C-Reactive Protein/Albumin Ratio in the Initial Evaluation of Patients with Migraine Attack Presented to the Emergency Department

Yıl 2021, , 80 - 87, 30.01.2021

Okan Bari Özgür Söğüt , Sümeyye Çakmak , Onur Kaplan

https://doi.org/10.21673/anadoluklin.756421

Öz

Aim: In this study, we aimed to investigate the role of serum C-Reactive Protein (CRP)/Albumin and neutrophil to lymphocyte (NRL) ratios measured in the initial evaluation of patients admitted to the emergency department (ED) with a headache due to migraine attack, in estimating the migraine-related disability that was measured by the Migraine Disability Assessment Scale (MIDAS) score.

Materials and Methods: Patients who admitted to the ED between June 2019 and August 2019 and diagnosed with migraine attack were included in the study. The patients were divided into groups according to the MIDAS score. In addition, it was divided into two subgroups as migraine attack patients with and without aura. Age, serum CRP/Albumin and NRL values were compared between the groups.

Results: A total of 252 migraine attack patients, 45 (17.9%) male and 207 (82.1%) female, were included in the study. The mean age of patients with aura was 39.6±11.9 years, and the mean age of patients without aura was 35.8±9.4 years. There was a statistically significant difference between patient groups with respect to age (p=0.005). However, there was no statistically significant difference between the groups in terms of mean serum CRP/Albumin and NRL levels. According to the MIDAS score, there was a statistically significant difference between the groups in terms of mean age (p<0.001). Additionally, a statistically significant positive correlation was found between the mean MIDAS score and age (rho=0.224 and p <0.001). However, there was no statistically significant difference between the groups in terms of mean serum CRP/Albumin and NRL levels (p=0.794 and p=0.2266, respectively).

Conclusion: Serum CRP/Albumin and NRL levels are not useful in predicting the severity of migraine-related disability, measured by MIDAS score, in patients presenting to the ED with migraine attack. However, we concluded that as age increases, the severity of migraine-related disability increases.

Anahtar Kelimeler

CRP/Albumin, NRL, MIDAS, migraine with aura, migraine without aura

Migren Atak ile Acil Servise Başvuran Hastaların İlk Değerlendirilmesinde C-Reaktif Protein/Albumin Oranı

Öz

Amaç: Bu çalışmada, migren atağına bağlı başağrısı şikayetiyle acil servise (AS) başvuran hastalarda ilk başvuruda ölçülen serum C-Reaktif Protein (CRP)/Albumin ve Nötrofil/lenfosit (NLO) oranlarının, MIDAS (Migrene bağlı iş kaybı değerlendirme ölçeği) skoru ile ölçülen migren ilişkili iş göremezlik durumunun derecesini tahmin etmedeki rolünün araştırılması amaçlanmıştır.

Gereç ve Yöntemler: Çalışmaya Haziran 2019-Ağustos 2019 tarihleri arasında acil service başvuran ve migren atak tanısı konulan hastalar dahil edildi. Hastalar MIDAS skoruna göre gruplara ayrıldı. Ayrıca auralı ve aurasız migren atak hastaları olmak üzere iki alt gruba ayrıldı. Gruplar arasında yaş, serum CRP/Albumin ve NLO değerleri karşılaştırıldı.

Bulgular: Çalışmaya 45’i erkek (%17,9), 207’si kadın (%82,1) olmak üzere toplam 252 migren atak tanısı konulan hasta dahil edildi. Aurası olan hastaların yaş ortalaması 39,6±11,9 yıl (yaş aralığı; 18-80), aurası olmayan hastaların yaş ortalaması 35,8±9,4 yıl (yaş aralığı; 18-89) olup, her iki grupta yaş ortalamaları açısından istatistiksel olarak anlamlı farklılık saptandı (p=0,005). Ancak ortalama serum CRP/Albumin ve NLO düzeyleri açısından gruplar arasında istatistiksel olarak anlamlı fark saptanmadı. MIDAS skoruna göre gruplar arasında yaş ortalaması açısından istatistiksel olarak anlamlı fark tespit edildi (p<0,001). Ek olarak, MIDAS skoru ile yaş arasında pozitif yönde istatistiksel olarak anlamlı korelasyon saptandı (rho=0,242 ve p<0,001). Ancak ortalama serum CRP/Albumin ve NLO düzeyleri açısından gruplar arasında istatistiksel olarak anlamlı fark saptanmadı (p=0,794 ve p=0,266, sırasıyla).

Sonuç: Migren atağı ile acil servise başvuran hastalarda serum CRP/Albumin ve NLO düzeyleri MIDAS skoru ile ölçülen migren ilişkili iş göremezlik durumunun şiddetini tahmin etmede yararlı değildir. Ancak yaş artıkça migren ilişkili iş göremezlik durumunun şiddetinin arttığı söylenebilir.

Anahtar Kelimeler

CRP/Albumin, NLO, MIDAS, auralı migren, aurasız migren

Kaynakça

• Özge A, Karadaş A. Headache classifications. Turkiye Klinikleri J Neurol-Special Topics. 2018;11(1):1-14.
• Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd-Edition-2018.pdf. Cephalalgia. 2018;38(1):1-211.
• Global Burden of Disease Study 2010 (GBD2010) Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd- Edition-2018.pdf. Cephalalgia. 2018;38(1):1-211.
• Global Burden of Disease Study 2015 (GBD2015) Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd- Edition-2018.pdf. Cephalalgia. 2018;38(1):1-211.
• Matowicka-Karna J. Markers of inflammation, activation of blood platelets and coagulation disorders in inflammatory bowel diseases. Postepy Hig Med Dosw (Online) 2016;70:305-12.
• Geyik S, Altunısık E, Neyal AM, Taysi S. Oxidative stress and DNA damage in patients with migraine. J Headache Pain. 2016;17:10.
• Eren Y, Dirik E, Neşelioğlu S, Erel Ö. Oxidative stress and decreased thiol level in patients with migraine: Cross-sectional study. Acta Neurol Belg. 2015;115(4):643–49.
• Lance JW. Current concepts of migraine pathogenesis. Neurology. 1993;43(6 Suppl 3):S11–15.
• Kallela M, Färkkilä M, Saijonmaa O, Fyhrquist F. Endothelin in migraine patients. Cephalalgia. 1998;18(6):329–32.
• Kinoshita A, Onoda H, Imai N, Nishino H, Tajiri H. C-reactive protein as a prognostic marker in patients with hepatocellular carcinoma. Hepatogastroenterology. 2015;62(140):966-70.
• Lelubre C, Anselin S, Zouaoui Boudjeltia K, Biston P, Piagnerelli M. Interpretation of C-reactive protein concentrations in critically ill patients. Biomed Res Int. 2013;2013:124021.
• Avci AY, Lakadamyali H, Arikan S, Benli US, Kilinc M. High sensitivity C-reactive protein and cerebral white matter hyperintensities on magnetic resonance imaging in migraine patients. J Headache Pain. 2015;16:9.
• Goh SL, De Silva RP, Dhital K, Gett RM. Is low serum albumin associated with postoperative complications in patients undergoing oesophagectomy for oesophageal malignancies? Interact Cardiovasc Thorac Surg. 2015;20:107-13.
• Danesh J, Wheeler JG, Hirschfield GM, Eda S, Eiriksdottir G, Rumley A, et al. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med. 2004;350(14):1387-97.
• Kaplan M, Ates I, Akpinar MY, Yuksel M, Kuzu UB, Kacar S, et al. Predictive value of C-reactive protein/albumin ratio in acute pancreatitis. Hepatobiliary Pancreat Dis Int. 2017;16(4):424-430.
• Wada H, Dohi T, Miyauchi K, Doi S, Naito R, Konishi H, et al. Independent and combined effects of serum albumin and C-reactive protein on long-term outcomes of patients undergoing percutaneous coronary intervention. Circ J. 2017;81(9):1293-1300.
• Stewart WF, Lipton RB, Whyte J, Dawson A, Kolodner K, Liberman JN, et al. An international study to assess reliability of the Migraine Disability Assessment (MIDAS) score. Neurology. 1999;53(5):988-994.
• Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629–808.
• Özdemir G, Aygül R, Demir R, Özel L, Ertekin A, Ulvi H. Migraine prevalence, disability, and sociodemographic properties in the eastern region of Turkey: A population-based door-to-door survey. Turk J Med Sci. 2014;44(4):624-9.
• Aygül R, Deniz O, Güzelcik M, Şahin A. Migrenli hastaların sosyodemografik özellikleri. The Eurasian J Med. 2001;33:91-6.
• Aygul R, Deniz O, Kocak N, Orhan A, Ulvi H. The clinical properties of a migraineuse population in Eastern Turkey-Erzurum. South Med J. 2005;98(1):23-7.
• Wacogne C, Lacoste JP, Guillibert E, Hugues FC, Le Jeunne C. Stress, anxiety, depression and migraine. Cephalalgia. 2003;23(6): 451-5.
• Ertas M, Baykan B, Orhan EK, Zarifoğlu M, Karli N, Saip S, et al. One-year prevalence and the impact of migraine and tension-type headache in Turkey: A nationwide home-based study in adults. J Headache Pain. 2012;13:147-57.
• Welch K, Brandes A, Salerno L, Brandes J. C-reactive protein may be increased in migraine patients who present with complex clinical features. Headache. 2006; 46:197-199.
• Guldiken B, Guldiken S, Demir M, Turgut N, Kabayel L, Ozkan H, et al. Insulin resistance and high sensitivity C-reactive protein in migraine. Can J Neurol Sci. 2008;35:448-51.
• Rockett FC, Perla Ada S, Perry ID, Chaves ML. Cardiovascular disease risk in women with migraine. J Headache Pain. 2013;14:75.
• Tekeşin A, Tunç A. Evaluation of inflammatory markers in patients with migraine. Arch Clin Exp Med. 2019;4(1):37-40.