Article

Assessment of Plasma C-Reactive Protein as a Biomarker of Posttraumatic Stress Disorder Risk

JAMA Psychiatry (Impact Factor: 12.01). 02/2014; 71(4). DOI: 10.1001/jamapsychiatry.2013.4374

ABSTRACT IMPORTANCE Posttraumatic stress disorder (PTSD) has been associated in cross-sectional
studies with peripheral inflammation. It is not known whether this observed association is the
result of PTSD predisposing to inflammation (as sometimes postulated) or to inflammation
predisposing to PTSD.
OBJECTIVE To determine whether plasma concentration of the inflammatory marker
C-reactive protein (CRP) helps predict PTSD symptoms.
DESIGN, SETTING, AND PARTICIPANTS The Marine Resiliency Study, a prospective study
of approximately 2600 war zone–deployed Marines, evaluated PTSD symptoms and various
physiological and psychological parameters before deployment and at approximately 3 and 6
months following a 7-month deployment. Participants were recruited from 4 all-male infantry
battalions imminently deploying to a war zone. Participation was requested of 2978
individuals; 2610 people (87.6%) consented and 2555 (85.8%) were included in the present
analysis. Postdeployment data on combat-related trauma were included for 2208
participants (86.4%of the 2555 included) and on PTSD symptoms at 3 and 6 months after
deployment for 1861 (72.8%) and 1617 (63.3%) participants, respectively.
MAIN OUTCOMES AND MEASURES Severity of PTSD symptoms 3 months after deployment
assessed by the Clinician-Administered PTSD Scale (CAPS).
RESULTS We determined the effects of baseline plasma CRP concentration on
postdeployment CAPS using zero-inflated negative binomial regression (ZINBR), a procedure
designed for distributions, such as CAPS in this study, that have an excess of zeroes in
addition to being positively skewed. Adjusting for the baseline CAPS score, trauma exposure,
and other relevant covariates, we found baseline plasma CRP concentration to be a highly
significant overall predictor of postdeployment CAPS scores (P = .002): each 10-fold
increment in CRP concentration was associated with an odds ratio of nonzero outcome
(presence vs absence of any PTSD symptoms) of 1.51 (95%CI, 1.15-1.97; P = .003) and a fold
increase in outcome with a nonzero value (extent of symptoms when present) of 1.06 (95%
CI, 0.99-1.14; P = .09).
CONCLUSIONS AND RELEVANCE A marker of peripheral inflammation, plasma CRP may be
prospectively associated with PTSD symptom emergence, suggesting that inflammation may
predispose to PTSD.

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