Mean Serum Levels Of hs-CRP Research Articles

#336 Early detection of vascular access complication in pediatric CKD hemodialysis patients

Abstract Background and Aims Vascular access (VA) dysfunction is a major clinical complication in the hemodialysis (HD) population and has a direct effect on dialysis outcome. Where in patients undergoing HD, neointimal hyperplasia results in vascular stenosis and subsequent thrombosis, which lead to vascular access failure. Interleukin-10 (IL-10), hs CRP, and tumor necrosis factor- (TNF–α) are inflammatory markers which are proved to be involved in the process neointimal hyperplasia & subsequent complications. We aimed to evaluate the value of these inflammatory markers in early detection of arterio-venous fistula (AVF) failure, in pediatric patients on regular HD, together with the clinical & radiological diagnoses, for proper intervention for correcting AVF failure according to guidelines. Method It was an prospective cohort study, where we included 59 pediatric chronic kidney disease patients’ stage 5, on regular HD (CKD5d), who were following up regularly with us for 1 year. Patients with nonfunctioning AVFs due to complications as thrombus occluding fistula, infections, or large aneurysm, were excluded from the beginning of the study. Monitoring of VA by pre-cannulation physical examination was performed to detect the physical signs of dysfunction, at least once per month according to KDOQI guidelines. Venous pressure (VP) and trans-membrane pressure (TMP) were recorded at each HD session, to detect any abnormalities and to record the pressure changes with the appearance of any AVF complications. Doppler ultrasound (DUS) was performed routinely every 3 months for all HD patients, & at the time of development AVF complications. Blood samples for measuring IL10, TNF, hs CRP were collected from the patients every 2 weeks for 12 months, prior to HD sessions, where we included the most recent samples prior to, and at the time of development complications, which were clinically and radiologically confirmed. Results The mean (±SD) age of our patients was 13.97 (±2.65) years, where we had 39 (56.5%) males, and 30 (43.5%) females, with a median (IQR) HD duration of 4.0 (5.0) years. On assessing the AVF complications, 33 patients (55.9%) had experienced complications, where thrombosis was the most common reported one (17 patients, 28.8%), followed by aneurysm formation in 14 patients (23.7%), while 6 patients (10%) had stenosed AVF, early VA failure in 2 patients (3.4%),1 patient (1.7%) had pseudoaneurysm, and another patient (1.7%) had perivascular hematoma. Mean serum levels of Hs-CRP, TNF-α, IL-10 were elevated at timing of early development of complication, in comparison to their baseline levels, meanwhile serum IL10, and TNF alpha were significantly higher among patients who developed AVF stenosis. The baseline hs-CRP had related positively with AVF diameter at the time of the development of the complications. Conclusion The inflammatory markers have no clinically applied role in early detection of AVF abnormalities, therefore, physical examination and DUS are deemed sufficient.

Stachys schtschegleevii tea, matrix metalloproteinase, and disease severity in female rheumatoid arthritis patients: a randomized controlled clinical trial.

Stachys schtschegleevii (SSC) is a herbal medicine used to treat infections. To date, this is the first study aimed to investigate the effects of SSC tea on disease activity score (DAS), serum inflammatory biomarkers and matrix metalloproteinases (MMP-1 and MMP-3) among women with rheumatoid arthritis (RA). This pilot, triple-blind, randomized controlled clinical trial was conducted among forty-four women (age: 30-65 years) diagnosed with moderately active RA. Subjects were randomly assigned (1:1 ratio) into either SSC group (2.4 g/day SSC + 2.4 g/day black tea, n=22) or placebo (2.4 g/day black tea, n=22) for 8 weeks. Serum high-sensitivity C-reactive protein (hs-CRP), interleukin-1 beta (IL-1β), and MMPs were measured using ELISA. According to the American College of Rheumatology guideline considering hs-CRP, DAS28 was assessed. Both study groups had respondent rates above 94.9%. The SSC intervention caused significant reductions in the number and the percent changes of the tender joints (SSC: -74.39%vs.placebo: -57.15%, mean differences= -0.77; P<0.05) and DAS28 [SSC: -32.44% vs.placebo: -22.32%, mean differences= -0.41, P<0.05). Unlike the intervention within SSC group that showed significant reductions in the mean serum levels of hs-CRP, IL-1β, and MMP-3, SSC caused significant MMP-3 reductions (SSC: -20.59%vs.placebo: 1.29%, P<0.05). The SSC intervention showed an appropriate clinical efficacy for female RA patients, accompanying remarkable reductions in the number of tender and swollen joints, DAS28, and serum levels of MMP-3. This can provide additional insights to the interventional studies controlling RA-related pathological and inflammatory outcomes. Trial registration Prospectively registered at the Iranian Registry of Clinical Trials (IRCT), linked to the WHO Registry Network ( https://en.irct.ir/trial/11602 , IRCT registration number: IRCT2015032011335N5, Registration date:2015-05-12). Key Points • Stachys schtschegleevii improved clinical outcomes and attenuated disease severity in RA patients. • Stachys schtschegleevii ameliorated serum level of MMP-3 in RA patients.

Rosuvastatin decreases serum inflammatory markers and slows atherosclerosis progression rate in treated HIV-infected patients with metabolic syndrome

Objectives Metabolic syndrome (MetS) is usually associated in general population with systemic inflammation and higher cardiovascular risk, but data about the effect of statins in patients with HIV infection and MetS are lacking to date. Methods Prospective cohort study of treated HIV-infected patients, aged from 40 to 60 years, with or without MetS, who started rosuvastatin (10 mg daily), and were followed-up for 12 months. The primary endpoint was change in serum levels of high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and tumour necrosis factor-α (TNF-α). The secondary endpoint was change in the carotid intima-media thickness (IMT). Results One hundred and twenty-five patients were enrolled: 61 with MetS (MetS group) and 64 without MetS (control group). After 12 months, rosuvastatin produced a significant decrease in mean serum levels of hsCRP (–0.28 mg/dL; p = .037), IL-6 (–2.1 pg/mL; p = .018) and TNF-α (–6.3 pg/mL; p = .004) in patients with MetS. On the contrary, in controls rosuvastatin did not lead to a significant change in mean levels of all biomarkers. After 12 months, the mean IMT increase at the carotid bifurcation was significantly lower in the MetS group than in the control group at the carotid bifurcation (0.017 vs. 0.031 mm; p = .037) and in all other anatomical sites. Conclusion Our findings suggest that rosuvastatin is effective in reducing serum inflammation markers and slowing atherosclerosis progression rate in HIV-infected patients on cART and with MetS, while its effects on serum biomarkers and IMT increase seem to be negligible in those without MetS.

Effects of nanocurcumin on inflammatory factors and clinical outcomes in critically ill patients with sepsis: A pilot randomized clinical trial

IntroductionSepsis is a severe reaction and excessive immune response to infection, which can lead to tissue damage, organ dysfunction, and death. This study aimed to investigate the protective effect of curcumin on inflammatory factors and clinical outcomes in patients with sepsis. MethodsThis randomized clinical trial was conducted on 40 patients with sepsis aged 18–55 years, who received 160 mg of nanocurcumin supplement (two capsules 80 mg) or placebo (two capsules of placebo) via a nasogastric tube for 10 days. Sequential organ failure assessment (SOFA) was evaluated on days 1 and 10. Serum levels of inflammatory factors of procalcitonin (PCT), Interleukin- 6 (IL-6), tumor necrosis factor-alpha, (TNF-α),and high-sensitive C-reactive protein (hs-CRP) were measured before the beginning of the intervention and on days 5 and 10. Length of hospital stay, mortality rate, and mechanical ventilation duration was compared between groups. ResultsSerum levels of PCT (p = 0.002), IL-6 (p = 0.012), and TNF-α (p = 0.026) in the nanocurcumin group on day 10 were significantly lower than the placebo group. The duration of mechanical ventilation in the nanocurcumin group was remarkably (p = 0.038) lower than the placebo group. Also, the SOFA score significantly (p = 0.005) decreased in the intervention group compared to the placebo group. No significant difference was observed in the mean serum levels of hs-CRP, duration of the intensive care unit stay, and mortality rates between the study groups. ConclusionsOur study indicated that nanocurcumin could decrease the levels of inflammatory factors, duration of mechanical ventilation, and organ failure in critically ill patients.

Association between Serum Levels of High Sensitivity C-Reactive Protein, Interleukin-1 and Interleukin-6 with Pain Intensity in Patients with Low Back Pain without Sciatica

BACKGROUND: A strictly mechanical and pathoanatomical explanation for low back pain (LBP) and sciatica has proved inadequate; therefore, the role of biochemical and inflammatory factors remains under investigation.AIM: The aim of this study is to evaluate whether there is any association between serum levels of high sensitivity C-reactive protein (hs-CRP), interleukin-1 (IL-1), and IL-6 with pain intensity in a patient with LBP without sciatica.METHODS: Venous blood serum levels of hs-CRP, IL-1, and IL-6 were measured on 50 patients with LBP who had a negative Lasègue test on physical examination. The pain intensity was measured using a visual analog scale (VAS).RESULTS: There were 50 patients with LBP without sciatica with mean of age of46.72 ± 10.79-year-old participated in this study comprised 8 (16%) men and 42 (84%) women. The mean serum levels of hs-CRP, IL-1, and IL-6 were 0.50 ± 0.61 mg/dL, 55.02 ± 49.73 ng/L, and IL-6 39.43 ± 38.56 ng/L, respectively. The mean of VAS score was 49.3±9.6 mm. There was no significant correlation (r = 0.05; p = 0.72) between hs-CRP serum levels and VAS scores. There was found a weak negative non-significant correlation (r = −0.10, p = 0.47) between IL-1 serum levels and VAS score. There was found a weak negative non-significant correlation (r = −0.17, p = 0.23) between IL-6 serum levels and VAS score as well.CONCLUSION: There was no significant correlation between serum levels of hs-CRP, IL-1, and IL-6 with VAS scores in patient with LBP without sciatica.

Effects of Synbiotics and Probiotics Supplementation on Serum Levels of Endotoxin, Heat Shock Protein 70 Antibodies and Inflammatory Markers in Hemodialysis Patients: a Randomized Double-Blinded Controlled Trial.

The aim of this study was to investigate the effects of probiotic and synbiotic supplementation on serum inflammatory markers, endotoxin, and anti-HSP70 in hemodialysis (HD) patients. This study was a randomized, double-blind, placebo-controlled trial. Seventy-five hemodialysis patients who met the inclusion and exclusion criteria were randomly assigned for 12weeks to one of the three arms: synbiotics [n = 23; 15g of prebiotics, 5g of probiotic powder containing Lactobacillus acidophilus T16, Bifidobacterium bifidum BIA-6, Bifidobacterium lactis BIA-6, and Bifidobacterium longum LAF-5 (2.7 × 107CFU/g each)], probiotics [n = 23; 5g probiotics as in synbiotic group with 15g of maltodextrin in the sachet as placebo], and placebo [n = 19; 20g of maltodextrin in the sachet]. Blood and feces were collected at baseline and after intervention. Serum high sensitive C-reactive protein (hs-CRP), interleukin-6, endotoxin, and anti-heat shock protein 70 antibodies (anti-HSP70) were measured. The number of fecal colonies was determined using the plate-counting method. The mean serum level of hs-CRP, anti-HSP70, and endotoxin decreased significantly between groups (p = 0.007, p = 0.037, and p = 0.036, respectively). For the synbiotic group, the mean changes in hs-CRP and IL-6 were significantly lower than for the placebo (p < 0.001 and p < 0.001, respectively) and probiotic group (p = 0.011 and p = 0.008, respectively). Anti-HSP70 mean changes in the synbiotic and probiotic groups differed from the placebo group (p = 0.002 and p = 0.013, respectively). Administration of synbiotics was more effective than probiotics for improvement of inflammatory markers, endotoxin and anti-HSP70 serum levels. Trial registration number: IRCT2017041233393N1.

Evaluating Cardiovascular Risk in Chronic Kidney Disease Patients: A Biomarker Approach

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in chronic kidney disease (CKD) patients. This study aimed to determine the roles of CVD biomarkers in CKD patients. This was a case-control study which recruited consecutive patients with stage 2-4 CKD patients with and without CVD. Serum levels of highly-sensitive C reactive protein (hs-CRP), cystatin C (CysC), asymmetrical dimetylarginine (ADMA) and symmetrical dimethylarginine (SDMA) were measured. Sixty two stage 2-4 CKD patients with a mean age of 60.3 ± 10.4 years were recruited. Twenty three (37.1%) of them had CVD. Those CKD patients with CVD were older (64.1±8.0 vs 58.1± 1.1, p 0.05). There were no differences in their mean serum levels of hs-CRP, CysC, ADMA and SDMA. Risk factors including age, diabetes mellitus, hypertension and renal functions were still the most important CVD risk factors in CKD patients.

The abnormal iron homeostasis among Egyptian obese children and adolescents: relation to inflammation of obesity

Background Obesity is associated with low-grade inflammatory changes that increase Fe tissue storage and affect the level of circulating serum Fe, leading to tissue overload and decreased availability of Fe for hematopoiesis. Objectives The objectives of this study were to determine the relation between the low iron state and the chronic inflammation found in obese children and to assess the role of inflammatory markers in the detection of iron status. Design and setting This was a case–control study. This study was conducted in the outpatient and clinical nutrition clinics of Pediatric Hospital, Ain Shams University. Patients and methods This was a case–control study conducted on 50 obese children and adolescents over 1 year. They were divided into two subgroups: iron deficient and noniron deficient patients. The study also included 20 normal weight children and adolescents as controls. All patients were subjected to the obesity sheet, anthropometric measurements, complete blood picture, measurement of iron profile and high-sensitivity C-reactive protein (hs-CRP). Results There were significantly lower mean values of hemoglobin, serum iron, ferritin and transferrin saturation among obese than among nonobese children. The mean serum level of hs-CRP was significantly higher among obese children than controls, and, of the 50 obese patients, 62% had high levels. The mean serum level of hs-CRP among anemic obese patients was significantly higher than in the nonanemic obese group. The hs-CRP showed significant positive correlations with BMI and significant negative correlations with serum iron. Conclusion The chronic inflammation changes of obesity lead to a low iron state. Thus, regular follow-up of obese children by measuring serum hs-CRP, hemoglobin, and iron profile is mandatory.

Serum levels of high-sensitivity C-reactive protein in acute ischemic stroke and its subtypes: a prospective case-control study

Background and objectives: Studies in different populations have shown that ischemic stroke can trigger an acute phase response resulting in a rise of plasma concentration of C-reactive protein (CRP) and high level of high-sensitivity CRP (hsCRP) is a risk factor for ischemic stroke. The objective of this study was to investigate the association of high hsCRP levels (≥ 1 mg/L) with ischemic stroke and its subtypes in Indian patients. Methods: This prospective observational case-control study included 150 patients (96 males, 54 females; aged 24–81 years) with first acute ischemic stroke who were admitted within 72 hours after onset, and 150 age- and sex-matched healthy controls. The study was conducted from July 2016 to July 2017. The patients were classified according to Trial of ORG 10172 in Acute Stroke Treatment classification. hsCRP levels were assessed in all included stroke patients. Results: The mean serum level of hsCRP was significantly higher in patients with first acute ischemic stroke than in healthy controls (P Conclusion: High hsCRP level is strongly associated with acute ischemic stroke and its subtypes, and it is an independent predictor of acute ischemic stroke. Ethics: The study was approved by the Sir Ganga Ram Hospital Ethics Committee (EC/07/14/701) on July 5, 2014.

Plasma Inflammatory Cytokines as Predictor Markers for Severity of Histological Variations of Intestine among Celiac Patients

Background: Celiac is a chronic hereditary intestinal disorder caused by autoimmune stimulation and injury of intestinal mucosa and different studies have reported an increase of inflammatory cytokines production in these patients. This study aimed to investigate the serum level of inflammatory cytokines and their correlations with the severity of histological variations among celiac patients. Material and methods: By a cross sectional study all celiac patients attending to gastrointestinal clinics in Ilam city during Oct. 2011- MAR. 2013 were investigated. Demographic data was collected using a validate questionnaire and patient's interview and each patient was taken a blood sample for laboratory investigation of tTG-IgA antibody via ELISA test and the serum level of hs- CRP, IL-6 and TNF-a was measured. All patients underwent endoscopic evaluation and biopsy samples were evaluated according to Marsh classification and correlation between severity of histological variations and serum levels of inflammatory cytokines was measured. Results: Totally 274 patients including 90 male and 184 female with a mean age of 28.8±14.4 years were evaluated. The mean serum levels of hs-CRP, IL-6 and TNF-a were 7.8±3.1 mg/l, 2.6±0.9 pg/ml and 6.9±4.6 pg/ml respectively (p=0.599, p=0.629 and p= 0.651). Hs-CRP showed a significant relationship with the severity of mucosal damage upon class I of Marsh classification (p=0.01); however, IL-6 showed a significant level among patients with Marsh I, II and IIIC (p=0.000, p=0.02 and p=0.000) but not in those with Marsh class IIIA and IIIB. Conclusion: There was a positive relationship between mean serum levels of IL-6 and TNF-a with increasing the Marsh classification from class I to class IIIC and the highest rate of IL-6 and TNF-a was shown in Marsh IIIC but the serum level of hs-CRP was not increased with Marsh class increasing. It was concluded that as the Marsh classification increased from class I to class IIIC, and/or the severity of pathologic variations was increased, the mean serum levels of inflammatory markers were increased too.

Serum levels of high-sensitivity C-reactive protein (hs-CRP) in Helicobacter pylori infected patients

Objective: C-reactive protein (CRP) is a protein found in the blood, the levels of which rise in response to inflammation. Its physiological role is to bind to phosphocholine expressed on the surface of dead or dying cells. In this study we aimed to examine the association between Helicobacter pylori (H.pylori) infection and serum levels of high sensitivity C-reactive protein (hs-CRP). Background: Recently, many studies have suggested that there is an association between H.pylori infection and serum high levels of hs-CRP. Subjects: 200 subjects with H.pylori infection (128 male, 72 female) aged 40-68 years (mean 49 years) and 50 healthy control subjects (36 male, 14 female) aged 35-70 years (mean 52.5 years) were included in this study. Blood samples were collected to determine serum hs-CRP. Results: The mean serum level of hs-CRP in patients with H.pylori infection subjects (0.048±0.005 mg/dl) was significantly higher than in healthy control subjects (0.037±0.003 mg/dl). Serum level of hs-CRP was high in 24% of patients group, while it was high in 12% of healthy group. No significant differences were shown among H.pylori infected subjects and healthy subjects regarding to age, sex, smoking, body mass index, and socio-economic status. Conclusion: Serum hs-CPR levels were higher in H.pylori infected patients, based on these results serum hs-CRP could be affected by H.pylori infection.

Serum Levels of High-Sensitivity C-Reactive Protein (hs-CRP) in Helicobacter pylori-Infected Peptic Ulcer Patients and Its Association with Bacterial CagA Virulence Factor

CRP is a marker of inflammation and infection of the gastric mucosa with Helicobacter pylori, which causes an inflammatory reaction. It has been reported that CagA(+) H. pylori strains induce more severe gastric inflammation and are also associated with higher risks of peptic ulcer and gastric cancer. The purpose of this study was to compare serum concentrations of hs-CRP in H. pylori-infected peptic ulcer (PU) patients, H. pylori infected asymptomatic (AS) carriers, and a healthy control group, and their association with bacterial virulence factor CagA. A total of 60 H. pylori infected PU patients (30 patients were positive for anti-CagA antibody and 30 were negative for anti-CagA antibody), 53 H. pylori-infected AS carriers (25 subjects were positive for anti-CagA antibody and 28 were negative for anti-CagA antibody), and 22 healthy H. pylori-negative subjects (as a control group) were enrolled in the study. Serum concentrations of hs-CRP were measured by use of an ELISA method. The mean serum level of hs-CRP in all PU patients (124.9±32.4 μg/dl) was significantly higher than that in all AS subjects (18.6±2.6 μg/dl; P<0.001) and the healthy uninfected control group (10.7±2.9 μg/dl; P<0.0001). Moreover, the mean serum level of hs-CRP in the AS group was significantly higher than that observed in the uninfected control group (P<0.04). No significant difference was observed between mean serum levels of hs-CRP of PU patients with positive test for anti-CagA antibody (132.6±49.4 μg/dl) and PU patients with negative test for anti-CagA antibody (117.1±42.9 μg/dl). Moreover, mean serum levels of hs-CRP were similar in AS subjects with positive test for anti-CagA (18.4±3.1 μg/dl) and in those who were negative for anti-CagA antibody (18.9±4.1 μg/dl). The results of this study showed that mean serum concentrations of hs-CRP in PU patients and in H. pylori infected AS carriers were higher than in a healthy control group. Although H. pylori infection is associated with higher serum levels of hs-CRP, serum concentrations of this inflammatory marker were not affected by expression of bacterial CagA virulence factor.

Obesity, and not obstructive sleep apnea, is responsible for increased serum hs-CRP levels in patients with sleep-disordered breathing in Delhi

Objective The present study was conducted to evaluate serum levels of high-sensitivity C-reactive protein (hs-CRP) in newly diagnosed patients with obstructive sleep apnea (OSA). Subjects and methods Between April 2005 and March 2006, a total of 231 consecutive adult habitual snorers underwent polysomnography (PSG) in the sleep laboratory. Ninety-seven subjects were found suitable for hs-CRP measurement after application of the following exclusion criteria: patients with diabetes mellitus, hypertension, coronary artery disease, acromegaly, hypothyroidism, chronic renal failure, congestive cardiac failure, or smoking history, patients who were pregnant, on steroid treatment, on hormone replacement therapy, or with chronic use of drugs such as non-steroidal anti-inflammatory drugs, oral anticoagulants and lipid-lowering drugs and patients having undergone upper airway surgery. Patients were classified as apneic [apnea–hypopnea index (AHI) > 5], obese non-apneic [body mass index (BMI) > 25, AHI < 5] and non-obese non-apneic (BMI < 25, AHI < 5). C-reactive protein levels were measured in stored sera by high-sensitivity enzyme immunoassay (Biocheck, Inc. Foster City, CA, USA). After checking normality with the Kolmogorov–Smirnov test and using a square-root transformation, Pearson’s and partial correlation coefficients were calculated for identified risk factors and confounders. A multiple linear regression model was used to identify variables that were independently associated with hs-CRP. Results The mean serum levels of hs-CRP were found to be 0.25 ± 0.23, 0.58 ± 0.55, and 0.51 ± 0.37 mg/dl in non-obese non-apneics ( n = 23), obese non-apneics ( n = 45) and apneics (obese and non-obese, n = 29), respectively. Pearson’s correlation coefficient of hs-CRP with BMI was found to be 0.25 ( p = 0.01), and with AHI 0.16 ( p = 0.12). Partial correlation analysis showed that hs-CRP levels correlated significantly with BMI after adjustment for AHI and age ( r = 0.22, p = 0.03), while correlation with disease severity as assessed by AHI after adjustment for BMI and age was not significant ( r = 0.10, p = 0.33). After stepwise multiple linear regression, only BMI was found to be significantly associated with serum hs-CRP levels (β = 0.02, p = 0.01). Conclusions In this first comprehensive cross-sectional study on Indian subjects, we found that obesity, and not obstructive sleep apnea, is associated with elevated serum levels of hs-CRP. No independent correlation was found between severity of OSA and hs-CRP in the present study.

C-reactive protein and other markers of inflammation among patients undergoing HELP LDL apheresis

Studies reveal important prognostic relationships between C-reactive protein (CRP) and atherosclerotic complications. A prospective trial of familial hypercholesterolemic patients treated with Heparin-induced Extra-corporeal Low-Density Lipoprotein Precipitation (HELP, B. Braun Melsungen) therapy was undertaken to evaluate the short- and long-term effects on CRP. Four patients received LDL apheresis therapy on an alternate week basis for 6 months. Pre- and post-treatment serum high sensitivity (hs) CRP levels (IMx®, Abbott Laboratories), LDL-C, triglycerides, and fibrinogen were measured. Pre- and post-treatment mean serum levels of LDL-C were 281±76 and 98±34 mg/dl; triglycerides 191±64 and 123±50 mg/dl; fibrinogen 332±46 and 117±31 mg/dl, respectively. Before and after apheresis mean serum levels of hsCRP were 8.99±7.88 and 3.15±3.16 mg/ml, respectively, representing a 65% decrease. After 6 months of therapy, pre-treatment hsCRP showed an overall mean level decrease of 49%. Preliminary results indicate that LDL apheresis results in a rapid and long-term decrease of serum hsCRP levels.