Identifying prognostic risk factors for poor outcome following COVID-19 disease among in-centre haemodialysis patients: role of inflammation and frailty
Heidy HendraGisele VajgelMarilina AntonelouAegida NeradováBethia MansonSarah Grace ClarkIoannis D. KostakisBen CaplinAlan D. Salama
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Abstract:
The pandemic of coronavirus disease (COVID-19) has highly affected patients with comorbidities and frailty who cannot self-isolate, such as individuals undergoing haemodialysis. The aim of the study was to identify risk factors for mortality and hospitalisation, which may be useful in future disease spikes.Keywords:
Univariate analysis
Risk of mortality
목적: 염증 반응이 대장암의 발생에 관련된다는 여러 연구 결과가 있다. 대장 선종은 대표적인 전암 병변으로서 대장암의 발생에 중요한 역할을 하며 CRP는 염증 반응의 표지자로서 여러 질환에서 임상 의의를 갖는다. 저자들은 대장 선종과 염증 표지자인 CRP와의 연관성에 대해 알아보고자 하였다. 대상 및 방법: 건강검진을 받은 수신자 중 대장내시경을 시행 받은 5,487명을 대상으로 선종이 발견된 1,982명을 대장 선종군으로, 선종이 발견되지 않은 3,505명을 대조군으로 하였다. 이 두 군에서 평균 CRP 농도를 비교하였으며 CRP 농도에 따른 대장 선종의 위험도를 알아보았다. 또한, CRP 농도와 관련된 여러 인자들의 차이에 대해 비교하였으며 대장 선종의 크기와 조직학적인 차이에 따른 CRP 농도의 변화를 알아보았다. 결과: 두 군을 비교했을 때, CRP 농도의 차이는 없었다. 또한, 여러 인자들을 보정했을 때도 CRP 농도는 대장 선종의 발생을 예측하지 못했으며 CRP 농도에 따른 대장 선종의 위험율에서도 차이는 없었다. 대장 선종의 크기와 조직학적인 차이에 따른 CRP 농도 역시 유의한 차이가 없었다. 결론: 염증 반응의 표지자로서 CRP 농도는 대장 선종의 발생 및 특징과 유의한 연관성을 갖지 않는다.
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C-Reactive protein serum levels were measured in 57 pediatric patients with 3% to 92% total body surface area burns to determine whether a defined rise in C-reactive protein serum levels could indicate sepsis earlier in burn patients. A rise in C-reactive protein serum levels was defined as an increase of at least 3 mg/dL for 2 days or 10 mg for 1 day. Increases the first 2 days after the burn or the day after surgery were excluded, since these injuries increase C-reactive protein serum levels. Patients were defined as septic when they were on systemic antibiotics and exhibited at least two of 16 specific clinical parameters. C-Reactive protein serum levels correctly predicted sepsis 82% of the time (efficiency=82%). Nonseptic patients generally did not show increased C-reactive protein serum levels (specificity=69%). When sepsis did occur, it always was preceded by increased C-reactive protein (sensitivity=100%), and the increased C-reactive protein occurred 2.3+/-0.5 days before the patient was deemed septic clinically. Hence, a defined rise in C-reactive protein serum levels can predict sepsis sooner in burned children.
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In centrally located non-small cell lung cancer (CLNSCLC) surgery, large tumors and extension to neighboring structures prevent the attainment of adequate surgical fields and make operations more difficult, and some patients have extremely poor outcomes. This study aimed to identify novel postoperative prognostic factors in patients with advanced CLNSCLC.CLNSCLC was defined as a tumor requiring pneumonectomy or sleeve lobectomy for complete removal. We retrospectively investigated the clinical courses of 35 patients with cT3-4 CLNSCLC.This study included 21 patients with cT3 and 14 with cT4 lung cancer. Nine patients underwent pneumonectomy and 26 underwent sleeve lobectomy. Univariate analysis revealed that a high neutrophil-to-lymphocyte ratio (NLR, p=0.005) and carcinoembryonic antigen (CEA) positivity (p=0.028) were significant poor prognostic factors. Only high NLR (p=0.020) was a significant independent predictor in multivariate analysis. Nine of 16 patients with high NLR (56%) experienced disease recurrence, whereas 6 of 19 patients without high NLR (32%) had recurrent disease.High NLR and CEA positivity were significant poor prognostic factors in patients with cT3-4 CLNSCLC, and only high NLR was an independent predictor. Our findings may be helpful in selecting optimal treatments for advanced CLNSCLC.
Univariate analysis
Carcinoembryonic antigen
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Dialysis efficiency can be increased while shortening the duration of the treatment by the use of highly permeable dialysis membranes, larger surfaces, and higher blood and dialysate flows. However, vascular repletion of water and solutes, compared with the amount removed by rapid dialysis, is a limitation of short dialysis. This can be overcome by ultrashort daily dialyses, preferably performed by the patient alone. A safe, efficient, and user-friendly apparatus has been developed to permit Ultrashort Daily Auto Dialysis (UDAD).
Dialysis tubing
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Objective To appraise the early changes and clinical significances of C-reactive protein(CRP) and high sensitive C-reactive protein(hsCRP) in septicemia of newborn.Methods The densities of CRP and hsCRP were measured in 96 newborn patients with septicemia(septicaemia group) and 93 newborn patients with other diseases(control group) from August 2009 to January 2011,then the changes of the CRP and hsCRP positive rate were observed in two groups.Results The CRP positive rate was 94.79% in septicaemia group,and 8.60% in control group,with the significant difference between them(P0.05);the hsCRP positive rate was 97.92% in septicaemia group,and 5.38% in control group,with the significant difference between them(P0.05).However,the densities of CRP and hsCRP were federatively measured can improve the successful rate.Conclusion The early changes of CRP and hsCRP were significant and they conduce to early clinical diagnosis in septicemia of newborn.
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It is now recognized that inflammatory processes regulate all stages of atherosclerosis, from disease initiation to thrombotic complications. C-reactive protein (CRP) is a plasmatic protein used as a general marker of inflammation. The high sensitivity C-reactive protein (hsCRP) refers to the measurement of CRP in blood samples using assays with sufficient sensitivity to quantify low (baseline) levels of this biomarker. Low-grade chronic inflammatory processes are linked to atherosclerosis and may be screened with the use of hsCRP, thus providing additional information in cardiovascular risk prediction. This review elaborates the role of CRP in atherogenesis and the value of hsCRP as a biomarker in cardiovascular risk prediction in both primary and secondary prevention setting. Keywords: Atherogenesis, biomarker, cardiovascular disease, C-reactive protein, high sensitivity C-reactive protein, inflammation, prevention.
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Atherosclerosis is the main cause of myocardial infarction (MI) and inflammation is considered as a main cause of atherosclerosis. Inflammatory indicators such as C-reactive protein (CRP) are considered as a diagnostic marker for MI in recent years. We studied the relationship between seropositivity to CRP and high-sensitivity- reactive protein (hsCRP) with MI and compared their relationship and diagnostic values. All sera of patients and control cases were examined by a commercial quantitative ELISA kit for measuring hsCRP and by a non-quantitative latex agglutination kit for detecting CRP, simultaneously. Results were analyzed by chi -square statistic test in SPSS software version 16. About 62.0% of patients were positive for CRP and 100% positive for hsCRP but in control group, seropositivity rate was 6.6% for CRP and 52.6% for hsCRP. Mean titer of hsCRP in patients was 23.2 but 6.3 mg/l in control group. We found significant relationship between CRP and MI (P=0.004) and with hsCRP with MI (P=0.002). hsCRP and CRP have significant relationship to MI as diagnostic indicators and hsCRP is more sensitive than CRP but regarding to their false positive and negative values, and for decreasing their accuracy, it is recommended to perform both simultaneously. Key words: C-reactive protein (CRP), high-sensitivity- reactive protein (hsCRP), myocardial infarction.
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Background Low C-reactive protein in acute bacterial infections could convey the erroneous impression of a mild infection. We focussed on gram-negative bacteraemia, a phenomenon frequently seen at the emergency room.Methods Of 2200 patients with gram-negative bacteraemia, 460 patients with first C-reactive protein <30 mg/L and 460 patients with C-reactive protein >187 mg/L were reviewed. Following exclusions, we finally investigated 229 and 289 patients with low and high C-reactive protein concentrations, respectively.Results The cohort was divided into low and high C-reactive protein groups. Median first C-reactive protein was 13.6 and 219.9 mg/L, respectively (interquartile range 6.4–21.6 and 195–270.1). Compared to patients with first high C-reactive protein, patients with first low C-reactive protein concentrations had a significant five-fold higher C-reactive protein level with their second test.Conclusions Patients with gram-negative bacteraemia can present with C-reactive protein within the range of apparently healthy individuals. A second C-reactive protein might help to avoid an erroneous decision regarding the severity of the infection.
Interquartile range
Bacteremia
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1989년 1월부터 1990년 6월까지 서울 고려병원 산부인과에 조기양막파수로 입원한 산모 89 명과 정상대조군 산모 46명을 대상으로 융모양막염의 조기진단을 위한 C-reactive protein검사 를 시행하여 아래와 같은 결과를 얻었다. 1. 두 군사이에 기존 검사인 백혈구수, 감별혈구수 및 적혈구 침강속도와 CRP의 평균치를 비교해본 결과 파수군에서 모두 높게 나타났으며, 특히 CRP test에서는 파수군 8.7mg/L, 대조 군 3.5mg/L로 유의한 차이를 보였다(p<0.01). 2. CRP양성율은 파수군이 43.8%로 대조군의 17.4%보다 높았다. 3. 융모약막염에서 염증 정도에 따라 경증 및 중증으로 분류하여 CRP평균치를 비교해 본 결 과, 경증은 10.7mg/L, 중증은 33.2mg/L로써 염증정도가 심한 경우 CRP평균치가 의미있게 높 았다(p<0.01). 4. CRP의 민감성, 특이성, 양성 및 음성 예측율을 기존의 검사법(백혈구수, 감별혈구수, 적혈 구 침강속도)과 비교한 결과 CRP test가 78.5%, 87.2%, 76.7%, 82.0%로써 기존의 검사법보다 모 두 우수한 결과를 보였다. 5. 파수군에서, 양막파수후 분만까지 시간이 경과할 수록 CRP양성율은 증가하는 경향을 보 였다. 6. 파수군에서, 임신주수가 적을 수록 CRP치도 높고, CRP양성율도 증가하는 경향을 보였다. 7. 두 군사이의 분만 방법을 비교해 본 결과, 파수군에서 제왕절개술의 비율이 39.3%로써 대 조군의 21.7%보다 높았다.
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Abstract Background Quality of life for haemodialysis (HD) patients may be affected by symptoms during dialysis treatments, and patient groups have highlighted the need to improve post-dialysis fatigue and dialysis-related symptoms. As changes in extracellular water (ECW) may lead to cramps and other symptoms, we wished to determine whether there was an association between ECW and intra-dialytic symptoms. Methods We reviewed the hospital records of HD patients who completed a self-reported intra-dialytic symptom questionnaire, using a visual analogue scale, who had contemporaneous pre- and postdialysis bioimpedance ECW measurements adjusted to height (aECW). Results We studied dialysis sessions of 506 patients, 314 (62.1%) male, 226 (44.7%) diabetic, mean age 64.6 ± 15.7 years, weight 69.9 ± 17.4 kg, and duration of dialysis treatment 26 (9.6–60.1) months. We divided patients into three groups according to pre-dialysis aECW, and total dialysis symptom scores were greater for those in the lower tertile (25 (10–41) vs middle 18 (8.5–34) vs upper 20 (7–31), p < 0.05). Only feeling cold, dizziness, and low blood pressure were statistically different between the three pre-dialysis aECW groups, and there was no difference in post-dialysis recovery times. We analysed the effect of the fall in aECW pre-to post-dialysis. Patients in the group with the greatest fall in aECW did not report more intra-dialytic symptoms or longer recovery times. Conclusion We found that patients starting dialysis with lower relative ECW were more likely to report intra-dialytic symptoms than those with greater amounts of fluid to remove, and most commonly reported symptoms were associated with intra-vascular volume depletion.
Nephrology
Dialysis adequacy
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