Correlation Of Urine Albumin Creatinine Ratio And C-Reactive Protein Levels on Carotid Artery Intima-Media Thickness And Flow-Mediated Dilatation Response In Children and Adolescent with Type 1 Diabetes Mellitus At Dr Saiful Anwar Hospital Malang

Abstract

Background: Early and accelerated atherosclerosis is a major cause of cardiovascular disease and often causes premature death in T1DM patients. In T1DM, atherosclerosis can be detected since adolescence. The initial association between urinary albumin to creatinine ratio (ACR) and c-reactive protein (hs-CRP) with subclinical cardiovascular disease in children and adolescents with T1DM supported findings from previous studies. Imaging tests using ultrasound can detect subclinical atherosclerosis in this patient population. Carotid artery intima-me- dia thickness (cIMT) and flow-mediated dilatation response (FMD) have been frequently used to detect subclini- cal atherosclerosis. Objectives: To find correlation between ACR and hsCRP on the thickness values of cIMT and FMD in children and adolescent T1DM patients at Dr Saiful Anwar Hospital Malang Methods: This is a cross-sectional study with 82 subjects of T1DM patients who routinely control the pediatric outpatient clinic of RSUD Dr. Saiful Anwar Malang, with the research period January – July 2019 and December 2021 – March 2022. Subjects were undergone valcuras ultrasound examination for measurements of cIMT and FMD. Blood sample from subjects were also collected to detect level of ACR and hsCRP. Associations between the study variables were estimated by calculating the Pearson’s rank correlation. Result: There was correlation between ACR with FMD and cIMT (r=-0.593; p=0.000 and r=0.339; p=0.002, respectively). ACR was negatively correlated with FMD and positively correlated with cIMT. There was also correlation between hsCRP with FMD and cIMT (p=-0.375; p=0.001 and r= 0.414; p=0.023, respectively). hsCRP was negatively correlated with FMD and positively correlated with cIMT. Conclusion: ACR and hsCRP have a correlation with increasing CIMT values and decreasing FMD values in children and adolescents with T1DM patients. Preadolescent children with T1DM displayed evidence of increased low-intensity vascular inflammation, increased cIMT and attenuated FMD measurements. These data suggest that endothelial dysfunction and systemic inflammation are present even in preadolescent children with T1DM