The Role of Chronic Inflammation in Polycystic Ovarian Syndrome-A Systematic Review and Meta-Analysis.

Shaimaa Aboeldalyl,Cathryn James,Emad Moussa Ibrahim,Saad Amer,Hossam El-Din Shawki,Emaduldin Seyam

doi:10.3390/ijms22052734

Abstract

Although the current literature associates polycystic ovarian syndrome (PCOS) with chronic inflammation, the evidence for this link remains inconclusive and its causal nature remains unclear. The purpose of this systematic review was to assess the inflammatory status in PCOS women and to determine whether it is related to PCOS or to its associated adiposity. We searched electronic databases including PUBMED, EMBASE and MEDLINE, SCOPUS, DynaMed plus, TRIP, ScienceDirect and Cochrane Library, for studies investigating C-reactive protein (CRP) and other inflammatory makers in PCOS women versus healthy controls. Quality and risk of bias for selected studies were assessed using the modified Newcastle–Ottawa scale. CRP data were extracted and pooled using RevMan for calculation of the standardized mean difference (SMD) and 95% confidence interval (CI). Eighty-five eligible studies were included in the systematic review, of which 63 were included in the meta-analysis. Pooled analysis of the 63 studies revealed significantly higher circulating CRP in PCOS women (n = 4086) versus controls (n = 3120) (SMD 1.26, 95%CI, 0.99, 1.53). Sensitivity meta-analysis of 35 high quality studies including non-obese women showed significantly higher circulating CRP in PCOS women versus controls (SMD 1.80, 95%CI, 1.36, 2.25). In conclusion, circulating CRP is moderately elevated in PCOS women independent of obesity, which is indicative of low-grade chronic inflammation.

Highlights

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women with a prevalence of 15–20% amongst reproductive age women according to the Rotterdam diagnostic criteria [1,2,3], 83% of women with anovulatory infertility [4] and 89%of hyperandrogenic women [5]
Serum C-reactive protein (CRP) level was measured in 85 comparative studies (n = 9880), of which 53 reported significantly higher levels in PCOS women (n = 5656) compared to healthy controls (n = 4224)
BMI of participants was either matched on selection (79 studies) or adjusted for during statistical analysis concluding that the difference in CRP was attributed to PCOS status rather than obesity (Table 1)

Summary

Introduction

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women with a prevalence of 15–20% amongst reproductive age women according to the Rotterdam diagnostic criteria [1,2,3], 83% of women with anovulatory infertility [4] and 89%of hyperandrogenic women [5]. Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women with a prevalence of 15–20% amongst reproductive age women according to the Rotterdam diagnostic criteria [1,2,3], 83% of women with anovulatory infertility [4] and 89%. Hyperandrogenism has been reported in about 80% of PCOS women [1] with hirsutism being the most common androgenic feature affecting 70% of cases [7]. PCOS has been associated with significant long-term metabolic and cardiovascular morbidities, possibly due to insulin resistance [6] It has been associated with chronic low-grade inflammation, which is thought to contribute to the long-term cardiovascular risks [12,13]

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Discussion

Conclusion