hs-CRP Assay Research Articles

Real-ambient bedroom light at night increases systemic inflammation and disrupts circadian rhythm of inflammatory markers

BackgroundExposure to light at night (LAN) has been associated with multiple adverse health outcomes. However, evidence is limited regarding the impacts of LAN exposure on human inflammation. ObjectivesTo examine the association between real-ambient bedroom LAN exposure with systemic inflammation and circadian rhythm of inflammatory markers. MethodsUsing data from a prospective cohort study of Chinese young adults. At baseline, bedroom LAN exposure was measured with a portable illuminance meter; fasting blood sample for high-sensitivity C-reactive protein (hs-CRP) assay was collected. At 3-year follow-up, 20 healthy young adults (10 LANavg < 5 lx, 10 LANavg ≥ 5 lx) were recruited from the same cohort; time-series venous blood samples were sampled every 4 h over a 24 h-cycle for the detection of 8 inflammatory markers. Circadian rhythm of inflammatory markers was assessed using cosinor analysis. ResultsAt baseline, the average age of the 276 participants was 18.7 years, and 33.3 % were male. Higher levels of bedroom LAN exposure were significantly associated with increased hs-CRP levels. The association between bedroom LAN exposure and systemic inflammation was only significant in the inactive group (MVPA < 2 h/d) but not in the physically active group (MVPA ≥ 2 h/d). In addition, exposure to higher levels of nighttime light (LANavg ≥ 5 lx) disrupted circadian rhythms (including rhythmic expression, circadian amplitude and circadian phase) of some inflammatory cytokines and inflammatory balance indicators. ConclusionExposure to bedroom nighttime light increases systemic inflammation and disrupts circadian rhythm of inflammatory markers. Keep bedroom darkness at night may represent important strategies for the prevention of chronic inflammation. Additionally, for people living a community with higher nighttime light pollution, regular physical activity may be a viable option to counteract the negative impacts of LAN exposure on chronic inflammation.

Comparing the Effectiveness of Octenidine Hydrochloride and Chlorhexidine Gluconate Mouthrinses in Reducing Plaque and Oxidative Stress in Institutionalized Children with Down Syndrome.

Due to decreased manual dexterity, a lack of motivation, and difficulty on the part of the caregiver conducting efficient oral hygiene measures at home, patients with Down syndrome (DS) are badly affected. The objective of this study is to compare the efficacy of 0.1% octenidine (OCT) hydrochloride and 0.12% chlorhexidine (CHX) gluconate on plaque control and oxidative stress in institutionalized children with DS. In 20 children, salivary samples were collected for analysis of the inflammatory marker high-sensitive C-reactive protein (hsCRP) and oxidative stress markers, specifically malondialdehyde (MDA). Plaque index (PlI) and gingival index (GI) were scored. After oral prophylaxis, the participants were randomly assigned to two groups, each consisting of 10 individuals (octenidol and CHX). Salivary oxidative stress marker assays were carried out using a modified version of Yagi's (1984) method, and absorbance was measured at 540 nm using an ultraviolet-visible spectrophotometer at 535 nm. hsCRP assays were conducted via latex turbidimetric immunoassay. On comparison between the two groups, the OCT group showed a statistically significant reduction in GI, PlI, and MDA values (p < 0.05). It was seen that the use of 0.1% OCT hydrochloride could facilitate the maintenance of good oral hygiene and periodontal status, especially in patients with motor difficulties. PMS/IEC/2016/02. Raj AS, George S, S A, et al. Comparing the Effectiveness of Octenidine Hydrochloride and Chlorhexidine Gluconate Mouthrinses in Reducing Plaque and Oxidative Stress in Institutionalized Children with Down Syndrome. Int J Clin Pediatr Dent 2024;17(4):437-441.

C-Reactive Protein Levels Correlate with Measures of Dysglycemia and Gut Microbiome Profiles.

C-reactive protein (CRP) is a commonly used marker of low-grade inflammation as well as a marker of acute infection. CRP levels are elevated in those with diabetes and increased CRP concentrations are a risk factor for developing type 2 diabetes. Gut microbiome effects on metabolism and immune responses can impact chronic inflammation, including affecting CRP levels, that in turn can lead to the development and maintenance of dysglycemia. Using a high-sensitivity C-reactive protein (hsCRP) assay capable of detecting subtle changes in C-reactive protein, we show that higher hsCRP levels specifically correlate with worsening glycemia, reduced microbial richness and evenness, and with a reduction in the Firmicutes/Bacteroidota ratio. These data demonstrate a pivotal role for CRP not only in the context of worsening glycemia and changes to the gut microbiota, but also highlight CRP as a potential target for mitigating type 2 diabetes progression or as a therapeutic target that could be manipulated through the microbiome. Understanding these processes will provide insights into the etiology of type 2 diabetes in addition to opening doors leading to possible novel diagnostic strategies and therapeutics.

The monomeric C-reactive protein level is associated with the increase in carotid plaque number in patients with subclinical carotid atherosclerosis.

The high-sensitivity C-reactive protein (hsCRP) assay measures the level of the pentameric form of CRP in blood. Currently, there are no available assays measuring the level of the monomeric form of CRP (mCRP), produced at sites of local inflammation. We developed an assay measuring the mCRP level in blood plasma with functional beads for flow cytometry. The assay was used to measure the mCRP level in 80 middle-aged individuals with initially moderate cardiovascular SCORE risk. By the time of the mCRP measurement, the patients have been followed up for subclinical carotid atherosclerosis progression for 7 years. Ultrasound markers of subclinical atherosclerosis, which included plaque number (PN) and total plaque height (PH), were measured at baseline and at the 7th-year follow-up survey. Inflammatory biomarkers, including mCRP, hsCRP, inteleukin-6 (IL-6) and von Willebrand factor (VWF) level, were measured at the 7th-year follow-up survey. The median level of mCRP was 5.2 (3.3; 7.1) μg/L, hsCRP 1.05 (0.7; 2.1) mg/L, IL-6 0.0 (0.0; 2.8) pg/mL, VWF 106 (77; 151) IU/dL. In the patients with the mCRP level below median vs. the patients with the median mCRP level or higher, change from baseline in PN was 0.0 (0.0; 1.0) vs. 1.0 (1.0; 2.0) and PH 0.22 (−0.24; 1.91) mm vs. 1.97 (1.14; 3.14) mm, respectively (p < 0.05). The adjusted odds ratio for the formation of new carotid atherosclerotic plaques was 4.7 (95% CI 1.7; 13.2) for the patients with the median mCRP level or higher. The higher mCRP level is associated with the more pronounced increase in PN and PH in patients with normal level of traditional inflammatory biomarkers and initially moderate cardiovascular SCORE risk.

Effect of age and gender on high - Sensitivity C - Reactive protein levels serum on health worker with latent tuberculosis and healthy control

BackgroundLatent tuberculosis is defined as a state of persistent immune response stimulated by Mycobacterium tuberculosis antigens with no evidence and signs of active TB . Health workers have a high risk of developing latent TB disease due to occupational exposure from patients. High sensitivity CRP (hs-CRP) assays have been developed for special values that may indicate low-grade inflammatory lesions as is true in measurement of latent tuberculosis infection. Factors that affect CRP levels are gender and age. Our study is conducted to asses effect of age and gender on Hs- CReactive protein leves serum on health worker with latent tuberculosis and healthy control. MethodThis research is a cross sectional study using primary data. The research was conducted at Wahidin Sudirohusodo Makassa Hospital and Community Center For Lung Health In South Sulawesi. Studied subject were recruited by consecutivesampling, in which the patient who met the inclusion criteria and then the serum HsCRP test was measured. Data analysis was performed using SPSS version 25. ResultDuring the study period , 80 subjects met the inclusion criteria. At age ≤ 32 years, the mean HsCRP was found to be lower in latent TB than in healthy controls, but not statistically significant (p>0.370). At age >32 years, the mean HsCRP was found to be higher in latent TB than in healthy controls, but not statistically significant (p>2.49). In males, the mean HsCRP was found to be higher in latent TB than in healthy controls, but not statistically significant (P =0.584). In women, the mean HsCRP was found to be lower in latent TB than in healthy controls, but not statistically significant (P =0.712). ConclusionSerum HsCRP levels were found to be higher in latent TB subjects with increasing age and male gender but not statistically significant.

High-sensitivity C-reactive protein as prognostic and predictive marker in metastatic non-small cell lung carcinoma : A prospective single center study.

e21101 Background: Systemic inflammation has been linked to incidence, progression, and poor outcomes in various cancers including non-small cell lung carcinoma (NSCLC). High-sensitivity CRP (hs-CRP) assays, generally used to assess cardiovascular risk, have rarely been evaluated in lung cancer studies. This study aimed to evaluate if baseline and on-treatment measurements of serum hs-CRP could provide prognostic and predictive information for patients with metastatic NSCLC treated with chemotherapy. Methods: In this single institutional prospective study 85 patients with metastatic NSCLC without targetable alterations who were treated with chemotherapy were included between 1st January 2020 and 31st December 2020, with a minimum follow-up duration of 6 months. Patients with coronary artery disease, active infections, autoimmune conditions, and chronic liver disease were excluded. Measurements of hs-CRP for all patients were done at baseline and every 12 weeks while on treatment. Patients were grouped by changes in hs-CRP levels compared to baseline levels as reduction (≥ 20% decline), and non-reduction (&lt; 20% decline) to assess association with radiologic response and progression- free survival (PFS). Results: Pre-treatment hs-CRP values were elevated for the majority (92.9% patients with ≥ 1 mg/L, 70.6% with ≥ 3 mg/L, and 42.3% with ≥ 10 mg/dL). No significant association was detected between the pre-treatment hs-CRP value and the number of metastatic sites (P = 0.4), histology (P = 0.3), or smoking status (P = 0.7). At a median follow-up of 13.7 months, the median PFS was 7.8 months (95% confidence interval [CI] 5.3 - 10.3). Patients with hs-CRP ≥10 mg/L had shorter PFS than those with hs-CRP &lt; 10 mg/L (Median PFS 7.5 months [95% CI 4.9 - 10] vs. 8.4 months [95% CI 0.1 - 17.4]; hazard ratio [HR] 1.8, 95% CI 1-3.4, P = 0.04). hs-CRP reduction (≥20% decline) after 12 weeks of treatment initiation predicted radiological response (P &lt; 0.001). Median PFS was 14.7 months (95% CI 7.4 – 22.1) in patients who demonstrated hs-CRP reduction (≥20% decline) at 12 weeks compared to 3.1 months (95% CI 2.3 – 3.9) in patients who did not (HR 0.17, 95% CI 0.08 - 0.33, P &lt; 0.001). Conclusions: Elevated hs-CRP at baseline was found to be a poor prognostic factor, while hs-CRP reduction by 20% or more on treatment predicted radiologic response and longer PFS in metastatic NSCLC patients treated with chemotherapy. Our findings of potential predictive and prognostic value of hs-CRP in metastatic NSCLC warrant validation in larger prospective studies.

Greater central adiposity resulting from increased market integration is associated with elevated C-reactive protein levels in older women from the Republic of Vanuatu

Objective: We characterized the relationship between circulating C-reactive protein (CRP) levels and nine anthropometric measures of body fat to identify the best anthropometric predictors of CRP in Ni-Vanuatu women.&#x0D; Sample and Methods: Anthropometric data and blood spot samples were collected from sixty-four Ni-Vanuatu female participants (age 35-78 years) on five islands with varying degrees of market integration, cultural change, and obesity. CRP concentration was determined with a high-sensitivity ELISA (hsCRP) assay and then compared to nine different anthropometric measurements.&#x0D; Results: BMI was significantly correlated with CRP (p=0.047). Among the eight additional anthropometrics, the suprailiac skinfold (p=0.003) and waist-circumference (p=0.009) were better predictors of CRP than BMI. Moreover, our stepwise selection model indicated that the suprailiac skinfold explained ~14% of CRP level variance.&#x0D; Conclusions: The BMI-CRP correlation coefficient for Ni-Vanuatu women falls within the range of previously reported values for East Asian populations with whom they share genetic ancestry. However, the best anthropometric predictors of CRP levels were waist circumference and suprailiac skinfold thickness. These measures capture central adiposity and are more closely associated with elevated CRP level and cardiovascular disease risk than fat distributed elsewhere on the body. Ni-Vanuatu in urban settings with high market integration are at greater risk for obesity, which is associated with elevated CRP levels. However, because nearly all Ni-Vanuatu still retain horticultural knowledge and land ownership, consumption of processed, imported foods is largely determined by degree of market integration and personal choice. Therefore, health interventions focusing on sustainable traditional food practices are feasible.

Agreement between high-sensitivity C-reactive protein and C-reactive protein assays

Abstract Background High sensitivity C-reactive protein (hs-CRP) is a biomarker used for risk prediction for cardiovascular disease (CVD) by assessing low concentrations of inflammatory markers. Measurements of regular CRP assays have become very sensitive too with a detection limit of 0.03mg/dL, while also being more available and cheaper. The aim of this study is to compare the association between CRP and hs-CRP. Methods This study compared CRP and hs-CRP serum concentrations and data acquired by medical chart review of 590 patients from 11/2017 to 10/2018 of our cardiology outpatient clinic who were divided into hs-CRP and CRP risk groups for CVD events: low&amp;lt;0.1 mg/dL, average 0.1–0.3mg/dL, high&amp;gt;0.3mg/dL. The agreement of classification in hs-CRP and CRP risk groups was assessed by kappa statistic, with Kappa coefficient of &amp;lt;0.20, 0.21–0.40, 0.41–0.60, 0.61–0.80, 0.81–0.99 interpreted as slight, fair, moderate, substantial and almost perfect agreement, respectively. Bland-Altman (BA) analysis was used to assess agreement between hs-CRP and CRP by plotting the mean of the two measurements on the x-axis against the mean difference of CRP - hs-CRP on the y-axis. Results Out of all 590 patients, 37.7% were in low risk, 33.9% in average risk and 28.5% in high risk hs-CRP group. Some group changes occurred after reclassification of the patients according to CRP measurements. Eight percent of patients reclassified into a higher risk group, 0.7% into a lower risk group, while 91.4% remained in the same risk group as determined by hs-CRP (kappa: 0.87; p&amp;lt;0.001) (Tab. 1). Important to note, there was a 100% agreement between the high-risk CRP and hs-CRP group patient classification. BA-plot displayed a fixed bias with an average difference between the two laboratory tests for CRP and hs-CRP of 0.02 mg/dL±0.09SD with only sporadic outliers (Fig. 1). The upper limit of agreement was 0.12 and lower limit of agreement was −0.07. In the lower range of CRP values, measurements were tightly clustered around the average difference. Greater variability could be observed at higher serum level of the inflammatory biomarker in the BA-plot with a bias to higher CRP concentrations than hs-CRP concentrations at values greater than 0.5mg/dL. This proportional bias, which was further demonstrated by linear regression analysis, does not affect the risk predicting qualities of hs-CRP or CRP for CVD because the cut-off values for risk groups (0.1mg/dL for low risk, 0.3mg/dL for high risk) are all below this threshold. Conclusion A close agreement between measurements of hs-CRP and CRP assays was identified, therefore regular CRP assays could replace hs-CRP for cardiac risk assessment. Benefits for clinical implementation are: First, CRP assessment is routinely available in most laboratories compared to hs-CRP. Second, CRP is less costly than hs-CRP, since no further laboratory acquisitions are necessary, which is especially relevant in regions where cost efficiency is of importance. Funding Acknowledgement Type of funding sources: None. Table 1. Kappa statisticFigure 1. Bland-Altman plot

Monomeric C-reactive protein as a marker of residual inflammatory risk in patients with asymptomatic carotid atherosclerosis

Background and Aims: C-reactive protein (CRP) can dissociate into monomeric subunits (mCRP) in proinflammatory milieu. The ability of mCRP to accumulate in atherosclerotic plaques and stimulate inflammatory response may enhance the progression of atherosclerosis. The aim of this study was to find whether novel mCRP or high-sensitivity CRP (hsCRP) assays correlate with plaque burden in non-obstructive asymptomatic carotid atherosclerosis (ACA).

Can High-Sensitivity C-Reactive Protein Levels Predict Functional Outcome Following Epidural Steroid Injection in Patients with Lumbar Disc Disease?

Study DesignProspective cohort study.PurposeInflammatory cytokines produced at the site of disc herniation are considered as pain generators in patients with lumbar disc disease. Whether a high-sensitivity C-reactive protein (hs-CRP) assay can be used in order to predict the quantum of inflammation surrounding nerve roots is a matter of investigation. This study aimed to evaluate the association of hs-CRP level and functional outcomes measured by the Modified Oswestry Low Back Pain Disability Questionnaire (MODY) before and after epidural steroid injection (ESI) in patients with lumbar disc disease.Overview of LiteratureAlthough many studies examining the role of hs-CRP levels and lumbar pain have been published previously, the results are equivocal, and there is no clear consensus regarding which patients will benefit from an ESI.MethodsThis was a prospective study, with 77 patients in the study group and 23 participants in the control group. Baseline hs-CRP levels were obtained for both groups. Study group patients received a single ESI and were subjected to detailed pre- and post-procedure evaluation using MODY scores. For this group, hs-CRP levels were measured at 1 and 2 months after injection.ResultsOut of 77 patients, 52 had acute and 25 had chronic low back pain. Thirty-six patients with acute pain obtained significant improvement, while 16 had an insignificant response to the ESI. None of the chronic cases had a significant response. The mean baseline hs-CRP (mg/L) among the study group (29.83±10.43) was significantly higher than for the controls (10.26±2.783). The baseline hs-CRP among acute cases, where post ESI MODY score at 2 months had significant reduction, was 32.19±5.126, and those with insignificant reduction was 18.13±7.949 (p<0.001).ConclusionsBaseline hs-CRP levels can be used to prognosticate the outcome following ESI in patients with acute lumbar disc disease, with radicular pain refractory to physiotherapy and analgesics.

P273 Ustekinumab and guselkumab treatment results in differences in serum IL-17A, IL-17F and CRP levels in PsA patients: a comparison from ustekinumab Phase 3 and guselkumab Phase 2 programmes

Abstract Background Ustekinumab (UST) is a monoclonal antibody (mAb) that binds the p40 epitope which is shared by IL-12 and IL-23, whereas guselkumab (GUS) is a mAb that selectively binds the p19 subunit of IL-23. In recent studies, both UST (Phase 3 programs) and GUS (Phase 2 program) have demonstrated a reduction in musculoskeletal clinical signs and symptoms and improvement of psoriatic lesions in patients with active psoriatic arthritis (PsA), implicating the IL-12/23 pathway in disease pathogenesis. This analysis explored the post-treatment pharmacodynamic changes of IL-17A, IL-17F, and CRP with GUS and UST in the context of PsA. Methods Serum protein levels of IL-17A, IL-17F, and CRP were measured in 142 subjects and 38 matched healthy controls from the GUS Phase 2 study at Week (W)0, W4, and W16. In the UST Phase 3 studies, biomarkers were assayed at W0, W4, and W24 as follows: IL-17A (n = 474), IL-17F (n = 237), CRP (n = 927). IL-17A and IL-17F were assayed using Single Molecule CountingTM Human Immunoassay Kits (formerly Singulex). CRP was measured using CardioPhase hsCRP assay (UST studies) or Meso Scale Discovery Platform (GUS study). Results At baseline, the Th17 effector cytokines IL-17A and IL-17F were elevated in the serum of PsA subjects in the GUS Phase 2 cohort compared to healthy controls. IL-17A and IL-17F levels significantly correlated with affected skin body surface area, but not swollen or tender joint scores, in both studies. While none of the baseline levels of evaluated cytokines were associated with American College of Rheumatology (ACR) or Psoriasis Area Severity Index (PASI) clinical responses to UST, baseline IL-17F levels were modestly associated with ACR20 response to GUS at Week 24. Both UST and GUS treatment resulted in pharmacodynamic decreases in IL-17A, IL-17F, and CRP levels, with GUS treatment restoring IL-17A and IL-17F levels to that of healthy controls by W16. Consistent with being a component of ACR scores, CRP changes were significantly associated with ACR20 responses to both UST and GUS treatment. W4 and W16 changes in IL-17F with GUS treatment were significantly associated with ACR20 response at W24. W24 PASI75 response to GUS was significantly associated with W4 changes in IL-17A, with a similar trend observed at W16. Conclusion These results underscore the relevance of the IL-23/Th17 pathway in PsA, with GUS treatment providing a stronger suppression of the pathway than UST treatment. The significant associations of changes in IL-17A and IL-17F levels with GUS treatment with PASI75 and ACR20 response, respectively, support the importance of the IL-23/Th17 pathway for both skin and joint pathologies. The associations of reduction in CRP levels with both UST and GUS treatment also reinforce the role of acute phase inflammation in joint pathology. Disclosures S. Siebert: Other; S.S. has been a study investigator for Janssen. M.J. Loza: Other; M.L. is a Janssen employee. Q. Song: Other; Q.S. is a Janssen employee. P.C. Gorecki: Other; P.G. is a Janssen employee. I.B. McInnes: Other; I.M. has been a study investigator for Janssen. K. Sweet: Other; K.S. is a Janssen employee.

C-reactive protein as a predictor of malignant ventricular arrhythmias in non-ST elevation myocardial infarction.

ObjectiveTo investigate whether C-reactive protein (CRP) is a biomarker of malignant ventricular arrhythmias (MVA) occurring in non-ST elevation myocardial infarction (NSTEMI) patients with Global Registry of Acute Coronary events (GRACE) scores < 140.MethodsA total of 1450 NSTEMI patients were included in this study. Hs-CRP blood levels were measured via a turbidimetric immunoassay after confirming the diagnosis of NSTEMI with GRACE scores < 140.ResultsConsistent with prior studies, the MVA occurrence rate in our cohort was 6.7%, and patients with MVA exhibited a reduced left ventricular ejection fraction (46.1% ± 6.9% vs. 61.5% ± 8.7%, P = 0.032), a higher incidence of Killip classification > 1 (34.1% vs. 24.2%, P < 0.001), an increased surgical revascularization rate (34.1% vs. 9.7%, P < 0.001), and increased mortality (16.5% vs. 5.8%, P < 0.001). Serum hs-CRP levels were higher (P = 0.003) in NSTEMI patients with MVA, and this increase appeared unrelated to other clinical parameters. The C-statistic to discriminate MVA was 0.82 (95% CI: 0.74–0.89). Using receiver operating characteristics analysis, we optimized a cutoff point of 16 mL/L, and the sensitivity and specificity were 95% and 61%, respectively; the positive predictive value was 20% and the negative predictive value was 99%.ConclusionsAn hs-CRP assay is a potential MVA biomarker in low-risk NSTEMI patients with GRACE scores < 140. If validated in prospective studies, hs-CRP may offer a low-cost supplementary strategy for risk stratification for NSTEMI patients.

Validity of biomarkers in screening for neonatal sepsis – A single center –hospital based study

The diagnosis of neonatal sepsis still considered to be a challenge for both clinicians and the laboratory due to the non-specific clinical presentations. The present study aimed to compare and assess the diagnostic & prognostic values of C-reactive protein (CRP), high sensitivity CRP (hsCRP), presepsin, interleukin-6 (IL-6) and procalcitonin (PCT) in neonatal sepsis separately and in combination. This hospital-based cross-sectional study has been conducted on 168 neonates recruited from the neonatal intensive care unit (NICU) of Qena University Hospitals, Upper Egypt. Measurements of CRP using latex agglutination test, hsCRP, presepsin, IL6 and PCT assays using commercially available ELISA assay kits were done to all included neonates. There were significantly higher serum levels of CRP among late onset versus early onset sepsis group with significantly higher serum levels of hsCRP and presepsin among early onset compared with the late onset sepsis group (p<0.05 for all). There were significantly higher hsCRP, presepsin and PCT serum levels in proven versus probable sepsis group (p<0.05 for all). Significantly higher serum levels of presepsin and PCT were noted among survivors versus non survivors sepsis group (p<0.05 for all). The cutoff value of the serum level of CRP >6mg/dl showed lower sensitivity and specificity than that of hsCRP at cutoff >140ng/ml in diagnosing neonatal sepsis. The cutoff value of presepsin >200ng/ml showed equal sensitivity and specificity to IL-6 at cutoff >22pg/ml. The cutoff value of PCT at > 389pg/ml showed sensitivity and specificity approximate to that of hsCRP. CRP could be a helpful prognostic marker in late onset neonatal sepsis. hsCRP and PCT have higher diagnostic accuracy in neonatal sepsis in comparison to other studied markers. Both IL-6 and presepsin have equal diagnostic utility in neonatal sepsis, but presepsin could be helpful diagnostic marker in early onset neonatal sepsis.

CRP-Based Cardiovascular Risk Assessment: New Conventional CRP Assay Fit for Purpose?

Subclinical inflammation was shown to play a role in the context of cardiovascular disorder processes. American College of Cardiology/American Heart Association guidelines on cardiovascular risk assessment in specific clinical contexts recommend the use of C-reactive protein (CRP) measurement with high sensitive (hs)-CRP assays that meet the precision requirements for values <2 mg/L. Until now, only hs-CRP assays reached the required limit of quantification. However, new regular CRP assays allow measuring CRP down to 0.6 mg/L. A multisite comparative study between hs-CRP and a new conventional CRP assay (Tina-quant) was performed to evaluate the possibility of using regular CRP assays for cardiovascular risk assessment. A satisfactory concordance was observed between regular CRP assays and the hs-CRP assay. Both assays met the analytical precision requirements at the different cutpoints tested (1.00, 2.00, and 3.00 mg/L). These results suggest that this new regular CRP assay can be used for cardiovascular risk assessment, which is expected to provide substantial operational and financial advantages when compared with hs-CRP assays.

High-sensitivity C-reactive protein as a potential marker for hypertension

Background Hypertension is a common, asymptomatic, readily detectable, and usually easily treatable disease that leads to lethal complications if left untreated. Hypertension results from the net effect of environmental and genetic factors. These factors include excess dietary salt or alcohol intake, stress, age, genetics, physical inactivity, diet rich in saturated fats, and family history. Evidences indicate that vascular inflammation may be involved in both the initiation and development of hypertension. C-reactive protein is a plasma protein present in trace amounts in healthy patients the concentration of which increases in response to injury, infection or inflammation. Aim The aim of this article is to evaluate the relationship between serum high-sensitivity C-reactive protein (hs-CRP) levels and various stages of hypertension including prehypertension in the Egyptian people. Patients and methods This study included 130 patients with hypertension recruited from the cardiology outpatient clinic of the Assiut University Hospital in addition to 50 apparently healthy controls, in the period from September 2014 to April 2016. The patients were classified according to their levels of systolic and diastolic blood pressure into pre-hypertensive group and stages I, II, III hypertensive patients. They were classified according to the duration of hypertension into less than 1-year duration, between 1 and 5 years and more than 5 years. In addition, the patients were classified into two groups according to weather taking treatment or not. hs-CRP assay using the BT-1500 system based on turbidimetric measurement has been performed. Results The hs-CRP levels were significantly higher in prehypertensive, stages I, II, and III patients compared with controls. In addition, there was significant elevation when comparing prehypertension with both stages II and III; significant increase when comparing stages I with stages II and III and significant increase when comparing stages II with III. Conclusion Increased serum hs-CRP levels are associated with hypertension, especially in the early stages of the disease.

PP113 High-Sensitivity C-Reactive Protein (hsCRP) Measurements And Burden In Patients With History Of Myocardial Infarction

INTRODUCTION:The inflammatory marker C-reactive protein (CRP) can be measured by a high-sensitivity assay (hsCRP) specific to vascular inflammation. We aimed to identify published literature on prevalence of elevated hsCRP and associated clinical, economic, and humanistic burden in patients with a history of myocardial infarction (MI).METHODS:A comprehensive literature search was performed for publications in English between January 2000 and February 2016 in MEDLINE, EMBASE, and MEDLINE In-Process. Search terms were variations on ‘Post myocardial infarction’, ‘CRP’, ‘epidemiology’ and ‘burden’. Clinical and real-world studies reporting baseline CRP levels in patients with a history of MI were included in the analysis.RESULTS:Ten studies (prevalence: two; burden: two; both: six) were included. Cut-off points in hsCRP assays varied from &gt;2 mg/L to ≥5.9 mg/L. Prevalence of hsCRP levels &gt;2, &gt;2.3, ≥2.37 and ≥2.9 mg/L were reported in 36 percent, 49 percent, 50 percent and 33 percent of patients, respectively (one publication each). Two publications reported &gt;3 mg/L levels in 27.6 percent and 53.7 percent of patients. Levels of ≥3.3, ≥3.8, ≥4.2 and ≥5.9 mg/L were found in 38.8 percent, 25 percent, 25 percent and 24.7 percent respectively (one publication each). Of six studies reported CV events, four studies found elevated hsCRP levels to be predictive of future risk. Elevated hsCRP levels independently predicted all-cause mortality in four studies and CV mortality in three studies. Three publications included data on comorbidities: Diabetes was associated with elevated hsCRP in two of three analyses; hypertension in one out of two. No consistent associations between elevated hsCRP levels and hyperlipidaemia (one study), stroke or angina pectoris (one study) were found. No study reported economic, resource use or quality-of-life burden.CONCLUSIONS:Due to limited evidence on prevalence of elevated hsCRP and associated burden of illness in patients with a history of MI, further research is warranted. Variations in findings, cut-off points and methods between studies make generalisations difficult.

The role of very high high-sensitivity C-reactive protein levels on mortality after stroke

High-sensitivity C-reaction protein (hsCRP) levels are correlated with risk of vascular disease. The clinical implications of markedly elevated hsCRP levels in the setting of acute stroke are less understood. ObjectiveTo determine the association of very high admission hsCRP levels (≥10mg/L) on all-cause mortality in patients with acute stroke. MethodsA retrospective cohort study of 1176 patients hospitalized with acute stroke between 2005 and 2012 who had a hsCRP assay drawn within seven days of admission. Mortality data was obtained using Ohio Death Index. Cox proportional analysis was used to determine hazard ratios of death among patients with hsCRP values >10mg/L after adjusting for age, sex, race and relevant co-morbid conditions. NIHSS was also adjusted in a subset of patients in whom it was available (n=378). ResultsPatients with hsCRP >10mg/L had 2.65 (95% CI: 1.99, 3.53) increased hazard of all-cause mortality compared to stroke patients with hsCRP ≤10mg/L. Association of hsCRP with mortality was greater for patients with low NIHSS and declined in patients with increasing NIHSS scores. A higher proportion of patients with hsCRP >10 died from nonvascular causes than patients with hsCRP ≤10mg/L. ConclusionVery high levels of hsCRP may be a useful marker to identify stroke patients at increased risk for death, especially those with stroke of mild severity. More research is needed to determine how this information can be used to improve patient care, especially in patients with mild stroke.

Effect of CPAP therapy on C-reactive protein and cognitive impairment in patients with obstructive sleep apnea hypopnea syndrome.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is associated with neurocognitive impairment. We examined the role of the systemic inflammatory response, measured by high-sensitivity C-reactive protein (hsCRP) assay, and the effect of CPAP treatment on hsCRP and cognitive impairment in patients with OSAHS. Eligible subjects (n = 178) were categorized into two groups: absent or mild OSAHS, and moderate to severe OSAHS. First, the Montreal Cognitive Assessment (MoCA) and serum hsCRP concentration were measured. Then, the moderate to severe OSAHS group was further divided into a conservative treatment subgroup (n = 68) and a CPAP subgroup (n = 68). After 6months of treatment, MoCA scores and hsCRP concentrations were re-measured in the moderate to severe group. Compared with the absent or mild OSAHS group, hsCRP concentration was higher (1.00 ± 1.28mg/L versus 2.71 ± 1.8, p < 0.001) and MoCA scores were significantly lower (27.4 ± 1.4 versus 26.3 ± 2.0, p < 0.001) in the moderate to severe group. After adjustment for age, education, body mass index, and neck circumference, hsCRP and MoCA scores correlated with parameters of overnight hypoxia. hsCRP and the proportion of time spent with blood oxygen saturation < 90% (T90) predicted MoCA score. hsCRP and MoCA score improved, and the subdomains of the MoCA were partially improved, in the CPAP treatment subgroup. In conservatively managed patients, hsCRP concentration increased, and there was no improvement in neurocognitive dysfunction, with the memory subdomain significantly worse. hsCRP may play a role in neurocognitive dysfunction in OSAHS. Long-term CPAP treatment could normalize the serum hsCRP concentration and partially reverse cognitive dysfunction in OSAHS.

Validation and application of a canine-specific automated high-sensitivity C-reactive protein assay.

Measurement of low concentrations of C-reactive protein (CRP) in dogs has previously been performed with nonautomated assays. The aim of this study was to validate an automated high-sensitivity CRP (hsCRP) assay, developed by modifying a routinely used canine-specific immunoturbidimetric CRP test (cCRP). Imprecision, linearity under dilution, limit of blank (LOB), limit of detection (LOD), and limit of quantification (LOQ) were determined for the hsCRP test, as well as the presence of prozone effect and interferences. The imprecision, measured as intra-assay variation, was ≤2.7%. The assay was acceptably linear under dilution. An analytically relevant prozone effect was present for samples with CRP concentration >150 mg/L, and there were mild interferences from hemolysis and lipemia. The LOB, LOD, and LOQ were 0.10 mg/L, 0.22 mg/L, and 0.50 mg/L, respectively. A method comparison study with a canine-specific enzyme-linked immunosorbent assay (ELISA) was performed, showing poor agreement between the hsCRP test and the ELISA. An additional aim of the study was to apply the hsCRP test to clinical research samples. Serum samples from 7 dogs undergoing ovariohysterectomy were collected pre- and postoperatively, and CRP was measured with both the cCRP and hsCRP assay. The expected postoperative increase in CRP was detected earlier with the hsCRP test, compared with the cCRP test. The hsCRP assay was further applied on samples from 6 lean and 9 overweight dogs. There was no significant difference in CRP concentration between the groups (P = 0.06). In conclusion, the hsCRP test had acceptable analytical performance, and the assay was successfully applied to clinical research samples.

Obstructive sleep apnea and obesity are associated with reduced GPR 120 plasma levels in children.

Obstructive sleep apnea (OSA) is a common health problem, particularly in obese children, in whom a vicious cycle of obesity and OSA interdependencies promotes increased food intake. G protein-coupled receptor 120 (GPR 120) is a long-chain free fatty acid (FFA) receptor that plays an important role in energy homeostasis, and protects against insulin resistance and systemic inflammation. We hypothesized that GPR 120 levels would be reduced in children with OSA, particularly among obese children. Cross-sectional prospectively recruited cohort. Academic pediatric sleep program. Two hundred twenty-six children (mean age: 7.0 ± 2.1 y) underwent overnight polysomnographic evaluation and a fasting blood draw the morning after the sleep study. In addition to lipid profile, homeostasis model assessment of insulin resistance (HOMA-IR) and high-sensitivity C-reactive protein (hsCRP) assays, monocyte GPR 120 expression, and plasma GPR 120 levels were assessed using quantitative polymerase chain reaction and enzyme-linked immunosorbent assay kits. Obese children and those with OSA had significantly lower GPR 120 monocyte expression and plasma GPR 120 levels. Furthermore, when both obesity and OSA were present, GPR 120 levels were lowest. Linear associations emerged between GPR 120 plasma levels and body mass index (BMI) z score, as well as with apnea-hypopnea index (AHI), saturation of peripheral oxygen (SpO2) nadir, and respiratory arousal index (RAI), with RAI remaining statistically significant when controlling for age, ethnicity, sex, and BMI z score (P < 0.001). Similarly, HOMA-IR was significantly associated with GPR 120 levels, but neither low density lipoprotein nor high density lipoprotein cholesterol or hsCRP levels exhibited significant correlations. G protein-coupled receptor 120 (GPR 120) levels are reduced in pediatric OSA and obesity (particularly when both are present) and may play a role in modulating the degree of insulin resistance. The short- and long-term significance of reduced GPR 120 relative to food intake and glycemic deregulation remains undefined.