C-reactive Protein Odds Ratio Research Articles

Diagnostic test accuracy of serum procalcitonin compared with C-reactive protein for bone and joint infection in children and adolescents: a systematic review and meta-analysis.

The objective of this review was to synthesize the best available evidence for the diagnostic test accuracy of serum procalcitonin compared with serum C-reactive protein for suspected osteomyelitis and septic arthritis in hospitalized children and adolescents. Measurement of serum C-reactive protein remains a routine investigation for the diagnosis of osteoarticular infection in children and adolescents. Measurement of serum procalcitonin has been shown to outperform C-reactive protein in adults with osteomyelitis and septic arthritis. Before procalcitonin can be considered as a potential replacement or add-on test in children and adolescents, a systematic review and meta-analysis targeting this population should be conducted. Original studies reporting the diagnostic accuracy of procalcitonin and/or C-reactive protein in children and adolescents between one month and 18 years of age admitted to hospital with suspected osteoarticular infection were included. Studies must have compared the index test to at least one reference test. Reference test was defined as positive culture or polymerase chain reaction confirmation of a pathogen from blood, bone biopsy, or joint fluid aspirate in combination with at least two of the following: i) purulent material from sterile site, ii) positive radiological findings consistent with osteoarticular infection, and ii) symptoms and signs consistent with osteomyelitis and/or septic arthritis. The JBI methodology for systematic reviews of diagnostic test accuracy was followed. Information was sourced from four databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science) and four gray literature sources (MedNar, OpenGrey, Google Scholar, and ProQuest Dissertations and Theses). Only studies published in English were considered. The methodological quality of selected studies was formally evaluated, sensitivity and specificity data were extracted, and 95% confidence intervals determined. Meta-analysis was performed to estimate summary points using a bivariate model and to generate a hierarchical summary receiver operating characteristic (HSROC) curve with global measures of test accuracy performance, such as likelihood ratio and diagnostic odds ratio. A narrative was provided where meta-analysis was not appropriate. Eight studies were included in the review. Four of these studies used a common C-reactive protein test threshold of 20 mg/L. At this threshold, the estimated pooled sensitivity of C-reactive protein was 0.86 (0.68-0.96) and the pooled specificity was 0.9 (0.83-0.94). Using a hierarchical summary receiver operating characteristic model from six studies, the diagnostic odds ratio for C-reactive protein was estimated to be 39.4 (14.8-104.9) with a positive likelihood ratio 5.3 (2.3-11.9) and a negative likelihood ratio 0.1 (0.07-0.2). There were insufficient studies from this review to statistically evaluate the diagnostic accuracy of procalcitonin. Clinicians should continue to measure serum C-reactive protein as the preferred inflammatory marker in hospitalized children and adolescents with suspected osteomyelitis or septic arthritis. More evidence is needed before incorporating procalcitonin routinely into clinicians' diagnostic test strategy. Improvements with the design, quality, and reporting of procalcitonin diagnostic test assays in children and adolescents with osteoarticular infection is needed. PROSPERO CRD42019140276.

Breakfast Frequency and Chronic Inflammation in Chinese Adults (P18-051-19)

ObjectivesPrevious studies have shown that regular breakfast consumption was associated with lower risk of cardiovascular disease (CVD), but this remains controversial. Chronic inflammation is a well-established risk factor for cardiovascular disease. We, thus, examined whether breakfast frequency was associated with inflammation, assessed by high sensitivity C-reactive protein (CRP) concentration, among individuals without CVD. MethodsIncluded were 71,748 participants of the Kailuan Study, an ongoing Chinese cohort, who were free of CVD and cancer. Breakfast frequency was assessed via questionnaire in 2014, and participants were categorized into four groups in the current analysis –no breakfast, 1–2 times/week, 3–5 times/week, or breakfast every day. Plasma CRP concentration was measured using a high-sensitivity, particle-enhanced immunonephelometry assay. General linear models were used to calculate adjusted means with 95% confidence intervals (CIs) for CRP, and logistic regression models were used to calculate odds ratios (ORs) of chronic inflammation (CRP concentration ≥1.0 mg/L or ≥3.0 mg/L), across the four breakfast groups. We adjusted for age, sex, diet quality score, body mass index, education level, occupation type, marital status, smoking status, systolic blood pressure, fasting blood glucose, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol in the models. ResultsGreater breakfast frequency was associated with lower CRP concentration (P-trend < 0.001). Adjusted mean CRP was 1.40 mg/L (95% CIs: 1.33, 1.48) for the “no breakfast” group and 1.07 mg/L (95% CIs: 1.02, 1.12) for the “breakfast everyday” group (P-difference < 0.001). Similar results were observed for the odds of chronic inflammation. The adjusted OR for CRP ≥ 1.0 mg/Lwas 2.55 (95% CIs: 2.39, 2.72) and for CRP ≥ 3.0 mg/L was1.21 (1.12, 1.30) for the “no breakfast” group, relative to the “breakfast everyday” group (P-trend < 0.001, Figure 1) ConclusionsSkipping breakfast was associated with chronic inflammation among individuals without CVD. Funding SourcesThe Institute for CyberScienceSeedGrantProgram, Penn State University and the start-up grant from the college of health and human development and the department of nutritional sciences, Penn State University. Supporting Tables, Images and/or Graphs▪

Prevalent peripheral arterial disease and inflammatory burden.

BackgroundStrong evidence implicates inflammation in the development of atherosclerotic heart disease but less is known about peripheral arterial disease (PAD). Our objective was to test the hypothesis that a composite index of inflammatory burden is associated with PAD.MethodsCross-sectional analysis of a randomly-selected group of 903 community-dwelling men in the MrOS cohort recruited between 2000 and 2002. Using blood samples, we measured seven cytokines and related these levels to prevalent PAD (ankle-brachial index (ABI) <0.9) both individually and as part of an “inflammatory burden score” (a composite sum of the number of pro-inflammatory cytokines in the highest quartile).ResultsOverall, 6.75% of men had ABI <0.9. The odds of prevalent PAD were higher in men with the highest quartile (Q4) levels of interleukin-6 multivariable (MV) adjusted (odds ratio (OR) =3.95 (95% CI, 1.4–11.3), tumor necrosis factor alpha OR = 4.44 (95% confidence interval (CI), 1.5–12.8), and C-reactive protein OR = 3.63 (95% CI, 1.4–9.4) compared to men in Q1. The magnitude of the association of these cytokines with PAD was similar to the effect of being 10 years older, OR = 2.41 (95% CI, 1.16–3.7). These significant effects persisted after additional MV adjustment for smoking except for CRP. Men with the highest inflammatory burden score (≥3) had 3.6 (95% CI, 1.5–8.7) increased odds of PAD, p trend = 0.03. After smoking adjustment the linear trend was borderline statistically significant (p trend = 0.10).ConclusionInflammatory burden is associated with prevalent PAD, an association similar to aging 10 years. The inflammatory effects of smoking contributes to the underlying association between inflammation and PAD.

Relationship of Neutrophil-to-Lymphocyte Ratio and Serum Albumin Levels with C-Reactive Protein in Hemodialysis Patients: Results from 2 International Cohort Studies

Background/Aim: The neutrophil-to-lymphocyte ratio (NLR), defined as the neutrophil count divided by lymphocyte count, is an inexpensive and readily available parameter, which may serve as a surrogate for inflammation markers, such as C-reactive protein (CRP). The aim of this study was to determine the utility of NLR in the prediction of elevated CRP levels in hemodialysis (HD) patients. Methods: We analyzed 43,272 HD patients from 2 distinct cohorts within the Monitoring Dialysis Outcomes research collaboration in whom contemporaneous measurements of neutrophil and lymphocyte counts, serum albumin and CRP levels were available. Logistic regression was used to determine the relationship of trichotomized NLR (<2.5, 2.5-5 and >5.0) and albumin levels (<3.1, 3.1-4.0 and >4.0 g/dl) with elevated CRP levels (>10.0, >20.0 and >30.0 mg/l). Congruence of the prediction models was examined by comparing the regression parameters and by cross-validating each regression equation within the other cohort. Results: We found that NLR >5.0 vs. <2.5 (cohort 1: OR 2.3; p < 0.0001 and cohort 2: OR 2.0; p < 0.0001) was associated with CRP levels >10.0 mg/l. Stepwise increase in odds ratio for CRP >10.0 mg/l was observed with the combination of high NLR and low albumin levels (NLR >5.0 and albumin <3.1) (cohort 1: OR 7.6; p < 0.0001 and cohort 2: OR 11.9; p < 0.0001). Cross-validation of the 2 regression models revealed a predictive accuracy of 0.68 and 0.69 in the respective cohorts. Conclusion: This study suggests that NLR could serve as a potential surrogate marker for CRP. Our results may add to diagnostic abilities in settings where CRP is not measured routinely in HD patients. NLR is easy to integrate into daily practice and may be used as a marker of systemic inflammation.

Association between inflammatory markers and liver fat: The Multi-Ethnic Study of Atherosclerosis.

Nonalcoholic fatty liver disease (NAFLD) is a common liver disease. Data is emerging that an independent association between markers of subclinical atherosclerosis and NAFLD exists and it may be considered as an independent predictor of cardiovascular (CV) outcomes. We aim to better characterize the relationship between NAFLD and inflammatory markers in a multi-ethnic cohort by assessing fatty liver on computed tomography (CT) scans. The Multi-Ethnic Study of Atherosclerosis (MESA) is a longitudinal, population-based study from four ethnic groups free of CV disease at baseline. The inflammatory markers studied include: C-reactive protein (CRP) and interleukin 6 (IL-6). On CT scans liver-to-spleen ratio (LSR: Hounsfield Units (HU) of the liver divided by HU of spleen) of <1 and liver attenuation of <40 HU were used as criteria for fatty liver. Unadjusted and adjusted multivariate linear and logistic regression analysis was performed. 4038 participants amongst 6814 MESA population with visible spleen on the CT scan, available CRP and IL-6 levels and no reported liver cirrhosis were included. The average age was 61 +/- 10 years, 37% Caucasians and 45% were males. Mean CRP and IL-6 were 2.36 mg/dl and 1.37 pg/ml respectively. 696 participants (17%) had LSR of <1 and 253 (6%) had liver attenuation of <40 HU. When using LSR <1 as a continuous variable, the correlation (adjusted odds ratio (OR)) with CRP >2.0 was 0.037 (95% CI: 0.02-0.054) and with IL-6 was 0.014 (95% CI: 0.004-0.023). On the other hand when presence and absence of LSR <1 was considered, higher ORs for association with CRP >2: 1.41 (95% CI: 1.16 to 1.73) and IL6:1.18 (95% CI: 1.05 to 1.31) were found. Similarly, the adjusted association of per unit decrease in liver attenuation with CRP>2 was 1.92 (95% CI: 1.20 to 2.63) while for IL-6 was 1.08 (95% CI: 0.69 to 1.47). When considering presence and absence of liver attenuation <40 HU the OR for CRP >2 was 2.27 (95% CI: 1.62 to 3.16) and for IL-6 was 1.33 (95% CI: 1.13 to 1.58). CRP and IL-6 levels were found to be significantly associated with liver fat assessed on CT scan after adjusting for other risk factors for atherosclerosis.

Significance of serum immune markers in identification of global functional impairment in the oldest old: cross-sectional results from the BELFRAIL study

The large burden and coexistence of physical disability, cognitive impairment, and depression in the oldest old makes summary markers of global functioning of great value, allowing for risk stratification. Inflammation may be a common underlying cause or represents a final common pathway. The present study investigated the association between elevated serum inflammatory markers and global functioning and its underlying aspects. A representative sample of 415 community-dwelling elderly subjects participating in the BELFRAIL study, with a mean age of 85 years, was included in the present analysis. Data on physical performance, dependence, and mental aspects of functioning and serum levels of 15 inflammatory proteins, including cytokines, chemokines, and acute-phase proteins, were assessed. Interleukin (IL)-6 was negatively associated with global functioning (odds ratio (OR) 4.35). The odds ratios for C-reactive protein (CRP) (OR 2.37) and the combined score of IL-6 and CRP (OR 2.59) were lower or not significant. IL-6 was significantly associated with physical dependence and cognitive function, and only a highly elevated serum level was associated with physical performance. Physical dependence was associated with a highly elevated CRP serum level. The proportion of functionally impaired older persons with elevated IL-6 was 81.93 %, giving a low positive predictive value (0.38), but a high negative predictive value (0.87). So, IL-6 is strongly associated with global functioning and all of the individual aspects of functioning, except suspected depression, in community-dwelling persons 80 years and older.

Associations between dietary/serum carotenoids and cardiovascular disease risk factors

Although cohort studies have found inverse associations between dietary/serum carotenoids and incidence of CVD, little is known about the association between dietary/serum carotenoids and CVD risk factors. A cross‐sectional study was conducted to examine the associations of dietary/serum carotenoids with plasma lipids, homocysteine (Hcy), and C‐reactive protein (CRP). A total of 7,398 participants aged over 19 y free of CVD or cancer in the NHANES 2003–2006 were utilized. After adjusting for covariates, the odds ratios for CRP &gt;; 2.4 mg/L (ref: CRP ≤ 2.4 mg/L) were 0.14 (95% CI: 0.04–0.47), 0.29 (CI: 0.17–0.77), 0.32 (CI: 0.12–0.85) and 0.39 (CI: 0.15–0.97) for participants in the highest quartile vs. the lowest of β‐cryptoxanthin, lycopene, lutein+zeaxanthin, and total carotenoid intakes, respectively. Serum carotenoids, except α‐carotene, were positively associated with plasma total cholesterol (p&lt;0.05). Serum α‐carotene, cis β‐carotene, and lutein+zeaxanthin were positively associated with HDL (p&lt;0.05) but not with LDL. The odds ratios for Hcy &gt;; 12 μmol/L (ref: Hcy ≤ 12 μmol/L) were 0.29 (CI: 0.12–0.72), 0.36 (CI: 0.14–0.95), and 0.24 (CI: 0.11–0.56) for participants in the highest quartile vs. the lowest of serum α‐carotene, cis β‐carotene, and lycopene, respectively. Serum carotenoids were better predictors than dietary carotenoids in terms of their protective effects against CVD.Grant Funding Source: NA

Índice cintura estatura y agregación de componentes cardiometabólicos en niños y adolescentes de Santiago

Waist to height ratio and ultrasensitive C-reactive protein are predictors of the presence of the metabolic syndrome in children.To determine the proportional risk of metabolic syndrome component clustering in children, using waist to height ratio and ultrasensitive C-reactive protein.Anthropometric measures, blood pressure, fasting serum lipid profile, blood glucose and ultrasensitive C-reactive protein were determined in 209 children aged 11.5 ± 2 years (50% females). The presence of the metabolic syndrome as a function of waist to height ratio and C-reactive protein was modeled using logistic regression equations. The risk of clustering one, two or more components of the metabolic syndrome was calculated.Metabolic syndrome was present in 5% of all children and 18% of those that were obese. The cut off points for waist to hip ratio and ultrasensitive C-reactive protein were 0.55 and 0.61 mg/L, respectively. For each 0.01 increment in waist to height ratio, the odds ratio of increasing one component of the metabolic syndrome was 1.2 (1.15-1.25) or 15 to 25%. The odds ratio for log-transformed ultrasensitive C-reactive protein was 1.62 (1.26-2.09). Excluding waist circumference, the odds ratio of adding one or more components of the metabolic syndrome was 1.05 (1.01-1.09) per 0.01 increment in waist to height ratio, but the odds ratio for C-reactive protein was no longer significant.Waist to height ratio and ultrasensitive C-reactive protein predict the risk of clustering components of the metabolic syndrome in these children.

Waist height ratio, ultrasensitive c reactive protein and metabolic syndrome in children

Waist to height ratio and ultrasensitive C-reactive protein are predictors of the presence of the metabolic syndrome in children. To determine the proportional risk of metabolic syndrome component clustering in children, using waist to height ratio and ultrasensitive C-reactive protein. Anthropometric measures, blood pressure, fasting serum lipid profile, blood glucose and ultrasensitive C-reactive protein were determined in 209 children aged 11.5 ± 2 years (50% females). The presence of the metabolic syndrome as a function of waist to height ratio and C-reactive protein was modeled using logistic regression equations. The risk of clustering one, two or more components of the metabolic syndrome was calculated. Metabolic syndrome was present in 5% of all children and 18% of those that were obese. The cut off points for waist to hip ratio and ultrasensitive C-reactive protein were 0.55 and 0.61 mg/L, respectively. For each 0.01 increment in waist to height ratio, the odds ratio of increasing one component of the metabolic syndrome was 1.2 (1.15-1.25) or 15 to 25%. The odds ratio for log-transformed ultrasensitive C-reactive protein was 1.62 (1.26-2.09). Excluding waist circumference, the odds ratio of adding one or more components of the metabolic syndrome was 1.05 (1.01-1.09) per 0.01 increment in waist to height ratio, but the odds ratio for C-reactive protein was no longer significant. Waist to height ratio and ultrasensitive C-reactive protein predict the risk of clustering components of the metabolic syndrome in these children.

Dietary total antioxidant capacity is inversely associated with the risk of cardiovascular disease in U.S. adults

Dietary total antioxidant capacity (TAC) and serum concentrations of homocystein (Hcy) and C‐reactive protein (CRP) have been addressed related to CVD; however, no documents reported the relationship between dietary TAC levels and these serum biomarkers in a large scale, free living population. The study aimed to investigate the association between the dietary TAC level and serum Hcy and CRP concentrations of US adults. The USDA flavonoid and proanthocyanidin databases, dietary supplement data and food consumption data of 4,391 U.S. adults aged ≥ 19 yrs in NHANES 2001–2002 were utilized. Previously measured vitamin C equivalent antioxidant capacity of 43 nutrients was applied. Serum CRP concentrations were higher in women, blacks, smokers, those with higher BMI, higher total cholesterol to HDL ratio, lower exercise levels and taking NASID and the subjects who had inflammatory chronic diseases (p&lt;0.05). Higher daily dietary TAC level was inversely associated with odds ratio for Hcy ≥ 13 μmol/L (p&lt;0.001) and odds ratio for CRP ≥ 3 mg/L (p&lt;0.1) after adjusting for relevant covariates. Our present study demonstrated that total TAC from diet and dietary supplements was inversely associated with the risk of CVD in U.S. adults. The potential benefit of dietary TAC as a biomarker of dietary antioxidant intake status and CVD risk needs further research.Grant Funding Source: American Heart Association

Predictors of Vascular and Gastrointestinal Complications in Severe Acute Pancreatitis

Aim: To determine prognostic factors for arterial injury and gastrointestinal perforation in patients with severe acute pancreatitis (AP). Methods: A prospective cohort study was performed in 39 patients with AP whose Ranson scores were ≥3. The following parameters were assessed: Ranson score, APACHE II score, C-reactive protein (CRP) concentration on admission and on day 7, and contrast-enhanced computed tomography (CT) scans on admission (first CT) and between days 6 and 8 (second CT). The Balthazar CT severity index was calculated. Results: Six patients developed seven vascular and/or gastrointestinal complications (duodenal perforations in 3 and arterial pseudoaneurysm in 4). CRP on day 7 and the CT severity indices at the second CT were significantly higher in the complication group than in the noncomplication group. A stepwise logistic regression analysis demonstrated that CRP ≥15 mg/dl on day 7 and CT severity index ≥7 at the second CT were independent risk factors (p = 0.02 and 0.04, respectively). The odds ratio for CRP ≥15 mg/dl was 23.0 and 15.7 for a CT severity index of ≥7. Conclusion: A persistent elevation of the CRP concentration and a high CT severity index are independent riskfactors for local complications associated with AP. Copyright © 2008 S. Karger AG, Basel and IAP

The added value of C-reactive protein to clinical signs and symptoms in patients with obstructive airway disease: results of a diagnostic study in primary care

BackgroundTo evaluate the diagnostic accuracy of clinical signs and symptoms, C-reactive protein (CRP) and spirometric parameters and determine their interrelation in patients suspected to have an obstructive airway disease (OAD) in primary care.MethodsIn a cross sectional diagnostic study, 60 adult patients coming to the general practitioner (GP) for the first-time with complaints suspicious for obstructive airway disease (OAD) underwent spirometry. Peak expiratory flow (PEF)-variability within two weeks was determined in patients with inconspicuous spirometry. Structured medical histories were documented and CRP was measured. The reference standard was the Tiffeneau ratio (FEV1/VC) in spirometry and the PEF-variability. OAD was diagnosed when FEV1/VC ≤ 70% or PEF-variability > 20%.Results37 (62%) patients had OAD. The best cut-off value for CRP was found at 2 mg/l with a diagnostic odds ratio (OR) of 4.4 (95% CI 1.4–13.8). Self-reported wheezing was significantly related with OAD (OR 3.4; CI 1.1–10.3), whereas coughing was inversely related (OR 0.2; CI 0.1–0.7). The diagnostic OR of CRP increased when combined with dyspnea (OR 8.5; 95% CI 1.7–42.3) or smoking history (OR 8.4; 95% CI 1.5–48.9). CRP (p = 0.004), FEV1 (p = 0.001) and FIV1 (p = 0.023) were related with the severity of dyspnea. CRP increased with the number of cigarettes, expressed in pack years (p = 0.001).ConclusionThe diagnostic accuracy of clinical signs and symptoms was low. The diagnostic accuracy of CRP improved in combination with dyspnea and smoking history. Due to their coherence with the severity of dyspnea and number of cigarettes respectively, CRP and spirometry might allow risk stratification of patients with OAD in primary care. Further studies need to be done to confirm these findings.

Prevalence of acidosis and inflammation and their association with low serum albumin in chronic kidney disease

Low serum albumin is a strong risk factor for mortality, but its association with low serum bicarbonate and inflammation in the setting of mild to moderately decreased kidney function is uncertain. We analyzed data from 15594 subjects over the age of 20 who participated in the Third National Health and Nutrition Examination Survey (NHANES III). Glomerular filtration rate (GFR) in mL/min/1.73 m2 was estimated by the abbreviated Modification of Diet in Renal Disease (MDRD) equation using appropriately calibrated serum creatinine. The age-adjusted prevalence of hypoalbuminemia (serum albumin <3.8 g/dL) at a GFR of 90, 60, 30, and 15 mL/min/1.73 m2 was 19%, 21%, 38%, and 59%, respectively, while the age-adjusted prevalence of C-reactive protein (CRP) >or= 0.22 mg/dL was 36%, 44%, 69%, and 81%, respectively, both P trend <0.001. Age, female gender, non-Hispanic black compared with non-Hispanic white race, diabetes, hypertension, hepatitis C, urine albumin: creatinine ratio >1 g/g, dietary protein intake, dietary caloric intake, serum bicarbonate, CRP, and GFR category were all significant predictors of hypoalbuminemia on univariate analysis. On simultaneously adjusting for the above variables, hypertension, diabetes, GFR, and dietary protein and caloric intake were no longer significant independent predictors of hypoalbuminemia. The adjusted odds ratio (OR) of serum bicarbonate (by quartile) for hypoalbuminemia was 1.0 for serum bicarbonate >28 mEq/L (reference), 1.25 for 26-28 mEq/L, 1.51 for 23-25 mEq/L, and 1.54 for <or=22 meq/L. The adjusted OR of CRP for hypoalbuminemia was 1.0 for CRP < 0.22 mg/dL (reference), 2.60 for 0.22-1.0 mg/dL, and 5.56 for >1.0 mg/dL. Elevated CRP and low serum bicarbonate are independently associated with hypoalbuminemia, explaining much of the high prevalence of hypoalbuminemia in chronic kidney disease.

C-Reactive Protein and Peripheral Artery Disease among Japanese Elderly: the Tsurugaya Project

We investigated the cross-sectional relationship between ankle brachial index and cardiovascular disease risk factors, including C-reactive protein (CRP), among Japanese elderly, a topic which has had little prior epidemiologic study. Our study population comprised 946 subjects aged at least 70 years in whom both CRP and ankle brachial index were measured. The participants were classified into a low (ankle brachial index<0.9) and normal ankle brachial index group. We found that current smoking, high-density lipoprotein cholesterol <40 mg/dl, a low body mass index (continuous variable), hypertension, diabetes and statin use were all significantly related to a lower ankle brachial index. Higher log-transformed CRP level was significantly related to a lower ankle brachial index after adjustment for the cardiovascular risk factors mentioned above (p <0.01). The odds ratios for low ankle brachial index compared to 0-1 risk factors were 5.79 (95% confidence interval [CI]: 2.99-11.20) for 2 risk factors and 17.45 (95% CI: 6.78-49.91) for 3 or more risk factors; independently of other risk factors, the odds ratio for CRP>1.0 mg/l was 2.10 (95% CI: 1.13-3.88) compared to lower CRP values. Thus, a high level of CRP is related to a low ankle brachial index among Japanese elderly as well as Western subjects. This is the first study to report the relationship between CRP and low ankle brachial index among Japanese elderly.