High-sensitivity C-reactive Protein Values Research Articles

How do early socioeconomic circumstances impact inflammatory trajectories? Findings from Generation XXI

BackgroundThe association between socioeconomic position and markers of inflammation in adults, including C-reactive protein (CRP), is well-established. We hypothesized that children from families of less-advantaged socioeconomic circumstances may be at higher inflammatory risk during childhood and, consequently, throughout their life course. Thus, we aimed to investigate whether early socioeconomic circumstances impact CRP trajectories using repeated measures of data from a population-based birth cohort. MethodsData from 2510 participants of Generation XXI, a prospective Portuguese population-based birth cohort, were included in this study. Early socioeconomic circumstances comprised maternal education and occupation, paternal education and occupation, and household income at the child’s birth. Venous blood samples were collected from the children at ages four, seven, and ten years, and high-sensitivity CRP (Hs-CRP) was quantified. Hs-CRP trajectories were computed using a linear mixed-model approach. ResultsParticipants from less-advantaged socioeconomic circumstances presented higher levels of Hs-CRP by age of ten years. The higher the mother´s education and disposable household income, the lower the minimum value of the log Hs-CRP observed throughout childhood. Further, the age at which that minimum log Hs-CRP value was reached occurs later, meaning that children born in more-advantaged socioeconomic circumstances had lower levels of log Hs-CRP compared with children from less-advantaged families. ConclusionsPoor socioeconomic circumstances early in life are associated with increased inflammation levels throughout the first decade of life. This study demonstrates that social inequalities may impact population health beginning at very early ages.

Diagnostic Value of Different Biomarkers to Identify Bacterial Coinfection in Vietnamese Children with Severe Rhinovirus Pneumonia

AbstractThis study aims to assess the diagnostic value of high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), and interleukin (IL)-6 in the diagnosis of pneumonia caused by Rhinovirus alone or with bacterial coinfection in Vietnamese children under 5 years of age. A cross-sectional study was conducted on 26 children under 5 years of age with severe pneumonia due to Rhinovirus at the National Pediatric Hospital. IL-6, hs-CRP, and PCT tests were performed. The diagnostic values of PCT, IL-6, and hs-CRP in classifying those with viral alone and those with bacterial coinfection were determined. Of 26 children, 10 children were diagnosed to have bacterial coinfections (38.5%). The optimal cutoff point for PCT was > 2.30 ng/mL (sensitivity 50%, specificity 94%, positive predictive value 83%, and negative predictive value 75%). The optimal cutoff point for hs-CRP was > 1.53 mg/dl (sensitivity 90%, specificity 56%, positive predictive value 56%, and negative predictive value 90%). Finally, the optimal cut-off point for IL-6 was > 441.5 pg/mL (sensitivity 20%, specificity 100%, positive predictive value 100%, and negative predictive value 60%). The accuracy rate of PCT was the highest with 69.2%, followed by hs-CRP with 65.4%. Inflammatory biomarkers such as PCT and hs-CRP were able to distinguish children with severe pneumonia caused by Rhinovirus alone and those with bacterial coinfection.

SHORT-TERM EFFECTS OF TESTOSTERONE REPLACEMENT THERAPY ON RISK PREDICTORS FOR ARTERIOSCLEROSIS AMONG MEN WITH LATE-ONSET HYPOGONADISM: A CASE–CONTROL STUDY

Background and objective This study assessed the short-term effects of testosterone replacement therapy (TRT) on some risk predic-tors for arteriosclerosis among men with late-onset hypogonadism (LOH).Materials and methods A total of 25 patients with LOH who received TRT for 6 months and 21 patients without TRT were enrolled in the present study. Information regarding the following parameters were collected: Aging Males’ Symptoms scale, Sexual Health Inventory for Men (SHIM), International Prostatic Symptom Score, waist circumfer-ence, and some laboratory data, including fasting blood sugar, hemoglobin A1c (HbA1c), low-density lipo-protein cholesterol, triglycerides, high-density lipoprotein cholesterol, high-sensitivity C-reactive protein (hs-CRP) values, and arteriosclerosis index (AI), at baseline and after 6 months. Patients in the TRT group had received intramuscular injections of testosterone enanthate (250 mg) every month for 6 months while those in the control group received no testosterone treatment during this trial.Results No significant differences were observed in any baseline patient characteristics between both groups. After 6 months, the TRT group exhibited significant improvements in SHIM scores (from 10.1 to 13.1; p = 0.00563), hs-CRP values (from 0.157 to 0.103 mg/dL; p = 0.00753), and the AI (from 2.10 to 1.95 mg/dL; p = 0.0429), with a significant decrease in AMS scale (from 44.3 to 41.8; p = 0.0388). The control group dis-played no significant changes in all parameters. No patient in the TRT group had additional interventions or medications worsening their urinary symptoms.Conclusions TRT for 6 months among men with LOH contributed to significant improvements in three predictive fac-tors for arteriosclerosis. Further studies including long-term TRT are expected to demonstrate the preven-tive effects of testosterone for arteriosclerosis among Japanese men with LOH syndrome.

2231HsCRP predicts mortality beyond troponin in 102,337 patients with suspected acute coronary syndrome (CRP-RISK study)

Abstract Background The incremental long-term prognostic value of high-sensitivity C-reactive protein (hsCRP) above troponin in a large real-world cohort of unselected patients presenting with suspected acute coronary syndromes (ACS) is unknown. Purpose We hypothesised that a mildly elevated hsCRP is associated with mortality risk in patients with suspected ACS, independent of troponin level. Methods We used the National Institute for Health Research Health Informatics Collaborative data of 257,948 patients who had a troponin measured at 5 cardiac centres. We excluded patients with clinically abnormal white cell counts and hsCRP >15 mg/L to try limiting the population to those without overt infections, malignancies or systemic inflammatory conditions that may confound our analyses. Patients were divided into four hsCRP groups (<2, 2–4.9, 5–9.9 and 10–15 mg/L) and the association between hsCRP levels and all-cause mortality assessed. Results There were 102,337 patients included in the analysis (hsCRP <2 mg/L (n=38,390), 2–4.9 mg/L (n=27,397), 5–9.9 mg/L (n=26,957) and 10–15 mg/L (n=9,593)). Figure 1A displays cumulative mortality per hsCRP group, revealing increasing mortality with each consecutive group. Figure 1B further stratifies the groups according to dichotomised peak troponin level as positive or negative. This shows the greatest mortality for patients in the highest hsCRP group who also had a positive troponin assay (36.0% at 3 years). In Cox regression analysis with time-dependent covariates, even mildly raised hsCRP was an independent predictor of mortality over time, after adjusting for age, gender, haemoglobin, white cell count, platelet count, creatinine and troponin positivity. There was a positive and graded relationship between hsCRP level and mortality at baseline, which remained at 3-years (hazard ratio (95% CI) of 1.32 (1.18–1.48) for those with hsCRP 2.0–4.9mg/L, and 1.40 (1.26–1.57), and 2.00 (1.75–2.28) for those with hsCRP 5–9.9 mg/L and 10–15 mg/L, respectively. We explored whether inclusion of hsCRP could better reclassify the population into at-risk mortality groups. The association with 30-day, 1-year and 3-year mortality was assessed using three different risk models (model 1: age, gender, haemoglobin, creatinine; model 2: model 1 plus troponin (positivity versus negativity); model 3: model 2 plus hsCRP groups. For cumulative mortality at each time point, each successive model was better able to discriminate risk than its precursor (p<0.0001); such that inclusion of troponin and hsCRP gave the most robust risk discrimination. Model 3 achieved an AUROC >0.8 at 30 days, 1-year and 3-year mortality, surpassing the use of troponin on its own. Figure 1. Kaplan-Meier mortality curves Conclusions These multi-centre, real-world data from a large cohort of patients with suspected ACS identify hsCRP as a clinically meaningful prognostic marker in addition to troponin levels and point to its potential utility in selecting patients for novel treatments targeting inflammation. Acknowledgement/Funding Funded by NIHR Imperial Biomedical Research Centre (BRC) using NIHR Health Informatics Collaborative data service, supported by OUH, GSTT & UCLH BRCs

TCT-838 Prognostic Value of High-Sensitivity C-Reactive Protein in Percutaneous Coronary Intervention According to Body Mass Index

TCT-838 Prognostic Value of High-Sensitivity C-Reactive Protein in Percutaneous Coronary Intervention According to Body Mass Index

High high-sensitivity C-reactive protein/BMI ratio predicts future adverse outcomes in patients with acute coronary syndrome.

The prognostic value of high-sensitivity C-reactive protein (hsCRP) and obesity in patients with coronary artery disease is controversial. In previous studies, hsCRP was significantly associated with BMI. Thus, we integrated hsCRP and BMI to assess the predictive value in patients with acute coronary syndrome (ACS). In this observational cohort study, 478 patients with ACS were enrolled in Fuwai Hospital from 2010 to 2011,with a mean follow-up of 4.2 years. The endpoint of major adverse cardiovascular events (MACE) was the composite of cardiovascular death, myocardial infarction, revascularization again, heart failure, or stroke. Compared with patients without MACE, we found that patients with MACE had higher hsCRP (3.86 ± 3.66 vs. 3.00 ± 3.17, P = 0.033). Furthermore, we identified that hsCRP was significantly correlated with BMI (r = 0.134, P = 0.005). Thus, hsCRP level was adjusted by BMI to further clarify its role in the prognosis of patients with ACS. According to the tertiles of hsCRP/BMI ratio, the rates of MACE in the lowest tertile group, the median tertile group, and the highest tertile group were 14.0% (21/150), 14.0% (21/150), and 26% (39/150) (P = 0.008), respectively. In multivariate analysis, hsCRP/BMI was independently and positively related to MACE. Similarly, according to risk category of hsCRP (low hsCRP group < 3.0 mg/l, high hsCRP group ≥ 3.0 mg/l) and BMI (< 24 and ≥ 24.0 kg/m), patients in the high hsCRP but normal or low weight group had the lowest MACE-free survival (log-rank P = 0.003) compared with other groups. We confirmed that C-reactive protein level should be adjusted by BMI to reflect the prognosis of patients with ACS. High hsCRP/BMI ratio was associated with adverse outcomes. Patients with ACS with high hsCRP plus overweight had the same risk for MACE as those with lower hsCRP but normal weight.

Association of Pubertal Development With Adiposity and Cardiometabolic Health in Girls and Boys—Findings From the Generation XXI Birth Cohort

PurposeEarly timing of pubertal development is associated with worse cardiometabolic health in adulthood. We aimed to evaluate this association in 10-year-old girls and boys and clarify if it is independent of previous body mass index (BMI). MethodsPubertal development was evaluated through the Tanner scale in 4,548 children from the birth cohort Generation XXI. Data on anthropometrics, body composition, blood pressure, lipid profile, fasting plasma glucose, insulin, homeostatic model assessment–insulin resistance (HOMA-IR), and high-sensitivity C-reactive protein were collected. Bonferroni correction was applied, using an alpha of .004 for statistical significance. Regression coefficients and 99.6% confidence intervals were computed using linear regression models. ResultsGirls with a Tanner stage ≥2 presented statistically significant higher values of BMI, waist circumference (WC), waist-to-height ratio, fat mass index, blood pressure, glucose, insulin, HOMA-IR, triglycerides, and high-sensitivity C-reactive protein and lower values of high-density lipoprotein cholesterol. Boys with a Tanner stage ≥2 presented statistically significant higher values of BMI, WC, systolic blood pressure, and HOMA-IR and lower values of high-density lipoprotein cholesterol. After adjustment, including previous BMI, a Tanner stage ≥2 remained associated with BMI z-score (girls β = .41 [.32, .50]; boys β = .10 [.01, .19]) and WC (girls β = 2.64 cm [1.86, 3.43]; boys β = .81 cm [.11, 1.51]), and only in girls with waist-to-height ratio (β = .01 [.00, .01]), fat mass index (β = .31 kg/m2 [.08; .54]), glucose (β = 1.59 mg/dL [.85, 2.33]), insulin (β = 1.73 μU/mL [.68, 2.78]), and HOMA-IR (β = .40 [.16, .64]). ConclusionsIndependently of previous BMI, preteens with early puberty already had more adiposity at age 10 years. In addition, girls had higher glucose, insulin, and HOMA-IR, which may predict a worse glucose metabolism. These preteens should be a target for public health interventions.

Evaluation of red blood cell distribution width,neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in patients with fibromyalgia

Objective: In the present study we investigate the level of subclinical inflammatory markers neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and red blood cell distribution width (RDW) in FMS Method: Included in the study were 98 patients who had been newly diagnosed with FMS according to the 2010 American College of Rheumatology (ACR) criteria and 38 healthy controls. The age, Body Mass Index (BMI), White Blood Cell (WBC), neutrophil, lymphocyte, platelet, high-sensitivity C-reactive protein (hsCRP) and Erythrocyte Sedimentation Rate (ESR) values of the participants in both groups were recorded, and also the Visual Analogue Scale (VAS) and Fibromyalgia Impact Questionnaire (FIQ) scores of the patients Results : There was no statistically significant difference between Groups 1 and 2 with respect to NLR, PLR and RDW values (p>0.05). Conclusions: Blood NLR, PLR and RDW values in patients with FMS have no significance in an investigation of subclinical inflammation.

Predictive value of white blood cell, procalcitonin and high-sensitivity C-reactive protein for the bloodstream infection in the super-elderly critically-ill patients

Objective: To investigate the ability of white blood cell (WBC), procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) in the super-elderly patients with bloodstream infection. Methods: It was a retrospective study. A total of 77 patients (≥85 years) admitted to the ICU of Peking Union Medical College Hospital from June, 2016 to December, 2017 were enrolled. The patients included 67 males and 10 females, with an age of 85-105 years and the average age was (92±5) years. According to the results of blood culture, patients were divided into positive blood culture group (n=50) and negative blood culture group (n=27). The data which obeyed normal distribution were compared with single sample t test between the two groups. Results: There was no significant difference in WBC level between the positive blood culture group and the negative blood culture group[12.4(7.8, 36.6)×10(9)/L vs 10.7(8.5, 18.7)×10(9)/L, U=0.109, P=0.124]. Compared to the positive blood culture group, the PCT level [2.6(0.8, 7.4)μg/L vs 1.5(0.6, 5.3)μg/L, U=3.015, P=0.004] and hs-CRP level [119(62, 220) mg/vs 54 (24, 80) mg/L, U=7.791, P<0.001] were significantly higher in the negative blood culture group. The ROC analysis showed that the area under the curves (AUC) of WBC, PCT and hs-CRP was 0.704(95%CI: 0.586-0.822, P<0.01), 0.896(95%CI: 0.829-0.964, P<0.01) and 0.864(95%CI: 0.778-0.949, P<0.01), respectively. The best cutoff value of PCT for discrimination of positive blood culture was 0.44 μg/L, which resulted in a sensitivity of 70.0% and a specificity of 92.6%. The best cutoff value of hs-CRP was 50.35 mg/L, which resulted in a sensitivity of 62.0% and a specificity of 88.9%. Conclusion: Compared to WBC, both PCT and hs-CRP have a better ability to predict bloodstream infection in the Super-elderly patients.

Sub-clinic atherosclerosis in patients with postprandial reactive hypoglycemia

Aim: Hypoglycemia is associated with excessive cardiovascular mortality because of the pro-inflammatory and pro-atherothrombotic pathway stimulation. Hypoglycemia is known to affect the development of sub-clinic atherosclerosis. This study aims to determine the development of sub-clinic atherosclerosis in patients with postprandial reactive hypoglycemia by investigating thickness of carotid intima media and epicardial fat, and high-sensitivity C-reactive protein values and their relationships with each other.Material and Methods: 51 patients in total were included in the project, including 28 patients (37.50±10.82 years) who had hypoglycemia symptoms and who had hypoglycemia during prolonged oral glucose tolerance test and 23 healthy adult volunteers (35.01±10.92 years) as a control group. Subjects underwent echocardiographic examination including EFT and IMT measurement using transthoracic echocardiography.Results: Postprandial Reactive Hypoglycemia group were marked with higher high-sensitivity C-reactive protein levels (1.67±0.67 vs. 1.20±0.52; p= 0.007), carotid intima media thickness (0.65±0.10 vs. 0.50±0.10; p0.001) and epicardial fat thickness (0.57±0.07 vs. 0.48±0.08; p= 0.001) values as compared to the control group.Conclusion: Patients with postprandial reactive hypoglycemia had impaired epicardial fat thickness and increased thickness of carotid intima media, and carotid intima media thickness linked with significantly with high-sensitivity C-reactive protein. These observations support the importance of chronic inflammation mechanism for the development of sub-clinic atherosclerotic disease in postprandial reactive hypoglycemia.

Long-Term Predictive Value of High-Sensitivity C-Reactive Protein for Cancer Mortality in Patients Undergoing Percutaneous Coronary Intervention.

High-sensitivity C-reactive protein (hs-CRP) is a well known risk factor for the development of cardiovascular disease and cancer. We investigated the long-term impact of hs-CRP on cancer mortality in patients with stable coronary artery disease (CAD). Methods and Results: This study was a retrospective analysis of 2,867 consecutive patients who underwent percutaneous coronary intervention for stable CAD from 2000 to 2016. The patients were divided into 2 groups according to median hs-CRP. We then evaluated the association between baseline hs-CRP and both all-cause and cancer deaths. Median hs-CRP was 0.10 mg/dL (IQR, 0.04-0.27 mg/dL). The median follow-up period was 5.8 years (IQR, 2.3-10.0 years). There were 416 deaths (14.5%), including 149 cardiovascular deaths (5.2%) and 115 (4.0%) cancer deaths. On Kaplan-Meier analysis the higher hs-CRP group had a significantly higher incidence of both all-cause and cancer death (log-rank, P<0.001 and P=0.001, respectively). On multivariable analysis higher hs-CRP was significantly associated with higher risk of cancer death (HR, 1.74; 95% CI: 1.18-2.61, P=0.005). Elevated baseline hs-CRP was significantly associated with cancer mortality in patients with stable CAD. Hs-CRP measurement may be useful for the identification of subjects with an increased risk of cancer death.

Adiponectin, leptin and high sensitivity C-reactive protein values in obese children - important markers for metabolic syndrome?

Background Obesity is a chronic inflammatory disorder in which leptin, adiponectin and C-reactive protein (CRP) play an important role. This study aimed to investigate the relationship between markers of adiposity such as leptin, adiponectin and high sensitivity C-reactive protein (hs-CRP) in obese children, and to determine whether these adipokines are significant markers in defining metabolic syndrome (MetS) in pediatric population. Methods A cross-sectional study was conducted over a period of 1 year, between July 2013 and June 2014, on 122 cases of obesity in children diagnosed at the Louis Ţurcanu Emergency Hospital for Children Timişoara, in the departments of Diabetes and Nutritional Diseases, Endocrinology and Cardiology. The patients were divided into two groups, according to the presence of MetS. Results MetS was present in 27% of obese children. The groups were homogenous with respect to age, sex and body mass index (BMI). Adiponectin, leptin and hs-CRP were significantly modified in the group with MetS (p=0.04, p=0.04, p=0.01, respectively). Conclusions hs-CRP, leptin and adiponectin can be used as predictors of cardiovascular risk in pediatric population.

Anti-inflammatory effects of empagliflozin in patients with type 2 diabetes and insulin resistance

BackgroundInflammation might be a pathological mediator of cardiovascular events in patients with type 2 diabetes and high cardiovascular risk.MethodsWe investigated whether empagliflozin (EMPA) exerts anti-inflammatory effects that are reflected in decreased high-sensitivity C-reactive protein (hsCRP) values. Patients were allocated to receive a placebo (n = 51) or EMPA (n = 51) as an add-on treatment. Fasting blood samples were collected before and every 3 months after this intervention for 1 year.ResultsEmpagliflozin tended to elicit reductions in BMI, HbA1c, aspartate aminotransferase, alanine aminotransferase (ALT), and gamma-glutamyl transpeptidase compared with the placebo, but the differences did not reach statistical significance. Levels of LDL-cholesterol, HDL-cholesterol, and triglycerides were unaltered, significantly increased, and decreased, respectively, by EMPA, but the differences were not statistically significant compared with the placebo. Empagliflozin for 12 months notably reduced the homeostatic model assessment of insulin resistance (HOMA-IR), remnant-like particle cholesterol (RLP-C), and hsCRP by 43%, 52% and 54%, respectively. The time courses of these reductions significantly differed from those of the placebo. Systolic and diastolic blood pressure were also significantly reduced by EMPA compared with the placebo. We applied multiple linear regression analysis to determine which factors were associated with changes in hsCRP induced by EMPA. The results revealed that alterations in hsCRP values (log [hsCRP at 12 months] minus log [hsCRP at month 0]) were significantly associated with changes in HOMA-IR, RLP-C, systolic blood pressure, HDL-C and ALT.ConclusionEmpagliflozin decreased hs-CRP and lowered levels of remnant related lipoproteins probably via ameliorating insulin resistance. The cardiovascular benefits conferred by EMPA might be driven at least partly by anti-inflammatory effects, and this mechanism might cooperate with other EMPA-induced changes including reduced blood pressure, to achieve the degree of cardioprotection revealed by the EMPA-REG OUTCOME trial.Trial registration UMIN Clinical Registry (UMIN000021552). Registered 21 March 2016, https://upload.umin.ac.jp/UMIN000021552

Follow-up in children with non-obese and non-autoimmune subclinical hypothyroidism.

Background The aim of our study was to evaluate clinical, laboratory and imaging findings and to have an idea about the clinical course of subclinical hypothyroidism in children. Methods Our study included 25 patients who were diagnosed with non-autoimmune subclinical hypothyroidism without goitre, between the ages of 3 and 18 and with body mass index (BMI) below the 85th percentile. Results The mean thyroid-stimulating hormone (TSH) level was 6.92±0.92 μIU/mL at diagnosis, 4.77±1.57 μIU/mL in the third month and 4.51±1.79 μIU/mL in the first year of follow-up. About 73.7% of subclinical hypothyroidism was recovered. There was no statistically significant difference between heart rate, diastolic blood pressure, lipid profile, fasting blood glucose (FBG), fasting insulin level, homeostatic model assessment of insulin resistance (HOMA-IR), hemoglobin, white blood cell, platelet, C-reactive protein (CRP) levels and thyroid volume at diagnosis and in the first year of follow-up. In the first year of follow-up, systolic blood pressure and high-sensitivity CRP value were significantly higher than at diagnosis. However, it was observed that these values were similar in the present group with subclinical hypothyroidism. Conclusions We concluded that there was no progression to overt hypothyroidism during 1-year follow-up and that subclinical hypothyroidism had no effect on height standard deviation score (SDS), BMI SDS, blood pressure, glucose and lipid metabolism during follow-up without treatment.

Association Between Stroke Severity and 5-Year Mortality in Ischemic Stroke Patients with High-Grade Stenosis of Internal Carotid Artery

BackgroundThe clinical presentations and outcomes of patients with high-grade stenosis of internal carotid artery (ICA) are highly variable. We investigate the influence of different stroke severity on outcomes of ischemic stroke patients with high-grade stenosis of ipsilateral ICA. Methods372 acute first-ever ischemic stroke patients with high-grade stenosis (70%-99%) or occlusion of ipsilateral ICA were enrolled and followed up for 5years. Stroke severities of the enrolled patients were grouped according to the Oxfordshire Community Stroke Project classification system as total anterior circulation infarcts (TACI) or non-TACI. Demographic features, vascular risk factors, comorbidities, and outcomes were compared between the 2 groups. ResultsA total of 71 patients (19.1%) were presented with TACI. Of laboratory data, the values of white blood cell count and high-sensitivity C-reactive protein were significantly higher in patients with TACI (P = .008 and P = .003, respectively). Of clinical course, the occurrence of initial impaired conscious, stroke-in-evolution, pneumonia, gastrointestinal bleeding, and urinary tract infection were significantly higher in patients with TACI. The prevalence of dependent functional status was higher in patients with TACI. Multivariate Cox regression revealed that TACI is a significant predictor of 5-year all-cause mortality in first-ever ischemic stroke patients with high-grade stenosis of ipsilateral ICA (HR [hazard ratio] = 3.66, 95% confidence interval = 2.23-6.00, P < .001). ConclusionsTACI is associated with increased risk of 5-year mortality in ischemic stroke patients with high-grade stenosis of ipsilateral ICA. Intensive medical treatment for stroke prevention in patients with severe carotid artery stenosis is warranted.

Decreased blood pressure is related to changes in NF-kB promoter methylation levels after bariatric surgery

BackgroundObesity is characterized by a chronic, low-grade inflammation, and bariatric surgery is proposed as an effective treatment for reducing the obesity-related co-morbidities. Epigenetic modifications could be involved in the metabolic improvement after surgery. ObjectiveThe main aim of this study was to evaluate whether DNA methylation pattern from genes related to inflammation and insulin response is associated with the metabolic improvement after bariatric surgery in morbidly obese patients and if these changes depend on the surgical procedure. SettingUniversity hospital, Spain. MethodsWe studied 60 severely obese patients; 31 underwent Roux-en-Y gastric bypass and 29 underwent laparoscopic sleeve gastrectomy. All patients were examined before and at 6 months after bariatric surgery. DNA methylation profile of genes related to the inflammatory response and insulin sensitivity was measured by pyrosequencing. ResultsThe promoter methylation levels of the NFKB1 gene were increased significantly after surgery (2.16 ± .9 versus 2.8 ± 1.03). The decrease in blood pressure, both systolic and diastolic, after surgery was significantly associated with the changes in the promoter methylation levels of the NFKB1 gene (β = −.513, P = .003 and β = −.543, P = .004, respectively). A decrease in inflammation status, measured by high sensitivity C-reactive protein values, was associated with changes in SLC19A1 methylation levels. ConclusionOur study shows for the first time an association between NFKB1 methylation levels and blood pressure after bariatric surgery, highlighting the possible function of this gene in the regulation of arterial pressure. Regarding SLC19A1, this gene could position as a potential target linking inflammation and insulin resistance.

Baseline High-Sensitivity C-Reactive Protein Predicts Macrovascular and Microvascular Complications of Type 2 Diabetes: A Population-Based Study

Background/Aims: This prospective study is aimed at examining the predictive value of high-sensitivity C-reactive protein (hs-CRP) for coronary heart disease (CHD) events and microvascular complications of type 2 diabetes mellitus (T2DM). Methods: A population-based study (NCT02958579) was conducted on 1,301 participants with T2DM (mean follow-up of 7.5 years). Risk assessment for vascular events was done at baseline, and serum hs-CRP was measured. End points of this study include CHD events, diabetic retinopathy, neuropathy, and diabetic kidney disease. Individuals with unavailable data or hs-CRP >20 mg/L were excluded. The discrimination and reclassification improvement of study end points were tested after addition of hs-CRP to traditional risk factors. Results: Median serum hs-CRP was 2.00 ranging from 0.1 to 17 mg/L. Hazards ratio of each SD increment in baseline hs-CRP was 1.028 (1.024–1.032) for CHD, 1.025 (1.021–1.029) for diabetic neuropathy, 1.037 (1.030–1.043) for diabetic retinopathy, and 1.035 (1.027–1.043) for diabetic kidney disease. The addition of hs-CRP to traditional risk factors of vascular complications of T2DM improved discrimination of all end points (p < 0.001). Net reclassification improvement ranged from 8% for diabetic neuropathy to 31% for diabetic kidney disease (p < 0.05). Conclusion: Baseline hs-CRP predicts both of CHD events and microvascular complications of patients with T2D.

High-sensitivity c-reactive protein (hs-CRP) value with 90 days mortality in patients with heart failure

Hospitalization in patients with chronic heart failure is associated with high rates of mortality and morbidity that during treatment and post-treatment. Despite the various therapies available today, mortality and re-hospitalization rates within 60 to 90 days post-hospitalization are still quite high. This period is known as the vulnerable phase. With the prognostic evaluation tools in patients with heart failure are expected to help identify high-risk individuals, then more rigorous monitoring and interventions can be undertaken. To determine whether hs-CRP have an impact on mortality within 90 days in hospitalized patients with heart failure, an observational cohort study was conducted in 39 patients with heart failure who were hospitalized due to worsening chronic heart failure. Patients were followed for up to 90 days after initial evaluation with the primary endpoint is death. Hs-CRP value >4.25 mg/L we found 70% was dead and hs-CRP value <4.25 mg/L only 6.9% was dead whereas the survival within 90 days. p:0.000.In conclusion, there were differences in hs-CRP values between in patients with heart failure who died and survival within 90 days.

Effects of Coenzyme Q10 Supplementation on Serum Values of Gamma-glutamyl transferase, Pseudocholinesterase, Bilirubin, Ferritin, and High-Sensitivity C-Reactive Protein in Women with Type 2 Diabetes.

Type 2 diabetes mellitus (T2DM) is a disease associated with increased oxidative stress which results from mitochondrial dysfunction. Coenzyme Q10 (CoQ10) is an essential antioxidant for energy production in mitochondria. The purpose of this randomized double-blind clinical trial study was to evaluate the effects of CoQ10 supplementation on serum values of gamma-glutamyl transferase (GGT), pseudocholinesterase (PchE), bilirubin, ferritin, and high-sensitivity c-reactive protein (hs-CRP) and metabolic syndrome biomarkers in women with T2DM. Eighty women with T2DM enrolled in this study. Thirty six of them were randomized in the drug group (receiving 100 mg/day of CoQ10) and 44 women were randomized in placebo group. Intervention was continued for 12 weeks. In both groups 35 subjects finished the study and were included in the analysis. Serum levels of the variables were measured before and after supplementation. Serum values of FBS (P=0.039), HOMA-IR (P=0.01), ferritin (P<0.001), total cholesterol (TC) (P=0.006), LDL-C (P=0.007) decreased and HDL-C (P=0.02) increased significantly in the drug group after intervention. Serum levels of triglyceride (P=0.09) decreased marginally in CoQ10 group. The results of the current study had shown that after supplementation with 100 mg/day of CoQ10 for 12 weeks, serum values of FBS, HOMA-IR, TC, LDL-C and ferritin were decreased and values of HDL-C were increased in women with T2DM.

Relationship between obesity and iron deficiency anemia: is there a role of hepcidin?

ABSTRACTObjectives: Iron deficiency is common in obese children although the underlying mechanism is unclear. The aim of this study was to investigate the associations between iron parameters, leptin, hepcidin and adiponectin levels in obese children.Methods: A total of 237 children, ranging in age from 5 to 18 years, 180 with primary obesity and 57 healthy children and adolescents, were enrolled. Complete blood count, serum iron levels, iron-binding capacity, ferritin levels, leptin, hepcidin and adiponectin levels were studied.Results: White blood cell and platelet count, iron-binding capacity, high-sensitive C-reactive protein, leptin and hepcidin values in the obese group were higher than those of the control group (p < 0.001, p = 0.002, p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). However, mean corpuscular volume, adiponectin and transferrin saturation values in the obese group were lower than in the control group (p = 0.026, p = 0.003, and p < 0.001, respectively). No significant differences were found in terms of hemoglobin, serum ferritin, iron and IL-6 levels.Conclusions: Our study suggests that hepcidin levels do not contribute to the development of iron deficiency anemia in pediatric obese individuals.