Assessing C reactive protein/albumin ratio as a new biomarker for polycystic ovary syndrome: a case–control study of women from Bahraini medical clinics

Abstract

ObjectivePolycystic ovary syndrome (PCOS) is an endocrine disorder affecting approximately one in seven women who experience androgen excess, menstrual cycle irregularities, frequent anovulation and a tendency for central obesity and insulin resistance. Chronic subclinical inflammation is now recognised as being common in the context of PCOS, which led to the postulation that PCOS may fundamentally be an inflammatory process. This study aimed to: (1) evaluate serum C reactive protein (CRP)/albumin ratio as a potential predictive biomarker for PCOS; (2) compare the relationship between CRP/albumin and PCOS to variables classically associated with the syndrome.DesignCase–control study.SettingAdult obstetrics/gynaecology, endocrinology and outpatient clinics; university hospital in Bahrain.Participants200 premenopausal women with a diagnosis of PCOS, and 119 ethnically matched eumenorrheic premenopausal women.Main outcome measuresCRP/albumin ratio, anthropometric measures, insulin resistance, androgen excess.ResultsIndependent of body mass index (BMI), receiver operating characteristic curve for CRP/albumin ratio as a selective biomarker for PCOS was 0.865 (95% CI 0.824 to 0.905), which was more sensitive than CRP alone. Binary regression analysis showed that CRP/albumin ratio outperformed classical correlates, Free Androgen Index and insulin resistance, in predicting PCOS for every BMI category.ConclusionCRP/albumin ratio, a marker for inflammation related to metabolic dysfunction, was found to have a stronger association with PCOS than either androgen excess or insulin resistance. Inflammation is known to be influenced by adiposity, but relative to controls, women with PCOS have higher levels of CRP/albumin irrespective of BMI. These findings support the view that inflammation plays a central role in the pathophysiology of PCOS.

The Possible Practical Implication of High CRP Levels in PCOS

“…Compared with controls, PCOS patients have increased CRP/albumin ratio irrespective of the BMI. 17 This finding supports the view that inflammation may be a central pathophysiologic player in PCOS, independent of BMI and adiposity.…”

“…These investigators have found that the CRP/albumin ratio had a higher specificity and sensitivity for inflammation associated with metabolic dysfunction than insulin resistance and androgens in matched PCOS patients. 17 Although none of our PCOS subjects 10 had any sign of inflammation, the higher erythrocyte sedimentation rate in the PCOS patients versus controls supports the study by Kelly et al 9 suggesting a chronic subclinical inflammatory process as an underlying mechanism of atherosclerosis in PCOS. 10,18 Visceral/abdominal fat distribution is independently associated with low-grade inflammation.…”

“…10 Our study, in 201 subjects (117 PCOS patients and almost a hundred controls, Figure1) suggested that CRP might indeed be a marker of possible prospective identification of young PCOS women prone to ultimately suffer CVD when they get older. 10 Recently, Kalyan et al 17 have shown that the ratio of CRP to albumin is a more accurate and stronger correlate of PCOS compared with both free androgens and insulin resistance. These investigators have found that the CRP/albumin ratio had a higher specificity and sensitivity for inflammation associated with metabolic dysfunction than insulin resistance and androgens in matched PCOS patients.…”

“…Recently, Kalyan et al 17 have shown that the ratio of CRP to albumin is a more accurate and stronger correlate of PCOS compared with both free androgens and insulin resistance. These investigators have found that the CRP/albumin ratio had a higher specificity and sensitivity for inflammation associated with metabolic dysfunction than insulin resistance and androgens in matched PCOS patients.…”

“…These investigators have found that the CRP/albumin ratio had a higher specificity and sensitivity for inflammation associated with metabolic dysfunction than insulin resistance and androgens in matched PCOS patients. 17…”