A high sensitivity assay is more accurate than a classical assay for the measurement of plasma CRP levels in endometriosis

Leuven University Fertility Centre, Department of Obstetrics & Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium.
Reproductive Biology and Endocrinology (Impact Factor: 2.23). 08/2011; 9(1):113. DOI: 10.1186/1477-7827-9-113
Source: PubMed


Endometriosis is associated with chronic subclinical inflammation. C-reactive protein (CRP), a marker of inflammation, could serve as a biomarker of endometriosis. We tested the hypothesis that a high sensitivity CRP assay (hsCRP) is more accurate than a classical CRP assay in the detection of subclinical inflammation in plasma of women with endometriosis.
CRP levels were measured by hsCRP and classical CRP assays in plasma of 204 women with endometriosis and 91 women without endometriosis. Both assays were compared with respect to their value for the diagnosis of endometriosis.
The number of plasma samples with detectable CRP was significantly higher (100%) using the hsCRP assay when compared to the classical CRP assay (42.7%) (p < 0.0001). Significantly increased CRP plasma levels were found in women with endometriosis when compared with controls when the hsCRP assay was used in samples obtained during the luteal phase (p = 0.008). The highest discriminative ability for the diagnosis of endometriosis was also obtained using the hsCRP assay during the luteal phase, especially for moderate -severe endometriosis. At a cut-off level of hsCRP > 0.71 mg/L, moderate-severe stages were diagnosed with 80.7% sensitivity and 63.9% specificity during the luteal phase. Using a similar cut-off value for CRP analyzed by the classical method, moderate-severe endometriosis was diagnosed with lower sensitivity (67.7%, p = 0.06) and comparable specificity (63.9%).
The hsCRP assay was superior to the classical CRP assay for the detection of low CRP levels and for revealing subclinical inflammation in plasma of women with endometriosis.

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Available from: Amelie Fassbender, Oct 06, 2015
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    • "Moreover, peritoneal macrophage migration inhibitory factor [20], TNF-± alpha [21], IL-1 BETA, IL-6 [7], and IL- 8 have also been observed to be increased in endometriosis. HsCRP, an inflammatory marker, has been shown to be increased in endometriosis patients, as well [22]. Nonetheless, CA-125 is the most commonly studied marker despite its low sensitivity. "
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    ABSTRACT: Although the exact pathogenesis of endometriosis is not known, it is proposed to be a chronic inflammatory disease. The asso- ciation between red cell distribution width (RDW) and inflammation is well established. Therefore, in the present study, the authors aimed to investigate the association between presence and severity of endometriosis and RDW. Fifty endometriosis patients and 48 controls were included in the study. The endometriosis group was categorized in two subgroups as mild-to-moderate (n = 35) and moderate-to-severe disease (n = 15). CA-125 and RDW values of all participants were measured. Both RDW (17.7 ± 2.2 vs 14.9 ± 1.5, p < 0.001) and CA-125 (50.6 ± 35.1 vs 27.9 ± 4.8) levels were significantly higher in the endometriosis patients when compared to the control group. Moreover the authors found a significant positive correlation between RDW and CA-125 levels (r: 0.495, p < 0.001). The present study results demonstrated that RDW levels were significantly increased in endometrio- sis patients and associated with the severity of endometriosis.
    Clinical and experimental obstetrics & gynecology 01/2014; 41(6):713-6. DOI:10.12891/ceog17572014 · 0.42 Impact Factor
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    • "In an additional methodology study (Vodolazkaia et al., 2011) we confirmed that the hsCRP assay was superior to the classical CRP assay for the detection of low CRP levels (indicating subclinical inflammation in the plasma of endometriosis patients) and for the diagnosis of moderate– severe endometriosis. The hsCRP assay was used for the measurement of CRP in the entire study population. "
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    ABSTRACT: At present, the only way to conclusively diagnose endometriosis is laparoscopic inspection, preferably with histological confirmation. This contributes to the delay in the diagnosis of endometriosis which is 6-11 years. So far non-invasive diagnostic approaches such as ultrasound (US), MRI or blood tests do not have sufficient diagnostic power. Our aim was to develop and validate a non-invasive diagnostic test with a high sensitivity (80% or more) for symptomatic endometriosis patients, without US evidence of endometriosis, since this is the group most in need of a non-invasive test. A total of 28 inflammatory and non-inflammatory plasma biomarkers were measured in 353 EDTA plasma samples collected at surgery from 121 controls without endometriosis at laparoscopy and from 232 women with endometriosis (minimal-mild n = 148; moderate-severe n = 84), including 175 women without preoperative US evidence of endometriosis. Surgery was done during menstrual (n = 83), follicular (n = 135) and luteal (n = 135) phases of the menstrual cycle. For analysis, the data were randomly divided into an independent training (n = 235) and a test (n = 118) data set. Statistical analysis was done using univariate and multivariate (logistic regression and least squares support vector machines (LS-SVM) approaches in training- and test data set separately to validate our findings. In the training set, two models of four biomarkers (Model 1: annexin V, VEGF, CA-125 and glycodelin; Model 2: annexin V, VEGF, CA-125 and sICAM-1) analysed in plasma, obtained during the menstrual phase, could predict US-negative endometriosis with a high sensitivity (81-90%) and an acceptable specificity (68-81%). The same two models predicted US-negative endometriosis in the independent validation test set with a high sensitivity (82%) and an acceptable specificity (63-75%). In plasma samples obtained during menstruation, multivariate analysis of four biomarkers (annexin V, VEGF, CA-125 and sICAM-1/or glycodelin) enabled the diagnosis of endometriosis undetectable by US with a sensitivity of 81-90% and a specificity of 63-81% in independent training- and test data set. The next step is to apply these models for preoperative prediction of endometriosis in an independent set of patients with infertility and/or pain without US evidence of endometriosis, scheduled for laparoscopy.
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