Increased CRP/albumin ratio is associated with superficial venous reflux disease and varicose vein formation

Abstract

Background: It has been recently postulated that inflammation may have an effect on varicose vein development and prognosis, besides increased venous pressure. CRP/albumin (CAR) is a novel inflammatory marker associated with poor prognosis in a various group of patients. Our aim in this study was to investigate the relation between varicose greater saphenous vein (VSM) diameter and CAR. Methods: A total of 150 patients with patients VSM insufficiency (Group 1, n: 114) and normal VSM (n: 36) were included in the study. The diameter of the VSM was measured with B-mode ultrasound, and reflux was quantified based on valve closure time using Doppler spectral tracings. Blood samples were taken during recruitment. The CAR value is determined by dividing the serum CRP level to the albumin level. Results: There were 21 (18.4%) males and 93 (81.5%) females in Group 1 and 7 males and 29 females in Group 2. Mean age of the patients were similar in both groups (48.02 +/- 12.20 years in Group 1 vs. 44.9 +/- 8.92 years in Group 2, p = 0.44). Mean BMI of the patients did not differ significantly (Group 1: 26.4 +/- 3.7 kg/m2 vs. Group 2: 25.7 +/- 4.2 kg/m2, p = 0.13). The mean diameter of VSM was measured 5.70 +/- 0.29 mm in Group 1 whereas 3.21 +/- 0.34 mm in Group 2 (p = 0.0023). Mean CRP and albumin values in Group 1 were 6.18 +/- 4.99 mg/L and 4.45 +/- 0.27 g/dL whereas 4.25 +/- 2.46 mg/L and 6.18 +/- 1.14 g/dL in Group 2, respectively (p value for CRP = 0.049, p value for albumin = 0.074). CRP/albumin was 1.28 +/- 1.34 in Group 1 and 1.11 +/- 1.21 in Group 2, which was not statistically significant (p = 0.58). There was a positive moderately strong correlation between VSM diameter and CRP/albumin ratio as well as superficial venous reflux disease (r: 0.48). Conclusion: CRP/albumin ratio is associated with increased incidence of varicose veins and increased diame-ter of greater saphenous vein; hence, superficial venous reflux disease. The findings support the hypothesis that systemic inflammation may play a role in varicose vein disease.

Kontext: Nedávno byl publikován názor, ?e krom? zv?šeného ?ilního tlaku m??e vznik a progresi k?e?ov?ch ?il ovliv?ovat i zán?t. Pom?r C-reaktivního proteinu (CRP) a albuminu (CRP/albumin ratio, CAR) p?edstavuje nov? marker zán?tu spojen? s nep?íznivou prognózou u r?zn?ch skupin pacient?. Cílem naší studie bylo zjistit vztah mezi pr?m?rem varikózní velké safény (varicose greater saphenous vein, VSM) a parametrem CAR. Metody: Do studie bylo za?azeno celkem 150 pacient? s nedostate?ností VSM (skupina 1, n = 114) a neposti?en?mi VSM (n = 36). Pr?m?r VSM se m??il B-mode ultrazvukem a refl ux se kvantifi koval délkou uzavírání chlopn? m??enou spektrální dopplerovskou k?ivkou. Krevní vzorky se odebíraly p?i za?azování pacient? do studie. Hodnota CAR se stanovuje vyd?lením hodnoty CRP hodnotou albuminu v séru. V?sledky: Skupinu 1 tvo?ilo 21 (18,4 %) mu?? a 93 (81,5 %) ?en; ve skupin? 2 bylo 7 mu?? a 29 ?en. Pr?m?rn? v?k pacient? v obou skupinách byl podobn? (48,02 ± 12,20 roku ve skupin? 1 vs. 44,9 ± 8,92 roku ve skupin? 2; p = 0,44). Pr?m?rná hodnota indexu t?lesné hmotnosti (BMI) pacient? se v?znamn? nelišila (skupina 1: 26,4 ± 3,7 kg/m2 vs. skupina 2: 25,7 ± 4,2 kg/m2 ; p = 0,13). Pr?m?rné hodnoty pr?m?ru VSM byly 5,70 ± 0,29 mm ve skupin? 1 a 3,21 ± 0,34 mm ve skupin? 2 (p = 0,0023). Pr?m?rné hodnoty CRP a albuminu ve skupin? 1 byly 6,18 ± 4,99 mg/l, resp. 4,45 ± 0,27 g/dl; ve skupin? 2 to bylo 4,25 ± 2,46 mg/l, resp. 6,18 ± 1,14 g/dl (hodnota p pro CRP = 0,049, hodnota p pro albumin = 0,074). Pom?r CRP/albumin ve skupin? 1 ?inil 1,28 ± 1,34; ve skupin? 2 byla nam??ena hodnota 1,11 ± 1,21, tedy statisticky nev?znamn? rozdíl (p = 0,58). Byla nalezena st?edn? t?sná korelace mezi pr?m?rem VSM a pom?rem CRP/albumin i refl uxem povrchov?ch ?il (r: 0,48). Záv?r: Zv?šen? pom?r CRP/albumin je spojen se zv?šenou incidencí varix? a v?tším pr?m?rem velké safény, a tedy i vyšší incidencí refl uxu povrchov?ch ?il. Zjišt?ní podporují hypotézu, ?e ve vzniku k?e?ov?ch ?il m??e hrát jistou úlohu systémov? zán?t.