Higher hs-CRP Research Articles

Role of High-Sensitivity C-reactive Protein Levels in Predicting the Risk of Six-Month Event Rates in Patients With Chronic Stable Angina Undergoing Percutaneous Transluminal Coronary Angioplasty With a Drug-Eluting Stent.

Introduction This prospective observational study reports the association between baseline high-sensitivity C-reactive protein (hs-CRP) levels and adverse events at six months in patients who were diagnosed with symptomatic chronic stable angina and then underwent percutaneous transluminal coronary angioplasty (PTCA) with a drug-eluting stent (DES). Methods A total of 104 patients were examined with chronic stable angina over a period of six months. Before conducting percutaneous coronary intervention (PCI), the baseline levels of hs-CRP were measured, and based on the levels, the patients were grouped into high and low hs-CRP groups. Results The primary causes of death or the need for repeat revascularization or myocardial infarction or angina were concluded after assessing the patients for six months. A total of 104 patients were studied, amongwhich 72 (69.23%) had low hs-CRP and 32 (30.77%) had high hs-CRP levels. The number of males in this study was 68 (65.38%) and females were 36 (34.62%). The mean age of the patients was 55.26 ± 10.31 years. There were no significant differences among the groups in terms of gender, age, comorbidities, and risk factors except for certain predisposing factors like dyslipidemia and smoking. Moreover, we did not find any significant difference amongthe groups in the cause of death and myocardial infarction after a follow-up of six months. However, we observed a higher need for revascularization and angina outcomes in the group with high hs-CRP compared to low hs-CRP. Conclusion It can be concluded that a higher risk of angina and repeat revascularization is related to a high baseline hs-CRP but there is no evidence whether it is somehow linked to myocardial infarction and mortality or not.

Frequency of maternal high serum hs-C reactive protein level in pre-eclampsia patients.

Objective: To determine the frequency of high serum high-sensitivity C-reactive protein (hs-CRP) level in pre-eclampsia women. Study Design: Cross-sectional study. Setting: Department of Obstetrics and Gynaecology, Bahawalpur Medical and Dental College, Bahawalpur. Period: October 2022 to February 2023. Material & Methods: A total of 206 women aged between 20-35 years with singleton pregnancy, gestational age >20 weeks, any parity, and pre-eclampsia were analyzed. High serum hs-CRP was defined as when serum hs-CRP was above 7.0mg/L. The patient was diagnosed with pre-eclampsia when she had systolic blood pressure ≥140mmHg, measured at two different intervals after 20 weeks of pregnancy and proteinuria (200 mg or more per 24-hour period) by laboratory test. The frequency of high hs-CRP was noted. Results: In a total of 206 females, the mean age was 29.69±3.12 years while 120 (58.3%) were aged between 18-30 years. The mean gestational age and parity were 27.83±2.64 weeks and 2.65±1.44 respectively. Frequency of high serum hs-CRP was noted in 135 (65.5%) females with pre-eclampsia. It was found that age (p=0.686), gestational age (0.253) and parity (p=0.927) were not having any statistically significant association with high serum hs-CRP. BMI was noted to have significant association with high serum hs-CRP (p<0.001). Conclusion: The frequency of high maternal hs-CRP was very high (65.5%) among females with pre-eclampsia.

Long COVID Syndrome: A Case-Control Study

BackgroundAcute coronavirus disease 2019 (COVID-19) causes various cardiovascular complications. However, it is unknown if there are cardiovascular sequelae in the medium and long-term. The aim of this study was dual. Firstly, we wanted to investigate symptomatology and health-related quality of life (HRQoL) at medium-term follow-up (6 months post-COVID). Secondly, we wanted to assess whether history of COVID-19 and persistent shortness of breath at medium-term follow-up are associated with ongoing inflammation, endothelial dysfunction, and cardiac injury. MethodsA case-control study was performed. Virologically proven COVID-19 cases and age- and gender-matched controls were interviewed to assess symptoms and HRQoL. Biochemical tests were also performed. ResultsThe study comprised 174 cases and 75 controls. The mean age of the participants was 46.1±13.8 years. The median follow-up was 173.5 days (interquartile range 129-193.25 days). There was no significant difference in the demographics between cases and controls. At follow-up, cases had a higher frequency of shortness of breath, fatigue, arthralgia, abnormal taste of food (P <.001), and anosmia. Cases also exhibited worse scores in the general health and role physical domains of the Short Form Survey-36. High-sensitivity C-reactive protein (hsCRP) was significantly higher in the cases, and there was a positive correlation of hsCRP with time. Significant determinants of shortness of breath were age, female gender and white cell count, troponin I, and lower hemoglobin levels at follow-up. ConclusionPost-COVID-19 patients have persistent symptomatology at medium-term follow-up. Higher hsCRP in cases and the positive association of hsCRP with time suggest ongoing systemic inflammation in patients persisting for months after COVID-19.

Factors associated with frailty transitions among the old‐old in a community

The study aimed to explore the factors associated with frailty transitions among the old-old (aged ≥75 years) in a community. The participants were all from a prospective cohort study in a community in Beijing, China. Frailty states were assessed using FRAIL at baseline and at 1-year follow-up. The association between factors, including comprehensive geriatric assessment and laboratory indicators, and frailty transitions were explored by binary logistic regression. The predicted value of the factors associated with frailty transitions was analyzed using the receiver operating characteristic curve (ROC) and the area under the ROC (AUC) for each factor was calculated. In total, 183 older adults (mean age: 83.9 ± 4.4 years; women, 59%) completed the frailty state assessment at baseline and 1-year follow-up. After adjusting for age and sex, physical function, including walking speed, timed up-and-go test and short physical performance battery, serum albumin and serum high-sensitivity C-reactive protein (hsCRP) were associated with worsening of the frailty state. Cognitive function was associated with improving the frailty state. ROC analysis showed that low walking speed (AUC: 0.81), long timed up-and-go test time (AUC: 0.77), low short physical performance battery score (AUC: 0.75), low serum albumin (AUC: 0.68) and high serum hsCRP (AUC: 0.80) could predict the decline in frailty state. Good cognitive function (AUC: 0.69) predicted an improvement in the frailty state. The frailty state of the old-old with poor physical function, low serum albumin and high serum hsCRP was likely to decline, but it could improve with good cognitive function. Geriatr Gerontol Int 2023; 23: 405-410.

Predictive value of high sensitivity C-reactive protein in three-vessel disease patients with and without type 2 diabetes

BackgroundDiabetes mellitus (DM) and atherosclerosis are multifactorial conditions and share a common inflammatory basis. Three-vessel disease (TVD) represents a major challenge for coronary intervention. Nonetheless, the predictive value of high-sensitivity C-reactive protein (hs-CRP) for TVD patients with or without type 2 DM remains unknown. Herein, we aimed to ascertain the long-term predictive value of hs-CRP in TVD patients according to type 2 DM status from a large cohort.MethodsA total of 2734 TVD patients with (n = 1040, 38%) and without (n = 1694, 62%) type 2 diabetes were stratified based on the hs-CRP (< 2 mg/L vs. ≥ 2 mg/L). Three multivariable analysis models were performed to evaluate the effect of potential confounders on the relationship between hs-CRP level and clinical outcomes. The Concordance index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to assess the added effect of hs-CRP and the baseline model with established risk factors on the discrimination of clinical outcomes. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE).ResultsThe median follow-up duration was 2.4 years. Multivariate Cox regression analyses showed that the incidence of MACCE (adjusted hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.01–1.35, p = 0.031) and all-cause death (HR 1.82, 95% CI 1.07–3.11, p = 0.026) were significantly higher in the diabetic group compared to the non-diabetic group. In the diabetic group, the incidence of MACCE (adjusted HR 1.51, 95% CI 1.09–2.10, p = 0.013) was significantly higher in the high hs-CRP group than in the low hs-CRP group; no significant difference was found for all-cause death (HR 1.63; 95% CI 0.58–4.58, p = 0.349). In the non-diabetic group, the prevalence of MACCE (adjusted HR 0.93, 95% CI 0.71–1.22, p = 0.613) was comparable between the two groups. Finally, the NRI (0.2074, p = 0.001) and IDI (0.0086, p = 0.003) for MACCE were also significantly increased after hs-CRP was added to the baseline model in the diabetic group.ConclusionsElevated hs-CRP is an independent prognostic factor for long-term outcomes of MACCE in TVD patients with type 2 diabetes but not in those without type 2 diabetes. Compared to traditional risk factors, hs-CRP improved the risk prediction of adverse cardiovascular events in TVD patients with type 2 diabetes.

CLINICAL SIGNIFICANCE OF NEUTROPHIL TO LYMPHOCYTE RATIO IN PREDICTING THE OUTCOME IN PATIENTS PRESENTING WITH ACUTE CORONARY SYNDROME : A DESCRIPTIVE LONGITUDINAL STUDY

Introduction: Cardiovascular disease is the leading cause of death worldwide, which accounts to about 17.7 million deaths worldwide.This makes it a paramount importance in nding newer bio markers which adds to the better prognostication. Recently Neutrophil to Lymphocyte ratio has gained the clinical importance in predicting the mortality and morbidity in patients with acute coronary syndrome owing to the association of inammatory reaction in pathogenesis of ACS. The present study was done to correlate the Neutrophil to Lymphocyte ratio in predicting the outcome in patients presenting with acute coronary syndrome. Aim: To determine the signicance of Neutrophil to Lymphocyte ratio in prognostication and risk stratication in patients presenting with acute coronary syndrome. Methodology: This is a short term hospital based study conducted in 150 patients presenting to tertiary care hospital with ACS. The data obtained from the hemogram, biochemical and radiological investigations were correlated between those without complications and those who developed complications in the due course in the hospital.Neutrophil to lymphocyte ratio is calculated for all these patients and were grouped into three tertiles for analysis as low NLR&lt;2.6, medium NLR 2.6-4.5 and high NLR &gt;4.5. Later prognostic efcacy of NLR ratio in these patients was determined. Results: In our study it was found that high NLR was signicantly associated with development of complications ( P &lt;0.001). It was also observed that all those patients who expired came under high NLR tertile. There was trend towards signicance with high NLR being more common in smokers i.e (43.9% v/s low or medium NLR 28.8% (p=0.072).High NLR was associated with high HsCRP both at 0 and 48 hrs. There was a trend towards signicance , with high NLR being more common in STEMI patients (49% v/s 32.7% in low /medium NLR group, P= 0.055) Conclusion:Assessment of NLR proves to be efcient in risk stratication and prognostication in patients with acute coronary syndrome. Higher incidence of mortality or increased length of stay was observed with high NLR values.

The GLVC scoring system: a single-center model for predicting survival and hospitalization in patients with heart failure

BackgroundHeart failure (HF) is the only cardiovascular disease with an ever-increasing incidence.AimsThe aim of this study was to assess the predictors of adverse clinical events (CE) and the creation and evaluation of the prognostic value of a novel personalized scoring system in patients with HF.MethodsThe study included 113 HF patients (median age 64 years (IQR 58–69); 57.52% male). The new novel prognostic score named GLVC (G, global longitudinal peak strain (GLPS); L, left ventricular diastolic diameter (LVDD); V, oxygen pulse (VO2/HR); and C, high sensitivity C-reactive protein (hs-CRP)) was created. The Kaplan–Meier method and log-rank test were used to compare the CE.ResultsResults from final analyses showed that low GLPS (< 13.9%, OR = 2.66, 95% CI = 1.01–4.30, p = 0.002), high LVDD (> 56 mm, OR = 2.37, 95% CI = 1.01–5.55, p = 0.045), low oxygen pulse (< 10, OR = 2.8, 95% CI = 1.17–6.70, p = 0.019), and high hs-CRP (> 2.38 µg/ml, OR = 2.93, 95% CI = 1.31–6.54, p = 0.007) were independent prognostic factors for adverse CE in HF population. All the patients were stratified into a low-risk or high-risk group according to a novel “GLVC” scoring system. The Kaplan–Meier analyses demonstrated that patients in the high-risk group were more predisposed to having higher adverse clinical events compared to patients in the low-risk group.ConclusionsA novel and comprehensive personalized “GLVC” scoring system is an easily available and effective tool for predicting the adverse outcomes in HF.Graphical abstract

Biomarkers of inflammation and endothelial dysfunction in elderly patients with myocardial infarction, hypertension and frailty

Aim. To analyze the level of biomarkers of inflammation and endothelial dysfunction in elderly patients with myocardial infarction (MI), hypertension (HTN) and frailty.Material and methods. Three following clinical groups were formed: patients aged 60-74 years with MI+ grade 1-2 HTN (n=80); patients aged 60-74 with MI+HTN+prefrailty (n=52); patients aged 60-74 years with MI+HTN+frailty (n=114). In patients of all groups 2-4 months after MI, the levels of high-sensitivity C-reactive protein (hsCRP), intercellular adhesion molecule 1 (ICAM-1), nitric oxide (NO) metabolites — nitrates and nitrites, endothelin-1, desquamated endotheliocytes, vascular endothelial growth factor (VEGF) were determined.Results. Patients with MI+HTN+frailty had a higher hsCRP — 6,4 mg/l compared with patients with MI+HTN+ prefrailty (4,2 mg/l; p&lt;0,01) and patients with MI+HTN (3,2 mg/l; p&lt;0,01). The level of ICAM-1 was 315,6, 242,7, and 213,5 ng/ml, respectively, in these groups (p&lt;0,01). Patients with MI+HTN+prefrailty, MI+HTN+frailty and MI+HTN had following levels of nitrite (NO2-) and nitrate (NO3-) — 6,7, 5,4, and 7,2 pmol/l (p&lt;0,01). A similar ratio is inherent in NO3-. On the contrary, the content of desquamated endotheliocytes and VEGF was significantly higher in patients with MI+HTN+frailty compared with patients with MI+HTN+ prefrailty (p&lt;0,01). The level of endothelin-1 was also significantly higher in patients with MI+HTN+frailty compared with the MI+HTN+prefrailty group: 18,85 vs 13,41 fmol/l (p&lt;0,05).Conclusion. The levels of inflammation and endothelial dysfunction in patients with MI+HTN are significantly higher than those in patients with MI+HTN+frailty compared with patients with MI+AH+prefrailty and MI+HTN, with the exception of nitric oxide metabolites.

A tryptophan metabolite prevents depletion of circulating endothelial progenitor cells in systemic low-grade inflammation.

Chronic systemic inflammation reduces the bioavailability of circulating endothelial progenitor cells (EPCs). Indoleamine 2,3-dioxygenase 1 (IDO1), a key enzyme of immune tolerance catalyzing the initial step of tryptophan degradation along the so-called l-kynurenine (l-kyn) pathway, that is induced by inflammatory stimuli and exerts anti-inflammatory effects. A specific relationship between IDO1 activity and circulating EPC numbers has not yet been investigated. In this study, circulating EPCs were examined in mice treated with low doses of lipopolysaccharide (LPS) to mimic low-grade inflammation. Moreover, the association between IDO1 activity and circulating EPCs was studied in a cohort of 277 patients with variable systemic low-grade inflammation. Repeated low doses of LPS caused a decrease in circulating EPCs and l-kyn supplementation, mimicking IDO1 activation, significantly increased EPC numbers under homeostatic conditions preventing EPC decline in low-grade endotoxemia. Accordingly, in patients with variable systemic low-grade inflammation, there was a significant interaction between IDO1 activity and high-sensitivity C-reactive protein (hs-CRP) in predicting circulating EPCs, with high hs-CRP associated with significantly lower EPCs at low IDO1 activity but not at high IDO1 activity. Overall, these findings demonstrate that systemic low-grade inflammation reduces circulating EPCs. However, high IDO1 activity and l-kyn supplementation limit circulating EPC loss in low-grade inflammation.

Determinants of bone mass in older adults with normal- and overweight derived from the crosstalk with muscle and adipose tissue

Lower bone mass in older adults may be mediated by the endocrine crosstalk between muscle, adipose tissue and bone. In 150 community-dwelling adults (59–86 years, BMI 17–37 kg/m2; 58.7% female), skeletal muscle mass index, adipose tissue and fat mass index (FMI) were determined. Levels of myokines, adipokines, osteokines, inflammation markers and insulin were measured as potential determinants of bone mineral content (BMC) and density (BMD). FMI was negatively associated with BMC and BMD after adjustment for mechanical loading effects of body weight (r-values between −0.37 and −0.71, all p < 0.05). Higher FMI was associated with higher leptin levels in both sexes, with higher hsCRP in women and with lower adiponectin levels in men. In addition to weight and FMI, sclerostin, osteocalcin, leptin × sex and adiponectin were independent predictors of BMC in a stepwise multiple regression analysis. Muscle mass, but not myokines, showed positive correlations with bone parameters that were weakened after adjusting for body weight (r-values between 0.27 and 0.58, all p < 0.01). Whereas the anabolic effect of muscle mass on bone in older adults may be partly explained by mechanical loading, the adverse effect of obesity on bone is possibly mediated by low-grade inflammation, higher leptin and lower adiponectin levels.

CRP, C-Peptide, and Risk of First-Time Cardiovascular Events and Mortality in Early Type 2 Diabetes: A Danish Cohort Study

We investigated the relationship between hs-CRP, a marker of low-grade inflammation, alone or in combination with C-peptide, a marker of hyperinsulinemia/insulin resistance, and risk for cardiovascular events (CVEs) and mortality in patients recently diagnosed with type 2 diabetes (T2D). In patients with recent-onset T2D, we measured serum hs-CRP (n = 7,301) and C-peptide (n = 5,765) in the prospective Danish Centre for Strategic Research in Type 2 Diabetes cohort study. Patients with no prior CVE (n = 6,407) were followed until first myocardial infarction, stroke, coronary revascularization, or cardiovascular death, and all patients (n = 7,301) were followed for all-cause mortality. We computed adjusted hazard ratios (aHRs) by Cox regression and tested for the interaction between hs-CRP and C-peptide. During follow-up (median 4.8 years), high (>3 mg/L) versus low (<1 mg/L) hs-CRP was associated with increased CVE risk (aHR 1.45 [95% CI 1.07-1.96]) and with even greater risk of all-cause mortality (2.47 [1.88-3.25]). Compared with patients with low hs-CRP (≤3 mg/L) and low C-peptide (<1,470 pmol/L), those with high levels of both biomarkers had the highest CVE (1.61 [1.10-2.34]) and all-cause mortality risk (2.36 [1.73-3.21]). Among patients with high C-peptide, risk of CVEs did not differ by low or high hs-CRP, whereas risk of all-cause mortality did. The finding of high hs-CRP as a stronger prognostic biomarker of all-cause mortality than of CVEs may facilitate improved early detection and prevention of deadly diseases besides CVEs. Conversely, elevated C-peptide as a strong CVE biomarker supports the need to target hyperinsulinemia/insulin resistance in T2D CVE prevention.

Expression pattern of miR-193a, miR122, miR155, miR-15a, and miR146a in peripheral blood mononuclear cells of children with obesity and their relation to some metabolic and inflammatory biomarkers

BackgroundThe widespread presence of childhood obesity has increased considerably over three decades. The present study was designed to investigate expression patterns of miR-146a, miR-155, miR-15a, miR-193a, and miR-122 in peripheral blood mononuclear cells (PBMCs) in children who are obese along with their association with metabolic and inflammatory biomarkers.MethodsNinety test subjects were admitted. The profile of blood pressure, resting energy expenditure (REE), anthropometric measures, body composition, dietary intakes, physical activity levels, insulin, and lipid profile, fasting blood glucose (FBG), high-sensitivity C-reactive protein (hs-CRP), and pubertal stage have been measured. Total RNA (including small RNAs) was extracted from PBMCs. The expression levels of miRNAs were measured by stem-loop RT-qPCR.ResultsThe miR-155a expression level was significantly lower in obese children, children with high hs-CRP, and children with high-fat mass. Obese girls had significantly higher PBMC levels of miR-122. MiR-155a had a significant negative association with fasting insulin, HOMA-IR, and hs-CRP. There were significant positive associations between miR-193a and miR-122 expression levels and fasting insulin, HOMA-IR, and TG. MiR-15a was positively correlated with fasting insulin and HOMA-IR. Children with metabolic syndrome, insulin resistance, and high-fat mass had higher PBMC levels of miR-122 and miR-193a. Higher miR-193a and miR-122 levels were also detected in PBMCs of children with fast REE, compared to those with slow REE, and the subjects with high hs-CRP, respectively.Conclusionlower level of miR-155 expression in obese subjects and significant associations unfolds the need for more studies to detect the possible underlying mechanisms.

Abstract P669: Inflammatory Markers and Calcification of Coronary Arteries, Aorta and Cardiac Valves in Older Adults: Findings From the Atherosclerosis Risk in Communities (ARIC) Study

Background: Inflammation plays an important role in the pathophysiology of atherosclerosis. However, inflammatory biomarkers have been found to have a weak association with coronary artery calcium (CAC), a representative measure of subclinical atherosclerosis. Moreover, the existing evidence does not sufficiently explore extra coronary calcium (ECC) in this context. Aim: To characterize the association of two inflammatory markers, high-sensitivity C-reactive protein (hs-CRP) and galectin-3, with CAC and ECC in a community-based cohort. Methods: Cardiac CT was performed among 1,934 ARIC participants (age 53-74 years) without coronary heart disease at visit 7 (2018-19). We examined the associations of hs-CRP and galectin-3 measured in middle age at visit 4 (1996-98) by quartile with the presence of CAC and ECC (Agatston score &gt;0 vs. 0) using multivariable logistic regression. Results: Higher hs-CRP was associated with calcifications in the ascending aorta, aortic valve ring, mitral valve and right coronary artery in the unadjusted model (Table). These associations were mostly attenuated after adjusting for potential confounders, but the associations with ascending aorta and right coronary artery calcifications remained significant (adjusted odds ratio (aOR) = 1.45 [95% CI = 1.02-2.07]) and (1.55 [1.12-2.16]) for the highest vs. lowest quartiles, respectively). Galectin-3 was also independently associated with right coronary artery calcification after adjusting for potential confounders (aOR 1.48 [1.02 - 2.01]) for the highest vs. lowest quartiles). These associations were generally consistent in demographic subgroups. Conclusions: Both hs-CRP and galectin-3 were associated with calcification of some but not all vascular beds tested, suggesting potentially unique atherosclerotic pathophysiology across different vascular beds. Robust associations of inflammatory markers with right coronary artery calcification deserve further investigation.

Implementation of risk enhancers in ASCVD risk estimation and hypolipidemic treatment eligibility: A sex-specific analysis

ObjectiveSex-specific data are limited regarding eligibility for hypolipidemic treatment. We aim to explore the sex-specific clinical utility of high-sensitivity C-reactive protein (hsCRP) and carotid ultrasound as risk modifiers for hypolipidemic treatment in primary prevention of atherosclerotic cardiovascular disease (ASCVD). MethodsWe aimed to explore these sex-specific trends in two pooled contemporary independent Greek cohorts (Athens Vascular Registry n = 698, 50.9% women and Menopause Clinic n = 373, 100% women) of individuals without overt ASCVD. Baseline ASCVD risk was estimated using the Systematic COronary Risk Evaluation-2 (SCORE2) tools. The presence of carotid plaque and hsCRP ≥2 mg/L were integrated as risk modifiers. ResultsMen had increased odds to achieve target LDL-C levels based on ASCVD risk (23.8% vs. 17.7%, OR: 1.45 95% CI: 1.05–2.00, p = 0.023, for men vs. women). Additionally, considering carotid plaque or high hsCRP levels did not change this association but reduced on-target LDL-C rate in both sexes. Women had decreased odds of being eligible for hypolipidemic treatment by ASCVD risk estimation (11.5% vs. 26.4%, p < 0.001) compared with men. The addition of carotid plaque presence or high hsCRP levels and their combination resulted in a higher relative increase in hypolipidemic treatment eligibility in women (from 11.5% to 70.9% vs. 26.4% to 61.4% for carotid plaque, from 11.5% to 38.5% vs. 26.4% to 50.8% for hsCRP and from 11.5% to 79.1% vs. 26.4% to 75% for their combination, all for women vs. men, pforinteraction < 0.001 for all) than men. ConclusionsImplementation of carotid plaque and hsCRP levels increases hypolipidemic treatment eligibility more prominently in women than in men. The impact on clinical outcomes in these untreated patients merits further investigation.

Construction of a nomogram model for predicting infectious intrapartum fever.

To investigate influencing factors of intrapartum fever during vaginal delivery and to construct a prediction model for infectious intrapartum fever. A total of 444 patients with intrapartum fever admitted in Ningbo Women and Children's Hospital from January 2020 to December 2021 were enrolled. The clinical data and laboratory findings were compared between patients with infectious intrapartum fever and non-infectious intrapartum fever, and the factors associated with intrapartum fever were analyzed with a multivariate logistic regression model. A prediction nomogram model was constructed based on the factors of intrapartum fever and its predictive efficiency was evaluated by correction curve and receiver operator characteristic curve. In the 444 cases, 182 (41.0%) had definite intrauterine infection and 262 (59.0%) had no infectious intrapartum fever. Univariate analysis showed that the length of hospital stay before induced labor, the time of induced abortion, misoprostol administration, autoimmune diseases, white blood cell count (WBC) and hypersensitive C-reactive protein (hs-CRP) levels were significantly different between the two groups (all P<0.05). Multivariate analysis showed that misoprostol administration and autoimmune diseases were protective factors (OR=0.31 and 0.36, both P<0.05) for infectious intrapartum fever, while high WBC and hs-CRP were risk factors (OR=1.20 and 1.09, both P<0.05). The area under the curve of nomogram model for predicting infectious intrapartum fever was 0.823, and the calibration curve validation showed that the predicted and measured values were in general agreement. Multiple factors cause intrapartum fever. The nomogram model constructed in this study has good predictive accuracy for infectious intrapartum fever.

Intracranial plaque characteristics on high-resolution MRI and high-sensitivity C-reactive protein levels: association and clinical relevance in acute cerebral infarction

To investigate the association between intracranial plaque characteristics and high-sensitivity C-reactive protein (hs-CRP) levels, and their combined effects on the occurrence of acute cerebral infarction (ACI). One hundred and forty-three patients with recent ischaemic events in the territory of middle cerebral artery or basilar artery were enrolled and divided into the ACI group (n=93) and non-ACI group (n=50) according to clinical data and diffusion-weighting imaging (DWI) results. All recruited patients underwent high-resolution magnetic resonance imaging (MRI) to assess intracranial plaque characteristics, including plaque enhancement, standardised wall index, stenosis ratio, T1 hyperintense component, remodelling pattern, plaque area, plaque burden, and maximum wall thickness. hs-CRP levels were further grouped into the low group (<1 mg/l), the intermediate group (1-3 mg/l), and the high group (≥3 mg/l). Multivariate logistic regression and receiver operating characteristic curve were constructed to evaluate the association between intracranial plaque characteristics and hs-CRP levels, as well as their synergistic effects on determining the occurrence of ACI. High hs-CRP levels were associated with strong plaque enhancement (p<0.001, odds ratio [OR]=7.497). Strong plaque enhancement (p=0.002, OR=2.109) and high hs-CRP levels (p=0.009, OR=3.893) were independently associated with the occurrence of ACI after adjustments for sex, age, and other traditional atherosclerotic risk factors. The combination of hs-CRP levels and strong plaque enhancement provided incremental information to determine ACI with an AUC of 0.823, which was significantly higher than that of strong plaque enhancement (0.711) and hs-CRP levels (0.686), respectively. High hs-CRP levels were associated with strong plaque enhancement. The synergistic effects of hs-CRP levels and strong plaque enhancement provided incremental effects on the occurrence of ACI.

Association of High Sensitivity C-Reactive Protein in Polycystic Ovary Syndrome

Objective: This study is aimed to see the level of high sensitivity C-reactive protein (hs-CRP) and its association with manifestations of polycystic ovary syndrome (PCOS). Design: This cross-sectional study was conducted over a period of one year (January 2017 to December 2018) in the department of Endocrinology of a University hospital. Participants: Fifty-five PCOS patients diagnosed on basis of revised Rotterdam diagnostic criteria 2003 and 50 age-matched healthy controls [PCOS vs. Control- BMI (kg/m2): 25.47±4.65 vs. 20.68±3.51, p&lt;0.001]. Main outcome measures: hs-CRP level, manifestations of PCOS Methods: After relevant history and physical examinations, blood was taken in fasting state during follicular phase of menstrual cycle to measure total testosterone (TT), luteinizing hormone (LH), follicle stimulating hormone (FSH) and hs-CRP. Hormones were measured by chemiluminescent microparticle immuno-assay and hs-CRP by nephelometric technique. Results: hs-CRP (mg/L) was found significantly higher in PCOS patients [1.67 (0.69, 2.54) vs. 0.94 (0.30, 1.42), p=0.006] even after adjustment for age and BMI [OR (95% CI): 1.585 (1.093, 2.299), p=0.015]. Also hs-CRP status (&gt;5 mg/L) was found significantly higher in them than that of controls; but only in non-obese (BMI &lt;25 kg/m2) participants [7.27% vs. 0.0%, p=0.018]. hs- CRP showed no significant correlation and predictive association with any of the manifestations of PCOS including age, BMI, waist circumference, TT and LH/FSH ratio [p=NS for all] Conclusions: Patients with PCOS had significantly higher hs-CRP level and high hs-CRP status without any significant association with its manifestations. J Dhaka Med Coll. 2021; 30(2) : 142-148

Serum C-reactive protein levels are associated with clinical pregnancy rate after in vitro fertilization among normal-weight women.

To assess whether low-grade inflammation, measured by serum high-sensitivity C-reactive protein (hsCRP) levels, is associated with in vitro fertilization (IVF) outcomes. A retrospective study. University-affiliated IVF center. In the present study, 875 women of normal weight who underwent their first fresh embryo transfer (ET) cycles for IVF treatment were divided into three groups according to serum concentrations of hsCRP. Serum from women undergoing IVF was collected on days 2-4 of a spontaneous menstrual cycle prior to the commencement of ovarian stimulation. The IVF outcomes included implantation, biochemical pregnancy, clinical pregnancy, miscarriage and live birth rates. The women were divided into three groups according to the baseline serum levels of hsCRP as follows: low hsCRP (<1 mg/L; n=517), medium hsCRP (1-3 mg/L; n= 270), high hsCRP (>3 mg/L; n=88). The maternal age was similar among the three groups. The women in the high and medium hsCRP group had significantly higher BMI compared with those in the low hsCRP group. The protocol of controlled ovarian hyperstimulation, the gonadotropin dose administered, the serum estradiol levels, progesterone levels and the endometrial thickness on the day of triggering, as well as the number of retrieved oocytes, fertilized oocytes and good quality embryos, and the oocyte maturation rate were similar among the three groups. Implantation, biochemical pregnancy and clinical miscarriage rates did not differ significantly were not significantly different among three groups. The clinical pregnancy rate was significantly lower in the high hsCRP group compared with that in the low hsCRP group (50.0% versus 63.4%; P<0.0167), which contributed to a significant decrease in birth rate (39.8% versus 53.8%; P<0.0167). High serum hsCRP levels was found to be a factor affecting live birth rate. Among women of normal weight undergoing their first IVF treatment, it was found that low-grade inflammation was associated with reduced clinical pregnancy and live birth rates following fresh ET cycles.

PS-P09-4: OBESITY AND ITS ASSOCIATION WITH HIGH SENSITIVITY C-REACTIVE PROTEIN AS AN INFLAMMATION MARKER AND THE RISK OF PREHYPERTENSION AMONG ADULTS

Objective: It has been reported that obesity could trigger the elevation of serum high sensitivity C-reactive protein (hsCRP) and abnormal lipid metabolism, manifesting in the progression of metabolic diseases (hypertension, cardiovascular diseases, and type 2 diabetes). Regarding the high prevalence of obesity both in developed and developing countries, assessing hsCRP as an inflammation marker is essential to prevent the high risk of the diseases. We aim to assess the association between obesity with hsCRP and prehypertension among adults. Design and method: A cross-sectional study was conducted from July to September 2021 in urban and rural areas. A total of 109 healthy adults were involved with inclusion criteria: aged 19 to 64 years, did not have pregnancy or breastfeeding for women, and did not have any metabolic disease histories. The data was collected by trained enumerators and blood samples were taken by a trained phlebotomist, including socio-demographic, body mass index (BMI), waist circumference (WC), blood pressure, and hs-CRP. A BMI of 30.00 kg/m2 and above was categorized as obesity. A waist circumference of 88 cm above (female) and 102 cm above (male) was categorized as central obesity. A blood pressure of 120 to 139 mmHg (systolic) or 80 to 89 mmHg (diastolic) was classified as prehypertension. The hsCRP of above 3.0 mg/L was classified as a high level. Results: 52.3% of the subjects were female, and 60.6% of them were living in urban. As 68.8% were obese, 78% were prehypertension, and 30.3% had high hsCRP. There was no association between obesity (BMI) with hsCRP (p &gt; 0.05) yet central obesity (WC) was significantly associated with hsCRP (p = 0.028, PR = 2.8, 95% CI 1.1–6.9). Being female increases by 3.5 higher risk of prehypertension than male (p = 0.015, 95% CI 1.3–9.8) while age was not a risk factor for prehypertension. The nutritional status, determined by BMI and WC, and hsCRP were not significant risk factors for prehypertension, even after being adjusted with covariates. Conclusion: Adults with central obesity increased by 2.8 greater risks of high-level hsCRP than normal. Nutritional status and hsCRP were not the risk factors for prehypertension, even after being adjusted with covariates. Comprehensive nutrition intervention, including personalized nutrition and creating a healthier environment, is needed to encourage adults in improving their healthy habits and preventing negative health outcomes.

C-reactive protein predicts endocortical expansion but not fracture in older men: the prospective STRAMBO study.

Data on the link of the high-sensitivity C-reactive protein (hsCRP) with bone loss and fracture risk are discordant. We studied the association of the hsCRP with the prospectively assessed decrease in areal bone mineral density (aBMD), bone microarchitecture decline, and fracture risk in older men. At baseline, hsCRP was measured in 823 men aged 60-88. Areal BMD and bone microarchitecture (distal radius, distal tibia) were assessed by dual-energy X-ray absorptiometry and high-resolution peripheral QCT, respectively, at baseline and after 4 and 8years. Data on incident fractures were collected for 8years. Higher hsCRP concentration was associated with faster increase in aBMD at the whole body and lumbar spine, but not other sites. Higher hsCRP levels were associated with faster decrease in cortical area and more rapid increase in trabecular area at the distal radius (0.048 mm2/year/SD, p < 0.05) and distal tibia (0.123 mm2/year/SD, p < 0.001). At the distal tibia, high hsCRP level was associated with greater decrease in total and cortical volumetric BMD (vBMD) and in failure load. The hsCRP levels were not associated with the fracture risk, even after accounting for competing risk of death. Higher hsCRP levels were associated with greater endocortical expansion at the distal radius and tibia. Higher hsCRP was associated with slightly faster decrease in total and cortical vBMD and failure load at distal tibia, but not with the fracture risk. Thus, high hsCRP levels are associated with faster cortical bone loss, but not with fracture risk in older men.