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The ability of the wide range CRP assay to classify individuals with low grade inflammation into cardiovascular risk
Tomer Ziv-Baran1, Shani Shenhar-Tsarfaty2, Inbal Etz-Hadar2
1Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Wide range C-reactive protein (wrCRP) can serve as a cost-effective alternative to high-sensitivity C-reactive protein (hsCRP) for routine cardiovascular risk assessment. Calibration and adjusted thresholds improve risk stratification accuracy in apparently healthy individuals.
Area of Science:
- Clinical Chemistry
- Cardiovascular Disease Biomarkers
- Health Economics
Background:
- High-sensitivity C-reactive protein (hsCRP) is standard for cardiovascular risk stratification.
- Wide range C-reactive protein (wrCRP) is proposed as a potential alternative.
- The utility of wrCRP for cardiovascular risk assessment remains unevaluated.
Purpose of the Study:
- To evaluate the potential of wrCRP as an alternative to hsCRP for cardiovascular risk assessment.
- To assess the agreement and reclassification of cardiovascular risk between wrCRP and hsCRP methods.
- To determine if wrCRP can be a cost-effective tool for routine cardiovascular risk evaluation.
Main Methods:
- 15,780 apparently healthy individuals were analyzed for both wrCRP and hsCRP levels.
- Agreement was assessed using Bland-Altman and concordance correlation coefficient.
- Deming regression and Cohen's kappa were used for calibration and risk reclassification analysis.
Main Results:
- A high correlation (r=0.98) was observed between wrCRP and hsCRP, necessitating calibration.
- A calibration equation (Adjusted wrCRP=0.3136+0.8803×wrCRP) resulted in high agreement and 8.4% risk reclassification.
- Adjusting the intermediate risk threshold to 0.9mg/L yielded near-perfect agreement (kappa=0.87) with minimal major reclassification.
Conclusions:
- wrCRP assay can be a viable routine method for cardiovascular risk assessment.
- This approach is particularly relevant in resource-limited settings.
- wrCRP offers a cost-effective alternative for routine health checkups.
Background:
High sensitivity C-reactive protein (hsCRP) has become a routine assessment tool to discriminate between patients at low, intermediate or high risk for cardiovascular events using the threshold values of 1 and 3mg/L, respectively. Over the past years, several studies have proposed the wide range C-reactive protein (wrCRP) as an alternative to the hsCRP in various clinical scenarios. However, the potential use of wrCRP in assessing the cardiovascular risk has not yet been evaluated.
Methods:
Both wrCRP and hsCRP were evaluated in 15,780 apparently healthy individuals who underwent a routine annual checkup in the Tel Aviv Sourasky Medical Center. Individuals with CRP levels >5mg/L were excluded. Agreement between the two methods was observed using the Bland-Altman method and the concordance correlation coefficient. Deming regression was used to build a calibration equation. Reclassification of individuals' risk level was observed and Cohen's kappa was used to evaluate risk agreement.
Results:
A high correlation (r=0.98) along with a significant difference (p<0.001) between hsCRP and wrCRP raised the need for calibration. A simple calibration equation (Adjusted wrCRP=0.3136+0.8803×wrCRP) led to high agreement which enabled 8.4% reclassification of the risk group. A change in the intermediate risk threshold value from 1 to 0.9mg/L led to an almost perfect agreement (kappa=0.87, p<0.001) and a low reclassification rate (7.6%), with under 0.05% of the population undergoing a major reclassification (from high to low risk or vice versa).
Conclusions:
In the era of limited financial resources, wrCRP assay may be used as a reasonable routine assay to evaluate the cardiovascular risk in patients undergoing a routine annual checkup.
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