Comparing high-sensitivity C-reactive protein (hs-CRP) with CRP as a soluble serum marker for the diagnosis of women with endometriosis

Abstract

To the Editor: We read the article by Lermann et al. (1Lermann J. Mueller A. Körber F. Oppelt P. Beckmann M.W. Dittrich R. et al.Evaluation of high-sensitivity C-reactive protein in comparison with C-reactive protein as biochemical serum markers in women with endometriosis.Fertil Steril. 2010; 93: 2125-2129Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar) with great interest. The aim of the study was to compare high-sensitivity C-reactive protein (hs-CRP) with CRP as a soluble serum marker for the diagnosis of women with endometriosis. There were no significant differences between hs-CRP and CRP levels in endometriosis, unknown endometriosis, and nonendometriosis. However, the authors reported that hs-CRP had positive correlations between CRP in endometriosis (also in all stages), unknown endometriosis, and nonendometriosis. It has been widely accepted that endometriosis is an inflammatory disease. Studies have demonstrated that serum levels of inflammatory markers are increased in endometriosis (2Bedaiwy M.A. Falcone T. Sharma R.K. Goldberg J.M. Attaran M. Nelson D.R. et al.Prediction of endometriosis with serum and peritoneal fluid markers: a prospective controlled trial.Hum Reprod. 2002; 17: 426-431Crossref PubMed Scopus (376) Google Scholar, 3Pizzo A. Salmeri F.M. Ardita F.V. Sofo V. Tripepi M. Marsico S. Behaviour of cytokine levels in serum and peritoneal fluid of women with endometriosis.Gynecol Obstet Invest. 2002; 54: 82-87Crossref PubMed Scopus (226) Google Scholar, 4Koumantakis E. Matalliotakis I. Neonaki M. Froudarakis G. Georgoulias V. Soluble serum interleukin-2 receptor, interleukin-6 and interleukin-1a in patients with endometriosis and in controls.Arch Gynecol Obstet. 1994; 255: 107-112Crossref PubMed Scopus (63) Google Scholar). In this study hs-CRP and CRP levels did not differ in endometriotic, unknown endometriotic, and nonendometriotic groups. There were 48 women in the endometriotic, 82 women in the unknown endometriotic, and 34 women in the nonendometriotic group. The largest group was the unknown endometriotic group, which may consist of both endometriotic women and nonendometriotic women. Moreover, 12 women were infertile and 48 women had pain symptoms in this group. This study would be better if the number of women in each group was equal or similar, and if there was no heterogeneous group that was defined as an unknown group, only this heterogeneous group can change all the results statistically because of its largeer number. We can see the same controversy in the number of the participants in stage I, II, III, and IV endometriosis. The study would be better if the number of these subgroups was larger and equal, so the results might be different statistically. The authors concluded that low hs-CRP might serve as a marker for an absence of endometriosis. We think it is an assertive conclusion to the readers. It would be better to make this conclusion if hs-CRP had been significantly lower in the nonendometriotic group and if they had showed a significant correlation between low hs-CRP and the group of women without endometriosis. Morerover, if they had had positive correlation with low hs-CRP and the absence of endometriosis, they had to perform receiver operator characteristics analysis and showed the sensitivity, specifity values, and cutoff levels of low hs-CRP as a promising marker in the nonendometriotic group. Evaluation of high-sensitivity C-reactive protein in comparison with C-reactive protein as biochemical serum markers in women with endometriosisFertility and SterilityVol. 93Issue 7PreviewTo compare high-sensitivity C-reactive protein (hs-CRP) with CRP as a soluble serum marker for the diagnosis of women with endometriosis. Full-Text PDF Reply of the Authors: Comparing high-sensitivity C-reactive protein (hs-CRP) with CRP as a soluble serum marker for the diagnosis of women with endometriosisFertility and SterilityVol. 94Issue 3PreviewWe appreciate the letter by Verit and Hilali and their comments regarding the evaluation of high-sensitivity C-reactive (hs-CRP) protein in comparison with C-reactive protein (CRP) as biochemical serum markers in women with endometriosis (1). Full-Text PDF