DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20160811

Elevated levels of serum sialic acid and C-reactive protein: markers of systemic inflammation in patients with chronic obstructive pulmonary disease

Mangala Sirsikar, Venkata Bharat Kumar Pinnelli, Raghavendra D. S.

Abstract


Background: Chronic obstructive pulmonary disease (COPD) is a systemic chronic inflammatory disease with pulmonary and extra-pulmonary manifestations involving lungs causing airways dysfunction. C-reactive protein (C-RP) is a positive acute phase reactant and albumin a negative phase reactant during inflammation in COPD patients. Sialic acid (SA) prevalent in mucus rich tissues is gaining importance as biochemical marker in inflammatory immune response. Purpose of present study was to measure serum C-reactive protein (C-RP), total sialic acid and albumin levels in COPD patients and establish there association in COPD and compare with healthy controls.

Methods: Seventy five clinically confirmed COPD patients, both male and female between the age group of 38-70 years were selected for the study and age/ sex matched healthy volunteers as controls were selected for comparison. Serum samples were analyzed for C-RP (mg/dl) by nephalometry and TSA (mmol/L) by periodate resorcinol method and albumin by dye binding method by spectrophotometer.

Results: The mean value of serum C-RP in cases was 3.26±2.0 (mg/dl) and in controls 0.57±0.34 (mg/dl) with p<0.001. TSA in cases was 3.53±1.41 (mmol/L) compared to controls 1.81±0.53 (mmol/L), p<0.001. There was a statistically significant positive correlation between C-RP and TSA (r=0.755, p<0.001). The mean value of Albumin in cases decreased (2.54±0.87) as compared to control (4.07±0.66) (p<0.001) showed negative correlation with C-RP (r= -0.418, p<0.01) and TSA (r= -0.728, p<0.001). There was a significant decrease in BMI among cases 19.95±3.17 compared to control 21.17±1.78 p<0.001.

Conclusions: C- reactive protein in association with TSA has increased in COPD as a marker of systemic inflammation. Albumin and BMI decreased as a result of nutritional depletion. Patients with low BMI and low serum albumin level have greater risk of having exacerbation, acute respiratory failure than patients with normal BMI.

 


Keywords


COPD, C- reactive protein, Total sialic acid, Albumin

Full Text:

PDF

References


Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J. 2006;27(2):188-207.

Foster TS, Miller JD, Marton JP, Caloyeras JP, Russell MW, Menzin J. Assessment of the economic burden of COPD in the US: a review and synthesis of the literature. COPD. 2006;3:211-8.

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: Revised 2015. Global Initiative for Chronic Obstructive Lung Disease (GOLD). www.goldcopd.org (Accessed on September 04, 2014).

Agusti AGN, Noguera A, Sauleda J, Sala E, Pons J, Busquets X. Systemic effects of chronic obstructive pulmonary disease. Eur Respir J. 2003;21:347-60.

Wouters EFM. The systemic face of chronic airway disease: role of C-reactive protein. Eur Respir J. 2006;27:877-9.

Thompson D, Pepys MB, Wood SP. The physiological structure of human C-reactive protein and its complex with phosphocholine Structure. 1999;7(2):169-77.

Pepys MB, Hirschfield GM.C-reactive protein: a critical update. J Clin Invest. 2003;111(12):1805-12.

Malo O, Sauleda J, Busquets X, Miralles C, Agusti AG, Noguera A. Systemic inflammation during exacerbations of chronic obstructive pulmonary disease. Arch Bronconeumol. 2002;38:172-6.

Sin DD, Paul Man SF. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular disease? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation. 2003;107:1514-9.

Pickup JC, Mattock MB, Chusney GD, Burt D: NIDDM as a disease of the innate immune system: association of acute phase reactants and interleukin-6 with metabolic syndrome X. Diabetologia. 1997;40:1286-92.

Nigam PK, Narain VS, Kumar A. Sialic acid in cardiovascula disease. Ind J Clin Biochem. 2006;21(1):54-61.

Mackiewicz A. Acute phase proteins and transformed cells. International Review of Cytology. 1997;170:225-300.

Rüdiger Horstkorte. Increased expression of the selectin ligand sialyl–Lewisx by biochemical engineering of sialic acids. Experimental Cell Research. 2004;295(2):549-54.

Baos SC, Phillips DB, Wildling L, McMaster TJ, Berry M. Distribution of sialic acids on mucins and gels: a defense mechanism. Biophys J. 2012;102(1):176-84.

AG, McAlevy MT, Smith JL. Nutritional assessment of patients with chronic obstructive pulmonary disease and acute respiratory failure. Chest. 1982;82:568-71.

Vandenbergh E, Woestijne van de KP, Gyselen A. Weight changes in the terminal stages of chronic obstructive pulmonary disease. Relation to respiratoryfunction and prognosis. Am Rev Respir Dis. 1967;95:556-66.

Ezzell L, Jensen GL. Malnutrition in chronic obstructive pulmonary disease. Am J Clin Nutr December. 2000;72(6):1415-6.

Arora NS, Rochester DF. Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. Am Rev Respir Dis. 1982;126:5-8.

Harik-Khan RL, Fleg JL, Wise RA. Body Mass Index and the Risk of COPD CHEST. 2002;121(2):370-6.

Higgins MW, Keller JB, Becker M. An index of risk for obstructiveairways disease. Am Rev Respir Dis. 1982;125:144-51.

Schols AM, Slangen J, Volovics L. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157:1791-7.

Landbo C, Prescott E, Lange P. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med.1999;160:1856-61.

C-reactive Protein Kit insert of BECKMAN COULTER, USA. 2003.

Jourdian GW, Dean L, Rosemans S. The Sialic Acids XI. A Periodate-Resorcinol Method for the Quantitative Estimation of Free Sialic Acids and Their Glycosides. J. Biol. Chem. 1971;246:2(25):43-5.

Tietz NW. Specimen Collection and Processing; Sources of Biological Variation. Textbook of Clinical Chemistry, 2nd Edition, W. B. Saunders, Philadelphia, PA. 1994.

Aim for a healthy weight: Assess your risk. National Institutes of Health. 2007:07-08.

Yende S, Waterer GW, Tolley EA. Inflammatory markers are associated with ventilatory limitation a muscle dysfunction in obstructive lung disease in well-functioning elderly subjects. Thorax. 2006;61:10-6.

Broekhuizen R, Wouters EF, Creutzberg EC, Schols AM. Raised CRP levels mark metabolic and functional impairment in advanced COPD. Thorax. 2006;61:17-22.

De Torres JP, Cordoba-Lanus E, Lo´pez-Aguilar C. C-reactive protein levels and clinically important predictive outcomes in stable COPD patients. Eur Respir J. 2006;27:902-7.

Driver AG, McAlevy MT, Smith JK. Nutritional assessment of patients with chronic obstructive pulmonary disease and ARF. Chest. 1982;82:568-7l.

Vermeeren MA, Creutzberg EC, Schols AM. Prevalence of nutritional depletion in a large out-patient population of patients with COPD. Respir Med. 2006;100:1349-55.

Schols AM, Mostert R, Soeters PB, Greve LH, Wouters EF. Nutritional state and exercise performance in patients with chronic obstructive lung disease. Thorax. 1989;44:937-41.

Katsura H, Ogata M, Kida K. Factors determining outcome in elderly patients with severe COPD on long-term domiciliary oxygen therapy. Monaldi Arch. Chest Dis. 2001;56:195-201.

Donahoe M, Rogers RM, Wilson DO, Pennock BE. Oxygen consumption of the respiratory muscles in normal and in malnourished patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 1989;140:385-91.

Decramer M, De Benedetto F, Del Ponte A. Systemic effects of COPD. Respir Med. 2005;99:S3-10.

Taniuchi K, Chifu K, Hayashi N, Nakamachi Y, Yamaguchi N, Miyamato Y: A new enzymatic method for the determination of sialic acid and its application as a marker of acute phase reactants. Kobe J Med Sci. 1998;27:91-102.

Lindberg G, Rastam L, Gullberg B, Lundblad A, Nilsson-Ehle P. Hanson BS. Serum concentrations of total sialic acid and sialo glycoproteins in relation to coronary heart disease risk markers. Atherosclerosis. 1993;103:123- 6.

Lopez-Vidriero MT, Del Donno M, Bittesnich D, Chetta A, Olivieri D. The effect of inflammation on mucociliary clearance in asthma: an overview. Chest. 2000;118(4):1142-9.

Sathiyapriya V, Nandeesha H, Selvaraj N, Bobby Z, Agrawal A, Pavithran P. Association between protein-bound sialic acid and high-sensitivity C-reactive protein in essential hypertension: a possible indication of underlying cardiovascular risk. Angiology. 2009;59(6):721-6.

Browning LM, Krebs JD, Jebb SA. Discrimination ratio analysis of inflammatory markers: implications for the study of inflammation in chronic disease. Metabolism. 2004;53(7):899-903.