Background:
The relevance of high-sensitivity C-reactive protein (hsCRP), a
marker of low-grade systemic inflammation, remains unclear with regard
to its association with severity and clinical outcomes in wheeze/asthma.
We aimed to assess the role of hsCRP across different phenotypes and
severity levels.
Methods:
We studied children with preschool wheeze (≥ 2 episodes), and
patients with GINA-defined asthma (school-age/adult) compared with
healthy controls (HCs) in the well-characterized ALLIANCE (All Age
Asthma Cohort) study. HsCRP was measured (AU5800®-CRP-Latex test) in 944
study participants (pediatric: n = 728; adult: n = 216) at baseline.
Age-stratified analyses (age groups 0-5, 6-18, ≥ 18 years) of
standardized log10-transformed hsCRP concentrations (age,
sex, BMI, site) were performed using univariable tests and regression
models. The validated ASSESS score and its dimensions (exacerbations,
lung function, inhaled corticosteroids, symptom control) were primary
outcomes.
Results:
Adult patients with asthma showed higher hsCRP than HCs (OR 2.22,
95% CI 1.56-3.24). Across all ages, hsCRP increased with clinical
severity of wheeze/asthma. The ASSESS score correlated positively with
hsCRP in patients aged ≥ 6 years (R = 0.19, p = 0.007). hsCRP was
increased in school-age asthmatics with prior exacerbations (OR 1.37,
95% CI 1.01-1.87), and in adult asthmatics with impaired lung function
(R = 0.2, p = 0.013). Inhaled corticosteroid use was associated with
lower hsCRP in preschool wheezers (OR 0.66, 95% CI 0.50-0.85) but higher
levels in adults (OR 1.99, 95% CI 1.02-4.09).
Conclusions:
HsCRP was increased in adult asthmatics compared to HCs and was
associated with several severity-related clinical characteristics. ICS
use was associated with higher hsCRP levels in adults, potentially
reflecting greater disease severity, whereas ICS use in preschool
wheezers was associated with lower hsCRP levels. These age-dependent
effects may mirror varying disease courses across the lifespan and
progression of asthma. The association of hsCRP with asthma severity in
child- and adulthood may indicate its potential relevance for the course
of disease and monitoring clinical outcomes. Future longitudinal
studies are needed to assess, whether hsCRP may support therapy
monitoring.
Trial registration:
ClinicalTrials.gov; Pediatric arm: NCT02496468, Registration date: 03 July 2015; Adult arm: NCT02419274, Registration date: 14 April 2015.