TY - JOUR
TI - Plasma high sensitivity C-reactive protein and its relationship with cytokine levels in children with newly diagnosed type 1 diabetes and ketoacidosis
AU - Karavanaki, K.
AU - Kakleas, K.
AU - Georga, S.
AU - Bartzeliotou, T.
AU - Mavropoulos, G.
AU - Tsouvalas, M.
AU - Vogiatzi, A.
AU - Papassotiriou, I.
AU - Karayianni, C.
JO - Clinical Biochemistry
PY - 2012
VL - 45
TODO - 16-17
SP - 1383-1388
PB - 
SN - 0009-9120
TODO - 10.1016/j.clinbiochem.2012.05.003
TODO - C reactive protein;  cytokine;  high sensitivity C reactive protein;  interleukin 10;  interleukin 1beta;  interleukin 2;  interleukin 6;  interleukin 8;  tumor necrosis factor alpha;  unclassified drug, article;  child;  clinical article;  correlational study;  diabetic ketoacidosis;  disease severity;  female;  human;  insulin dependent diabetes mellitus;  leukocyte count;  male;  priority journal;  protein blood level;  school child, Analysis of Variance;  Biological Markers;  Brain Edema;  C-Reactive Protein;  Child;  Child, Preschool;  Cytokines;  Diabetes Mellitus, Type 1;  Diabetic Ketoacidosis;  Female;  Humans;  Leukocyte Count;  Male;  Pulmonary Edema;  Statistics, Nonparametric
TODO - Background: High-sensitivity C-reactive protein (hs-CRP) and pro-inflammatory cytokines have been suggested as sensitive markers of endothelial dysfunction. Our aim was to monitor plasma hs-CRP levels at different time-points and in different degrees of ketoacidosis severity, its association with cytokine levels and its role as a marker of severe ketoacidosis complications. Patients and methods: We studied in 38 newly diagnosed children with type 1 diabetes and ketoacidosis, aged 7.7. ±. 3.1. years, hs-CRP, white blood cell count (WBC), and plasma levels of cytokines IL-1β (interleukin-1β), IL-2, IL-6, IL-8, IL-10, TNF-α (tumor necrosis factor-α) prior to and during DKA management. Results: On admission, the levels of WBC, PMN, IL-6 and IL-10 were elevated, but were all reduced within 120. h after ketoacidosis management. In the group with moderate/severe ketoacidosis, but not in mild ketoacidosis, hs-CRP levels were significantly reduced at 24. h (p= 0.021), WBC and IL-6 at 120. h (p= 0.003), while IL-10 was prematurely reduced at 6-8. h (p= 0.008). Moreover hs-CRP was significantly associated with WBC (p= 0.023) and IL-6 (p= 0.028) on admission, with IL-6 (p= 0.002) and IL-8 (p= 0.014) at 24. h and with IL-10 (p= 0.027) at 120. h. The above were not observed in the group with mild ketoacidosis. Conclusions: In the children with moderate/severe diabetic ketoacidosis of our study, increased levels of hs-CRP and IL-6 were observed, together with leukocytosis and neutrophilia, without the presence of infection. As hs-CRP was found to be strongly associated with the inflammatory IL-6, the prolonged elevation of hs-CRP levels in children with severe ketoacidosis could serve as a marker for the development of its severe complications. © 2012 The Canadian Society of Clinical Chemists.
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