Role of Acute Phase Reactants: Study in Diabetic and Non Diabetic Patients Suffering from Sepsis in India
Acute Phase Reactants on Patients Suffering From Sepsis in India
Abstract
Background: In the modern era of critical care management, sepsis remains a serious problem accounting for thousands of death per year with noteworthy morbidity and mortality. Sepsis results in multi-organ dysfunction secondary to culture-positive or negative infection. In diabetes mellitus (DM), the major problem is vurnerable infection or sometimes development of sepsis and septic shock. Researchers showed DM has reduced bacterial clearance as hyperglycemia decreases polymorphonuclear function and less production of inflammatory cytokines. Thus DM creates a co-morbid condition in sepsis. The mechanism of the inter-twining of diabetes, infection and inflammatory response in sepsis is quite unclear.
Research methods: Our objective remains in clarifying the reliability of acute phase biomarkers as diagnostic tool (Procalcitonin; PCT and C-reactive protein; CRP) in diabetic patient in comparison to non-diabetic patients with sepsis. A total of 40 subjects, (20 patients had sepsis with DM, 20 patients had sepsis without DM) were enrolled. PCT, CRP, and other laboratory testing (WBC count, ESR, serum lactate, albumin) were done for all subjects at admission. Subjects were managed according to hospital protocol and followed up till remedy. Acute phase biomarker status was assessed based on their stratified concentration in groups.
Results: Compared with non-DM group, PCT and CRP in DM group were significantly high (all P < 0.05) and associated with bad outcome.
Conclusion: PCT level (> 40 ng/mL; odds ratio> 1) and CRP level (>100 mg/L; odds ratio >1) proved to be a reliable acute phase marker of sepsis patients with DM in Indian population.
Keywords:
Sepsis, C-reactive protein, diabetes, biomarker, procalcitonin
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References
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Becker K.L., Nylen E.S., White J.C., Muller B., Snider R.H., Jr. (2004). Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: A journey from calcitonin back to its precursors. J Clin Endocrinol Metab., 89, 1512–1525. doi: 10.1210/jc.2002-021444.
Boras E., Slevin M., Alexander M.Y., Aljohi A., Gilmore W., Ashworth J., Krupinski J., Potempa L.A., Al Abdulkareem I., Elobeid A., Matou-Nasri S. (2014). Monomeric C-reactive protein and Notch-3 co-operatively increase angiogenesis through PI3K signalling pathway. Cytokine., 69(2),165-79. doi: 10.1016/j.cyto.2014.05.027. Epub 2014 Jun 25.
Brechot N., Hekimian G., Chastre J., Luyt, C.E. (2015). Procalcitonin to guide antibiotic therapy in the ICU. Int J Antimicrob Agents., 46, S19–S24. doi: 10.1016/j.ijantimicag.2015.10.012.
Brenner D.R., Scherer D., Muir K., Schildkraut J., Boffetta, P., Spitz M.R., Le Marchand L., Chan A.T., Goode EL., Ulrich C.M., Hung R.J. (2014). A review of the application of inflammatory biomarkers in epidemiologic cancer research. Cancer Epidemiol Biomarkers Prev., 23(9),1729-51. doi: 10.1158/1055-9965.EPI-14-0064. Epub 2014 Jun 24.
Calrk I.A., Alleva L.M., Mills A.C., Cowden W.B. (2004). Pathogen of malaria and clinically similar conditions. Clin Microbio Rev., 17(3),509–39.
Chatterjee S., Bhattacharya M., Todi S.K. (2017). Epidemiology of Adult-population Sepsis in India: A Single Center 5 Year Experience. Indian J Crit Care Med. , 21(9),573-577. doi: 10.4103/ijccm.IJCCM_240_17.
Dandona P., Nix D., Wilson M.F., Aljada A., Love J., Assicot M., Bohuon C. (1994). "Procalcitonin increase after endotoxin injection in normal subjects". The Journal of Clinical Endocrinology and Metabolism., 79 (6), 1605–8. doi:10.1210/jc.79.6.1605. PMID 7989463.
Davies J. (2015).Procalcitonin. J Clin Pathol. , 68,675–679. doi: 10.1136/jclinpath-2014-202807.
Feldmann H., Geistbert T.W. (2011). Ebola, hemorrhagic, fever. Lancet., 377(97768),849–62.
Filho R.R., Rocha L.L., Corrêa T.D., Pessoa C.M., Colombo G., Assuncao M.S. (2016). Blood Lactate Levels Cutoff and Mortality Prediction in Sepsis-Time for a Reappraisal? a Retrospective Cohort Study. Shock., 46(5),480-485.
Fleischmann. C., Scherag. A., Adhikari. N.K., Hartog C.S., Tsaganos T., Schlattmann P., Angus D.C., Reinhart K. (2016). International Forum of Acute Care Trialists. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. Am J Respir Crit Care Med., 193(3), 259-72. doi: 10.1164/rccm.201504-0781OC.
Hine J.L., de Lusignan S., Burleigh D., Pathirannehelage S., McGovern A., Gatenby P., Jones S., Jiang D., Williams J., Elliot AJ., Smith GE., Brownrigg J., Hinchliffe R., Munro N. (2017). Association between glycaemic control and common infections in people with Type 2 diabetes: a cohort study. Diabet Med., 34(4), 551-557. doi: 10.1111/dme.13205. Epub 2016 Sep 22.
Hübner M., Mantziari S., Demartines N., Pralong F., Coti-Bertrand P., Schäfer M. (2016). Postoperative Albumin Drop Is a Marker for Surgical Stress and a Predictor for Clinical Outcome: A Pilot Study. Gastroenterol Res Pract., 8743187. doi: 10.1155/2016/8743187. Epub 2016 Jan 6.
King H., Aubert R.E., Herman W.H. (1998). Global burden of diabetes, 1995-2025: Prevalence, numerical estimates, and projections. Diabetes Care., 21,1414-31.
Lelubre C., Anselin S., Zouaoui Boudjeltia K., Biston P., Piagnerelli M. (2013). Interpretation of C-reactive protein concentrations in critically ill patients. Biomed Res Int., 124021. doi: 10.1155/2013/124021. Epub 2013 Oct 28.
Levy M.M., Fink M.P., Marshall J.C., Abraham E., Angus D., Cook D., Cohen J., Opal SM., Vincent J.L., Ramsay G. (2001). SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med., 29, 530–538. doi: 10.1007/s00134-003-1662-x.
Long S.S., Pickering LK., Prober C.G, eds. (2012). "Bacterial infections in the neonate". Principles and Practice of Pediatric Infectious Diseases (4th ed.). Elsevier., ISBN 978-1437727029.
Meisner M., Tschaikowsky K., Palmaers T., Schmidt J. (1999). "Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS". Critical Care., 3 (1), 45–50. doi:10.1186/cc306. PMC 29013. PMID 11056723.
Morigi M., Angioletti S., Imberti B., Donadelli R., Micheletti G., Figliuzzi M., Remuzzi A., Zoja C., Remuzzi G. (1998). Leukocyte- endothelial interaction is augmented by high glucose concentrations and hyperglycemia in a NF-κB-dependent fashion. J Clin Invest., 101,1905–1915. doi: 10.1172/JCI656.
Oberhoffer M., Bögel D., Meier-Hellmann A., Vogelsang H., Reinhart K. (1996). Procalcitonin is higher in non-survivors during the clinical course of sepsis, severe sepsis and septic shock. Intensive Care Med., 22, A245.
Paessler S., Walker D.H. (2013). Pathogenesis of the viral hemorrhagic fever. Annu Rev Pathol., 8,411–40.
Pepys M.B., and Baltz M.L. (1983). Acute phase proteins with special reference to C-reactive protein and related proteins (pentaxins) and serum amyloid A protein. Adv. Immunol., 34,141–212.
Pepys M.B. Hirschfield G.M. C-reactive protein: A critical update. J. Clin. Invest., 2003, 111, 1805–1812. doi:10.1172/JCI200318921.
Pickup J.C., Chusney G.D., Thomas S.M., Burt D. (2000).Plasma interleukin-6, tumour necrosis factor alpha and blood cytokine production in type 2 diabetes. Life Sci., 67(3), 291–300.
Póvoa P., Coelho L., Almeida E., Fernandes, A., Mealha R., Moreira P., Sabino H. (2005).C-reactive protein as a marker of infection in critically ill patients. Clin Microbiol Infect.,11(2),101-8.
Raveendran A.V., Kumar A., Gangadharan S. (2019).Biomarkers and newer laboratory investigations in the diagnosis of sepsis. J R Coll Physicians Edinb.,49(3),207-216. doi: 10.4997/JRCPE.2019.308.
Reinhart K., Bauer M., Reideman N.C., Hartog C.S. (2010). New approaches to sepsis: molecular diagnostics and biomarkers. J Cln Microbiol., 25,609–34.
Sakr Y., Brgett U., Nacul F.E., Reinhart K., Brunkhorst F. (2008). Lipopolysaccharide binding protein in a surgical intensive care unit: a marker of sepsis? Crit Care Med., 36,2014–22.
Sang B.H., Bang J.Y., Song J.G., Hwang G.S. (2015). Hypoalbuminemia Within Two Postoperative Days Is an Independent Risk Factor for Acute Kidney Injury Following Living Donor Liver Transplantation: A Propensity Score Analysis of 998 Consecutive Patients. Crit Care Med., 43(12),2552-61. doi: 10.1097/CCM.0000000000001279.
Seymour C.W., Liu V.X., Iwashyna T.J., Brunkhorst F.M., Rea T.D., Scherag A., Rubenfeld G., Kahn J.M., Shankar-Hari M., Singer M., Deutschman C.S., Escobar G.J., Angus D.C. (2016). Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA., 23;315(8),762-74. doi: 10.1001/jama.2016.0288.
Shah B.R., Hux J.E. (2003).Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care., 26, 510–513. doi: 10.2337/diacare.26.2.510.
Shankar-Hari M., Phillips G.S., Levy M.L., Seymour C.W., Liu V.X., Deutschman C.S., Angus D.C., Rubenfeld G.D., Singer M. (2016). Sepsis Definitions Task Force. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA., 23, 315(8), 775-87. doi: 10.1001/jama.2016.0289.
Sharma D., Farahbakhsh N., Shastri S., Sharma P. (2018). Biomarkers for diagnosis of neonatal sepsis: a literature review. J Matern Fetal Neonatal Med., Jun;31(12),1646-1659. doi: 10.1080/14767058.2017.1322060.
Sierra R., Rello J., Bailen M.A., Benitez E., Gordillo A., Leon C., Pedraza S. (2004). C-reactive protein used as an early indicator of infection in patients with systemic inflammatory response syndrome. Intens Care Med., 30,2038–2045. doi: 10.1007/s00134-004-2434-y.
Singer M., Deutschman C.S., Seymour C.W., Shankar-Hari M., Annane D., Bauer M., Bellomo R., Bernard G.R., Chiche J.D., Coopersmith C.M., Hotchkiss R.S., Levy M.M., Marshall J.C., Martin G.S., Opal S.M., Rubenfeld G.D., van der Poll T., Vincent J.L., Angus D.C. (2016). The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA., 23;315(8),801-10. doi: 10.1001/jama.2016.0287.
Snider R.H. Jr., Nylen E.S., Becker KL. (1997). Procalcitonin and its component peptides in systemic inflammation: immunochemical characterization. J Invest Med., 45,552–560.
Standage S.W., Wong H.R. (2011). Biomarkers for paediatric sepsis and septic shock. Expert Rev Anti-Infect Ther., 9(1),71–9.
Tan M., Lu Y., Jiang H., Zhang L. (2018). "The diagnostic accuracy of procalcitonin and C-reactive protein for sepsis: A systematic review and meta-analysis". Journal of Cellular Biochemistry., 120 (4), 5852–5859. doi:10.1002/jcb.27870. PMID 30417415.
Thompson D., Pepys M.B., Wood S.P. (1999) The physiological structure of human C-reactive protein and its complex with phosphocholine. Structure, 7, 169–77. doi: 10.1016/S0969-2126(99)80023-9.
Tillet W.S., Francis T. (1930). Serological reactions in pneumonia with a non- protein somatic fraction of Pneumococcus. J Exp Med., 52(4):561–71. doi:10.1084/jem.52.4.561
Usama M., Nermin A., Ayman A., Sultan M.H. (2011). Serum procalcitonin in viral and bacterial meningitis. J Glob Infect Dis., 3:14–8.
Vashist S.K., Venkatesh A.G., Marion Schneider E., Beaudoin C., Luppa P.B., Luong J.H. ( 2016). Bioanalytical advances in assays for C-reactive protein. Biotechnol Adv., 34:272–290. doi: 10.1016/j.biotechadv.2015.12.010.
Volanakis J.E. (2001). Human C-reactive protein: expression structure and function. Mol Immunol., 38,189–97. doi:10.1016/S0161-5890(01)00042-6
Wang X., Sun Y., Shao X. (2019). Predictive value of procalcitonin for infection of patients with type-2 diabetes mellitus. Exp Ther Med., 18(1),722–728. doi:10.3892/etm.2019.7611.
Wellen K.E., Hotamisligil G.S. (2005). Inflammation, stress, and diabetes. J Clin Invest., 115, 1111–1119. doi: 10.1172/JCI25102.
World Health Organization. (2005). WHO Report on the burden of endemic health care-associated infection worldwide. 2017-11-21 15:11:22 2011.
World Health Organization. (WHO) (2018). https://www.who.int/news-room/fact-sheets/detail/sepsis
Becker K.L., Nylen E.S., White J.C., Muller B., Snider R.H., Jr. (2004). Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: A journey from calcitonin back to its precursors. J Clin Endocrinol Metab., 89, 1512–1525. doi: 10.1210/jc.2002-021444.
Boras E., Slevin M., Alexander M.Y., Aljohi A., Gilmore W., Ashworth J., Krupinski J., Potempa L.A., Al Abdulkareem I., Elobeid A., Matou-Nasri S. (2014). Monomeric C-reactive protein and Notch-3 co-operatively increase angiogenesis through PI3K signalling pathway. Cytokine., 69(2),165-79. doi: 10.1016/j.cyto.2014.05.027. Epub 2014 Jun 25.
Brechot N., Hekimian G., Chastre J., Luyt, C.E. (2015). Procalcitonin to guide antibiotic therapy in the ICU. Int J Antimicrob Agents., 46, S19–S24. doi: 10.1016/j.ijantimicag.2015.10.012.
Brenner D.R., Scherer D., Muir K., Schildkraut J., Boffetta, P., Spitz M.R., Le Marchand L., Chan A.T., Goode EL., Ulrich C.M., Hung R.J. (2014). A review of the application of inflammatory biomarkers in epidemiologic cancer research. Cancer Epidemiol Biomarkers Prev., 23(9),1729-51. doi: 10.1158/1055-9965.EPI-14-0064. Epub 2014 Jun 24.
Calrk I.A., Alleva L.M., Mills A.C., Cowden W.B. (2004). Pathogen of malaria and clinically similar conditions. Clin Microbio Rev., 17(3),509–39.
Chatterjee S., Bhattacharya M., Todi S.K. (2017). Epidemiology of Adult-population Sepsis in India: A Single Center 5 Year Experience. Indian J Crit Care Med. , 21(9),573-577. doi: 10.4103/ijccm.IJCCM_240_17.
Dandona P., Nix D., Wilson M.F., Aljada A., Love J., Assicot M., Bohuon C. (1994). "Procalcitonin increase after endotoxin injection in normal subjects". The Journal of Clinical Endocrinology and Metabolism., 79 (6), 1605–8. doi:10.1210/jc.79.6.1605. PMID 7989463.
Davies J. (2015).Procalcitonin. J Clin Pathol. , 68,675–679. doi: 10.1136/jclinpath-2014-202807.
Feldmann H., Geistbert T.W. (2011). Ebola, hemorrhagic, fever. Lancet., 377(97768),849–62.
Filho R.R., Rocha L.L., Corrêa T.D., Pessoa C.M., Colombo G., Assuncao M.S. (2016). Blood Lactate Levels Cutoff and Mortality Prediction in Sepsis-Time for a Reappraisal? a Retrospective Cohort Study. Shock., 46(5),480-485.
Fleischmann. C., Scherag. A., Adhikari. N.K., Hartog C.S., Tsaganos T., Schlattmann P., Angus D.C., Reinhart K. (2016). International Forum of Acute Care Trialists. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. Am J Respir Crit Care Med., 193(3), 259-72. doi: 10.1164/rccm.201504-0781OC.
Hine J.L., de Lusignan S., Burleigh D., Pathirannehelage S., McGovern A., Gatenby P., Jones S., Jiang D., Williams J., Elliot AJ., Smith GE., Brownrigg J., Hinchliffe R., Munro N. (2017). Association between glycaemic control and common infections in people with Type 2 diabetes: a cohort study. Diabet Med., 34(4), 551-557. doi: 10.1111/dme.13205. Epub 2016 Sep 22.
Hübner M., Mantziari S., Demartines N., Pralong F., Coti-Bertrand P., Schäfer M. (2016). Postoperative Albumin Drop Is a Marker for Surgical Stress and a Predictor for Clinical Outcome: A Pilot Study. Gastroenterol Res Pract., 8743187. doi: 10.1155/2016/8743187. Epub 2016 Jan 6.
King H., Aubert R.E., Herman W.H. (1998). Global burden of diabetes, 1995-2025: Prevalence, numerical estimates, and projections. Diabetes Care., 21,1414-31.
Lelubre C., Anselin S., Zouaoui Boudjeltia K., Biston P., Piagnerelli M. (2013). Interpretation of C-reactive protein concentrations in critically ill patients. Biomed Res Int., 124021. doi: 10.1155/2013/124021. Epub 2013 Oct 28.
Levy M.M., Fink M.P., Marshall J.C., Abraham E., Angus D., Cook D., Cohen J., Opal SM., Vincent J.L., Ramsay G. (2001). SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med., 29, 530–538. doi: 10.1007/s00134-003-1662-x.
Long S.S., Pickering LK., Prober C.G, eds. (2012). "Bacterial infections in the neonate". Principles and Practice of Pediatric Infectious Diseases (4th ed.). Elsevier., ISBN 978-1437727029.
Meisner M., Tschaikowsky K., Palmaers T., Schmidt J. (1999). "Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS". Critical Care., 3 (1), 45–50. doi:10.1186/cc306. PMC 29013. PMID 11056723.
Morigi M., Angioletti S., Imberti B., Donadelli R., Micheletti G., Figliuzzi M., Remuzzi A., Zoja C., Remuzzi G. (1998). Leukocyte- endothelial interaction is augmented by high glucose concentrations and hyperglycemia in a NF-κB-dependent fashion. J Clin Invest., 101,1905–1915. doi: 10.1172/JCI656.
Oberhoffer M., Bögel D., Meier-Hellmann A., Vogelsang H., Reinhart K. (1996). Procalcitonin is higher in non-survivors during the clinical course of sepsis, severe sepsis and septic shock. Intensive Care Med., 22, A245.
Paessler S., Walker D.H. (2013). Pathogenesis of the viral hemorrhagic fever. Annu Rev Pathol., 8,411–40.
Pepys M.B., and Baltz M.L. (1983). Acute phase proteins with special reference to C-reactive protein and related proteins (pentaxins) and serum amyloid A protein. Adv. Immunol., 34,141–212.
Pepys M.B. Hirschfield G.M. C-reactive protein: A critical update. J. Clin. Invest., 2003, 111, 1805–1812. doi:10.1172/JCI200318921.
Pickup J.C., Chusney G.D., Thomas S.M., Burt D. (2000).Plasma interleukin-6, tumour necrosis factor alpha and blood cytokine production in type 2 diabetes. Life Sci., 67(3), 291–300.
Póvoa P., Coelho L., Almeida E., Fernandes, A., Mealha R., Moreira P., Sabino H. (2005).C-reactive protein as a marker of infection in critically ill patients. Clin Microbiol Infect.,11(2),101-8.
Raveendran A.V., Kumar A., Gangadharan S. (2019).Biomarkers and newer laboratory investigations in the diagnosis of sepsis. J R Coll Physicians Edinb.,49(3),207-216. doi: 10.4997/JRCPE.2019.308.
Reinhart K., Bauer M., Reideman N.C., Hartog C.S. (2010). New approaches to sepsis: molecular diagnostics and biomarkers. J Cln Microbiol., 25,609–34.
Sakr Y., Brgett U., Nacul F.E., Reinhart K., Brunkhorst F. (2008). Lipopolysaccharide binding protein in a surgical intensive care unit: a marker of sepsis? Crit Care Med., 36,2014–22.
Sang B.H., Bang J.Y., Song J.G., Hwang G.S. (2015). Hypoalbuminemia Within Two Postoperative Days Is an Independent Risk Factor for Acute Kidney Injury Following Living Donor Liver Transplantation: A Propensity Score Analysis of 998 Consecutive Patients. Crit Care Med., 43(12),2552-61. doi: 10.1097/CCM.0000000000001279.
Seymour C.W., Liu V.X., Iwashyna T.J., Brunkhorst F.M., Rea T.D., Scherag A., Rubenfeld G., Kahn J.M., Shankar-Hari M., Singer M., Deutschman C.S., Escobar G.J., Angus D.C. (2016). Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA., 23;315(8),762-74. doi: 10.1001/jama.2016.0288.
Shah B.R., Hux J.E. (2003).Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care., 26, 510–513. doi: 10.2337/diacare.26.2.510.
Shankar-Hari M., Phillips G.S., Levy M.L., Seymour C.W., Liu V.X., Deutschman C.S., Angus D.C., Rubenfeld G.D., Singer M. (2016). Sepsis Definitions Task Force. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA., 23, 315(8), 775-87. doi: 10.1001/jama.2016.0289.
Sharma D., Farahbakhsh N., Shastri S., Sharma P. (2018). Biomarkers for diagnosis of neonatal sepsis: a literature review. J Matern Fetal Neonatal Med., Jun;31(12),1646-1659. doi: 10.1080/14767058.2017.1322060.
Sierra R., Rello J., Bailen M.A., Benitez E., Gordillo A., Leon C., Pedraza S. (2004). C-reactive protein used as an early indicator of infection in patients with systemic inflammatory response syndrome. Intens Care Med., 30,2038–2045. doi: 10.1007/s00134-004-2434-y.
Singer M., Deutschman C.S., Seymour C.W., Shankar-Hari M., Annane D., Bauer M., Bellomo R., Bernard G.R., Chiche J.D., Coopersmith C.M., Hotchkiss R.S., Levy M.M., Marshall J.C., Martin G.S., Opal S.M., Rubenfeld G.D., van der Poll T., Vincent J.L., Angus D.C. (2016). The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA., 23;315(8),801-10. doi: 10.1001/jama.2016.0287.
Snider R.H. Jr., Nylen E.S., Becker KL. (1997). Procalcitonin and its component peptides in systemic inflammation: immunochemical characterization. J Invest Med., 45,552–560.
Standage S.W., Wong H.R. (2011). Biomarkers for paediatric sepsis and septic shock. Expert Rev Anti-Infect Ther., 9(1),71–9.
Tan M., Lu Y., Jiang H., Zhang L. (2018). "The diagnostic accuracy of procalcitonin and C-reactive protein for sepsis: A systematic review and meta-analysis". Journal of Cellular Biochemistry., 120 (4), 5852–5859. doi:10.1002/jcb.27870. PMID 30417415.
Thompson D., Pepys M.B., Wood S.P. (1999) The physiological structure of human C-reactive protein and its complex with phosphocholine. Structure, 7, 169–77. doi: 10.1016/S0969-2126(99)80023-9.
Tillet W.S., Francis T. (1930). Serological reactions in pneumonia with a non- protein somatic fraction of Pneumococcus. J Exp Med., 52(4):561–71. doi:10.1084/jem.52.4.561
Usama M., Nermin A., Ayman A., Sultan M.H. (2011). Serum procalcitonin in viral and bacterial meningitis. J Glob Infect Dis., 3:14–8.
Vashist S.K., Venkatesh A.G., Marion Schneider E., Beaudoin C., Luppa P.B., Luong J.H. ( 2016). Bioanalytical advances in assays for C-reactive protein. Biotechnol Adv., 34:272–290. doi: 10.1016/j.biotechadv.2015.12.010.
Volanakis J.E. (2001). Human C-reactive protein: expression structure and function. Mol Immunol., 38,189–97. doi:10.1016/S0161-5890(01)00042-6
Wang X., Sun Y., Shao X. (2019). Predictive value of procalcitonin for infection of patients with type-2 diabetes mellitus. Exp Ther Med., 18(1),722–728. doi:10.3892/etm.2019.7611.
Wellen K.E., Hotamisligil G.S. (2005). Inflammation, stress, and diabetes. J Clin Invest., 115, 1111–1119. doi: 10.1172/JCI25102.
World Health Organization. (2005). WHO Report on the burden of endemic health care-associated infection worldwide. 2017-11-21 15:11:22 2011.
World Health Organization. (WHO) (2018). https://www.who.int/news-room/fact-sheets/detail/sepsis
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How to Cite
Ansar, W., & Habib, S. (2020). Role of Acute Phase Reactants: Study in Diabetic and Non Diabetic Patients Suffering from Sepsis in India. International Journal of Advancement in Life Sciences Research, 3(2), 40-49. https://doi.org/https://doi.org/10.31632/ijalsr.20.v03i02.005
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Research Articles
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