Online ISSN: 2515-8260

Keywords : CRP

Does COVID-19 hit hard in Diabetic Patient: A Cross-sectional study at Tertiary Care Hospital

Dr.C.Ranjani, Dr.S.Sukanya, Dr.R.Rajesh Gowtham, Dr.Sopia Abigail, Dr.B.Ananthi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 717-724

Background and Objective
Coronaviruses are a family of viruses that can cause respiratory illness in humans. They are called “corona” because of crown-like spikes on the surface of the virus. Severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and the common cold are examples of coronaviruses that cause illness in humans.
The primary mode of transmission of SARS-CoV-2 is via exposure to respiratory droplets carrying the infectious virus from close contact or droplet transmission from pre-symptomatic, asymptomatic, or symptomatic individuals harbouring the virus
This study is conducted to analyse the extent of association between COVID-19 & Diabetes Mellitus and its correlation with the inflammatory markers as it is still unclear if diabetes interferes in the prognosis of COVID-19
Material & Methods
A Cross-sectional study was conducted over a period of 6 months from April 2021–September 2021.Among 149 RT-PCR positive COVID-19 patients the random blood sugar levels, CT chest severity score & C-Reactive Protein was compared among the diabetic & non-diabetic population in ACS Medical college & hospital Chennai.
The study shows that out of 149 COVID-19 positive patients, 88 (59.1%) were diabetic & 61 (40.9%) were non-diabetic. Patients with diabetes had significantly higher CT chest severity score and elevated C-reactive protein than non-diabetic patients.
The interaction between covid-19 & diabetes could be bi-directional, with SARS-CoV-2 potentially worsening pre-existing diabetes.

To identify rising level of CRP and D-Dimer as a predictor of increased morbidity and mortality in COVID -19 patient- A retrospective study

Dr. Mayank Varshney, Dr. Y.P. Singh, Dr. Akhil Taneja, Dr. Saurabh Jain, Dr. Gaurav Pratap Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 847-855

Aim and objectives: The present study assessed the correlation between rising levels of CRP and D-dimer with morbidity and mortality in adult Covid -19 patients.
Materials and method: This retrospective observational study was conducted at Max Super speciality Hospital I.P. Extension, Delhi a tertiary care centre in North India. CRP and D-Dimer values were collected at the time of admission and within 15 days after admission. The statistical analysis was done by independent t-test.
Results: The study population consisted of 194 (64.7%) males and 106 (35.3%) females. The mean age of the study population was 56.78±15.42 (28-94) years. The mean age of the non-survivors (58.83±15.64 years) was significantly more than survivors (54.43±14.85 years). The mean CRP and D-DIMER at the time of admission and within 15 days after admission was significantly more among non-survivors compared to survivors.
Conclusion: A high CRP and elevated D-Dimer levels among COVID-19 patients predict higher odds of mortality; however, large scale and longer-term studies are needed to validate our findings. The predictive model based upon CRP and D-DIMER levels can help the clinicians to improve individual treatment, make timely clinical decisions, and make optimal use of limited clinical resources.

Role of C-Reactive Protein and Neutrophil Lymphocyte Ratio in Predicting Severity of Acute Appendicitis

Puli Vineela, N.Ashok Vardhan Kumar, MdShadab Jaseem, J. Parthasarathi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2435-2442

Background:The aim of this study is to analyse the role of c- reactive protein and neutrophil lymphocyte ratio accuracy in diagnosis of acute appendicitis and perforated appendicitis.
Materials and Methods: The present study is ROLE OF C-REACTIVE PROTEIN AND NEUTROPHIL LYMPHOCYTE RATIO IN PREDICTING SEVERITY OF ACUTE APPENDICITIS done at Kamineni Institute of Medical Sciences, Narketpally from October 2018 to September 2020.
Results: 100 cases of acute appendicitis which were admitted in kamineni institute of medical sciences were studied. The statistical data and analysis of the cases studied during this period are presented in this study out of 100 cases 14 were managed conservatively and 86 were subjected to surgery, 4 had no inflammatory changes on histopathology and 82 had histopathological features confirming acute appendicitis. Acute appendicitis more common in males than females with a ratio of 2.22:1 with complications also being more common in males. Incidence of acute appendicitis was highest in age group ranging from 20-30 years , with complicated appendicitis being more common in the age distribution of 35.87 +/-18.31 years. Most patients present with pain predominantly in right iliac fossa (100%) followed by nausea/vomiting in 82% and fever in 78% cases. Total leucocyte count was found to be elevated in 86% of individuals with elevations in range of 15825+/-4575 in patients with complicated appendicitis. Neutrophil lymphocyte ratio was found to be elevated in 86% of individuals with elevation in range of 10.6+/-5.49 in patients with complicated appendicitis. CRP values were found to be elevated in 68% of cases. In patients with uncomplicated appendicitis 52% showed elevation of CRP levels whereas in patients with complicated appendicitis 87% showed elevation of CRP levels.
Conclusion: CRP and neutrophil lymphocyte ratio were found to be elevated in cases of acute appendicitis with complications. Elevation in neutrophil lymphocyte ration and c - reactive protein levels can be used to anticipate severity and complications in patients of acute appendicitis.

To assess the function of CRP as a biomarker in COPD acute exacerbation

Dr. Shikhar Tripathi, Dr. Rohit Pathak, Dr. Vipin Chaudhary

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 11726-11731

Aim: The purpose of this research is to assess the function of CRP as a biomarker in COPD acute exacerbation.
Methods: The Department of Respiratory Medicineconducted this cross-sectional research. After washing their mouths twice with plain water, all patients were advised to collect deep coughed up phlegm into a sterile wide mouth container with a screw cover. The samples were promptly sent to the microbiology laboratory and processed within 30 minutes of being collected. Gram staining was performed on a sputum sample and results were reported using Bartlett's grading method. A appropriate sample was defined as one with a score of 1 or above. Mac Conkey's agar, chocolate agar, and blood agar plates were inoculated with appropriate sputum samples. Standard microbiological procedures established by the American Society for Microbiology were used to identify the isolated organisms. Sputum samples cultured for pathogenic bacteria were classed as Bacterial exacerbations, whereas samples with no pathogenic bacteria or oral commensals were classified as Non bacterial exacerbations.
Results: Among the 100 patients, 65 had bacterial growth on culture and were classed as Bacterial COPD exacerbation. The other 35 instances in which no bacterial growth or oral commensals were found were classed as Non Bacterial COPD exacerbation. Using the crude odds ratio, it was determined that the chances of Bacterial Exacerbation for patients with COPD "≥5 years" are 2.87 (95 percent CI: [1.26,6.88]) times greater than persons with COPD "<5 years." Furthermore, smokers had a 3.77(95 percent CI[1.50,10.28]) greater risk of bacterial exacerbation than nonsmokers. In our investigation, the optimal CRP cut-off point for separating Bacterial COPD patients with Bacterial Exacerbation from those without Bacterial Exacerbation was 8.77 mg/L (sensitivity:97%; specificity:40%; PPV:75%; NPV:87%, AUC:0.77).
Conclusion: Higher CRP levels are related with individuals experiencing Bacterial COPD exacerbations rather than Non Bacterial COPD exacerbations. CRP levels might therefore be utilised to anticipate Bacterial exacerbations and also to recommend antibiotic treatment.

Assessment of patients with sepsis and septic shock Using Procalcitonin and C-reactive Protein

Abdelhamid Mohammad Abdelhamid, Hassan Mohammad Mageed, Ghada Mohammad Abdel Razik,Sherif M. S. Mowafy .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 885-894

Background: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection inside ICU. The aim of the present study was to assess the Relation between levels of procalcitonin and C-reactive protein as markers with severity of sepsis and septic shock.
Patients and methods: This observational study was involved 60 patients who diagnosed with sepsis or septic shock and admitted to Surgical intensive care unit, Zagazig University Hospitals, Egypt. Procalcitonin and C-reactive protein levels were estimated in the 1st, 3rd, and 5th ICU day. APACHE II as well as SOFA Scores were estimated on ICU admission.
Results: Patients were classified according to the need for mechanical ventilation (MV group and non-MV group), CRP showed no significant difference between the two groups on the first day (100.51 and 83.21 mg/dl respectively- p=0.108). The remaining readings showed a significant rise in the patients that needed invasive mechanical ventilation. Serum PCT levels showed a significant rise in the MV group throughout the all study readings (p < 0.001). Likewise, SOFA score recordings were significantly higher in the MV patients (p < 0.001). On assessment of the predictors for vasopressor need, the highest sensitivity was reported for 3rd day CRP (84.1% - cut off = 62.01 mg/dl), and 5th  day PCT (84.1% - cutoff = 0.505 ng/ml). Slight decrease in sensitivity (81.8%) was reported with the application of 1st day PCT and 3rd day SOFA.
Conclusion: PCT and CRP can be used as a  prognostic markers for evaluating the prognosis of patients with sepsis and septic shock.regarding need for vasopressors the highest sensitivity was reported for 3rd day CRP and fifth day PCT, however the length of stay was found to be highly correlated with 3rd day PCT, also 1st day PCT value was better to Predict need for Mechanical ventilation.

Correlating inflammatory markers with clinical profile and final outcome in patients with Covid 19 admitted to a tertiary care setup

Dr. Mallikarjun HP,Dr. Ashwin DK,Dr. Ashitha B,Dr. Ramya Bhat S

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 2296-2303

Background: The ongoing worldwide Coronavirus Disease 2019 (COVID-19) pandemic has posed a huge threat to global public health1. COVID-19 represents a spectrum of clinical severity ranged from asymptomatic to critical pneumonia, acute respiratory distress syndrome (ARDS) and even death. Therefore, full monitoring the severity of COVID-19 and effective early intervention are the fundamental measures for reducing mortality.
Accumulating evidence has suggested that inflammatory responses play a critical role in the progression of COVID-19 3. Inflammatory responses induce the release of cytokines and chemokines. These cytokines and chemokines then attract immune cells and activate immune responses, leading to cytokine storms and aggravations4. Several inflammatory markers have some tracing and detecting accuracy for disease severity and fatality. But the results are inconclusive, with various studies giving different results. Our study intends to correlate levels of inflammatory markers with severity of Covid 19 infection and its final outcome.
Methods and materials:This is a retrospective study which includes 818 patients admitted to our hospital during the second wave of Covid 19 pandemic with confirmed Covid 19 infections by RTPCR. Admitted patients included mild disease to severe Covid 19 infections. Those patients who have received standardized treatment according to hospital protocol were included in the study. Data was collected and entered in pre-designed proforma. Results obtained will be compiled in excel sheet and will be analyzed statistically.
Results: Total of 818 patients were admitted to our hospital between May to July 2021. Of which 341 had mild disease, 241 had moderate disease, 237 patients had severe disease on presentation.While looking into the final outcome of the disease, 175 patients died due Covid 19 pneumonia or its complication, 52 patients were discharged with oxygen support.  Of 237 patients with severe disease 150 patients had CRP levels >75mg/dl. Of 175 patients who died, 121 had CRP levels >75 mg/dl. Of 237 patients with severe disease, 122 of them had D-dimer >1000 ng/ml. Of 175 patients who died with Covid 19, 103 of them had d-dimer levels >1000 ng/ml.CRP and D-dimer were significantly increased in patients with severe disease and in patients who died of Covid 19 with p value <0.0001.
Conclusion: Increasing levels of CRP and D-dimer were good predictors of severe disease in Covid 19. Also, increased levels of CRP and d-dimer were suggestive of poorer outcome of the disease in terms of mortality and morbidity in Covid 19 infection.

Using of calprotectin and lactoferrin levels in early detection of acute uncomplicated appendicitis in children

Athir Ahmed Kadium; Alaa Mohammed Ali Al Baazi; Mahmood Mosa Mahmood

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 4335-4341

This study was conducted in Kirkuk city for the period from December, 2019 to June 2020, and included 50 children with acute appendicitisand 50 children without any other disease, where the ages of children in both groups ranged from 3-12 years. The study included collecting information from children in both groups, including gender, age, living situation, number of family members, standard of living and social as well as the number of family members, number of rooms in the house. Amount of 5 ml of blood samples were collected from all the children included in this study, where the blood samples were separated by the centrifuge device and the serum samples were separated from them and kept in the refrigerator until the tests for determination of calprotectin and lactoferrin by ELISA and CRP by immunofluorescence. In this study, there were no significant difference between the 2 groups regarding age, sex and residence. The study found that, 95% of children with appendicitis was suffered from abdominal pain , 50% with fever and weight loss, 48% with nausea and 40% with vomiting. The study revealed a significant elevated level of calprotectin in children with appendicitis as compared with healthy children(18.54±4.25 vs 11.37±3.28 ng/ml) (P<0.001). The study also exposed a significant higher level of lactoferrin in children with appendicitis as compared with healthy children(10.51±1.52 vs 2.18±0.19 ng/ml) (P<0.001).The study showed that the maximum means of calprotectin and lactoferrin in children with appendicitis were observed in those with abdominal pain, followed by vomiting. The study revealed a significant positive correlation between calprotectin and lactoferrinlevel among children with acute appendicitis.The mean serum level of CRP was significantly elevated in children with acute appendicitiscompared to control group (27.57 ± 4.22 and 5.57 ± 3.9 mg/dl) respectively at a P value < 0.001. Conclusions:The study showed a significant relation of calprotectin and lactoferrin withappendicitis.

C-reactive protein: A reliable parameter to predict the success of medical expulsive therapy using silodosin in small distal ureteric calculus

Dr.NandakishoreB, Dr.Suyog Shetty, Dr.Imdad Ali, Dr.Ravishankar THS

European Journal of Molecular & Clinical Medicine, 2018, Volume 5, Issue 1, Pages 356-361

Background: Plasma C-Reactive Protein (CRP) is an acute-phase protein whose serum level increases in response to inflammation, as happens in impacted ureteric calculus. Few studies have investigated the efficacy of silodosin, a selective alpha 1-A adrenoceptor antagonist, in medical expulsive therapy (MET) for distal ureteral calculi. The studies showed the efficacy of silodosin 8 mg/day as a potential treatment for distal ureteric calculus expulsion. In this study wedetermined the correlation of CRP Levels at the starting of MET and the success of METwith SILODOSIN after 3 weeks. Materials and Methods: 70 patients with distal ureteric calculus between 5-9 mm size were included in this study. They were divided into 2 groups based on the initial CRP level at the time of first presentation to the hospital.CRP level of 6mg/L was taken as cut-off. Group 1 with 35 patients having CRP value morethan 6and Group 2 with 35 patients having CRP value of less than 6.