title: Plasma high sensitivity C-reactive protein and its relationship with cytokine levels in children with newly diagnosed type 1 diabetes and ketoacidosis.
abstract: BACKGROUND
  High-sensitivity C-reactive protein (hs-CRP) and pro-inflammatory cytokines have been suggested as sensitive markers of endothelial dysfunction. Our aim was to monitor plasma hs-CRP levels at different time-points and in different degrees of ketoacidosis severity, its association with cytokine levels and its role as a marker of severe ketoacidosis complications.
  
  
  METHODS
  We studied in 38 newly diagnosed children with type 1 diabetes and ketoacidosis, aged 7.7 ± 3.1 years, hs-CRP, white blood cell count (WBC), and plasma levels of cytokines IL-1β (interleukin-1β), IL-2, IL-6, IL-8, IL-10, TNF-α (tumor necrosis factor-α) prior to and during DKA management.
  
  
  RESULTS
  On admission, the levels of WBC, PMN, IL-6 and IL-10 were elevated, but were all reduced within 120 h after ketoacidosis management. In the group with moderate/severe ketoacidosis, but not in mild ketoacidosis, hs-CRP levels were significantly reduced at 24h (p=0.021), WBC and IL-6 at 120 h (p=0.003), while IL-10 was prematurely reduced at 6-8h (p=0.008). Moreover hs-CRP was significantly associated with WBC (p=0.023) and IL-6 (p=0.028) on admission, with IL-6 (p=0.002) and IL-8 (p=0.014) at 24h and with IL-10 (p=0.027) at 120 h. The above were not observed in the group with mild ketoacidosis.
  
  
  CONCLUSIONS
  In the children with moderate/severe diabetic ketoacidosis of our study, increased levels of hs-CRP and IL-6 were observed, together with leukocytosis and neutrophilia, without the presence of infection. As hs-CRP was found to be strongly associated with the inflammatory IL-6, the prolonged elevation of hs-CRP levels in children with severe ketoacidosis could serve as a marker for the development of its severe complications.
authors.affiliation: Diabetic Clinic, 2nd Department of Pediatrics, University of Athens, P&A Kyriakou Children's Hospital, Athens, Greece.
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Karavanaki
authors.forename: Kostas
authors.initials: K
authors.lastname: Kakleas
authors.forename: Soultana
authors.initials: S
authors.lastname: Georga
authors.forename: Alphanastasia
authors.initials: A
authors.lastname: Bartzeliotou
authors.forename: George
authors.initials: G
authors.lastname: Mavropoulos
authors.forename: Manolis
authors.initials: M
authors.lastname: Tsouvalas
authors.forename: Alice
authors.initials: A
authors.lastname: Vogiatzi
authors.forename: Ioannis
authors.initials: I
authors.lastname: Papassotiriou
authors.forename: Christina
authors.initials: C
authors.lastname: Karayianni
mesh_terms: D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001929:Brain Edema / Q000097:blood / Q000209:etiology; D002097:C-Reactive Protein / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D016883:Diabetic Ketoacidosis / Q000097:blood* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D011654:Pulmonary Edema / Q000097:blood / Q000209:etiology; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D016207:Cytokines; D002097:C-Reactive Protein