Serum High Sensitivity-C-reactive Protein and Hs-CRP/albumin Ratio in Workers Exposed to Lead from Lead-battery Manufacturing Process
Ravibabu Kalahasthi, Tapu Barman
CDC/AHA risk categories of serum Hs-CRP, Hs-CRP/albumin ratio, Pb-exposure, ROC Curve.,Blood lead
Citation Information :
Kalahasthi R, Barman T. Serum High Sensitivity-C-reactive Protein and Hs-CRP/albumin Ratio in Workers Exposed to Lead from Lead-battery Manufacturing Process. Indian J Med Biochem 2018; 22 (2):120-125.
Purpose: The present study assessed the serum high sensitivity- C-reactive protein (Hs-CRP) and Hs-CRP/albumin ratio of workers exposed to lead (Pb) from Pb-battery manufacturing process with the use of center for disease control and prevention (CDC)/american hospital association (AHA) recommended risk categories of serum Hs-CRP and receiver operating characteristic curve (ROC) to examine the diagnostic accuracy.
Materials and methods: This study involved a total of 256 subjects, including both study and control. The study group consists of 176 workers involved in Pb-battery manufacturing process. Control group consists of 80 office workers with no occupational exposure to Pb. Blood lead levels (BLLs) in the study and control groups were determined with atomic absorption spectrophotometer. Serum Hs-CRP concentration was determined using the latex turbidimetric immunoassay method. Serum albumin concentration was measured by using the bromo-cresol green (BCG) method. The serum Hs-CRP/albumin ratio was calculated by dividing the serum Hs-CRP by the serum albumin. Analysis of data was done by using statistical package for the social sciences (SPSS), version 20.0.
Results: The mean levels of serum Hs-CRP and Hs-CRP/ albumin ratio were shown significantly higher in the study group than in the control group. The abnormal frequency distribution of serum Hs-CRP and Hs-CRP/albumin ratio among study group found significantly higher than in control. Spearmen correlation coefficients (r) was found a positive and significant association between BLLs and serum Hs-CRP (r = 0.190) and Hs-CRP/albumin ratio (r = 0.193). Area under the curve (AUC) of ROC values among the study group noted as 0.465 (95% of CI = 0.393-0.537, p = 0.366) for serum albumin, 0.601(95% of CI = 0.526-0.675, p = 0.010) for serum Hs-CRP and 0.598 (95% of CI = 0.524-0.672, P = 0.012) for Hs-CRP/ albumin ratio.
Conclusion: The levels of Hs-CRP and Hs-CRP/albumin ratio were significantly increased in the study group as compared to the control and reduction of Pb-exposure is needed to avoid the risk of cardiovascular disease (CVD) and atherosclerosis.
Abdallah ESH, Badary DM. Folic acid protects against lead acetate-induced hepatotoxicity by decreasing NF-B, IL-1 production and lipid peroxidation mediataed cell injury. Pathophysiology [Internet]. Elsevier BV; 2017 Mar;24(1):39-44.
Ibeh N, Aneke J, Okocha C, Okeke C, Nwachukwuma J. The Influence of Occupational Lead Exposure on Haematological Indices among Petrol Station Attendants and Automobile Mechanics in Nnewi, South-East Nigeria. Journal of Environmental and Occupational Science [Internet]. ScopeMed International Medical Journal Management and Indexing System; 2016;5(1):1-6.
Bagepally B, Kalahasthi R, Barman T. Serum Iron, Zinc and its relationship with Blood lead levels among lead exposed worker from lead battery plant. Journal of Molecular Pathophysiology [Internet]. ScopeMed International Medical Journal Management and Indexing System; 2016;5(3):49.
Navas-Acien A, Selvin E, Sharrett AR, Calderon-Aranda E, Silbergeld E, Guallar E. Lead, Cadmium, Smoking, and Increased Risk of Peripheral Arterial Disease. Circulation [Internet]. Ovid Technologies (Wolters Kluwer Health); 2004 Jun 29;109(25):3196-3201.
Peters JL, Kubzansky LD, Ikeda A, Fang SC, Sparrow D, Weisskopf MG, et al. Lead Concentrations in Relation to Multiple Biomarkers of Cardiovascular Disease: The Normative Aging Study. Environmental Health Perspectives [Internet]. Environmental Health Perspectives; 2012 Mar;120(3):361-366.
Chibowska K, Baranowska-Bosiacka I, Falkowska A, Gutowska I, Goschorska M, Chlubek D. Effect of Lead (Pb) on Inflammatory Processes in the Brain. International Journal of Molecular Sciences [Internet]. MDPI AG; 2016 Dec 19;17(12):2140.
Aoki Y, Brody DJ, Flegal KM, Fakhouri THI, Axelrad DA, Parker JD. Blood Lead and Other Metal Biomarkers as Risk Factors for Cardiovascular Disease Mortality. Medicine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2016 Jan;95(1):e2223.
Xu C, Shu Y, Fu Z, Hu Y, Mo X. Associations between lead concentrations and cardiovascular risk factors in U.S. adolescents. Scientific Reports [Internet]. Springer Nature; 2017 Aug 22;7(1).
Datta S, Iqbal Z, Prasad KR. Comparison Between Serum hsCRP and LDL Cholesterol for Search of a Better Predictor for Ischemic Heart Disease. Indian Journal of Clinical Biochemistry [Internet]. Springer Nature; 2011 Jan 19;26(2):210-213.
Wang A, Liu J, Li C, Gao J, Li X, Chen S, et al. Cumulative Exposure to High Sensitivity C Reactive Protein Predicts the Risk of Cardiovascular Disease. Journal of the American Heart Association [Internet]. Ovid Technologies (Wolters Kluwer Health); 2017 Oct 11;6(10):e005610.
Burroughs Pena MS, Rollins A. Environmental Exposures and Cardiovascular Disease. Cardiology Clinics [Internet]. Elsevier BV; 2017 Feb;35(1):71-86.
Sponder M, Fritzer-Szekeres M, Marculescu R, Mittlbock M, Uhl M, Kohler-Vallant B, Strametz-Juranek J. Blood and urine levels of heavy metal pollutants in female and male patients with coronary artery disease. Vascular health and risk management. 2014;10:311.
Bal C, Karakulak U, Gunduzoz M, Ercan M, Tutkun E, Y.lmaz OH. Evaluation of Sub clinical Inflammation with Neutrophil Lymphocyte Ratio in Heavy Metal Exposure. J Clin Anal Med 2016;7(5):643-647.
Prokopowicz A, Sobczak A, Szu.a-Chraplewska M, Zaciera M, Kurek J, Szo.tysek-Bo.dys I. Effect of occupational exposure to lead on new risk factors for cardiovascular diseases. Occup Environ Med. 2017 May 1;74(5):366-373.
Khan D, Qayyum S, Saleem S, Khan F. Lead-induced oxidative stress adversely affects health of the occupational workers. Toxicology and Industrial Health [Internet]. SAGE Publications; 2008 Oct;24(9):611-618.
Kasperczyk A, Prokopowicz A, Dobrakowski M, Pawlas N, Kasperczyk S. The Effect of Occupational Lead Exposure on Blood Levels of Zinc, Iron, Copper, Selenium and Related Proteins. Biological Trace Element Research [Internet]. Springer Nature; 2012 Aug 26;150(1-3):49-55.
Pollack AZ, Mumford SL, Sjaarda L, Perkins NJ, Malik F, Wactawski- Wende J, Schisterman EF. Blood lead, cadmium and mercury in relation to homocysteine and C-reactive protein in women of reproductive age: a panel study. Environmental Health. 2017 Dec;16(1):84.
Songdej N, Winters PC, McCabe MJ, Wijngaarden E van. A population-based assessment of blood lead levels in relation to inflammation. Environmental Research [Internet]. Elsevier BV; 2010 Apr;110(3):272-277.
Sirivarasai J, Wananukul W, Kaojarern S, Chanprasertyothin S, Thongmung N, Ratanachaiwong W, et al. Association between inflammatory marker, environmental lead exposure, and glutathione S-transferase gene. Biomed Res Int. 2013;2013:474963.
Westberg H, Elihn K, Andersson E, Persson B, Andersson L, Bryngelsson I-L, et al. Inflammatory markers and exposure to airborne particles among workers in a Swedish pulp and paper mill. International Archives of Occupational and Environmental Health [Internet]. Springer Nature; 2016;89:813-822.
Markert A, Baumann R, Gerhards B, Gube M, Kossack V, Kraus T, et al. Single and Combined Exposure to Zinc- and Copper-Containing Welding Fumes Lead to Asymptomatic Systemic Inflammation. Journal of Occupational and Environmental Medicine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2016 Feb;58(2):127-132.
Elango N, Kasi V, Vembhu B, Poornima JG. Chronic exposure to emissions from photocopiers in copy shops causes oxidative stress and systematic inflammation among photocopier operators in India. Environmental Health [Internet]. Springer Nature; 2013 Sep 11;12(1):78.
Mehere BA, Patil MB, Pingle SK, Thakkar LR, Butle AB. Determination of levels of C-Reactive Protein (CRP) and Liver function test parameters among occupationally exposed stone quarry workers of Central India: A quest in pursuit of Biomarkers of occupational diseases of stone quarries. Bull. Env. Pharmacol. Life Sci. 2016 May 6;5:33-38.
Hertel S, Viehmann A, Moebus S, Mann K, Brocker-Preuss M, Mohlenkamp S, et al. Influence of short-term exposure to ultrafine and fine particles on systemic inflammation. European Journal of Epidemiology [Internet]. Springer Nature; 2010 Jun 18;25(8):581-592.
Adukauskien D, iginskien A, Adukauskait A, Pentiokinien D, ˇSlapikas R, eponien I. Clinical relevance of high sensitivity C-reactive protein in cardiology. Medicina [Internet]. MDPI AG; 2016;52(1):1-10.
Pais P, Kamath D, Xavier D, Sigamani A. High sensitivity C-reactive protein (hsCRP) and cardiovascular disease: An Indian perspective. Indian Journal of Medical Research [Internet]. Medknow; 2015;142(3):261.
World Health Organization. Recommended health-based limits in occupational exposure to heavy metals. Report of a WHO Study Group. Geneva, Switzerland; 1980.
Chandrashekara S. C-reactive protein: An inflammatory marker with specific role in physiology, pathology, and diagnosis. Internet Journal of Rheumatology and Clinical Immunology. 2014 Oct 30;2(S1).
Hwang JC, Jiang MY, Lu YH, Wang CT. Precedent fluctuation of serum hs-CRP to albumin ratios and mortality risk of clinically stable hemodialysis patients. PloS one. 2015 Mar 20;10(3):e0120266.