA patients whose disease is tightly controlled with tocilizumab. Of note, the C-reactive protein (CRP) level and temperature lacked clinical utility for such detection. [ABSTRACT FROM AUTHOR]

Background: We have recently profiled inflammatory gene expression in acute appendicitis (AA) and identified a set of genes that are overexpressed in AA. The purpose of this study was to determine whether serum levels of a subset of proteins coded for by these overexpressed genes could differentiate patients with AA from those with other causes of abdominal pain and whether the serum levels of these proteins correlate with the histologic severity of appendicitis. Materials and Methods: Serum samples were obtained from a convenience sample of children between 1 and 21 y of age who presented to the emergency department (ED) with symptoms/signs of AA. Patients were assigned to the proven appendicitis (AA) or nonappendicitis (control) group based on histologic findings, chart review, and follow-up phone calls. The serum levels of haptoglobin, granulocyte colony stimulating factor (GCSF), interleukin 8 (IL-8), and C-reactive protein (CRP) were compared between groups. For patients with histologically proven appendicitis, a histologic severity score was assigned and correlated with the levels of potential serum biomarkers. Results: thirty-two patients were enrolled; 23 patients (72%) had AA. Serum levels of CRP and GCSF were significantly different between AA and control groups (7.0 versus 0.8, P =0.01 and 104.2 versus 58.7, P =0.03, respectively.) In patients with AA, there was significant correlation between GCSF serum levels and the appendicitis severity score [r=0.537, P =0.02]. Conclusions: GCSF serum levels can distinguish between patients with AA and controls. GCSF may prove to be a useful adjunctive test in the diagnosis and staging of acute appendicitis. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) is a recurrent, debilitating suppurative skin disease. The major challenge is the choice of optimal treatment. Assessment of treatment effectiveness is currently associated with clinical observations of disease activity based on Hurley’s or Sartorius’ grading system. Detailed examination of patients with HS and evaluation of disease severity is frequently time-consuming and undoubtedly subjective. With regard to these factors, there is a need for laboratory findings that will help resolve the problem. The aim of this study was to determine the usefulness of soluble interleukin-2 receptor (sIL-2R) serum concentration as a marker of HS clinical staging and comparative analysis with the commonly conducted laboratory measurements, including white blood cell count, C-reactive protein and erythrocyte sedimentation rate. The statistical analysis of all these laboratory parameters conducted within a group of 54 individuals with HS revealed that sIL-2R serum level seems to be the most sensitive measurement for evaluation of disease stage. Moreover, the existence of strong dependences between sIL-2R serum concentration and Hurley’s HS grading system were demonstrated. In conclusion, we believe that sIL-2R serum level could be used as a valuable marker for disease staging in patients with HS. [ABSTRACT FROM AUTHOR]

Abstract: Background: Appendectomy is the treatment of choice in acute appendicitis in children. Delayed diagnosis of acute appendicitis in children can lead to complications like perforation. Studies on the diagnostic value of WBC and CRP in establishing the diagnosis of appendicitis have contradictory results. Our study evaluates the role of CRP in diagnosing appendicitis in a pediatric population. Methods: A retrospective chart study on 130 patients aged less than 19 years who had an appendectomy at Sparrow hospital during years 2002–2006 formed the basis for this report. Based on histology appendicitis was classified as simple or perforated (complicated). Results: Patients (75 boys, 55 girls) were 6–18 years of age (median 14 years). The appendix was normal in 9/130 cases. Appendicitis was simple in 58/130 cases and perforated in 63/130 cases. Overall WBC count had the highest sensitivity in the prediction of (diagnosis) appendicitis at 88% whereas CRP was 69% and, WBC and CRP combined was 60%. PPV of WBC was highest at 0.81 (47/58) for simple appendicitis and 0.93 (59/63) for perforated appendicitis, when compared to CRP at 0.57 (33/58) and 0.81 (51/63); and CRP and WBC combined at 0.45 (26/58) and 0.75 (47/63). Conclusion: The sensitivity and PPV of WBC were better than CRP alone, or in combination with WBC. We conclude that CRP does not aid in the diagnosis of appendicitis. Simple appendicitis was seen in spite of normal WBC and CRP. [Copyright &y& Elsevier]

Summary: Objectives: Despite the high frequency of cervical lymphadenopathy in the outpatient clinics, there was no published data on the disease spectrum of cervical lymphadenopathy among adult outpatients. We are evaluating the disease spectrum of cervical lymphadenitis in the outpatient setting. Methods: As for the patients with cervical lymphadenitis, ultrasound-guided core-needle gun biopsy has been performed in Korea University Hospital. We reviewed medical records of adult outpatients with cervical lymphadenitis between January 2004 and April 2006, and compared the clinical, laboratory and radiological differences among them. Results: The study included 147 patients with the mean age of 33.7 years. Histopathological diagnoses were obtained from 137 (93.2%) cases: Kikuchi''s disease (34.7%), tuberculous lymphadenitis (22.4%), non-specific lymphadenitis (22.4%), lymphoma (6.1%), metastatic carcinoma (3.4%), etc. Overall, clinical manifestations were indistinguishable among tuberculous lymphadenitis, Kikuchi''s disease and non-specific lymphadenitis. Leucopenia was characteristic of Kikuchi''s disease, while anemia, thrombocytosis and pulmonary tuberculosis (irrespective of activity) were more common in the tuberculous lymphadenitis. Conclusion: Kikuchi''s disease and tuberculosis were the most common and clinically important causes of cervical lymphadenitis. Complete blood count, chest X-ray and ultrasound-guided core-needle gun biopsy would be helpful in the differential diagnosis of cervical lymphadenitis, especially between Kikuchi''s disease and tuberculous lymphadenitis. [Copyright &y& Elsevier]

Reliably predicting infection soon after craniotomies would prevent infection and reduce treatment costs and hospitalization expenses. Therefore we analysed potential risk factors and blood count data after craniotomies for brain tumours in order to predict infection as soon as possible after surgery. We analysed 139 patients who underwent craniotomies for brain tumours from January 1997 to December 2001, and divided them into four categories (Types A to D) according to the following: increase in their white blood counts (WBCs) from Day 0 to Day 1, maximum WBC between Day 0 and Day 2, and maximum c-reactive protein (CRP) between Day 0 and Day 4 after surgery. We evaluated potential risk factors and the blood count data for infections via logistic regression analysis. Type D patients had a significantly higher rate of infection ( p  = 0.0123) than the other Types, while Type B patients had the lowest rate among the four groups ( p  = 0.0006). When Type A patients suffered CSF leakages, they had a significantly higher possibility of meningitis ( p  < 0.0001) or scalp infection ( p  = 0.012). In those Type A or D patients who were male, more than 70 years old, and suffered from metastases from primary lung cancer lesions, the possibility of pneumonia was significantly higher ( p  = 0.0178). In conclusion, we are able to predict infection within four days after craniotomies for brain tumours according to standard blood count data and certain risk factors. This possibility allows for improved care and better clinical outcomes in patients that undergo craniotomies for brain tumours. [ABSTRACT FROM AUTHOR]

: ObjectivesThis study was designed to determine the relationship between baseline white blood cell (WBC) count and angiographic and clinical outcomes in patients with unstable angina (UA)/non–ST-segment elevation myocardial infarction (NSTEMI) and to see if WBC count was a significant predictor of outcomes independent of other biomarkers.: BackgroundInflammation has been shown to play a role in atherosclerosis and acute coronary syndromes.: MethodsWe evaluated the relationship between baseline WBC count, other baseline variables and biomarkers, angiographic findings, and clinical outcomes in 2,208 patients in the Treat angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis In Myocardial Infarction 18 (TACTICS-TIMI 18) trial.: ResultsHigher baseline WBC counts were associated with lower Thrombolysis In Myocardial Infarction (TIMI) flow grades (p = 0.0045) and TIMI myocardial perfusion grades (p = 0.03) as well as a greater extent of coronary artery disease (CAD) (p < 0.0001). A higher baseline WBC count was predictive of higher six-month mortality, ranging from 1.5% to 3.6% to 5.1% for patients with low, intermediate, and high WBC counts, respectively (p = 0.0017). In a multivariable proportional hazards model, patients with a low C-reactive protein (CRP) but an elevated WBC remained at significantly higher risk of death at six months (hazard ratio [HR] 4.3, p = 0.049), and patients with a high CRP were at even higher risk (HR 8.6, p = 0.004).: ConclusionsIn patients with UA/NSTEMI, elevations in a simple, widely available blood test, the WBC count, were associated with impaired epicardial and myocardial perfusion, more extensive CAD, and higher six-month mortality. After adjustment for traditional risk factors and other biomarkers, assessment of two inflammatory markers, WBC count and CRP, can be used to stratify patients across an eightfold gradation of six-month mortality risk. [Copyright &y& Elsevier]

: ObjectivesThe aim of this study was to determine the significance of peripheral monocytosis in clinical outcome after reperfused acute myocardial infarction (AMI), especially relating to post-infarct left ventricular (LV) remodeling.: BackgroundPeripheral monocytosis occurs two to three days after AMI, reflecting infiltration of monocytes and macrophages into the necrotic myocardium. However, the prognostic significance of peripheral monocytosis after AMI remains to be determined.: MethodsA total of 149 patients with first Q-wave AMI were studied. White blood cell (WBC) count, percentage of monocytes and serum C-reactive protein level were measured every 24 h for four days after the onset of AMI. We assessed association between peripheral monocytosis and prognosis including pump failure, LV aneurysm and long-term outcome after AMI.: ResultsPatients with pump failure (p < 0.0001) or LV aneurysm (p = 0.005) had higher peak monocyte counts than those without these complications. Predischarge left ventriculography revealed that peak monocyte count was positively correlated with LV end-diastolic volume (p = 0.024) and negatively correlated with ejection fraction (p = 0.023). Multivariate analyses showed that peak monocyte count ≥900/mm3 was an independent determinant of pump failure (relative risk [RR] 9.83, p < 0.0001), LV aneurysm (RR 4.78, p = 0.046) and cardiac events (RR 6.30, p < 0.0001), including readmission for heart failure, recurrent myocardial infarction and cardiac deaths, including sudden deaths.: ConclusionsPeripheral monocytosis is associated with LV dysfunction and LV aneurysm, suggesting a possible role of monocytes in the development of LV remodeling after reperfused AMI. [Copyright &y& Elsevier]