hs-CRP Levels In Patients Research Articles

Effect of Statins on Serum level of hs-CRP and CRP in Patients with Cardiovascular Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background Several studies have reported that statins have anti-inflammatory effects. Nevertheless, results of clinical trials concerning the effect of statins on the levels of C-reactive protein (CRP) and high-sensitivity CRP (hs-CRP) have been inconsistent. Therefore, we performed a systematic review and meta-analysis of randomized clinical trials (RCTs) evaluating the effect of statins on CRP and hs-CRP levels in patients with cardiovascular diseases (CVDs). Methods Literature search of the major databases was performed to find eligible RCTs assessing the effect of statins on serum levels of CRP and hs-CRP from the inception until the last week of April 2021. The effect sizes were determined for weighted mean difference (WMD) and 95% confidence intervals (CI). Results 26 studies were identified (3010 patients and 2968 controls) for hs-CRP and 20 studies (3026 patients and 2968 controls) for CRP. Statins reduced the serum levels of hs-CRP (WMD = −0.97 mg/L; 95% CI: -1.26 to -0.68 mg/L; P < 0.001) and CRP (WMD = −3.05 mg/L; 95% CI: -4.86 to -1.25 mg/L; P < 0.001) in patients with CVDs. Statins decreased the serum levels of hs-CRP in patients receiving both high-intensity and moderate/low-intensity treatments with these drugs. In addition, the duration of treatment longer than 10 weeks decreased hs-CRP levels. Only high-intensity statin treatment could marginally decrease serum levels of CRP in CVDs patients. Conclusions This meta-analysis showed the efficacy of statins to reduce the concentrations of CRP and hs-CRP in patients with different types of CVDs.

Therapeutic effect of tocilizumab on inhibiting cytokine release syndrome in severe Coronavirus Disease 2019 patients

Background and Objectives: Older adults are more susceptible to coronavirus disease 2019 (COVID-19). Interleukin-6 (IL-6) is an important cytokine in the cytokine release syndrome (CRS), and tocilizumab blocks the IL-6 receptor. The objective is to analyze the effect of tocilizumab on CRS in older patients with severe COVID-19. Materials and Methods: Between February 10 and March 21, 2020, a total of 19 patients aged ≥60 years with severe or critical COVID-19 met the study inclusion criteria at the Tongji Hospital in Wuhan City, Hubei Province, China. The patients were divided into two groups: the tocilizumab group, with IL-6 levels, which exceeded the upper limit of normal by >10-fold and non-tocilizumab group. Results: Patients in the tocilizumab group were older (73.20 ± 4.44 vs. 66.21 ± 5.06 years, P = 0.014), had lower lymphocyte counts (0.71 ± 0.18 vs. 1.18 ± 0.59 × 109/L, P = 0.016), and higher high-sensitivity C-reactive protein (hsCRP) levels (94.04 ± 57.24 vs. 51.65 ± 45.37 mg/L, P = 0.035). Increases in ferritin (FER) and hsCRP levels in patients in the tocilizumab group were marked. Except for one patient who died, IL-6, FER, hsCRP levels, and the neutrophil/lymphocyte ratio in the remaining four patients decreased following treatment with tocilizumab. Tocilizumab did not cause any serious adverse reactions. There were no differences in mortality, days until lung computerized tomography improvement, or renal function between the two groups. The total mortality rate was 10.53%. Conclusions: Our results support the therapeutic efficacy and safety of tocilizumab in older patients with severe COVID-19.

English

BACKGROUND Relationship between serum uric acid and cardiovascular system has been recognised since years. High-sensitivity C-reactive protein (hs-CRP) is a known risk factor for cardiovascular and cerebrovascular events. The role of uric acid as a risk factor for vascular disease and acute stroke is controversial and there is little information about it.1 It is unclear as to whether high uric acid concentrations promote or protect against the development of cerebrovascular disease, or simply acts as a passive marker of increased risk. As serum hs-CRP is an established risk factor for stroke, its positive correlation with serum uric acid levels would suggest that high serum uric acid could predict stroke risk. Also, it would prove to be a more cost-effective investigative tool in our present set up. METHODS In this cross-sectional study, we assessed 100 patients admitted with acute stroke in Victoria and Bowring and Lady Curzon Hospital from October 2016 to November 2018. Clinical records, routine investigations, radiological imaging, serum uric acid and hs-CRP of the patients were investigated. RESULTS Majority of the patients (33 %) belonged to the age group of &gt; 70 yrs., followed by 61 - 70 yrs. (26 %). 69 % of the patients were males and 31 % were females. 67 % of them were hypertensive and 32 % were diabetic. 91 % had an hs-CRP level of &gt; 3.0 mg / L and 8 % had hs-CRP levels between 1.0 and 3.0 mg / L. None of the female patients had a serum uric acid value &gt; 6.5 mg / dL and none of the male patients had a uric acid level of &gt; 7.0 mg / dL. There was a correlation between serum uric acid levels and serum hs-CRP levels in patients ≤ 50 yrs. of age. There was no correlation between serum hs-CRP levels and serum uric acid levels in patients more than 50 yrs. of age. CONCLUSIONS Our study showed that stroke is most common in persons &gt; 70 yrs. of age and is more common in males compared to females. Hypertension is an independent risk factor for stroke. hs-CRP is a well-established risk marker for stroke, being raised in majority of stroke patients. Serum uric acid is not raised in all patients of acute stroke. So, it cannot be used as a risk marker for stroke. KEY WORDS hs-CRP, Serum Uric Acid, Acute Stroke

A Comparison on Effects of High Dose Rosuvastatin versus High Dose Atorvastatin on Lipid Profile and CRP Level in Patients Undergoing Percutaneous Coronary Intervention: A Randomized Study

Background: Statins are the most common drugs used for reducing low-density lipids (LDL). In addition to their lipid-lowering effects, they have well-documented anti-inflammatory actions. The goal of this study was to compare the effects of high dose atorvastatin and rosuvastatin on lipid profiles and high sensitivity C Reactive Protein (hs-CRP) in patients undergoing percutaneous coronary intervention (PCI). Methods: The study was done between October 2017 and September 2018 in Semnan Kowsar Hospital. In this randomized trial, 69 patients with atherosclerotic coronary artery disease were randomly assigned 1:1 to receive atorvastatin (80 mg daily) or rosuvastatin (40 mg daily) for 4 months. Levels of hs-CRP and lipid profiles including cholesterol, triglyceride, low-density lipids (LDL), and high-density lipids (HDL) were measured and compared before and after the treatments. Lipid profiles were measured at baseline, 2 months, and 4 months of the treatment. Results: Sixty patients completed the study. The mean age was 61.1 ± 6.6 years with an excess of males. After 4 months, both drugs could significantly reduce LDL levels, however, the between-group differences were not statistically significant. Rosuvastatin significantly increased HDL levels (p &lt; 0.05). In addition, triglyceride levels had a significant reduction in both groups, yet the differences were not significant. Both drugs caused significant reductions in hs-CRP levels (p &lt; 0.05). Moreover, the effects of treatments were seen in drug naïve patients as well as patients who were on statins prior to the trial. Conclusion: Our study indicates that high dose therapies with atorvastatin and rosuvastatin have similar effects on lipid profiles and hs-CRP levels in patients undergoing PCI.

Randomized Study of the Effects of Zinc, Vitamin A, and Magnesium Co-supplementation on Thyroid Function, Oxidative Stress, and hs-CRP in Patients with Hypothyroidism.

Hypothyroidism can occur due to deficiencies in micronutrients such as zinc, magnesium, and vitamin A. The aim of this study was to determine the effects of supplementation with these micronutrients on thyroid function, oxidative stress, and hs-CRP levels in patients with hypothyroidism. In a randomized double-blind, placebo-controlled trial with two parallel groups, 86 hypothyroid patients aged 20-65 were allocated to receive daily supplementation with either: (intervention group, n = 43) one 30mg zinc gluconate capsule per day, one 250mg magnesium oxide tablet per day, and one 25,000IU vitamin A capsule twice/week for 10weeks or (placebo group, n = 43) placebo capsules and tablets as above for 10weeks. Neither of the groups changed their diet or physical activity. Thyroid hormones (free and total thyroxine (FT4 and TT4), free tri-iodothyronine (FT3), and thyroid-stimulating hormone (TSH)), oxidative markers (malondialdehyde (MDA) and total antioxidant capacity (TAC)), serum hs-CRP, and anthropometric indices (height and weight) were assessed at the baseline and at the end of the study. In the intervention group, we found a significant increase in serum FT4, decreased anthropometric indices, and lower levels of serum hs-CRP by the end of the 10week protocol (P < 0.05). In the placebo group, serum TAC was decreased and hs-CRP increased (P < 0.05), with no significant changes in serum TSH, FT3, TT4, and MDA after the intervention. Zinc, vitamin A, and magnesium supplementation may have beneficial effects in patients with hypothyroidism and in diseases associated with hyperthyroidism.

Protective effects of propolis on hepatic steatosis and fibrosis among patients with nonalcoholic fatty liver disease (NAFLD) evaluated by real-time two-dimensional shear wave elastography: A randomized clinical trial.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, while no drugs have been approved for its treatment. The pieces of evidence indicate that propolis as a novel anti-inflammatory agent might be a promising candidate to treat NAFLD. We aimed to evaluate the efficacy of propolis on hepatic steatosis and fibrosis in patients with NAFLD. This randomized clinical trial was conducted on 54 patients with NAFLD. Patients were randomly assigned to receive propolis tablets at a dose of 250 mg twice daily for 4 months or placebo. The improvement in hepatic steatosis and fibrosis was evaluated using two-dimensional shear wave elastography. Improvement in the hepatic steatosis was significantly higher in the propolis group than the placebo group, even after adjustment for baseline value and changes in weight, energy intake, and physical activity (odds ratio [OR]: 5.67; 95% confidence intervals [CI]: 1.41-22.8; p = .014). A significant reduction was observed on the liver stiffness in the propolis group (-0.65 ± 0.56 kPa; p = .001), whereas it increased in the placebo group (0.27 ± 0.59 kPa; p = .037). Also, the intake of propolis significantly decreased high-sensitivity C-reactive protein (hs-CRP) levels compared with the placebo group (-0.371; 95%CI: -0.582 to -0.16 mg/L; p = .01). Changes in serum levels of fasting blood sugar, alanine aminotransferase, aspartate aminotransferase, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, cholesterol, and triglyceride did not differ significantly between the two groups (p > .05). There was no significant improvement in insulin resistance in both groups (p > .05). Propolis seems to have protective effects on hepatic steatosis and fibrosis and to reduce the serum levels of hs-CRP in patients with NAFLD.

Вплив терапії артеріальної гіпертензії в залежності від класів препаратів на рівні нових біомаркерів запалення РФД-15, Р-селектину та галектину-3

The purpose of the study was to assess the impact of antihypertensive therapy depending on the classes of drugs on the level of new biomarkers of inflammation: GDF-15, P-selectin and Galectin-3 in blood plasma in patients with hypertension in combination with type 2 diabetes. Material and methods. The study included 121 patients, including 59 women and 62 men aged 40 to 87 years (mean age 64.7±10.6 years). We determined the levels of new biomarkers of inflammation (GDF-15, P-selectin, Galectin-3), and a reference marker of systemic inflammation (high-sensitive CRP (hs-CRP) using standard kits in patients who participated in the study. We also evaluated the effect of different classes of antihypertensive drugs at the level of new biomarkers. Results and discussion. In the group of patients with unattainable target blood pressure, the level of GDF-15 was significantly higher compared with the group of patients whose target level of "office" blood pressure was achieved at the time of inclusion in the study (3286.10±1523.02 and 2326.60±1581.70 ng / ml, p &lt;0.05, respectively). At the same time, plasma levels of P-selectin and Galectin-3 in patients did not differ significantly. After 12 months of hypertension treatment, depending on the achievement of blood pressure control showed that in the group of patients who managed to achieve the target "office" blood pressure, the level of GDF-15 was significantly lower than in the group of patients who did not reach the target level of "office" blood pressure after 12 months of treatment (3129.67±1134.87 and 2543.12±976.54 ng / ml, p &lt;0.05, respectively). Changes of P-selectin, Galectin-3 and hs-CRP were insignificant after 12 months of treatment of hypertension. Baseline plasma levels GDF-15, P-selectin, Galectin-3 and hs-CRP in patients who received or did not receive RAAS blockers had no significant difference. There was a significantly lower baseline level of GDF-15 in the group of patients receiving CCB (2343.42±1280.70 and 3248.29±1178.56 pg / ml, p = 0.05, respectively). Baseline plasma levels of P-selectin, Galectin-3 and hs-CRP in patients who took or did not take CCB did not have a significant difference. According to the meta-analysis of the chances of taking the drugs had a significant effect on the level of GDF-15, while some groups of drugs did not show a significant additional risk of affecting the level of GDF-15 in patients. Conclusion. The dependence of the GDF-15 level on the achievement of the "target" level of blood pressure can be explained by the positive impact on hemodynamics and structural changes in the cardiovascular system due to better control of blood pressure per se. Antihypertensive drugs affect different pathogenetic mechanisms of inflammation in different ways. According to the analysis of the chances, CCB had the greatest impact on reducing the level of GDF-15. None of the classes of antihypertensive drugs had a significant effect on the level of Galectin-3, and there was a tendency to lower levels of hs-CRP in patients taking blockers of RAS and CCB. The level of P-selectin decreased in patients taking β-blockers due to concomitant use of antiplatelets and anticoagulants

Changes in intestinal flora in preeclampsia rats and effects of probiotics on their inflammation and blood pressure.

The aim of this study was to investigate the changes in intestinal flora in preeclampsia rats and the effects of probiotics on their inflammation and blood pressure. A total of 40 Specific Pathogen Free (SPF) Wistar rats were randomly selected in this study. Abdominal operation was performed to reduce uterine blood perfusion, so as to establish the model of preeclampsia in rats. All rats were randomly divided into two groups, namely, observation group (treated with probiotics, n=20) and control group (not treated with probiotics, n=20). Subsequently, the changes in serum endotoxin level during intervention, the 24-h urinary 99mTc-diethylene triamine pentaacetic acid (DTPA) excretion rate, and intestinal flora colonization ability after intervention were compared between the two groups. The distribution of intestinal flora after intervention was recorded in the two groups. Meanwhile, vascular endothelial function and blood pressure following intervention were compared between the two groups as well. In addition, the changing trend of inflammatory cytokines during intervention in the two groups, and the correlation of colonization ability of intestinal flora with changes in systolic blood pressure and high-sensitivity C-reactive protein (hs-CRP) level in patients were analyzed. At 3 days and 1 week after intervention, serum endotoxin level in the observation group was significantly lower than that in the control group at the same period (p<0.05). Following intervention, observation group exhibited remarkably higher excretion rate of 24-h urinary 99mTc-DTPA (p<0.05), stronger colonization ability of intestinal flora (p<0.05), higher levels of Bifidobacteria and Lactobacillus in intestinal flora (p<0.05), lower level of endothelin-1 (ET-1) (p<0.05) and higher level of nitric oxide (NO) (p<0.05) than the control group. In addition, the systolic blood pressure and diastolic blood pressure in the observation group were basically normal, which were both notably lower than those in the control group (p<0.05). At 3 days and 1 week after intervention, the levels of serum inflammatory cytokine hs-CRP in the observation group was markedly lower than that in the control group (p<0.05) at the same period. Furthermore, the colonization ability of intestinal flora was negatively associated with the changes in systolic blood pressure and hs-CRP level in patients (p<0.05). Treating preeclampsia rats with probiotics can effectively reduce the level of serum endotoxin, improve the body's capacity to eliminate metabolites and the colonization ability of intestinal flora, maintain the stability of intestinal flora, enhance vascular endothelial function, and reduce blood pressure and the body's inflammatory responses.

Association Between Long-term Functional Outcome and Change in hs-CRP Level in Patients With Acute Ischemic Stroke.

Elevated high-sensitivity C-reactive protein (hs-CRP) has been suggested as a risk factor for ischemic stroke. However, the predictive value of hs-CRP for long-term outcomes is poorly defined. Therefore, we conducted this study to evaluate whether change in hs-CRP level plays a role in the prognostic value of long-term functional disability. We studied 263 patients with acute ischemic stroke and 104 healthy controls (67.5±11.26 and 68.17±11.21 y, respectively). hs-CRP was measured on admission and on the seventh day of hospitalization. The patients were classified into 2 groups on the basis of difference in hs-CRP level from admission to the seventh day of hospitalization (group 1, hs-CRP on admission>the seventh hospital day; group 2, hs-CRP on admission<the seventh hospital day). The correlation between change in hs-CRP level and functional disability using the modified Rankin Scale score (mRS) at 1, 3, 6, and 12 months after stroke onset was analyzed. We observed significant differences between initial hs-CRP level in all patients (0.96±2.82 mg/dL) and healthy controls (0.34±0.71 mg/dL, P=0.029). Significant differences in mRS at the 4 different timepoints was not observed between 2 groups (P=0.453, 0.225, 0.229, and 0.396, respectively). The Spearman rank-order correlation coefficients showed that change in hs-CRP level increasingly differed over time and was statistically correlated with mRS (coefficient/P: at 1 mo, 0.139/0.024; at 3 mo, 0.149/0.015; at 6 mo, 0.147/<0.001; and at 12 mo, 0.134/0.03). However, the results were very low correlation coefficients, despite their statistical significance. This study did not clearly show an association between increase in hs-CRP level over time and long-term functional disability.

Association of CRP levels with ARMS2 and CFH variants in age-related macular degeneration.

To investigate whether plasma high sensitivity C-reactive protein (hs-CRP) level is associated with exudative age-related macular degeneration (AMD) as well as variants of ARMS2 A69S and CFH I62V in patients with exudative AMD. A case-control study was done comparing CRP among patients with exudative AMD including those with polypoidal choroidal vasculopathy, typical AMD and retinal angiomatous proliferation, and CRP were also compared between cases and controls. Plasma CRP was measured from peripheral blood using latex nepherometry for all participants. Genotyping of ARMS2 A69S and CFH I62V was performed for all patients with exudative AMD using TaqMan technology. Among 125 patients with exudative AMD, including 31 with typical neovascular AMD, 73 with PCV and 21 with RAP lesions and 150 controls, CRP levels were higher in exudative AMD than in controls. (P = 2.7 × 10-5) There was not a significant difference in hs-CRP levels among AMD subtypes. Neither variants of ARMS2 nor CFH was associated with hs-CRP level in patients with exudative AMD. A multiple regression analysis revealed that gender male, presence of exudative AMD and presence of cardiovascular diseases were associated with increased plasma hs-CRP. Plasma hs-CRP was elevated independent of variants of ARMS2 A69S and CFH I62V in patients with exudative AMD.

The Effects of Serum hs-CRP on the Incidence of Lung Cancer in Male Patients with Pulmonary Tuberculosis

This study intended to investigate the effects of serum high-sensitivity C-reactive protein (hs-CRP) on the incidence of lung cancer in male patients with pulmonary tuberculosis. A total of 1091 male patients with pulmonary tuberculosis in Zhejiang Cancer Hospital, Hangzhou, China from Jan 2009 to Jan 2012 were selected as the research objects. All patients were followed up from the beginning of hospitalization. According to serum hs-CRP level, patients were divided into two groups: group A (hs-CRP < 1 mg/L) and group B (hs-CRP > 3 mg/L). The relationship between baseline hs-CRP and the risk of lung cancer in patients with pulmonary tuberculosis was analyzed by multivariate Cox proportional risk regression model, and the serum levels of hs-CRP between lung cancer patients in all groups and other non-lung cancer patients were compared. There were differences in age, drinking, smoking, diabetes history, body mass index (BMI), thyroglobulin (TG), history of hypertension and hyperglycemia among the three groups (P=0.036, 0.018, 0.040, 0.029, 0.006, 0.034, 0.020, 0.010). The serum levels of hs-CRP in patients with squamous carcinoma, adenocarcinoma and small cell carcinoma were significantly higher than those in non-lung cancer patients (P=0.022, 0.043, 0.011). The incidence rates of lung cancer in patients in group B and C were 1.37 and 1.69 times higher than that in group A, respectively. The increased serum level of hs-CRP will increase the incidence rate of lung cancer in male patients with pulmonary tuberculosis.

Association between severity of obstructive sleep apnea and high-sensitivity C-reactive protein in patients with hypertrophic obstructive cardiomyopathy.

BackgroundObstructive sleep apnea (OSA) is highly prevalent in patients with hypertrophic obstructive cardiomyopathy (HOCM). Inflammatory responses are increased in patients with OSA, meanwhile, inflammation is also associated with adverse outcomes in HOCM.HypothesisTo investigate the association between severity of OSA and high‐sensitivity C‐reactive protein (hs‐CRP) in patients with HOCM.MethodsThree hundred and ninteen patients with HOCM who underwent sleep evaluations at Fuwai Hospital were retrospectively included between February 2010 and December 2018. Data from baseline clinical characteristics and polysomnography studies were collected.ResultsOSA was present in 168 (52.7%). Patients with OSA were older, more likely to be male, had a higher body mass index and more clinical comorbidities. Patients with OSA had enlarged left ventricular diameter and similar left ventricular outflow tract obstruction compared with those without. In multivariate logistic analysis, apnea‐hypopnea index (OR, 1.024; 95% CI, 1.005‐1.044; P = .014), oxygen desaturation index (OR, 1.025; 95% CI, 1.004‐1.046; P = .018) and lowest oxygen saturation (OR, 0.951; 95% CI, 0.915‐0.989; P = .011) were independently associated with high risk hs‐CRP (>3 mg/L) after adjusting for confounders. In addition, decreasing lowest oxygen saturation (β = −.159, P = .004) was also independently correlated with increasing hs‐CRP concentrations in multivariate linear analysis after adjusting for confounders.ConclusionsSeverity of OSA was independently associated with elevated hs‐CRP levels in patients with HOCM. Further studies are needed to evaluate the effects of treating OSA on hs‐CRP as well as clinical outcomes in these patients.

Randomized Controlled Trial of Herbal Extracts (Eugenia polyantha, Apium graveolens, Nigella sativa) and Allopurinol Effect on Serum Uric Acid, Urinary Uric Acid and High Sensitivity C-Reactive Protein Levels in Subject with Hyperuricemia

Background: Eugenia polyantha, Apium graveolens, and Nigella sativa are extracts which in preclinical trial can reduce uric acid serum, increase urinary uric acid excretion. Allopurinol is an inhibitor of the xanthine oxidase enzyme which can also reduce the increase of hsCRP in subjetcs with hyperuricemia.&#x0D; &#x0D; Objective: To determine the safety and effect of herbal extracts in reducing serum uric acid, increasing uric acid excretion and reducing hsCRP levels in patients with hyperuricemia compared with allopurinol.&#x0D; &#x0D; Method: This study was a double blind randomized controlled trial (RCT). The subjects were hyperuricemic patients aged ³18 years. The subject was divided into groups that received 3000 mg/day of herbal extracts and allopurinol 100 mg/day for 4 weeks. Evaluation of serum uric acid and urinary uric acid urine were every week, and hsCRP levels was baseline and end of intervention. Other parameters related to the safety of use were examined every 2 weeks.&#x0D; &#x0D; Results: A number of 44 hyperucemia subjects, 23 subjects received herbal extracts and 21 subjects received allopurinol. The decrease of uric acid serum levels in the herbal extract group was 0,467±1,123;0,600;-2,70-3,00 (p=0.027), while in the allopurinol group 1,11&#x0D; 4±0,813;1,30;-1,30-2,30 (p=0,000). Uric acid excretion in the herbal extract group decrease 71,00±1,970;5,50;-92,00-702,00 (p=0,269) and in the allopurinol group decrease 64,54±1,298;22,00;-29,00-440,0 (p=0.003). The reduction of hsCRP in the herbal extract group was 0.08±0.639; 0.01; -1.55-2.05 (p=0.658), and the allopurinol group was -0.33 ± 0.806; -0.01; -2.73- 0.31 (p=0.256).&#x0D; &#x0D; Conclusion: Herbal extracts (Eugenia poliantha, Apium graveolens and Nigella sativa) and allopurinol can reduce serum uric acid levels in patients with hyperuricemia. Allopurinol also can reduce urinary uric acid excretion.

Anti-Varicella Zoster Virus IgG and hsCRP Levels Correlate with Progression of Coronary Artery Atherosclerosis

The relationship between high levels of anti-Varicella Zoster Virus (VZV) IgG in cerebrospinal fluid (CSF) and cerebrovascular atherosclerosis commends a possible similar association in other vessels. We aimed to investigate the association of VZV-seropositivity with coronary artery atherosclerosis. We recruited 88 newly diagnosed patients with more than 50% stenosis in at least one of the main coronary arteries. As the control group, 99 age-matched individuals with normal/insignificant coronary artery findings were included. Clinical, paraclinical, and demographical data were gathered at the time of sampling. High-sensitivity C-reactive protein (hsCRP) levels were measured by nephelometry. VZV-seropositivity was determined by measuring of anti-VZV IgG level in plasma. Multivariable logistic regression was used to evaluate the correlation of data with coronary vascular atherosclerosis. The frequency of VZV-seropositivity was significantly higher in the atherosclerosis group compared to the controls (OR=1.88; 95%CI=1.03-3.44). The plasma levels of anti-VZV IgG were significantly higher in patients with atherosclerosis (Median=2.70, IQR=1.53-4.30 AU/mL) than in the controls (Median=2.10, IQR=1.70-3.10 AU/mL, p=0.034). The hsCRP levels in patients and controls were 5.19±2.00 and 1.51±1.07 mg/L, respectively. The correlation between hsCRP and anti-VZV IgG level in plasma was observed (r=0.40, p<0.001). The levels of hsCRP and anti-VZV IgG increased based on the number of diseased vessels but only the difference in hsCRP levels reached a significant level (p<0.001 and p=0.168, respectively). Our data suggest that VZV-seropositivity and hsCRP elevation jointly increase the risk of atherosclerosis. The multifactorial nature of atherosclerosis; however, leaves more options for the inflammatory milieu to be generated.

Atherosclerosis Prediction with High Sensitivity C-Reactive Protein (hs-CRP) and Related Risk Factor in Patient with Dyslipidemia.

BACKGROUND:Inflammation plays a major role in the initiation, destabilization and the progression of atherosclerosis. High Sensitivity C-Reactive Protein (hs-CRP) reflects active systemic inflammation and have shown to be a strong predictor of future cardiovascular events.AIM:The purpose of this study was to determine the role of High Sensitivity C-Reactive Protein (hs-CRP) independent for atherosclerosis severity prediction and to find out which factors largely is affecting hs-CRP level in dyslipidemia patient.METHODS:A total of 388 patients (267 dyslipidemia, 121 controls) were enrolled in this study. We investigated whether plasma hs-CRP is associated with atherosclerosis severity that was quantified by ankle-brachial index (ABI) and Doppler ultrasound. Related risk factor that influence hs-CRP levels in patients with dyslipidemia included determination of age, gender, diabetes, smoking, hypertension, total cholesterol, TG, LDL, HDL, and fasting glucose.RESULTS:Data showed a significant association between hs-CRP concentration level and the severity of atherosclerosis (p < 0.01). Univariate analysis showed that fasting plasma glucose, triglyceride, and BMI were significantly positively correlated with hs-CRP levels. Whereas, HDL cholesterol was negatively correlated with hs-CRP levels. Multivariate regression analysis using model 1 and 2, showed that in determining hs-CRP levels, triglyceride and BMI were taking a big role.CONCLUSION:Hs-CRP correlates with extent of atherosclerosis, and high triglyceride and BMI is closely associated with high hs-CRP levels in patients with dyslipidemia.

Large-scale evidence for an association between low-grade peripheral inflammation and brain structural alterations in major depression in the BiDirect study

Preliminary research suggests that major depressive disorder (MDD) is associated with structural alterations in the brain; as well as with low-grade peripheral inflammation. However, even though a link between inflammatory processes and altered brain structural integrity has been purported by experimental research, well-powered studies to confirm this hypothesis in patients with MDD have been lacking. We aimed to investigate the potential association between structural brain alterations and low-grade inflammation as interrelated biological correlates of MDD. In this cross-sectional study, 514 patients with MDD and 359 healthy controls underwent structural MRI. We used voxel-based morphometry to study local differences in grey matter volume. We also assessed serum levels of high-sensitivity C-reactive protein (hsCRP) in each participant. Compared with healthy controls (age [mean ± standard deviation] 52.57 ± 7.94 yr; 50% male), patients with MDD (49.14 ± 7.28 yr, 39% male) exhibited significantly increased hsCRP levels (Z = −5.562, p < 0.001) and significantly decreased grey matter volume in the prefrontal cortex and the insula. Prefrontal grey matter volume reductions were significantly associated with higher hsCRP levels in patients with MDD (x = 50, y = 50, z = 8; t1,501 = 5.15; k = 92; pFWE < 0.001). In the MDD sample, the significant negative association between hsCRP and grey matter appeared independent of age, sex, body mass index, current smoking status, antidepressant load, hospitalization and medical comorbidities. This study had a cross-sectional design. The present study highlights the role of reduced grey matter volume and low-grade peripheral inflammation as interrelated biological correlates of MDD. The reported inverse association between peripheral low-grade inflammation and brain structural integrity in patients with MDD translates current knowledge from experimental studies to the bedside.

Long Non-Coding RNA MALAT1 Promotes Acute Cerebral Infarction Through miRNAs-Mediated hs-CRP Regulation

The occurrence of cerebral infarction commonly takes atherosclerosis as the pathophysiological basis, accompanied by chronic inflammation. Hypersensitive C-reactive protein (hs-CRP) is an important inflammatory factor involved in the formation of atherosclerosis. This study aims to investigate the regulation of hs-CRP expression by long-chain non-coding RNA (LncRNA) MALAT1 in acute cerebral infarction patients. Plasma levels of LncRNA MALAT1 and hsa-miR-145-5p, hsa-miR-140-5p, hsa-miR-483-3p, and hsa-miR-338-3p in 256 Chinese Han ACI patients and 256 controls were analyzed. HUVECs were transfected with LncRNA MALAT1, MALAT1 NC, and si-MALAT1, respectively. The expression levels of hsa-miR-145-5p, hsa-miR-140-5p, hsa-miR-483-3p, and hsa-miR-338-3p were analyzed. Then, HUVECs were transfected with hsa-miR-145-5p inhibitor, hsa-miR-140-5p inhibitor, hsa-miR-483-3p inhibitor, hsa-miR-338-3p inhibitor, and hsa-miR-145-5p mimic, hsa-miR-140-5p mimic, hsa-miR-483-3p mimic, hsa-miR-338-3p mimic, and the expression level of hs-CRP was detected by Western blotting. The levels of hsa-miR-145-5p, hsa-miR-140-5p, hsa-miR-483-3p, and hsa-miR-338-3p in the plasma of ACI patients were significantly lower than those in the control group (p < 0.001), and the plasma LncRNA MALAT1 levels were significantly higher in ACI patients than in the control group (p < 0.001). The level of LncRNA MALAT1 in plasma of ACI patients and control group was negatively correlated with hsa-miR-145-5p, hsa-miR-140-5p, hsa-miR-483-3p, and hsa-miR-338-3p (r = - 0.36, - 0.79, - 0.76, - 0.75; - 0.60, - 0.68, - 0.48, - 0.56). Plasma levels of hsa-miR-145-5p, hsa-miR-140-5p, hsa-miR-483-3p, and hsa-miR-338-3p were negatively correlated with hs-CRP levels in patients with ACI and controls (r = - 0.74, - 0.81, - 0.84, - 0.56; - 0.61, - 0.69, - 0.69, - 0.50). MALAT1 transfection resulted in the decreased levels of hsa-miR-145-5p, hsa-miR-140-5p, hsa-miR-483-3p, and hsa-miR-338-3p in HUVECs while overexpression of hsa-miR-145-5p, hsa-miR-140-5p, hsa-miR-483-3p, and hsa-miR-338-3p led to a decrease in hs-CRP levels in HUVECs. LncRNA MALAT1 induced the upregulation of CRP expression through inhibiting the expression of hsa-miR-145-5p, hsa-miR-140-5p, hsa-miR-483-3p, and hsa-miR-338-3p.

The Effect of Simvastatin on Nitric Oxide and hs-CRP Levels in patients with Liver Cirrhosis at Dr. Moewardi Hospital, Surakarta

Background: The prevalence of liver cirrhosis (SH) worldwide is at seventh place as the cause of death. Increased pressure in the portal vein Portal Hypertension (HP) causes esopha­geal varices and the more likely the patient to bleed. Endothelial dysfunction in cirrhosis of the liver causes a decrease in nitric oxide (NO) levels resulting in an imbalance between relaxation factors and portal vein contractions and increasing hs-CRP levels. Simvastatin can increase NO levels and improve endothelial dysfunction in patients with SH and can reduce levels of hs-CRP. This study aimed to determine the effect of simvastatin administration on nitric oxide and hs-CRP level in patients with liver cirrhosis. Subjects and Method: This was a randomized controlled trial conducted at Dr. Moewardi hospital, Surakarta, Central Java. A sample of 29 patients was divided into treatment and control groups. 14 patients in the treatment group were given simvastatin dose of 20 mg. 15 patients in the control group received a placebo. The dependent variable was a nitric oxide and hs-CRP levels. The inde­pendent variable was Simvastatin administration. Nitric oxide serum level was measured by an enzyme-linked immunosorbent assay (ELISA). Hs-CRP level was measured by the immune­chemilu­minescent method. The data were analyzed by t-test. Results: NO level after Simvastatin 20 mg administration (Mean= 7.93 µg/mL; SD= 1.78 µg/ mL) was higher than before (Mean= 5.14 µg/mL; SD= 2.25 µg/mL) and it was statistically significant (p = 0.001). Hs-CRP level after Simvastatin 20 mg administration (Mean= 2.04 mg/L; SD= 0.80 mg/L) was lowered than before (Mean= 7.82 mg/L; SD= 1.15 mg/L) and it was statistically significant (p= 0.001). Conclusion: Simvastatin administration increases NO serum levels and reduces the hs-CRP level in patients with liver cirrhosis. Keywords : nitric oxide, hs-CRP, simvastatin, liver cirrhosis Correspondence: Budhi Hariyanto. Masters Program in Family Medicine, Universitas Sebelas Maret. Jl. Ir Sutami 36A, Surakarta 57126, Centra Java. Email: antohariyanto787@gmail.com. Mobile: 0823280­10442. Indonesian Journal of Medicine (2019), 4(1): 9-14 https://doi.org/10.26911/theijmed.2019.04.01.02

Association between C-reactive protein, neutrophil to lymphocyte ratio and the burden of apical periodontitis: a case-control study

Objective: Endodontic originated chronic apical periodontitis (AP) is an inflammatory disease of periapical tissue. High-sensitivity C-reactive protein (hsCRP) as an inflammatory marker and hemogram indexes provide valuable information to clinicians for diagnosis, screening and follow-up of various diseases. The aim of this study was to investigate AP in terms of its association with hemogram indices and hsCRP levels.Material and methods: Study includes 104 patients with AP and 40 participants as the control group. 160 teeth were diagnosed as AP through digital radiographic images and scored with respect to Periapical Index (PAI) scoring. Afterwards, patients were categorized into 3 grades in accordance with both the number and the severity of AP. AP grade 0 was considered for the control group with regard to a new scoring system. Patients with only one tooth involved with AP with a PAI score of 3 or 4 were categorized as an AP Grade 1, when a patient had more than one tooth with a PAI score of 3 or 4 he was classified as an AP Grade 2 and a patient with at least one tooth scored as a PAI 5 was rated as an AP Grade 3. Hemograms and hsCRP levels were measured for each individual to establish a correlation with inflammatory markers.Results: The neutrophil/lymphocyte ratio (NLR) levels of patients with AP Grade 3 were significantly higher than all other AP grades (p < .05). hsCRP levels in patients with an AP Grade 2 and 3 were higher than both AP Grade 0 and 1 (p < .05).Conclusions: hsCRP levels of patients were reliable predictive indicators for AP severity in correlation with the new proposed scoring system for AP.

Estimation of Serum Interleukin-18 and Hs-CRP in Chronic Hepatitis C Infected Patients at Assuit Governorate, Egypt

Hepatitis C virus (HCV) infection is a global health problem. Egypt has the highest prevalence of hepatitis C virus (HCV) in the world. Interleukin-18 (IL-18) as a critical multipotent inducer of innate and acquired immune responses. This study aimed to estimate IL-18 and hs-CRP levels in patients at different stages of chronic HCV infection and to evaluate IL-18 as a non-invasive marker of the severity of liver damage in chronic hepatitis C patients, and to investigate the characteristics of hs-CRP and its correlation to chronic HCV infection. This study included 50 chronic HCV patients and 20 healthy. They were subjected to history taking, liver function tests, real-time PCR test and other laboratory tests. Serum IL-18 levels were assayed by an enzyme-linked immunosorbent assay. Our study was conducted on 70 subjects with their ages ranging between 9-70 years. 50 HCV chronically infected patients, were 42 (84.0%) males and 8 (16.0%) female. Twenty apparent healthy individuals without HCV infection used as a control, they were 18 (90%) males and 2 (10%) females. Serum IL-18 and Hs-CRP levels were higher in chronic HCV patients compared to healthy. Responders to interferon treatment had higher interleukin-18 levels than non-responders. However, Serum Hs-CRP were higher in non-responders than Responders to interferon treatment. Patients with hepatocellular carcinoma had higher interleukin-18 and Hs-CRP levels than those without hepatocellular carcinoma. Serum IL-18 could be a significant predictor for the severity of HCV infection and monitoring of therapy response in chronic HCV patients with other tests.