Untangling the influence of depression on clinical risks: role of leukocytes and somatic symptoms
Alessandro GialluisiFrancesca BraconeSimona CostanzoAugusto Di CastelnuovoSabatino OrlandiAmalia De CurtisChiara CerlettiMaria Benedetta DonatiGiovanni de GaetanoLicia Iacoviello
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Abstract Background Depression has been associated with increased hospitalization and mortality risk, especially for cardiovascular causes. We previously found a composite circulating inflammation score (INFLA-score) to explain part of this link, although the role of its component and of depressive symptoms domains in this relationship is unexplored. Methods In an Italian population cohort (N = 13,191; age≥35 years; 51.7 % women; 4,856 hospitalizations and 471 deaths, median follow-up 7.28/8.24 years), we estimated the proportion of association explained by C-reactive protein levels (CRP), platelet count, granulocyte-to-lymphocyte ratio (GLR) and white blood cell counts (WBC), in multivariable Cox regressions modelling first hospitalization/mortality for all and cardiovascular (CVD), ischemic heart (IHD) and cerebrovascular disease (CeVD) causes vs depression severity based on an alternative validated version of PHQ-9. We also estimated the proportion of association explained by INFLA-score in the associations of polychoric factors tagging somatic and cognitive depressive symptoms with clinical risks. Results In models adjusted for age, sex and education, significant proportions of the positive influence of depression on clinical risks were explained by CRP (4.8% on IHD hospitalizations), GLR (11% on all-cause mortality) and WBC (24% on IHD/CeVD hospitalizations). Stable associations of somatic but not of cognitive depressive symptoms were observed with increased hospitalization risk (+16% for all causes, +14% for CVD causes), with INFLA-score again explaining small but significant proportions of these associations (2.5% for all causes, 8.6% for IHD causes). Conclusions These findings suggest a prominent explanatory role of leukocytes in the link between depression and clinical (especially CVD) risks, and highlight the importance of inflammation in the influence of somatic depressive symptoms. Therefore, acting on these factors may reduce clinical risks associated with depression. Key messagesKeywords:
Depression
White blood cell
White blood cell
Inflammatory response
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Objective To study the quickread C-reactive protein and white cell examining in the child clinical application. Methods To choice children of fever outpatient of various disease in child hospital totally 745 examples, direct from new born baby's heel bottom or child's finger point to adopt the whole blood to makes the CRP examination and white cell examination, statistics analysis. Results In 745 examples fever sufferer, the white cell and CRP abnormal for 195 examples, only the white cell abnormal for 201 examples, only the CRP abnormal for 98 examples, the white cell and the CRP are normal for 349 examples. CRP examination compare to CRP examination compare to WBC counting, χ 2=35.5, P0.005; WBC counting compare to CRP examination and WBC counting, χ 2=98, P0.005. Conclusion The WBC counting is more sensitive than CRP test, but the CRP and the WBC jionting examination in the child clinical application is more extensive and more sensitive, the particularrity is higher, identification for the germs or not germs infection, judgering buildup inflammation or harms, it is benificial to react the sufferer's condition on time.
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Objective To study the relationship between C-reactive protein(CRP) and white blood cell(WBC) in children with acute bacterial infection(ABI).Methods Serum CRP and WBC were detected in 41 patients with ABI,at different stage(age:≤28 d,≤2 months,6 months,6 months-6 years).Comparison study was performed in diagnostic rate of ABI between CRP and WBC.CRP was assayed by immuturbimetric method.WBC was detected by cell counter model CD-3700.Results In the 41 cases,the level of CRP and WBC were increased in 6 cases accounting for 14.63%;the level of CRP was increased and that of WBC was normal in 27 cases accouuting for 65.85 %;the level of CRP and WBC was normal in 8 cases accounting for 19.51%(8/41).Conclusion The measurement of serum level of CRP provides the evidence of diagnosis in patients with ABI more sensitively and specifically than does WBC.CRP also plays an important role for the observation in patients with ABI.
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We examined the association between baseline peripheral white blood cell count and C-reactive protein (CRP) values with outcomes among 153 children hospitalized with pneumonia. In multivariable analyses, CRP, but not white blood cell count, was significantly associated with both fever duration and hospital length of stay. For every 1mg/dL increase in CRP, length of stay increased by 1 hour.
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Objective To explore the significance of CRP in the diagnosis and treatment of pediatric diseases. Methods The highest CRP value and the total number of white blood cells of hospitalized children during hospitalization were detected ,divided into 6 groups according to the level. To compare the relationship among the total number of WBC,CRP and PCT of each group in the infectious diseases and compare the changes of the total number of WBC and CRP before and after treatment. Results CRP and serum procalcitonin (PCT) was positively correlated (P ＜ 0.01), but a large part of white blood cells did not associate with the PCT. In total white blood cells of 6 groups,3 groups had no statistically significant changes before and after treatment, while the CRP abnormal changes of 5 groups before and after treatment was statistically significant(P ＜0.05). Conclusion CRP was not only as the initial identification of indicators of the children with bacterial infections and viral infections,but also reflected the severity of inflammation. CRP should be used as a routine examination of outpatient with fever, associated with the analysis of the white blood cell could play an important role in reducing the abuse of antibiotics.
Key words:
C-reactive protein; Diagnosis; White blood cell; Infection
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White blood cell
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Objective To investigate the clinical value of high sensitive C-reactive protein(hs-CRP)in septic knee.Methods The results of hs-CRP,erythrocyte sedimentation rate (ESR),white blood cell count(WBC),neutrophile granulocyte percentage (NGP) of 46 septic knee cases were compared and analyzed retrospectively.Results The sensitivity of hs-CRP was higher than WBC and NGP,not higher than ESR.The same as other examinations,the levels of hs-CRP had not significant difference between the patients with different degree of synovial infection.None of the four examinations showed significant difference when symptoms relieve.There was weak positive linear correlation between hs-CRP and ESR.Conclusion High sensitive C-reactive protein doesn’t show higher clinical value in septic knee.
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Total white blood cell (WBC) counts and serum C-reactive protein (CRP) are used as inflammatory markers in febrile children. We studied the occurrence and clinical significance of discrepancy in these markers. From a 2-y period, we retrospectively reviewed the medical records of febrile children (≥1 month of age) with WBC ≥15×109/l and/or CRP levels ≥80 mg/l, as well as of children with lower values in both these parameters. WBC and CRP were discordant in 556 children and concordantly high in 194 children. A severe bacterial disease was presumed in 57% of children with concordantly high WBC and CRP, in 20% of those with discordant values, and in 5% of those with low levels of these markers (p<0.001). Non-streptococcal tonsillitis was the most common viral infection associated with elevated WBC and CRP. In conclusion, WBC and CRP are commonly discrepant in febrile children. Measuring both markers increases substantially the detection rate of bacterial infections.
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