Increased hsCRP Levels Research Articles

Comparative study of serum levels of albumin and hs-CRP in hemodialysis patients according to protein intake levels

Protein-energy malnutrition, PEM, and increased hs-CRP level are considered to be associated with increased risk of cardiovascular disease (CVD) in hemodialysis (HD) patients. This is commonly referred to as the vicious circle of malnutrition-inflammation-atherosclerosis cardiovascular disease (MIA syndrome) in chronic kidney disease (CKD). Low protein intake can decrease the serum level of albumin and increase inflammational markers; further, both low serum albumin and high hs-CRP are independent risk factors for all-cause mortality in HD patients. The aim of this study is comparing the serum levels of albumin and hs-CRP in HD patients according to the protein intake levels. The total number of subjects was 60 hemodialysis patients; they were grouped by dietary protein intake: low protein intake group (LPI, protein intake ＜ 1.0 g/kg IBW, 11 men and 19 women) and adequate protein intake group (API, protein intake ≥ 1.0 g/kg IBW, 12 men and 18 women). Blood biochemical parameters, nutrient intake, and dietary behaviors were compared between the LPI and API groups. The LPI group showed a significantly lower serum level of albumin and higher serum level of hs-CRP than the API group (p ＜ 0.05). The LPI group showed a significantly lower intake of most nutrients than the API group (p ＜ 0.05). Index of Nutritional Quality of most nutrients of the LPI and API groups were lower than 1.0. Dietary protein intake was positively correlated with the serum level of albumin (r = 0.306, p ＜ 0.05) and negatively correlated with the serum level of hs-CRP (r = -0.435, p ＜ 0.01). The serum level of hs-CRP was negatively correlated with that of albumin (r = -0.393, p ＜ 0.01). According to these result, serum albumin and hs-CRP in HD patients were influenced by the protein intake levels. To prevent MIA syndrome, it is necessary to improve nutritional status, especially in protein and energy.

Increased Inflammatory Markers in Patients with Reduced Antiplatelet Effect of Aspirin.

AbstractAbstract 2252 IntroductionInflammation may modify platelet function. This may lead to reduced antiplatelet drug efficacy in patients with coronary artery disease (CAD). The impact of low-grade inflammation on platelet aggregation in stable CAD patients receiving mono antiplatelet therapy with aspirin has not been investigated. ObjectiveTo investigate the association between platelet activation, platelet aggregation, and the inflammatory markers high-sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6). MethodsWe performed a cross-sectional study on 524 stable high-risk CAD patients. Among these, 91% had a history of myocardial infarction, 23% had type 2 diabetes, and 13% had both. All patients received 75 mg aspirin daily as mono antiplatelet therapy, but no other antithrombotic treatment. Aspirin was ingested exactly one hour before blood sampling. Standardized blood sampling procedures included 30 minutes of rest in supine position before blood sampling, a large bore needle (19 G) and a minimum of stasis. Platelet aggregation was assessed by VerifyNow® and multiple electrode aggregometry (Multiplate®, MEA) using two agonists: arachidonic acid (AA, 1.0 mM) and collagen (1.0 μg/mL). Inflammation was evaluated by hs-CRP and IL-6. Platelet activation was assessed by soluble P-selectin (sP-selectin), and cyclooxygenase-1 inhibition was evaluated by measurement of serum thromboxane B2. ResultsHs-CRP levels were significantly higher in upper aggregation tertile patients than in lower aggregation tertile patients. Similar results were obtained with IL-6, though not statististically significant (p≥0.15). Independent determinants of AA-induced MEA platelet aggregation were investigated using multiple regression analysis including hs-CRP, IL-6, prior myocardial infarction, diabetes, age, sex, and smoking. Hs-CRP (p=0.01) and smoking (p= 0.03) were significant determinants of AA-induced MEA platelet aggregation. Hs-CRP levels were elevated by 28–55% in upper aggregation tertile patients compared with lower aggregation tertile patients (p-values<0.05).Platelet activation evaluated by sP-selectin was significantly higher in patients with MEA aggregation levels in the upper tertile than in the lower tertile (p=0.0001). Similar results were found with VerifyNow®, though not statististically significant (p=0.26). No difference was found between hs-CRP or IL-6 levels in the upper and lower sP-selectin tertile (p-values≥0.84).Optimal compliance in all patients was confirmed by serum thromboxane B2 levels (median thromboxane B2 ng/mL (IQR) 1.0 (0.5–1.8), range 0.02–26.4) below 30 ng/mL, corresponding to a more than 95% inhibition of cyclooxygenase-1 activity. However, patients with platelet aggregation in the upper aggregation tertile had higher serum thromboxane B2 levels than patients in the lower aggregation tertile (median ng/mL: 3rd tertile 1.2–1.7 vs. 1st tertile 0.8–0.9). This difference was significant with MEA/AA (p=0.0002) and VerifyNow® (p<0.0001), whereas only a trend was seen with MEA/collagen (p=0.06). No difference was found in hs-CRP or IL-6 levels in the upper and lower serum thromboxane B2 tertile (p-values>0.17). ConclusionIn stable high-risk CAD patients receiving mono antiplatelet therapy with aspirin, significantly increased hs-CRP levels were demonstrated in patients with augmented platelet aggregation. Our results indicate an association between chronic low-grade inflammation and reduced antiplatelet effect of aspirin, suggesting that patients with increased hs-CRP levels may have reduced cardiovascular protection from aspirin. Disclosures:No relevant conflicts of interest to declare.

Independent and Synergistic Associations of Asthma and Obesity with Systemic Inflammation in Adolescents

Introduction. Both asthma and obesity often occur in the same individual. Each increases the risk of cardiovascular disease (CVD) with systemic inflammation likely playing a vital role. We examined the independent and synergistic associations of asthma and obesity with systemic inflammation using high-sensitivity C-reactive protein (hs-CRP) levels in adolescents. Methods. This study involves the cross-sectional design carried out in the adolescent and respiratory medicine practices in a children’s hospital. Out of 124 adolescents (mean age 16.1 ± 2.3 years), who were either of obese (N = 75) or of normal weight (N = 49). 51 had asthma (18 normal weight and 33 obese). Results. hs-CRP levels were higher in obese versus normal weight groups (geometric mean ± SD: 2.38 ± 2.91 vs. 0.72 ± 3.54; p < .001), and in the asthmatic versus non-asthmatic groups (geometric mean ± SD: 1.21 ± 3.71 vs.1.96 ± 3.28; p = .039). We found a trend of increasing hs-CRP levels across the four groups (p < .001), with the obese asthmatic group having the highest level. In multivariate regression, we found a strong association between obesity and log-CRP (β ± SE: 1.43 ± 0.23; p < .001) and a moderate association between asthma and log-CRP (β ± SE: 0.48 ± 0.21; p < .028), with additive synergy between obesity and asthma. Conclusions. Both asthma and obesity are independently and synergistically associated with systemic inflammation. These findings underline the need of a multifaceted approach to address CVD risk in adolescence.

Decreased endogenous secretory RAGE and increased hsCRP levels in serum are associated with atrial fibrillation in patients undergoing coronary angiography

Decreased endogenous secretory RAGE and increased hsCRP levels in serum are associated with atrial fibrillation in patients undergoing coronary angiography

Impact of Supplementing Preoperative Intravenous Omega 3 Fatty Acids in Fish Oil on Immunomodulation in Elderly Patients Undergoing Hip Surgery

The aim of this study was to evaluate the immunomodulatory effects of supplementing intravenous omega-3 fatty acids in fish oil (IVFO) in elderly patients undergoing hip surgery. This was a single centre, randomized, controlled, comparative, phase IV study in elderly patients undergoing hip surgery. The subjects, within the age range of 50-90years, were assigned randomly to the group receiving intravenous omega-3 fatty acids in fish oil (IVFO, Omegaven®) or the control group not receiving intravenous fish oil (n = 20 in each group). IL-6, IL-8, IL-10, and HS-CRP levels were the inflammatory markers assessed in this study. The within-group comparison was done by paired t-test and between-group comparison by unpaired t-test. At day 4, IL-6 values in the IVFO group decreased as compared to day 0. At day 4, IL-8 mean values increased for both IVFO and control groups. This increase was highly significant in the control group (P = 0.0182). IL 10 values decreased at day 4 and increased at day 8 in the IVFO group. Increase in HS-CRP levels was nonsignificant at day 4 in the IVFO group (P = 0.60) and significant at day 8 for the control group (P = 0.0084) as compared to day 0. Various biochemical parameters including albumin, protein, SGOT, SGPT, blood glucose, and urea values generated evidence regarding the safety profile of IVFO. This study suggests a role for IVFO in the short-term suppression of inflammatory mediators for patients undergoing hip surgery. However, further, larger trials may be needed to establish its definitive role in this patient population.

Changes in Cardiac Biomarkers During Doxorubicin Treatment of Pediatric Patients With High-Risk Acute Lymphoblastic Leukemia: Associations With Long-Term Echocardiographic Outcomes

Doxorubicin causes cardiac injury and cardiomyopathy in children with acute lymphoblastic leukemia (ALL). Measuring biomarkers during therapy might help individualize treatment by immediately identifying cardiac injury and cardiomyopathy. Children with high-risk ALL were randomly assigned to receive doxorubicin alone (n = 100; 75 analyzed) or doxorubicin with dexrazoxane (n = 105; 81 analyzed). Echocardiograms and serial serum measurements of cardiac troponin T (cTnT; cardiac injury biomarker), N-terminal pro-brain natriuretic peptide (NT-proBNP; cardiomyopathy biomarker), and high-sensitivity C-reactive protein (hsCRP; inflammatory biomarker) were obtained before, during, and after treatment. cTnT levels were increased in 12% of children in the doxorubicin group and in 13% of the doxorubicin-dexrazoxane group before treatment but in 47% and 13%, respectively, after treatment (P = .005). NT-proBNP levels were increased in 89% of children in the doxorubicin group and in 92% of children in the doxorubicin-dexrazoxane group before treatment but in only 48% and 20%, respectively, after treatment (P = .07). The percentage of children with increased hsCRP levels did not differ between groups at any time. In the first 90 days of treatment, detectable increases in cTnT were associated with abnormally reduced left ventricular (LV) mass and LV end-diastolic posterior wall thickness 4 years later (P < .01); increases in NT-proBNP were related to an abnormal LV thickness-to-dimension ratio, suggesting LV remodeling, 4 years later (P = .01). Increases in hsCRP were not associated with any echocardiographic variables. cTnT and NT-proBNP may hold promise as biomarkers of cardiotoxicity in children with high-risk ALL. Definitive validation studies are required to fully establish their range of clinical utility.

Association of Mitral Annulus Calcification with High-Sensitivity C-Reactive Protein, Which Is a Marker of Inflammation

Objectives. There are limited clinical data revealing the relationship between mitral annular calcification (MAC) and systemic inflammation. The goal of the present study was to compare high-sensitivity C-reactive protein (hs-CRP) levels in patients with and without MAC and investigate the relationship between MAC and hs-CRP. Methods. One hundred patients with MAC who underwent transthoracic echocardiography (TTE) and 100 age-matched controls without MAC who underwent TTE were included in our study. Hs-CRP levels were compared between groups. Results. Prevalence of female gender, hypertension, and coronary artery disease were significantly higher in the MAC group than in the control group (64% versus 45%, P = 0.007, 42% versus 28%, P = 0.03 and 37% versus 18%, P = 0.003, resp.). On multivariate analysis, age, gender, and coronary artery disease were the only independent predictors of MAC. The levels of hs-CRP were higher in the MAC group than in the control group (2.02 ± 0.35 versus 1.43 ± 0.47 mg/dl, P < 0.001). This increase in hs-CRP levels in the MAC group persisted in patients without hypertension, coronary artery disease, and in male patients when compared to the control group. Conclusions. Our study demonstrated that hs-CRP, which is a sensitive marker of systemic inflammation, increased in patients with MAC.

Highly sensitive C reactive protein in patients with metabolic syndrome and cardiovascular disease

Context: Although there are several studies reported in the western literature regarding the association of C reactive protein (CRP) level with components of metabolic syndrome, data in the Indian population were lacking. As there will be a considerable difference in the profile of risk factors for cardiovascular diseases (CVDs), studies regarding the correlation of CRP level with cardiovascular risk factors and metabolic syndrome in the Indian population are required. Objective: To correlate the highly sensitive CRP (hsCRP) level to individual components of metabolic syndrome and coronary vascular disease. Materials and Methods : Forty patients who were diagnosed clinically with metabolic syndrome were included in the study. Detailed history with regard to diabetes mellitus, hypertension and other CVD was collected from each patient. All the patients underwent complete physical examination, including ECG. Height, weight, fasting blood glucose and lipid levels were measured in all the patients. CVD was assessed with the following: new-onset angina, fatal and non-fatal myocardial infarction or stroke, transient ischemic attack, heart failure or intermittent claudication. Results: The mean hsCRP level was higher in patients with CVD compared with those without CVD. The CRP level correlation with CVD showed a statistically significant correlation. hsCRP level was very high in eight hypertensive patients, whereas it was very high in five normotensives. But, statistical analysis has not shown any significant correlation between hypertension and hsCRP level. Similarly, although a higher hsCRP level was seen in diabeteics, statistical analysis failed to show a significant correlation between diabetes and the hsCRP level. Analyses of hsCRP correlation with body mass index, fasting glucose, cholesterol, triglycerides, high-density lipoprotein and low-density lipoprotein did not show a significant correlation with the hsCRP level. Conclusions: Increased hsCRP levels are associated with an increase in the incidence of CVDs. Higher values of hsCRP were observed in patients with hypertension and diabetes. No correlation was seen between hsCRP and components of the metabolic syndrome.

Usefulness of high-sensitivity CRP increases during circadian rhythm for prediction of long-term cardiovascular events in patients with stable coronary artery disease

We investigated the value of circadian variations in high-sensitivity C-reactive protein (hs-CRP) levels in prediction of long-term cardiovascular events (CVE) in patients with stable coronary artery disease (CAD). The study included 94 patients (70 men, 24 women; mean age 58 ± 9 years) with stable CAD. High-sensitivity CRP levels were measured at six-hour intervals, namely, morning (06:00), midday (12:00), evening (18:00), and midnight (24:00). Absolute change in hs-CRP (absolute ΔCRP) was calculated by subtracting the midday hs-CRP level from that of the morning. Relative change in hs-CRP (relative ΔCRP) was calculated by dividing absolute ΔCRP by the midday hs-CRP level. The patients were followed-up for a mean of 40.2 ± 8.0 months for monitoring of CVE. During the follow-up period, CVE occurred in 24 patients (25.5%). Patients who developed CVE exhibited significantly higher serum creatinine, B-type natriuretic peptide, morning, evening, and midnight hs-CRP levels, absolute and relative ΔCRP, and left atrial end-diastolic diameter compared to patients without CVE (p<0.05). In logistic regression analysis, only left atrial end-diastolic diameter and absolute ΔCRP were independent predictors of CVE (OR=1.11, 95% CI 1.003-1.236, p=0.044 and OR=1.58, 95% CI 1.195-2.090, p=0.001, respectively). Every 1 mg/l increase in absolute ΔCRP represented a 58.1% increase in CVE risk. In receiver operating characteristics curve analysis, the cut-off value of 2 mg/l for absolute ΔCRP predicted CVE with 89.5% sensitivity and 84.2% specificity. Our findings suggest that absolute circadian increases in hs-CRP levels may be helpful in predicting long-term CVEs in patients with stable CAD.

C-reactive protein levels in relation to various features of non-alcoholic fatty liver disease among obese patients

Non-alcoholic fatty liver disease (NAFLD) is a major hepatic consequence of obesity. It has been suggested that the high sensitivity C-reactive protein (hs-CRP) is an obesity-independent surrogate marker of severity of NAFLD, especially development of non-alcoholic steato-hepatitis (NASH), but this remains controversial. We aimed to investigate whether associations between various features of NAFLD and hs-CRP are independent of body mass index (BMI) in its broad range among obese patients. A total of 627 obese adults (80% females), representing three cohorts from France and Belgium, had information on liver histology obtained from liver biopsies and measures of hs-CRP and BMI. We investigated whether the different features of NAFLD and BMI were associated with hs-CRP, with and without mutual adjustments using linear regression. BMI and hs-CRP were strongly associated. Per every 10% increase in BMI the hs-CRP level increased by 19-20% (p<0.001), and adjustment for NAFLD-stage (including no-NAFLD) did not influence the association. We found no BMI-independent association between NASH and hs-CRP. However, a positive association between degree of steatosis and hs-CRP was observed (p<0.05) and this effect remained significant after adjusting for BMI, lobular inflammation, hepatocyte ballooning, and fibrosis. We found no significant associations between the other features of NAFLD and hs-CRP. This study indicates that it is the accumulation of fat -both in the adipose tissue and in liver steatosis- that leads to increased hs-CRP levels among obese patients. Thus, hs-CRP may be a marker of steatosis, but not of severity of NAFLD, in obese patients.

C-Reactive Protein

See related article, pp 208–215 In response to inflammatory stress, C-reactive protein (CRP) is predominantly secreted from the liver and adipose tissue(s), and an independent relationship exists between different markers of overweight/obesity and elevated high sensitive (hs) CRP levels (Figure). Figure. CRP is predominantly secreted from the liver and adipose tissue(s) in response to inflammatory stress resulting from plaque rupture and subsequent microembolization. High levels of CRP induce endothelial dysfunction, activate platelets, and aggravate stress-induced alterations in cardiac function and morphology (ie, cardiomyocyte apoptosis and hypertrophy, fibrosis, and LV dilatation). NFkB indicates nuclear factor κB; iNOS, inducible nitric oxide synthase; LV, left ventricle; IL-6, interleukin 6. Higher hsCRP levels predict incident myocardial infarction (MI), stroke, peripheral arterial disease, sudden cardiac death, and all-cause mortality in healthy individuals with no history of cardiovascular disease.1,2 hsCRP at admission predicts in-hospital outcome, and hsCRP at discharge predicts 6-month event rate and 30-day mortality (Global Utilization of Strategies To Open occluded arteries [GUSTO] IV) in patients with an acute coronary syndrome. Indeed, adding hsCRP levels to the Global Registry in Acute Coronary Events (GRACE) acute coronary syndrome risk model improves the prediction of 30-day mortality. In patients with non-ST-elevated MI, an increased hsCRP level predicts the death rate even at 20-month follow-up but does not predict stent-related complications. The question of whether CRP, apart from serving …

Association between fasting plasma glucose and high-sensitivity C-reactive protein: gender differences in a Japanese community-dwelling population

BackgroundHigh sensitivity C-reactive protein (hsCRP) is an acute phase reactant and a sensitive marker of inflammation. Hyperglycemia can potentially promote the production of CRP. The aim of this study was to determine whether increased fasting plasma glucose (FPG) levels are associated with elevated hsCRP concentrations by gender.MethodsWe recruited 822 men (mean age, 61 ± 14 years) and 1,097 women (63 ± 12 years) during their annual health examination from a single community. We cross-sectionally examined whether FPG levels are associated with hsCRP concentrations, and whether this association is independent of gender, body mass index (BMI) and other components of the metabolic syndrome.ResultsIn women only, hsCRP increased significantly and progressively with increasing FPG (r = 0.169, P < 0.001). The stepwise multiple linear regression analysis using hsCRP as an objective variable, adjusted for confounding factors as explanatory variables, showed that FPG as well as age, BMI, systolic blood pressure, high-density lipoprotein cholesterol (HDL-C), uric acid, and high molecular weight adiponectin were significantly associated with hsCRP in women, but not in men. There was significant gender interaction, and an increase in hsCRP levels that was greater in women with BMI ≥ 25 kg/m2 and higher FPG than in men.ConclusionsThese results suggested that hsCRP levels increase continuously across the FPG spectrum starting from the lowest FPG in both men and women. However, increase in hsCRP levels was greater in women than men.

High-sensitivity C-reactive Protein Can Predict Major Adverse Cardiovascular Events in Korean Patients with Type 2 Diabetes

Inflammation is thought to play a role in the pathogenesis of major adverse cardiovascular events (MACE). It has been suggested that the measurement of markers of inflammation may aid in predicting the risk of such events. Here, the relationship between high-sensitivity C-reactive protein (hs-CRP) levels and MACE in Korean patients with type 2 diabetes is assessed. A retrospective cohort study was conducted as a follow-up among 1,558 patients with type 2 diabetes and without cardiovascular diseases over a mean period of 55.5 months. A Cox proportional-hazards model was used to determine whether increased hs-CRP levels are useful as a predictor for future MACE. The hazard ratio of MACE was 1.77 (95% CI; 1.16-2.71) in subjects who had the highest hs-CRP levels (> 0.21 mg/dL) compared to subjects who had the lowest hs-CRP levels (< 0.08 mg/dL), after adjusting for age, regular physical activity, current smoking, and duration of diabetes. The present results indicate that high hs-CRP levels can act as a predictor for the MACE occurrence in Korean patients with type 2 diabetes.

E0430 Highsensitivity Creactive protein levels at admission can not be used to predict inhospital mortality in patients with acute myocardial infarction a retrospective study

ObjectiveTo investigate the possible influencing factors of serum high-sensitivity C-reactive protein (hs-CRP) levels on admission, and to assess the the association between admission serum hs-CRP levels and mortality in patients...

Elevated homocysteine and C-reactive protein levels independently predict worsening prognosis after stroke in Chinese patients

Increased plasma total homocysteine (tHcy) and high sensitivity C-reactive protein (hsCRP) levels are independent risk factors for cardiovascular disease. However, the predictive value of tHcy in combination with hsCRP in patients with stroke is not known. To determine the relationship between tHcy and hsCRP, we enrolled 291 patients with first-onset stroke (196 ischemic and 95 hemorrhagic). Plasma tHcy and hsCRP levels were measured and subsequent vascular events and deaths were determined over a 5-year period. Using the arbitrary cutoff for tHcy (<18 μmol/L and ≥18 μmol/L) and hsCRP (<1 mg/L, 1-3 mg/L and >3 mg/L), the patients were divided into 6 groups. Survival analysis showed that the probability of death or new vascular events during a 5-year follow-up increased according to tHcy and hsCRP levels (P<0.01). The relative risk (RR) of death or new vascular events was 4.67 (95% CI, 1.96 to 11.14, P=0.001) in patients with high tHcy (≥18 μmol/L) and hsCRP (>3 mg/L) compared with those with low tHcy (<18 μmol/L) and hsCRP (<1 mg/L). The increased tHcy level (≥18 μmol/L) combined with increased hsCRP level (>3 mg/L) was still significantly associated with the risk of death or new vascular events (RR, 4.10, 95% CI, 1.61 to 10.45, P=0.003) even when adjusted for other risk factors at inclusion. The combination of increased tHcy and hsCRP levels had a stronger predictive value than increased hsCRP alone or increased tHcy level alone. Further studies are required to evaluate the potential decrease in risks associated with lowering both Hcy and hsCRP levels in patients that present with both increased tHcy and hsCRP.

The relation of C-reactive protein to vasoocclusive crisis in children with sickle cell disease

In view of evidence linking sickle cell anemia (SCA) with chronic inflammation, and given the role of high sensitivity C-reactive protein (hs-CRP) as inflammatory mediator, we hypothesized that SCA vasoocclusive crisis (VOC) is associated with heightened hs-CRP levels. Study subjects comprised 104 SCA patients who experienced VOC event during the study period (VOC group), and 40 SCA patients who did not develop VOC for at least 9 months prior to blood collection (Steady-state group). hs-CRP determination was done by latex-enhanced nephelometry. Higher hs-CRP levels were seen in VOC [median(range) = 31.3(1.14–363.0)] than steady-state [median(range) = 5(0.16–185.0)] groups ( P < 0.001), with enrichment in high hs-CRP percentiles in VOC cases, which translated into step-wise increased VOC risk. Receiver-operating characteristic (ROC) analysis was employed in assessing the usefulness of hs-CRP as predictor of the frequency and severity of VOC. Spearman's correlation coefficient between hs-CRP and VOC was 0.65 ( P < 0.001) among unselected patients (0.71 in males and 0.59 in females). hs-CRP area under ROC curves was 0.90 (95% CI = 0.85–0.94) among unselected patients, 0.94 (95% CI = 0.89–0.98) for males, and 0.85 (95% CI = 0.77–0.93) for females. Logistic regression analysis confirmed the positive association of increased hs-CRP levels with VOC, which correlated positively with VOC frequency ( P < 0.001), type ( P < 0.001), pain ( P < 0.001), and need for hospitalization ( P = 0.024). These data support strong association of increased hs-CRP levels with VOC, which impacts VOC-related parameters, and support a role for hs-CRP in VOC follow-up.

C-Reactive protein levels are associated with adiposity and a high inflammatory foods index in mountainous Cypriot children

Inflammatory marker levels have long been associated with obesity status in adult populations, but relevant data are scarce in children, especially in diverse races. The aim of this study was thus to examine the association between overall and central obesity and C-reactive protein (CRP) levels in Cypriot children of Greek ancestry. Eighty three children (9.2 ± 1.7 years) were studied. Body mass index (BMI) was calculated according to the age-sex specific International Obesity Task Force (IOTF) criteria while body fat percentage (BF%) was measured via leg-to-leg bioelectric impedance (BIA). Central obesity was defined as waist circumference ≥ 75 th percentile. Physical activity was assessed using a pedometer and diet quality was evaluated by applying the KIDMED index. An inflammatory foods' index, composed of nine foods/food groups, was also calculated. CRP levels were measured using a high-sensitivity (hs) immunoassay. Obese children, children with excess BF% and children with WC ≥ 75 th percentile were 7.35, 6.84 and 7.81 times (P < 0.05) respectively more likely to have hs-CRP levels ≥ 0.10 mg/dL; a high score of the dietary inflammation index was positively associated with CRP levels. Obesity is associated with increased hs-CRP levels in 6-12 year-old children, a finding that supports the inflammation-obesity hypothesis at an early stage of life. Furthermore, frequent consumption of inflammatory foods is positively related to CRP levels.

Prediction of malignant middle cerebral artery infarction by plasma MMP-9 and hsCRP level

Objective To evaluate the predicting value of the marker of endothelial injury: plasma matrix metalloproteinase-9( MMP-9) and high sensitivity C-reactive protein( hsCRP) level on the progression of acute anterior circulating territory infarction progressing to malignant middle cerebral artery infarction (m-MCAI). Methods 90 patients with acute anterior circulating territory infarction, in which 46 patients progressed to m-MCAI, were collected and sampled consecutively. The plasma MMP-9 and hsCRP of all patients were determined by ELISA and immunotur-bidimetry,respectively,at admission. And the clinical characters and cranial CT features of the patients were analyzed. Results At admission,the plasma MMP-9 level in the patients with m-MCAI(242.0 ±58.0)ng/ml was significantly higher than that in the patients with non m-MCAI( 169.0 ± 50.0) ng/ml( P < 0. 01) ,the plasma hsCRP level in the patients with m-MCAI(6.25 ±1.2) ng/ml was significantly higher than that in the patients with non m-MCAI( 1.55 ± 0.9) mg/ml( P <0. 01).Conclusion The increased level of plasma MMP-9 and hsCRP could be predictors for the m-MCAI proceeding. Key words: Infarction,middle cerebral artery; Matrix metalloproteinase 9; C-reactive protein; Tomography, x-ray computed

Changes in High-Sensitivity C-Reactive Protein in Serum and Exhaled Breath Condensate after Intensive Exercise in Patients with Allergic Asthma

Background: Exercise-induced bronchoconstriction (EIB) in asthmatics depends on the presence of allergic inflammation. This study was performed to assess the possible association of EIB with low-grade systemic inflammation, whose presence was revealed in asthmatic patients. Methods: The study was conducted in a group of 24 asthmatics (14 with EIB, 10 without EIB) and 8 healthy volunteers. Changes in serum and exhaled breath condensate (EBC) high-sensitivity C-reactive protein (hs-CRP) levels induced by intensive exercise were determined. Moreover, the possible correlation of these measurements with the results of other tests used in the diagnosis of asthma as well as laboratory tests commonly associated with asthma were investigated. Results: In asthmatic patients with EIB, a statistically significant increase in hs-CRP levels both in serum and EBC after an exercise test was observed. Twenty-four hours after the exercise test in the group of asthmatics with EIB, a statistically significant increase in exhaled nitric oxide (F_ENO), serum eosinophil cationic protein (ECP) concentrations and bronchial hyperreactivity to histamine was revealed. A statistically significant correlation between the maximum increase in hs-CRP levels both in serum and EBC after exercise and either baseline F_ENO and an increase in serum ECP or F_ENO 24 h after exercise in the group of asthmatics with EIB was revealed. Conclusions: We show that, as a result of intensive exercise leading to bronchoconstriction, an increase in serum and EBC hs-CRP occurs. Our observations could suggest that in asthmatic patients, as a consequence of exercise-induced bronchoconstriction, an intensification of low-grade systemic inflammation can be observed.

Antioxidant potential, paraoxonase 1, ceruloplasmin activity and C-reactive protein concentration in diabetic retinopathy

The aim of this study was to evaluate the ferric-reducing ability of serum (FRAS), paraoxonase 1 (PON1), ceruloplasmin serum oxidase activity and hsCRP level in patients with type1 diabetes mellitus without and with diabetic retinopathy. The study was performed in 76 patients with type 1 diabetes mellitus, 35 without diabetic retinopathy (group 1) and 41 with preproliferative and proliferative retinopathy (group 2). Control group consisted of 35 nondiabetic, age-, gender-, body mass-matched healthy volunteers who came to the outpatient clinic for a routine health check-up. We evaluated FRAS using the method described by Benzie and Strain; PON1 by kinetic spectrophotometric assay with paraoxon as substrate and ceruloplasmin using its oxidative activity with 3-phenylenodiamine as substrate. CRP was measured with a high sensitive enzyme immunoassay. PON1 activity was significantly decreased in patients with diabetic retinopathy (227.66 +/- 123.57 U/l) when compared with control (312.04 +/- 129.77 U/l). FRAS was significantly decreased in group 2 (439.33 +/- 79.87 micromol/l) when compared with group 1 (522.79 +/- 167.56 micromol/l) and control (529.80 +/- 81.99 micromol/l). Ceruloplasmin activity was significantly elevated in group 1 (58.36 +/- 22.56 U/g protein) when compared with control (45.22 +/- 14.96 U/g protein). We have found significant increase in hsCRP level in group 2 (3.71 +/- 2.47 mg/l) when compared with group 1 (1.75 +/- 1.01 mg/l) and control (0.57 +/- 0.46 mg/l). The PON1/CRP ratio in control group was significantly increased when compared with diabetic patients and was significantly decreased in group 2 compared with group 1. We have not found gender-dependent difference in studied parameters in both control and in study groups. We have found tendency to decrease the serum activity of FRAS and hsCRP in elder patients but the difference was significant only in group 2. FRAS and PON 1 activity is decreased in patients with type 1 diabetes mellitus with presence of diabetic retinopathy which confirms that oxidative stress could play a role in pathogenesis of diabetic retinopathy. Significantly elevated levels of hsCRP in diabetic patients with the presence of diabetic retinopathy compared with patients without diabetic retinopathy providing a link between inflammation and the development of microvascular complication of diabetes. Because of the significant difference in PON1/CRP ratio between patients without and with the presence of diabetic retinopathy, it seems that PON1:CRP ratio may be used as a biochemical marker for progression of retinopathy. The link between the antioxidant concentration, inflammation and the development of diabetes complications needs further longitudinal studies in order to confirm our findings.