Does CRP Predict Outcome in Bipolar Disorder?

Balukova, S.M. ( Sonya) (2014) Does CRP Predict Outcome in Bipolar Disorder? thesis, Medicine.

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Abstract

Background: Inflammatory activation is reported as one of the pathophysiological processes in Bipolar Disorder (BD), and cross-sectional studies have examined immunological markers such as high-sensitivity C-reactive protein (hsCRP), but no studies have investigated if these play a role in consequent mood state alterations. Objective: This study aims to investigate if a sub-group of patients with BD can be identified for which a higher hsCRP level at baseline is associated with a more unfavorable prognosis. Methods: This is a cohort study using historical information of medical records. The extracted data included hsCRP value and measurement date, with follow-up of mood status and medication 15 months after this measurement. Two types of analyses were performed: cross-sectional analyses included boxplots, one-way ANOVA, Receiver Operating Characteristics (ROC) curve and chi-square test, and the longitudinal analysis used multivariate Cox-regression. Results: A total of 68 patients were included in the analyses. Cross-sectionally, no hsCRP cut-off level was distinguished between euthymic and non-euthymic patients according to the ROC curve (p=0.88, AUC= 0.511, 95%CI: 0.369, 0.652), while using a literature-derived cut-off value (3 mg/L) showed a prevalence of low hsCRP among non-euthymic patients but without statistical significance (p=0.562). Longitudinally, no association was found between hsCRP and prognosis of disease neither in euthymic (-2 Log Likelihood= 98.321; CRP: p=0.408, B= 0.143, Exp(B)= 1.153 (95% CI: 0.823 – 1.616) or non-euthymic patients (-2 Log Likelihood= 158.450; CRP: p=0.942, B= 0.010, Exp(B)=1.010 (95% CI: 0.766 – 1.333)). Medication use did not affect these associations. Discussion: These results support recent theories that BD constitutes a more complex pathophysiological model than is possible to demonstrate by a single biomarker, so additional factors such as other immunological pathways should be examined to address the possibility of immune dysregulation. Important limitations of this study were the co-occurrence of somatic or psychiatric events around hsCRP measurement and no healthy controls. Conclusions: This study found no statistically significant association between hsCRP values and a more unfavorable BD prognosis. Future studies are advised to perform multiple CRP measurements in a larger sample size and to compare the results with those of healthy controls.

Item Type:	Thesis (Thesis)
Supervisor name:	Schoevers, R.A. MD and Haarman, B.C.M. MD and Riemersma – van der Lek, R.F. MD and Bipolar Disorder Outpatient Clinic and Psychiatry Department and University Medical Center Groningen
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:39
Last Modified:	25 Jun 2020 10:39
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/92

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