Longitudinal association between CRP levels and risk of psychosis: a meta-analysis of population-based cohort studies

Abstract

Meta-analyses of cross-sectional studies suggest that patients with psychosis have higher circulating levels of C-reactive protein (CRP) compared with healthy controls; however, cause and effect is unclear. We examined the prospective association between CRP levels and subsequent risk of developing a psychotic disorder by conducting a systematic review and meta-analysis of population-based cohort studies. Databases were searched for prospective studies of CRP and psychosis. We obtained unpublished results, including adjustment for age, sex, body mass index, smoking, alcohol use, and socioeconomic status and suspected infection (CRP > 10 mg/L). Based on random effect meta-analysis of 89,792 participants (494 incident cases of psychosis at follow-up), the pooled odds ratio (OR) for psychosis for participants with high (>3 mg/L), as compared to low (≤3 mg/L) CRP levels at baseline was 1.50 (95% confidence interval [CI], 1.09-2.07). Evidence for this association remained after adjusting for potential confounders (adjusted OR [aOR] = 1.31; 95% CI, 1.03-1.66). After excluding participants with suspected infection, the OR for psychosis was 1.36 (95% CI, 1.06-1.74), but the association attenuated after controlling for confounders (aOR = 1.23; 95% CI, 0.95-1.60). Using CRP as a continuous variable, the pooled OR for psychosis per standard deviation increase in log(CRP) was 1.11 (95% CI, 0.93-1.34), and this association further attenuated after controlling for confounders (aOR = 1.07; 95% CI, 0.90-1.27) and excluding participants with suspected infection (aOR = 1.07; 95% CI, 0.92-1.24). There was no association using CRP as a categorical variable (low, medium or high). While we provide some evidence of a longitudinal association between high CRP (>3 mg/L) and psychosis, larger studies are required to enable definitive conclusions.

Fig. 1. Odds ratios for psychosis at follow-up for individuals with high (>3 mg/L), as compared to low (≤3 mg/L), CRP levels at baseline.

a Unadjusted analysis; b adjusted for age, sex and BMI; c adjusted for age, sex, BMI, smoking, alcohol consumption and socioeconomic status. * see “Methods” for specific covariates used for each study. BMI body mass index, CRP C-reactive protein, mg/L milligrams per litre.

Fig. 2. Odds ratios for psychosis at follow-up per SD increase in CRP levels at baseline.

a Unadjusted analysis; b adjusted for age, sex and BMI; c adjusted for age, sex, BMI, smoking, alcohol consumption and socioeconomic status. * see “Methods” for specific covariates used for each study. BMI body mass index, CRP C-reactive protein, SD standard deviation.