Miyastenia graviste prognostik bir biyobelirteç olarak C-reaktif protein/albüminin rolü

Year 2025, Volume: 8 Issue: 1, 126 - 131, 12.01.2025

Esen Çiçekli , Dilcan Kotan

https://doi.org/10.32322/jhsm.1600622

Abstract

Amaçlar: Sınırlı sayıda araştırma, miyastenia gravis'te (MG) yeni inflamatuar hedefleri araştırmıştır. Bu çalışma, MG hastalarında hastalık aktivitesi ve prognozda C-reaktif protein (CRP)/albümin oranının (CAR) rolünü araştırmayı amaçlamıştır.
Yöntemler: CRP, albümin ve CAR düzeyleri MG hastaları ile sağlıklı kontroller arasında karşılaştırılmıştır. Bu parametrelerin MG günlük yaşam aktiviteleri (MG-ADL) skorları ve mortalite ile ilişkileri incelenmiştir.
Sonuçlar: Altmış altı hasta ve 51 kontrol katılmıştır. CRP ve CAR düzeyleri hasta grubunda anlamlı şekilde daha yüksekti (p=0,002, 0,003). Albümin düzeylerinde anlamlı bir fark bulunmamıştır (p=0,154). MG-ADL evresi ile hem CRP hem de CAR düzeyleri arasında pozitif bir korelasyon gözlenmiştir (her ikisi için de p=0,000), bu belirteçler MG-ADL kötüleştikçe artmıştır. MG-ADL evresi ile albümin arasında negatif bir korelasyon bulunmuştur (p=0,003). CRP, CAR ve albumin düzeyleri mortalite ile anlamlı şekilde ilişkiliydi (p=0,000, 0,000, 0,005).
Sonuç: MG hastalarında yüksek CRP ve CAR düzeyleri, akut inflamasyonun klinik düşüşe katkıda bulunduğunu düşündürmektedir. Albüminin kötüleşen MG-ADL ile azalması, tanısal olmaktan çok prognostik bir belirteç olarak değerini düşündürmektedir. CAR, hastalık tanısı, şiddet takibi ve mortalite tahmini için albuminden daha güçlü bir belirteç olduğu kanıtlanmıştır. Bulgularımız, MG ve diğer nöromüsküler hastalıklardaki inflamatuar mekanizmaları aydınlatmaya yardımcı olabilir.

Keywords

Myastenia gravis, C-reaktif protein, albumin

C-reactive protein/albumin ratio as a prognostic biomarker in myasthenia gravis

Abstract

Aims: Limited research has explored novel inflammatory targets in myasthenia gravis (MG). This study aimed to investigate the role of the C-reactive protein (CRP)/albumin ratio (CAR) in disease activity and prognosis in MG patients.
Methods: CRP, albumin, and CAR levels were compared between MG patients and healthy controls. The relationships of these parameters with MG activities of daily living (MG-ADL) scores and mortality were examined.
Results: Sixty-six patients and 51 controls participated. CRP and CAR levels were significantly higher in the patient group (p=0.002, 0.003). No significant difference was found in albumin levels (p=0.154). A positive correlation was observed between the MG-ADL stage and both CRP and CAR levels (p=0.000 for both), with these markers increasing as MG-ADL worsened. A negative correlation was found between the MG-ADL stage and albumin (p=0.003). CRP, CAR, and albumin levels were significantly associated with mortality (p=0.000, 0.000, 0.005).
Conclusion: Elevated CRP and CAR levels in MG patients suggest acute inflammation contributing to clinical decline. Albumin’s decrease with worsening MG-ADL suggests its value as a prognostic marker rather than a diagnostic. CAR proved to be a stronger marker than albumin for disease diagnosis, severity monitoring, and mortality prediction. Our findings could help illuminate inflammatory mechanisms in MG and other neuromuscular diseases.

Keywords

Myasthenia gravis, C-reactive protein, albumin

References

• Bokoliya SC, Kumar VP, Nashi S, Polavarapu K, Nalini A, Patil SA. Anti-AchR, MuSK, and LRP4 antibodies coexistence: a rare and distinct subtype of myasthenia gravis from Indian subcontinent. Clin Chim Acta. 2018;486:34-35. doi:10.1016/j.cca.2018.07.011
• Iorio R. Myasthenia gravis: the changing treatment landscape in the era of molecular therapies. Nat Rev Neurol. 2024;20(2):84-98.
• Lazaridis K, Tzartos SJ. Myasthenia gravis: autoantibody specificities and their role in MG management. Front Neurol. 2020;11:596981.
• Gomez AM, Van Den Broeck J, Vrolix K, et al. Antibody effector mechanisms in myasthenia gravis-pathogenesis at the neuromuscular junction. Autoimmunity. 2010;43(5-6):353-370.
• Duan L, Rao X, Sigdel KR. Regulation of inflammation in autoimmune disease. J Immunol Res. 2019;2019:7403796.
• Woo MS, Mayer C, Binkle-Ladisch L, et al. STING orchestrates the neuronal inflammatory stress response in multiple sclerosis. Cell. 2024; 187(15):4043-4060.
• Huda R. Inflammation and autoimmune myasthenia gravis. Front Immunol. 2023;14:1110499.
• Yang DH, Qian MZ, Wei MM, et al. The correlation of neutrophil-to-lymphocyte ratio with the presence and activity of myasthenia gravis. Oncotarget. 2017;8(44):76099-76107.
• Mahmoud FA, Rivera NI. The role of C‐reactive protein as a prognostic indicator in advanced cancer. Curr Oncol Rep. 2002;4(3):250‐255.
• Rizo-Téllez SA, Sekheri M, Filep JG. C-reactive protein: a target for therapy to reduce inflammation. Front Immunol. 2023;14:1237729.
• Kharel S, Ojha R, Preethish-Kumar V, Bhagat R. C-reactive protein levels in patients with amyotrophic lateral sclerosis: a systematic review. Brain Behav. 2022;12(3):e2532.
• Artigas A, Wernerman J, Arroyo V, Vincent JL, Levy M. Role of albumin in diseases associated with severe systemic inflammation: pathophysiologic and clinical evidence in sepsis and in decompensated cirrhosis. J Crit Care. 2016;33:62-70.
• Sheinenzon A, Shehadeh M, Michelis R, Shaoul E, Ronen O. Serum albumin levels and inflammation. Int J Biol Macromol. 2021;184:857-862. doi:10.1016/j.ijbiomac.2021.06.140
• Wang W, Ren D, Wang CS, Li T, Yao HC, Ma SJ. Prognostic efficacy of high-sensitivity C-reactive protein to albumin ratio in patients with acute coronary syndrome. Biomark Med. 2019;13(10):811-820. doi:10. 2217/bmm-2018-0346
• Ethemoglu O, Calik M. Effect of serum inflammatory markers on the prognosis of adult and pediatric patients with Guillain-Barré syndrome. Neuropsychiatr Dis Treat. 2018;14:1255-1260. doi:10.2147/NDT.S162896
• Gao M, Zhang C, Gao L, Sun S, Song L, Liu S. Association between C-reactive protein-albumin ratio and overall survival in Parkinson’s disease using publicly available data: a retrospective cohort study. Heliyon. 2023;9(2):e12671.
• Muppidi S, Silvestri NJ, Tan R, Riggs K, Leighton T, Phillips GA. Utilization of MG-ADL in myasthenia gravis clinical research and care. Muscle Nerve. 2022;65(6):630-639. doi:10.1002/mus.27476
• Mehnert A, Bershan S, Kollmus-Heege J, et al. Identifying patients at risk for myasthenic crisis with hemogram and inflammation-related laboratory parameters-a pilot study. Front Neurol. 2024;15:1297997
• Gilhus NE, Romi F, Hong Y, Skeie GO. Myasthenia gravis and infectious disease. J Neurol. 2018;265(6):1251-1258.
• Delogu LG, Deidda S, Delitala G, Manetti R. Infectious diseases and autoimmunity. J Infect Dev Ctries. 2011;5(10):679-687.
• Weng YY, Yang DH, Qian MZ, et al. Low serum albumin concentrations are associated with disease severity in patients with myasthenia gravis. Medicine (Baltimore). 2016;95(39):e5000.
• Yoshimoto Y, Ishida S, Hosokawa T, Arawaka S. Assessment of clinical factors affecting outcome of myasthenia gravis. Muscle Nerve. 2021; 64(1):90-94.
• Chien CY, Chang CW, Liao MF, et al. Myasthenia gravis and independent risk factors for recurrent infection: a retrospective cohort study. BMC Neurol. 2023;23(1):255.
• Soltys BJ, Hsia JC. Steroid modulation of human serum albumin binding properties. A spin label study. J Biol Chem. 1978;253(12):4266-4269.
• Friedman AN, Fadem SZ. Reassessment of albumin as a nutritional marker in kidney disease. J Am Soc Nephrol. 2010;21(2):223-230.
• Nacu A, Andersen JB, Lisnic V, Owe JF, Gilhus NE. Complicating autoimmune diseases in myasthenia gravis: a review. Autoimmunity. 2015;48(6):362-368. doi:10.3109/08916934.2015.1030614
• Zhu Y, Wang B, Hao Y, Zhu R. Clinical features of myasthenia gravis with neurological and systemic autoimmune diseases. Front Immunol. 2023;14:1223322.