Download CRP LEVELS IN PREECLAMPTIC PATIENTS IN KENYATTA

CRP LEVELS IN PREECLAMPTIC PATIENTS IN KENYATTA NATIONAL HOSPITAL –
A COMPARATIVE STUDY
DR. NDEGWA, P.M. (MBChB)
Supervisors:
1. DR. ANGELA AMAYO (MBChB, MMed Path)
DEPARTMENT OF CLINICAL CHEMISTRY
UNIVERSITY OF NAIROBI
2. DR. ZAHIDA QURESHI (MBChB, MMed Obs/Gyn)
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
UNIVERSITY OF NAIROBI
3. PROF. C. SEKADDE-KIGONDU (BSc, PhD)
DEPARTMENT OF CLINICAL CHEMISTRY
UNIVERSITY OF NAIROBI
Degree: MMed Pathology
2004
ABSTRACT
Background
Pre-eclampsia is a severe complication of pregnancy, occurring in 2-6% of all pregnancies.
Women who develop preeclampsia are at an increased risk of developing abruption-placenta,
acute renal failure, cerebral hemorrhage, disseminated intravascular coagulopathy, pulmonary
edema, circulatory collapse and eclampsia. Preeclampsia contributes to morbidity and mortality
in both the mother and fetus. It is the major cause of premature delivery and prenatal death. It is
responsible of a fifth to a third of all maternal deaths.
Pre-eclampsia has been described as a “disease of theories”. It has been linked to placental
dysfunction initiating the systemic vasospasm, ischaemia and thrombosis that eventually
damages maternal organs and causes placental infarction, fetal morbidity and fetal death. Of late,
there has been an increasing interest in possible link between infection-inflammation and
endothelial dysfunction, and between endothelial dysfunction and preeclampsia. C-reactive
protein (CRP) is a sensitive marker of systemic inflammation and therefore, will be raised in preeclampsia and can be used as a biologic marker of inflammation in pre-eclampsia. Currently,
there is no biological marker for preeclampsia.
The rationale of this study is the fact that preeclampsia is an important contributor to the
maternal and fetal morbidity and mortality in our set-up. No studies have been done to
investigate the role of infection/inflammation in the causation of preeclampsia locally.
Objectives: The main objective of the study was to determine CRP levels in preeclamptic and
non-preeclamptic patients and compare the levels in the two groups and then make relevant
recommendations based on the study findings.
Methods: This was a comparative descriptive study conducted at the KNH between January and
May 2004. A total of 140, comprising 73 preeclamptic patients and 67 normotensive pregnant
mothers were recruited for this study. Personal and medical data were obtained from each patient
using a questionnaire. Blood was taken for CRP and urea estimation.
Results: A total of 140, comprising of 73 preeclamptic and 67 non-preeclamptic patients were
recruited. The mean age was similar in the two groups. Mean systolic and diastolic blood
pressures were 150.3 mmHg and 97 mmHg for preeclamptic group and 120.8 mmHg and 73.7
mmHg for the non-preeclamptic group respectively. 82.1% of preeclamptic patients had oedema
with an odds ratio of 13.7 and 95% confidence interval from 6.0 to 31.3 and p-value<0.001.
Preeclamptics had higher levels of protein in urine (mean 1.6+) compared to the comparative
group (mean 0.25+) (p<0.001). Preeclamptics had higher levels of urea (mean 5.29 mmol/l,
p<0.001) than non-preeclamptics (mean 2.83 mmol/l). CRP levels were higher in preeclamptics
(mean 71.1mg/l) than non-preeclamptics (mean 50.0mg/l) (p<0.001).
Conclusion: CRP value is significantly higher in preeclampsia indicating an association between
inflammation and preeclampsia. This supports the postulate that preeclampsia results from
endothelial injury due to inflammation, among other theories.