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Expression and prognostic value of C-reactive protein in adult immune thrombocytopenia (ITP) patients

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Abstract

The aim of this study was to investigate the effect of C-reactive protein (CRP) on the prognosis of adult patients with Immune thrombocytopenia purpura (ITP). A retrospective study of 628 adult ITP patients, as well as 100 healthy and 100 infected patients, attending the Affiliated Hospital of Xuzhou Medical University from January 2017 to June 2022 was performed. The ITP patients were grouped according to their CRP levels, and the differences in clinical characteristics of each group and the influencing factors of efficacy in newly diagnosed ITP patients were analyzed. CRP levels were significantly higher in the ITP and infected groups compared with healthy controls (P < 0.001), and platelet counts were significantly lower in the ITP group (P < 0.001). Between the CRP normal and elevated group, their age, white blood cell count, neutrophil count, lymphocyte count, red blood cell count, hemoglobin, platelet count, complement C3 and C4, PAIgG, bleeding score, proportion of severe ITP, and proportion of refractory ITP were significantly different (P < 0.05). Patients of severe ITP (P < 0.001), refractory ITP (P = 0.002), and with active bleeding (P < 0.001) had significantly higher CRP levels. Patients with no response after treatment had significantly higher CRP levels than those who achieved CR or R (P < 0.001). Platelet counts (r = − 0.261, P < 0.001) in newly diagnosed ITP patients and treatment outcomes (r = − 0.221, P < 0.001) were negatively correlated with CRP levels, and bleeding score was positively correlated with CRP levels (r = 0.207, P < 0.001). Treatment outcome was positively correlated with decrease in CRP levels (r = 0.313, P = 0.027). A multifactorial regression analysis of the influencing factors of treatment outcomes on newly diagnosed patients found that CRP was an independent risk factor of the prognosis (P = 0.011). In conclusion, CRP can help assess the severity and predict the prognosis of ITP patients.

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References

  1. Cooper N, Ghanima W. Immune thrombocytopenia. N Engl J Med. 2019;381(10):945–55.

    Article  PubMed  Google Scholar 

  2. Lynch DR, Stringham EN, Zhang B, et al. Anchoring IgG-degrading enzymes to the surface of platelets selectively neutralizes antiplatelet antibodies. Blood Adv. 2022;6(15):4645–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Lu J, Marjon KD, Mold C, Du Clos TW, Sun PD. Pentraxins and Fc receptors. Immunol Rev. 2012;250(1):230–8.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Thrombosis and Hemostasis Group CSoHCMA. Chinese guideline on the diagnosis and management of adult primary immune thrombocytopenia (version 2020). Zhonghua Xue Ye Xue Za Zhi. 2020;41(8):617–23.

    Google Scholar 

  5. Nehring SM, Goyal A and Patel BC, C Reactive Protein, in StatPearls. 2022, StatPearls Publishing Copyright© 2022, StatPearls Publishing LLC: Treasure Island (FL).

  6. Sproston NR, Ashworth JJ. Role of C-reactive protein at sites of inflammation and infection. Front Immunol. 2018;9:754.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lee Y, McKechnie T, Doumouras AG, et al. Diagnostic value of C-reactive protein levels in postoperative infectious complications after bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2019;29(7):2022–9.

    Article  PubMed  Google Scholar 

  8. Johns I, Moschonas KE, Medina J, et al. Risk classification in primary prevention of CVD according to QRISK2 and JBS3 ‘heart age’, and prevalence of elevated high-sensitivity C reactive protein in the UK cohort of the EURIKA study. Open Heart. 2018;5(2):e000849.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Blake GJ, Ridker PM. Inflammatory bio-markers and cardiovascular risk prediction. J Intern Med. 2002;252(4):283–94.

    Article  CAS  PubMed  Google Scholar 

  10. Vítek L, Jirásková A, Malíková I, et al. serum bilirubin and markers of oxidative stress and inflammation in a healthy population and in patients with various forms of atherosclerosis. Antioxidants (Basel, Switzerland). 2022;11(11):2118.

    PubMed  PubMed Central  Google Scholar 

  11. Semple JW. C-reactive protein boosts antibody-mediated platelet destruction. Blood. 2015;125(11):1690–1.

    Article  CAS  PubMed  Google Scholar 

  12. Kapur R, Heitink-Pollé KMJ, Porcelijn L, et al. C-reactive protein enhances IgG-mediated phagocyte responses and thrombocytopenia. Blood. 2015;125(11):1793–802.

    Article  CAS  PubMed  Google Scholar 

  13. Campbell CL, Steinhubl SR, Hooper WC, et al. Bleeding events are associated with an increase in markers of inflammation in acute coronary syndromes: an ACUITY trial substudy. J Thromb Thrombolysis. 2011;31(2):139–45.

    Article  CAS  PubMed  Google Scholar 

  14. Di Napoli M, Godoy DA, Campi V, et al. C-reactive protein in intracerebral hemorrhage: time course, tissue localization, and prognosis. Neurology. 2012;79(7):690–9.

    Article  PubMed  Google Scholar 

  15. Di Napoli M, Parry-Jones AR, Smith CJ, et al. C-reactive protein predicts hematoma growth in intracerebral hemorrhage. Stroke. 2014;45(1):59–65.

    Article  PubMed  Google Scholar 

  16. Palandri F, Catani L, Auteri G, et al. Understanding how older age drives decision-making and outcome in Immune Thrombocytopenia. A single centre study on 465 adult patients. Br J Haematol. 2019;184(3):424–30.

    Article  CAS  PubMed  Google Scholar 

  17. Krémer V, de Chaisemartin L, Jönsson F. The role of neutrophils in antibody-driven autoimmune cytopenias. Int J Biochem Cell Biol. 2022;147:106231.

    Article  PubMed  Google Scholar 

  18. Verschoor A, Langer HF. Crosstalk between platelets and the complement system in immune protection and disease. Thromb Haemost. 2013;110(5):910–9.

    CAS  PubMed  Google Scholar 

  19. Tsubakio T, Tani P, Curd JG, McMillan R. Complement activation in vitro by antiplatelet antibodies in chronic immune thrombocytopenic purpura. Br J Haematol. 1986;63(2):293–300.

    Article  CAS  PubMed  Google Scholar 

  20. Nagamine T, Ohtuka T, Takehara K, et al. Thrombocytopenia associated with hepatitis C viral infection. J Hepatol. 1996;24(2):135–40.

    Article  CAS  PubMed  Google Scholar 

  21. Hohmann AW, Booth K, Peters V, Gordon DL, Comacchio RM. Common epitope on HIV p24 and human platelets. Lancet (London, England). 1993;342(8882):1274–5.

    Article  CAS  PubMed  Google Scholar 

  22. Huang C-E, Chen W-M, Wu Y-Y, et al. Comparison of antiplatelet antibody profiles between hepatitis C virus-associated immune thrombocytopenia and primary immune thrombocytopenia. Platelets. 2021;32(8):1043–50.

    Article  CAS  PubMed  Google Scholar 

  23. Zhang W, Nardi MA, Borkowsky W, Li Z, Karpatkin S. Role of molecular mimicry of hepatitis C virus protein with platelet GPIIIa in hepatitis C-related immunologic thrombocytopenia. Blood. 2009;113(17):4086–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Wright JF, Blanchette VS, Wang H, et al. Characterization of platelet-reactive antibodies in children with varicella-associated acute immune thrombocytopenic purpura (ITP). Br J Haematol. 1996;95(1):145–52.

    Article  CAS  PubMed  Google Scholar 

  25. Li Z, Nardi MA, Karpatkin S. Role of molecular mimicry to HIV-1 peptides in HIV-1-related immunologic thrombocytopenia. Blood. 2005;106(2):572–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Takeuchi H, Okamoto A. Infection and chronic immune thrombocytopenia. J Clin Med. 2022;11(16):4822.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Han B, Kim HJ, Yhim H-Y, et al. Sequential eradication of Helicobacter pylori as a treatment for immune thrombocytopenia in patients with moderate thrombocytopenia: a multicenter prospective randomized phase 3 study. Ann Hematol. 2022;101(7):1435–45.

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was supported by grants from the National Natural Science Foundation of China (82070127).

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Author notes

  1. YaNan Zhang, FengAn Liu and XiuLi Liang have contributed equally to this study.

Authors and Affiliations

  1. Faculty of Clinical Medicine, Xuzhou Medical University, Xuzhou, China

    YaNan Zhang, FengAn Liu, XiuLi Liang, JingJing Zhu, Li Han & XueDong Shi

  2. Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Quanshan District, Xuzhou, Jiangsu Province, China

    Jiang Cao, ZhenYu Li, Wei Chen, KaiLin Xu & Hai Cheng

  3. Blood Diseases Institute, Xuzhou Medical University, Xuzhou, China

    Jiang Cao, ZhenYu Li, Wei Chen, KaiLin Xu & Hai Cheng

  4. Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, China

    Jiang Cao, ZhenYu Li, Wei Chen, KaiLin Xu & Hai Cheng

Authors
  1. YaNan Zhang
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  2. FengAn Liu
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Contributions

HC, KX, WC diagnosed the ITP patients, designed the research study. YZ, FL and XL analyzed the results and wrote the manuscript; JZ, LH and XS followed up the patients; JC and ZL reviewed and critically edited the manuscript.

Corresponding authors

Correspondence to Wei Chen, KaiLin Xu or Hai Cheng.

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No relevant conflicts of interest are related to this study.

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Zhang, Y., Liu, F., Liang, X. et al. Expression and prognostic value of C-reactive protein in adult immune thrombocytopenia (ITP) patients. Clin Exp Med 23, 4483–4491 (2023). https://doi.org/10.1007/s10238-023-01043-y

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  • DOI: https://doi.org/10.1007/s10238-023-01043-y

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