Serum Amyloid A is a Better Predictor of Clinical Outcomes than C-Reactive Protein in Non-ST-Segment Elevation Acute Coronary Syndromes

Kosuge, Masami; Ebina, Toshiaki; Ishikawa, Toshiyuki; Hibi, Kiyoshi; Tsukahara, Kengo; Okuda, Jyun; Iwahashi, Noriaki; Ozaki, Hiroyuki; Yano, Hideto; Kusama, Ikuyoshi; Nakati, Tastuya; Umemura, Satoshi; Kimura, Kazuo

doi:10.1253/circj.71.186

Cited by 77 publications

(72 citation statements)

References 26 publications

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“…13 Previous reports have taken the view that elevated CRP levels are also associated with adverse outcomes in healthy individuals, as well as in patients with stable angina or acute coronary syndromes. 14 Among patients with plasma CRP concentrations higher than 10 mg/dl, 80 to 85% have bacterial infections, according to previous studies. 15,16 In this present study, patients from both groups presented plasma CRP concentrations higher than 10 mg/dl during the seven-day observation period, but no difference between septic shock (infected) and SIRS (non-infected) patients was found, thus contrasting with the results of Gabay et al 16 It is important to stress that Meisner et al observed that CRP plasma concentrations were postoperatively elevated in almost all patients, regardless of the type of surgery.…”

Section: Discussionmentioning

confidence: 80%

C-reactive protein is not a useful indicator for infection in surgical intensive care units

2009

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CONTEXT AND OBJECTIVE: C-reactive protein (CRP) is commonly used as a marker for inflammatory states and for early identification of infection. This study aimed to investigate CRP as a marker for infection in patients with postoperative septic shock. DESIGN AND SETTING:Prospective, single-center study, developed in a surgical intensive care unit at Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. METHODS:This study evaluated 54 patients in the postoperative period, of whom 29 had septic shock (SS group) and 25 had systemic inflammatory response syndrome (SIRS group). All of the patients were monitored over a seven-day period using the Sequential Organ Failure Assessment (SOFA) score and daily CRP and lactate measurements. RESULTS:The daily CRP measurements did not differ between the groups. There was no correlation between CRP and lactate levels and the SOFA score in the groups. We observed that the plasma CRP concentrations were high in almost all of the patients. The patients presented an inflammatory state postoperatively in response to surgical aggression. This could explain the elevated CRP measurements, regardless of whether the patient was infected or not. CONCLUSIONS:This study did not show any correlation between CRP and infection among patients with SIRS and septic shock during the early postoperative period. RESUMOCONTEXTO E OBJETIVO: A proteína C reativa (PCR) é muito usada como marcador de estados inflamatórios e na identificação precoce de infecção. Este estudo teve como proposta investigar a PCR como marcadora de infecção em pacientes em choque séptico no período pós-operatório. TIPO DE ESTUDO E LOCAL:Estudo prospectivo, monocêntrico, desenvolvido numa unidade de terapia intensiva pós-operatória do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. MÉTODOS:Foram avaliados 54 pacientes no pós-operatório, sendo 29 deles com choque séptico (grupo SS) e 25 com síndrome da resposta inflamatória sistêmica (grupo SI). Todos os pacientes foram acompanhados durante sete dias pelo escore SOFA (Sequential Organ Failure Assessment) e com dosagens diárias de PCR e lactato.RESULTADOS: As dosagens de PCR não diferiram entre os grupos. Não foi observada correlação entre dosagem de PCR e lactato ou escore SOFA nos grupos estudados. Observamos que as concentrações plasmáticas de PCR estavam elevadas em quase todos os pacientes avaliados. Os pacientes no pós-operatório apresentam estado inflamatório em resposta à agressão cirúrgica, sendo este fato capaz de explicar as dosagens de PCR elevadas, independentemente de o paciente estar ou não infectado.CONCLUSÕES: Este estudo não evidenciou correlação entre PCR e infecção nos pacientes com síndrome da resposta inflamatória sistêmica e choque séptico no período pós-operatório precoce.

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Section: Discussionmentioning

confidence: 80%

C-reactive protein is not a useful indicator for infection in surgical intensive care units

2009

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“…A-SAA, a rapid response acute-phase protein circulates at very high levels in RA (23) and has been reported in cardiovascular disease (24) and diabetes (25). In chronic inflammation, it may induce amyloidosis and organ failure (26).…”

Section: Discussionmentioning

confidence: 99%

Acute Serum Amyloid A Induces Migration, Angiogenesis, and Inflammation in Synovial Cells In Vitro and in a Human Rheumatoid Arthritis/SCID Mouse Chimera Model

Connolly

Marrelli

Blades

et al. 2010

The Journal of Immunology

107

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Serum amyloid A (A-SAA), an acute-phase protein with cytokine-like properties, is expressed at sites of inflammation. This study investigated the effects of A-SAA on chemokine-regulated migration and angiogenesis using rheumatoid arthritis (RA) cells and whole-tissue explants in vitro, ex vivo, and in vivo. A-SAA levels were measured by real-time PCR and ELISA. IL-8 and MCP-1 expression was examined in RA synovial fibroblasts, human microvascular endothelial cells, and RA synovial explants by ELISA. Neutrophil transendothelial cell migration, cell adhesion, invasion, and migration were examined using transwell leukocyte/monocyte migration assays, invasion assays, and adhesion assays with or without anti–MCP-1/anti–IL-8. NF-κB was examined using a specific inhibitor and Western blotting. An RA synovial/SCID mouse chimera model was used to examine the effects of A-SAA on cell migration, proliferation, and angiogenesis in vivo. High expression of A-SAA was demonstrated in RA patients (p < 0.05). A-SAA induced chemokine expression in a time- and dose-dependent manner (p < 0.05). Blockade with anti-scavenger receptor class B member 1 and lipoxin A4 (A-SAA receptors) significantly reduced chemokine expression in RA synovial tissue explants (p < 0.05). A-SAA induced cell invasion, neutrophil–transendothelial cell migration, monocyte migration, and adhesion (all p < 0.05), effects that were blocked by anti–IL-8 or anti–MCP-1. A-SAA–induced chemokine expression was mediated through NF-κB in RA explants (p < 0.05). Finally, in the RA synovial/SCID mouse chimera model, we demonstrated for the first time in vivo that A-SAA directly induces monocyte migration from the murine circulation into RA synovial grafts, synovial cell proliferation, and angiogenesis (p < 0.05). A-SAA promotes cell migrational mechanisms and angiogenesis critical to RA pathogenesis.

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“…Some studies point to a positive correlation between SAA and angiographically proven coronary artery disease, and serum concentration of SAA is reported to be a powerful predictor of cardiovascular events 12,13. It has been shown that patients with a high SAA concentration have more active atherosclerotic disease,14 but the relationship between serum SAA levels and transient myocardial ischaemia during exercise is not known.…”

Section: Discussionmentioning

confidence: 99%

Serum high-sensitivity C-reactive protein, amyloid-associated protein and N-terminal proBNP levels do not predict reversible myocardial ischaemia

Başkurt¹,

Aktürk²,

Keskin³

et al. 2011

CardioVascular Journal of Africa

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AimThe aim of this study was to detect any relationship between serum high-sensitivity C-reactive protein (hs-CRP), serum amyloid-associated protein (SAA) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and reversible myocardial ischaemia during cardiovascular exercise tests and to determine whether these biomarkers could predict transient myocardial ischaemia.MethodsNinety-six patients (36 women, 60 men, mean age 57 ± 8.5 years) were included in the study. Venous blood samples were taken from patients before and 15 minutes after exercise testing. SAA and hs-CRP were analysed using immunonephelometric assays (Dade-Behring, BN II, Marburg, Germany). NT-proBNP (pg/ml) was determined using the immulite 1 000 chemiluminescence immunoassay system (Siemens Medical Solution Diagnostics, Deerfiled, USA). Forty-eight patients (18 women, 30 men) with positive exercise tests were allocated to the exercise-positive group and 48 (18 women, 30 men) with negative exercise tests were put in the exercise-negative group. Coronary angiography was performed on all patients in the exercise-positive group.ResultsThere was no difference between the levels of hs-CRP, SAA and NT-pro-BNP before and after exercise testing in both of the exercise groups.ConclusionSerum levels of hs-CRP, SAA and NT-proBNP could not predict the occurrence of reversible myocardial ischaemia during exercise. Large-scale clinical studies are needed to clarify the status of hs-CRP, SAA and NT-proBNP with exercise.

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Serum Amyloid A is a Better Predictor of Clinical Outcomes than C-Reactive Protein in Non-ST-Segment Elevation Acute Coronary Syndromes

Cited by 77 publications

References 26 publications

C-reactive protein is not a useful indicator for infection in surgical intensive care units

C-reactive protein is not a useful indicator for infection in surgical intensive care units

Acute Serum Amyloid A Induces Migration, Angiogenesis, and Inflammation in Synovial Cells In Vitro and in a Human Rheumatoid Arthritis/SCID Mouse Chimera Model

Serum high-sensitivity C-reactive protein, amyloid-associated protein and N-terminal proBNP levels do not predict reversible myocardial ischaemia

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