Clinical and prognostic significance of C-reactive protein in the conditions of stable angina pectoris in combination with chronic obstructive pulmonary disease stage II–III
DOI:
https://doi.org/10.14739/2310-1210.2023.5.283643Keywords:
angina pectoris, chronic obstructive pulmonary disease, C-reactive protein, inflammation, troponin I, prognosisAbstract
The aim of the study: to evaluate the clinical and prognostic value of the altered C-reactive protein expression level in functional class II–III stable angina pectoris combined with chronic obstructive pulmonary disease (COPD) stage II–III.
Materials and methods. In accordance with the goal of the study, 122 individuals were examined being assigned to 4 clinical groups: Group 1 – 30 patients with ischemic heart disease (IHD, functional class II–III stable angina pectoris, mean age 56.93 ± 1.25 years; male / female ratio 86.67 % / 13.33 %); Group 2 – 30 patients with COPD stage II–III (mean age 57.99 ± 1.12 years; male / female ratio 80.0 % / 20.0%); Group 3 – 40 patients with IHD + COPD (mean age 56.48 ± 1.16 years; male / female ratio 76.92 / 23.08 %) and Group 4 – 22 apparently healthy individuals (mean age 54.37 ± 1.84 years old, male / female ratio 77.50 % / 22.50 %).
Results. Significant correlations have been found between the level of C-reactive protein (CRP) and troponin I (r = +0.71 and r = +0.82, p < 0.01 for both pairs) in IHD and IHD + COPD groups. When the level of CRP expression was elevated, a clear increase in the level of cardiospecific proteins (troponin I) was seen, which could indicate a damage to the myocardium.
A positive association was found between the CRP level and the CAT scale score in COPD and IHD+COPD groups (r = +0.65 and r = +0.73, respectively, p < 0.05) indicating a significant association between the processes of systemic inflammation and the dynamics of a patient’s subjective condition, caused mainly by the severity of ventilatory and respiratory disorders and pulmonary obstruction.
The relative risk for cardiorespiratory fitness impairment (according to 6MWD) in patients with a high level of CRP (>6 mg/L) was almost 13 times higher (EER 80.0 % CER 6.25 %, RR = 12.8 at 95 % CI, which was 1.87–87.56, р < 0.001), while the odds ratio was 60 (OR = 60.0 with CI 4.69–767.85, р < 0.001), compared to patients with a CRP level <6 mg/L, indicating systemic inflammatory process progression in the development of a negative prognosis of IHD combined with COPD.
Conclusions. The study and examination of the CRP level is necessary as a prognostic predictor for assessing the risk for developing cardiovascular complications in ІHD combined with COPD.
References
Ministry of Health of Ukraine. (2021, December 23). Pro zatverdzhennia Unifikovanoho klinichnoho protokolu pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy "Stabilna ishemichna khvoroba sertsia" [On the approval of the Unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care "Stable ischemic heart disease" (No. 2857)]. https://zakon.rada.gov.ua/rada/show/v2857282-21#n609
Krakhmalova, O. O., Hetman, O. A., Kharchenko, Yu. Y., & Izmaylova, O. V. (2017). Dynamika ultrazvukovykh parametriv diastolichnoi ta systolichnoi funktsii sertsia u khvorykh na KHOZL ta suputniu IKHS v zalezhnosti vid vyboru bazysnoi terapii KHOZL ta naiavnosti pulmonalnoi reabilitatsii [Dynamics of ultrasound parameters of diastolic and systolic heart function in patients with COPD and concomitant coronary heart disease depending on the choice of basic COPD therapy and presence of pulmonary rehabilitation]. Ukrainskyi pulmonolohichnyi zhurnal, (4), 30-34. [in Ukrainian].
Ministry of Health of Ukraine. (2013, June 27). Pro zatverdzhennia ta vprovadzhennia medyko-tekhnolohichnykh dokumentiv zi standartyzatsii medychnoi dopomohy pry khronichnomu obstruktyvnomu zakhvoriuvanni lehen [On the approval and implementation of medical and technological documents on the standardization of medical care for chronic obstructive pulmonary disease (No. 555)]. https://zakon.rada.gov.ua/rada/show/v0555282-13?lang=en#Text
Pope, J. E., & Choy, E. H. (2021). C-reactive protein and implications in rheumatoid arthritis and associated comorbidities. Seminars in arthritis and rheumatism, 51(1), 219-229. https://doi.org/10.1016/j.semarthrit.2020.11.005
Yao, Z., Zhang, Y., & Wu, H. (2019). Regulation of C-reactive protein conformation in inflammation. Inflammation research, 68(10), 815-823. https://doi.org/10.1007/s00011-019-01269-1
Pathak, A., & Agrawal, A. (2019). Evolution of C-Reactive Protein. Frontiers in immunology, 10, 943. https://doi.org/10.3389/fimmu.2019.00943
Herwald, H., & Egesten, A. (2021). C-Reactive Protein: More than a Biomarker. Journal of innate immunity, 13(5), 257-258. https://doi.org/10.1159/000519091
Dyer, E. M., Waterfield, T., & Baynes, H. (2019). How to use C-reactive protein. Archives of disease in childhood. Education and practice edition, 104(3), 150-153. https://doi.org/10.1136/archdischild-2018-315079
Bogner, J. R. (2021). C-reaktives Protein (CRP) : Serie Laborparameter, Folge 1 [C-reactive protein]. MMW Fortschritte der Medizin, 163(5), 52-53. https://doi.org/10.1007/s15006-020-9504-0
Levinson, T., & Wasserman, A. (2022). C-Reactive Protein Velocity (CRPv) as a New Biomarker for the Early Detection of Acute Infection/Inflammation. International journal of molecular sciences, 23(15), 8100. https://doi.org/10.3390/ijms23158100
Said, S., Pazoki, R., Karhunen, V., Võsa, U., Ligthart, S., Bodinier, B., Koskeridis, F., Welsh, P., Alizadeh, B. Z., Chasman, D. I., Sattar, N., Chadeau-Hyam, M., Evangelou, E., Jarvelin, M. R., Elliott, P., Tzoulaki, I., & Dehghan, A. (2022). Genetic analysis of over half a million people characterises C-reactive protein loci. Nature communications, 13(1), 2198. https://doi.org/10.1038/s41467-022-29650-5
Agarwala, P., & Salzman, S. H. (2020). Six-Minute Walk Test: Clinical Role, Technique, Coding, and Reimbursement. Chest, 157(3), 603-611. https://doi.org/10.1016/j.chest.2019.10.014
Ross, R., Blair, S. N., Arena, R., Church, T. S., Després, J. P., Franklin, B. A., Haskell, W. L., Kaminsky, L. A., Levine, B. D., Lavie, C. J., Myers, J., Niebauer, J., Sallis, R., Sawada, S. S., Sui, X., Wisløff, U., American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic Health, Council on Clinical Cardiology, Council on Epidemiology and Prevention, Council on Cardiovascular and Stroke Nursing, … Stroke Council (2016). Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association. Circulation, 134(24), e653-e699. https://doi.org/10.1161/CIR.0000000000000461
Sundh, J., Ställberg, B., Lisspers, K., Kämpe, M., Janson, C., & Montgomery, S. (2016). Comparison of the COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ) in a Clinical Population. COPD, 13(1), 57-65. https://doi.org/10.3109/15412555.2015.1043426
Pohanka, M. (2022). Diagnoses Based on C-Reactive Protein Point-of-Care Tests. Biosensors, 12(5), 344. https://doi.org/10.3390/bios12050344
Liu, T., Zhang, Q., Song, C., Siyin, S. T., Chen, S., Zhang, Q., Song, M., Cao, L., & Shi, H. (2022). C-reactive protein trajectories and the risk of all cancer types: A prospective cohort study. International journal of cancer, 151(2), 297-307. https://doi.org/10.1002/ijc.34012
Puthucheary, Z., Tadié, J. M., & Patel, J. J. (2022). C-reactive protein in immunometabolism: spared from 'paying the piper'. Intensive care medicine, 48(1), 103-105. https://doi.org/10.1007/s00134-021-06586-w
Singh, S. K., & Agrawal, A. (2019). Functionality of C-Reactive Protein for Atheroprotection. Frontiers in immunology, 10, 1655. https://doi.org/10.3389/fimmu.2019.01655
Friend, S. F., Nachnani, R., Powell, S. B., & Risbrough, V. B. (2022). C-Reactive Protein: Marker of risk for post-traumatic stress disorder and its potential for a mechanistic role in trauma response and recovery. The European journal of neuroscience, 55(9-10), 2297-2310. https://doi.org/10.1111/ejn.15031
Ullah, N., & Wu, Y. (2022). Regulation of Conformational Changes in C-reactive Protein Alters its Bioactivity. Cell biochemistry and biophysics, 80(4), 595-608. https://doi.org/10.1007/s12013-022-01089-x
Rajab, I. M., Hart, P. C., & Potempa, L. A. (2020). How C-Reactive Protein Structural Isoforms With Distinctive Bioactivities Affect Disease Progression. Frontiers in immunology, 11, 2126. https://doi.org/10.3389/fimmu.2020.02126
McFadyen, J. D., Zeller, J., Potempa, L. A., Pietersz, G. A., Eisenhardt, S. U., & Peter, K. (2020). C-Reactive Protein and Its Structural Isoforms: An Evolutionary Conserved Marker and Central Player in Inflammatory Diseases and Beyond. Sub-cellular biochemistry, 94, 499-520. https://doi.org/10.1007/978-3-030-41769-7_20
Santonocito, C., Sanfilippo, F., De Locker, I., Chiarenza, F., Giacomo, C., Njimi, H., George, S., Astuto, M., & Vincent, J. L. (2022). C-Reactive protein kinetics after cardiac surgery: A retrospective multicenter study. Annals of cardiac anaesthesia, 25(4), 498-504. https://doi.org/10.4103/aca.aca_141_21
Manolis, A. S., & Manolis, A. A. (2022). High C-Reactive Protein/Low Serum Albumin: A Hidden Villain in Cardiovascular Disease. Angiology, 73(9), 797-799. https://doi.org/10.1177/00033197221120135
Ngwa, D. N., & Agrawal, A. (2019). Structure-Function Relationships of C-Reactive Protein in Bacterial Infection. Frontiers in immunology, 10, 166. https://doi.org/10.3389/fimmu.2019.00166
Avan, A., Tavakoly Sany, S. B., Ghayour-Mobarhan, M., Rahimi, H. R., Tajfard, M., & Ferns, G. (2018). Serum C-reactive protein in the prediction of cardiovascular diseases: Overview of the latest clinical studies and public health practice. Journal of cellular physiology, 233(11), 8508-8525. https://doi.org/10.1002/jcp.26791
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
