Association of maternal serum high sensitive C-reactive protein level with body mass index and severity of pre-eclampsia at third trimester.

AIM

To assess a maternal serum level of high sensitive C-reactive protein (hs-CRP) as a useful clinical parameter in prediction of pre-eclampsia severity and, to evaluate the correlation between hs-CRP and body mass index (BMI).

MATERIAL & METHODS: Using cross-sectional study design, CRP was measured by a high sensitive immunoturbidimetric method between 24 and 40 weeks of gestation in normotensive controls (n = 115), in mild (n = 63) and severe (n = 34) pre-eclamptic patients. The receiver operating characteristic analysis was used to estimate the optimal threshold score of hs-CRP.

RESULTS

For disease severity evaluation, a hs-CRP concentration of 9.66 mg/L was determined as cut-off point with 88% sensitivity, 81% specificity, 71% positive predictive value and 92% negative predictive value. When all three groups of patients were adjusted for gestational age [24(°/7) -27,(6/7) 28(°/7) -33,(6/7) 34(°/7) -40(6/7) ] and BMI, hs-CRP levels of severe pre-eclamptic patients were significantly higher than mild ones and controls in the study group with BMI < 25 kg/m(2) (P < 0.001). In the study group with BMI ≥ 25 kg/m(2), only severe pre-eclamptic patients between 28(°/7) and 33(6/7) weeks of gestation had significantly higher hs-CRP levels when compared with control and mild pre-eclamptic group (P < 0.001). When the patients were subgrouped as high (≥ 9.66 mg/L) and low hs-CRP group (< 9.66 mg/L), adverse outcomes for hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome and intrauterine growth-restricted baby were statistically significant higher in high hs-CRP group (P = 0.004 and P < 0.001, respectively).

CONCLUSION

Elevated level of hs-CRP is a useful parameter in the severity of clinical risk of pre-eclampsia in patients with BMI < 25 kg/m(2) at third trimester.