[Assessment of high sensitivity C-reactive protein (HS-CRP) as a marker of liver inflammation in patients with metabolic syndrome].
C-reactive protein (CRP) plays an important role on inflammatory processes associated to the metabolic syndrome (MS), alike of insulin sensitivity, endothelial dysfunction and fibrinolysis insufficiency. Alanine aminotransferase (ALT) may be a sensible marker for the diagnosis of hepatic damage and has therefore been used as an alternative method for the noninvasive diagnosis of non-alcoholic fatty liver disease (NAFLD), especially in epidemiological studies. At the present time, the possible utility of high sensitivity CRP (hsCRP) as a simple measure to detect the degree of hepatic inflammatory response during the development NAFLD in MS has not been explored.


OBJECTIVE
To evaluate the measurement of serologic hsCRP for the identification of hepatic inflammatory response in patients with MS.


METHODS
Seven hundred and forty persons (526 men and 214 women), mean age 45 +/- 11 years who were asymptomatic and otherwise seeming healthy in whom a medical questionnaire was applied underwent physical examination, laboratory testing, hepatic ultrasound and measurement of hsCRP by the immuno-turbidimetric method. Receiver operating characteristic (ROC) analysis was used to evaluate the sensitivity and specificity of all possible hsCRP for detecting different degrees of hepatic inflammation (ALT > 44 U/L and ALT > 88 U/L). Patients were stratified according to the presence of metabolic syndrome (MS) and ALT concentration in three groups: Group I, having MS and ALT > 44 U/L (n = 39); Group II, having ALT > 44 U/L without MS (n = 105) and Group III, having ALT < or = 44 U/L without MS (n = 596).


RESULTS
The optimal hsCRP cut-off for detecting patients with ALT 44 U/L was 2.5 mg/L (sensibility 66%; specificity 50%) and for detecting patients with ALT > 88 U/L was 2.35 (sensibility 72%; specificity 59%). hsCRP serum concentrations in Group I were significantly higher than in Group II and Group III (p < 0.05) but no difference was found between Group II and Group III (Group I = 6.0 +/- 6.7 mg/L vs. Group II = 2.8 +/- 3.1 mg/L, vs. Group III = 2.9 +/- 4.1 mg/L). ALT concentrations were also significantly higher in Group I than in Group II and Group III, (p < 0.05) and a difference between Group II and Group III (p < 0.05) was also found (Group I = 72 +/- 31 U/L vs. Group II = 64 +/- 29 U/L vs. Group III = 24 +/- 8 U/L).


CONCLUSIONS
These results suggest that the measurement of hsCRP for the identification of hepatic inflammatory response in patients with MS with NAFLD is limited because of its low sensibility and specificity observed on identifying different degrees of hepatic inflammation.
Rodríguez-Leal
Gustavo Arturo
GA
Clínica de Gastroenterología, Hospital Medica Sur, México, DF. grodriguezleal@hotmail.com
Morán
Segundo
S
Gallardo
Irazu
I
Milke
Pilar
P
Guevara-González
Luis
L
D000328:Adult; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis* / Q000378:metabolism; D005234:Fatty Liver / Q000097:blood / Q000175:diagnosis; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis; D008099:Liver / Q000378:metabolism; D008111:Liver Function Tests; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000175:diagnosis; D008875:Middle Aged; D012680:Sensitivity and Specificity
D015415:Biomarkers; D002097:C-Reactive Protein