The Association between ESR and CRP and Systemic Hypertension in Sarcoidosis

Abstract

Introduction. The association between the level of systemic inflammation and systemic hypertension (sHTN) among subjects with sarcoidosis has not been previously explored. Methods. A retrospective study was conducted to investigate the relation between the level of systemic inflammation in sarcoidosis, measured by various serum inflammatory markers, and sHTN. Results. Among a total of 108 cases with sarcoidosis (mean age: 53.4 years, 76.9% females), 55 (50.9%) had sHTN and 53 (49.1%) were normotensive. ESR was highly associated with sHTN. The patients with sHTN had higher mean ESR levels compared with normotensives (48.8 ± 35 versus 23.2 ± 27 mm/hr, resp.; P = 0.001). ROC curve analysis for ESR revealed an AUC value of 0.795 (95% CI: 0.692-0.897; P = 0.0001). With regard to CRP, there was a trend towards higher mean values in sHTN group (3.4 versus 1.7 mg/L; P = 0.067) and significantly higher prevalence of sHTN in the highest CRP quartile compared to the lowest one (69.6% versus 30%; OR 4.95; P = 0.017). ROC curve analysis for CRP revealed an AUC value of 0.644 (95% CI: 0.518-0.769; P = 0.03). On multivariate analysis, ESR and the CRP remained independent predictors for sHTN among subjects with sarcoidosis. Conclusion. Systemic inflammation is associated with the presence of sHTN in sarcoidosis.

Figure 1

Receiver operating characteristic (ROC) curve to detect the best cutoff value for ESR and CRP in the prediction of systemic hypertension in sarcoidosis patients. ESR had an AUC value of 0.795 (95% CI 0.692–0.897, P = 0.0001). A cutoff value for ESR of 30 mm/hr yielded a 62% sensitivity and 80% specificity for predicting systemic hypertension in sarcoidosis patients. With regard to CRP, the AUC value is 0.644 (95% CI 0.518–0.769, P = 0.03). A cutoff value for CRP of 3 mg/L yielded a 37% sensitivity and 95% specificity for predicting systemic hypertension in sarcoidosis patients.

Figure 2

Receiver operating characteristic (ROC) curve to detect the best cutoff value for albumin in the prediction of systemic hypertension in sarcoidosis patients. AUC value of 0.670 (95% CI 0.564–0.776, P = 0.003). An albumin level < 3.3 gm/dL yielded a 35% sensitivity and 87% specificity for predicting systemic hypertension in sarcoidosis patients.

Figure 3

Forest plot of multivariate logistic regression analysis demonstrating independent factors associated with systemic hypertension in sarcoidosis patients. Hosmer and Lemeshow P = 0.775.