Assessment of Correlation of Serum High-Sensitive C-Reactive Protein, Urinary Albumin-to-Creatinine Ratio, and Lipid Profile in Diabetics.

BACKGROUND: This study aimed to measure the level of serum high-sensitive C-reactive protein (hs CRP), urinary albumin-to-creatinine ratio (ACR), lipid profile, and their association in diabetics.
METHODOLOGY: One hundred and fifty diabetic patients were classified into three groups of 50 each. Group I were newly diagnosed with <5 years of diabetes, Group II were those having 5-10 years of diabetes, and Group III were diabetics with more than 10 years of diabetes. Lipid profile, hs-CRP level, and ACR were measured.
RESULTS: There was a correlation between hS CRP and ACR and triglyceride in Group I, hS CRP with ACR and triglyceride in Group I. In group II hS CRP showed significant correlation with ACR whereas in Group III significant correlation was observed with ACR, low density lipoprotein (LDL) and cholesterol.
CONCLUSION: The level of hS CRP and ACR was found to be higher in patients with a longer duration of diabetes. Copyright:

INTRODUCTION

Diabetes is one of the systemic disorders characterized by the state of hyperglycemia due to defects in insulin secretion, insulin resistance, or both.[1] It is affecting almost every organ and system of the body. It is the reason for high morbidity and mortality among developed as well as developing countries such as India, Bangladesh, Nepal, and Bhutan.[2] There is no permanent treatment for this condition of the body; thus, an effective management strategy is essential to prevent complications. Its effect on the renal system, eyes, cardiovascular system, central nervous system, and urinary system is demanding extra care. Patients suffering from diabetes mellitus are more prone to have kidney failure as compared to those without it.[3]

Microalbuminuria is the state of low level of albumin in the blood usually ranges from 30 to 300 mg/day. This abnormal and low level of albumin is the early sign of nephropathy, a complication of diabetes mellitus.[4] According to the American Diabetic Association, microalbuminuria can only be confirmed after collecting a urine sample for 24 h. This is the gold standard test for microalbuminuria. The National Kidney Foundation recommended measuring of urinary albumin-to-creatinine ratio (ACR) a more reliable and effective method for microalbuminuria. All diabetic patients are advised of these tests. The classification of chronic kidney disease also considers urinary albumin-to-creatinine ratio a useful test for confirming kidney disease.[5]

The level of C-reactive protein (CRP) is increased in various infectious, inflammatory, and traumatic conditions. Thus, high-sensitive CRP (hs-CRP) is a potent marker of inflammation. Its level is also elevated in association with ACR.[6] This study aimed to measure the level of serum hs CRP, urinary ACR, lipid profile, and their association in diabetics.

METHODOLOGY

This comparative study was conducted among 150 diabetic patients of either gender after they agreed to participate in the study. The study lasted for 4 months. The enrollment of patients and risk assessment were mentioned and discussed. After satisfying the committee, the study proceeded.

The inclusion criteria were confirmed diabetic patients within age range 25–65 years of either gender. The exclusion criteria were patients with a history of cardiac or renal ailment and endocrinopathies, patients on long-standing use of cyclosporine, beta-lactamases, and thiazides, and pregnant ladies.

All patients underwent a thorough systemic examination. Based on the duration of diabetes, patients were classified into three groups of 50 each. Group I were newly diagnosed with <5 years of diabetes, Group II were those having 5–10 years of diabetes, and Group III were diabetics with more than 10 years of diabetes history. Five milliliter of venous blood was collected from peripheral veins and assessment of fasting blood glucose, random blood glucose, and glycosylated blood hemoglobin A1c level was estimated. Lipid profile such as cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride (TG) level was measured. Patients also underwent measurement of serum hs-CRP level. Urine sample was collected from all patients and urine albumin and creatinine level was measured using semi-automated analyzer or automated analyzer. Data of the study were clubbed together and sent to a statistician for checking significance of the values obtained from patients. ANOVA and post hoc analysis test were employed and the level of significance was set below 0.05.

RESULTS

Table 1 and Graph 1 show that there were 30 males and 20 females in Group I, 22 males and 28 females in Group II, and 24 males and 26 females in Group III.

Table 1

Gender-based patient distribution

Groups	Group I	Group II	Group III
Male	30	22	24
Female	20	28	26

Graph 1

Gender based patient distribution

Table 2 and Graph 2 show that mean hS CRP in Group I was 0.03 ± 0.02 mg/dl, in Group II, it was 0.07 ± 0.09 mg/dl, and in Group III, it was 0.12 ± 0.17 mg/dl. ACR was 102.4 ± 13.2 in Group I, in Group II, it was 116.4 ± 15.8, and in Group III, it was 129.5 ± 12.5. TG level was 221.4 ± 25.8 mg/dl in Group I, 250.2 ± 26.2 mg/dl in Group II, and 261.3 ± 27.8 mg/dl in Group III. The mean cholesterol level in Group I was 210.5 ± 35.2 mg/dl in Group I, 225.4 ± 30.4 mg/dl in Group II, and 232.1 ± 27.1 mg/dl in Group III. LDL level was 132.5 ± 30.4 in Group I, 140.2 ± 31.6 in Group II, and 145.2 ± 37.5 in Group III. HDL level was 48.2 ± 4.5 in Group I, 49.1 ± 4.6 in Group II, and 50.1 ± 4.9 in Group III. ANOVA test showed a statistically significant difference between all groups (P < 0.05).

Table 2

Assessment of parameters in all groups

Variables	Mean±SD			P
	Group I	Group II	Group III
hs CRP	0.03±0.02	0.07±0.09	0.12±0.17	0.01
ACR	102.4±13.2	116.4±15.8	129.5±12.5	0.05
TG	221.4±25.8	250.2±26.2	261.3±27.8	0.01
Cholesterol	210.5±35.2	225.4±30.4	232.1±27.1	0.04
LDL	132.5±30.4	140.2±31.6	145.2±37.5	0.03
HDL	48.2±4.5	49.1±4.6	50.1±4.9	0.05

hs CRP: High-sensitivity c-reactive protein, ACR: Albumin-tocreatinine ratio, TG: Triglyceride, LDL: Low-density lipoprotein, HDL: High-density lipoprotein, SD: Standard deviation

Graph 2

Assessment of parameters in all groups

Table 3 shows that there was significant correlation between hS CRP with ACR and triglyceride in Group I. In group II hS CRP showed significant correlation with ACR whereas in Group III significant correlation was observed with ACR, low density lipoprotein (LDL) and cholesterol.

Table 3

Assessment of Pearson correlation coefficient between high-sensitivity-C-reactive protein, albumin-to-creatinine ratio, and lipid profile

Groups	Parameters	Correlation coefficient (r)	P
Group I	ACR	0.612	0.001
	TG	0.214	0.002
	Cholesterol	0.650	0.09
	LDL	0.235	0.08
	HDL	−0.0812	0.124
Group II	ACR	0.628	0.02
	TG	0.172	0.18
	Cholesterol	0.236	0.09
	LDL	0.372	0.05
	HDL	0.140	0.281
Group III	ACR	0.614	0.01
	TG	0.015	0.954
	Cholesterol	0.671	0.02
	LDL	0.005	0.03
	HDL	0.613	0.902

ACR: Albumin-to-creatinine ratio, TG: Triglyceride, LDL: Lowdensity lipoprotein, HDL: High-density lipoprotein

DISCUSSION

Diabetes is the state of increased blood glucose level. It is characterized by complications such as diabetic nephropathy, diabetic retinopathy, diabetic foot ulcer, and diabetic neuropathy. Microalbuminuria is regarded as an early stage of diabetic nephropathy and is also labeled as an interpreter of cardiovascular disease in diabetic patients.[7] The occurrence of microalbuminuria depends on the duration of diabetes. It is evident that microalbuminuria mostly occurs after 5 years of diabetes. It is also found in studies that urinary protein excretion of more than 300 mg/day often develops after 10–15 years.[89] End-stage renal disease is usually seen after 10–15 years in more than 50% of type 1 diabetic patients.[10] This study aimed to measure the level of serum hs CRP, urinary ACR, lipid profile, and their association in diabetics.

In the present study, there were 150 diabetic patients. Group I were newly diagnosed with <5 years of diabetes, Group II were patients with 5–10 years of diabetes, and Group III patients were >10 years of diabetes. Acharjya et al.[11] in their study on 120 diabetic subjects aged 30–60 years were randomly divided into three groups as newly diagnosed, with 5–10 years of diabetes and >10 years of diabetes. The results showed that the mean values of hs-CRP were 0.04, 0.08, and 0.10 in Group I, II, and III, respectively. ACR value was found to be 100.29, 117.65, and 128.80 in Groups I, II, and III respectively. It is found that both hs-CRP and ACR increased significantly and statistically with a duration of diabetes in all three groups unlike the parameters of lipid profile. Hs-CRP, ACR, cholesterol, and LDL revealed a significant correlation between each other (P < 0.05).

We observed that mean hS CRP in Group I was 0.03 ± 0.02 mg/dl, in Group II, it was 0.07 ± 0.09 mg/dl, and in Group III, it was 0.12 ± 0.17 mg/dl. ACR was 102.4 ± 13.2 in Group I, in Group II, it was 116.4 ± 15.8, and in Group III, it was 129.5 ± 12.5. Shin et al.[12] found that there is an independent association of ACR with hsCRP. The results revealed that ACR level positively correlated with the hsCRP levels in type 2 diabetics.

In this study, the level of TG level was 221.4 ± 25.8 mg/dl in Group I, 250.2 ± 26.2 mg/dl in Group II, and 261.3 ± 27.8 mg/dl in Group III. The mean cholesterol level in Group I was 210.5 ± 35.2 mg/dl, 225.4 ± 30.4 mg/dl in Group II, and 232.1 ± 27.1 mg/dl in Group III. LDL level was 132.5 ± 30.4 in Group I, 140.2 ± 31.6 in Group II, and 145.2 ± 37.5 in Group III. HDL level was 48.2 ± 4.5 in Group I, 49.1 ± 4.6 in Group II, and 50.1 ± 4.9 in Group III. ANOVA test showed a statistically significant difference between all groups (P < 0.05). Varghese et al.[13] assessed the prevalence and risk factors for microalbuminuria in 1425 south type 2 diabetics. The results showed that there was a 36.3% prevalence of microalbuminuria among patients. The prevalence of microalbuminuria enhanced with the increase in duration of diabetes. It was observed that age, diastolic blood pressure, glycated hemoglobin, fasting plasma glucose, and duration of diabetes were associated with microalbuminuria.

Asegaonkar et al.[14] determined the role of hs-CRP as an independent cardiovascular risk marker in 60 type 2 diabetes patients with normal lipid profile. The mean values of hs-CRP were 0.7 ± 0.2 in low-risk, 1.75 ± 0.7 in moderate-risk, and 5.8 ± 1.4 in high-risk CRP-level patients. Relative risk was 4.75 with an odds ratio of 10.23. The authors concluded that hs-CRP is an independent cardiac risk predictor even with a normal lipid profile.

The shortcoming of the study is the small sample size.

CONCLUSION

The authors found a correlation of hS CRP, ACR, and lipid profile in diabetics. The level of hS CRP and ACR was found to be higher in patients with a longer duration of diabetes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.