Correlation of serum C-reactive protein in painful vaso-occlusive crisis in sickle cell disease and its response to analgesic therapy

Background: Sickle cell disease is characterized by chronic hemolysis, frequent infections and recurrent occlusions of microcirculations, which causes painful crisis and results in chronic organ damage and failure. Occlusion of microcirculation and infection are important factors that stimulates production of cytokines and acute phase proteins like C- reactive protein. Aim: To estimate serum C-reactive protein levels in cases of painful vaso-occlusive crisis of sickle cell disease, to study correlation of level of serum C-reactive protein with duration of painful vaso-occlusive crisis of sickle cell disease, to study relation between level of serum C-reactive protein and treatment response of analgesic versus analgesic opioid in cases of painful vaso-occlusive crisis of sickle cell disease. Materials and methods: This hospital based observational case control study was carried out at IGGMC, Nagpur, Maharashtra, India. Total 31 cases of sickle cell vaso-occlusive crisis, of age 12 years and above, admitted in hospital and 31 controls included in study. Study protocol was followed in each case. Results: Musculoskeletal, joint pain (83.87%) was most common form of presentation. Exhaustion and severe physical activity (25.80%) was most common precipitating factor. Mean hemoglobin, bilirubin showed statistically significant difference in cases compared to control. Mean CRP on day 1 (40.87±17.22 mg/L) was significantly high compared to control (3.67±0.77 mg/L) with statistical significance p<0.0001. Conclusion: Serum C- reactive protein levels are higher in cases of painful sickle cell vaso-occlusive crisis than control. C- reactive protein levels correlate positively with duration of pain in cases of painful sickle cell VOC. Steady state C- reactive protein level is normal in cases of sickle cell anemia. Cases of painful sickle cell VOC in whom opioid had to be used in addition to NSAIDs for pain management had higher CRP levels than who responded to NSAIDs alone. The cases in whom serum C- reactive protein levels were >33.2mg/L required use of opioid for pain management of sickle cell VOC. However, sample size of the present study is small and will need further prospective study.