Assessing the Relationship of CRP and ESR Inflammatory Biomarkers with Acute Multiple Sclerosis Attack and Clinical Syndrome Type in Patients Attending Selected Tehran Hospitals

Background — Multiple sclerosis (MS) is a chronic progressive neurological disease that results in the expansion of pathological pathways of neuronal destruction, such as neuroaxonal injury, apoptosis, and gliosis. Due to the complexity of the mechanisms involved in the pathophysiology of multiple sclerosis, finding reliable biomarkers is a challenging task. However, it is of utmost importance to identify effective biomarkers with high sensitivity that can determine the level of disease activity and progression. Objective — The goal of this study was to specify the relationship between inflammatory biomarkers, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), with acute attacks of MS and the type of clinical syndrome in patients attending Baqiyatallah Al-Azam and Shahid Mostafa Khomeini Hospitals from 2017 to 2021. Methods — This retrospective study was conducted in the above-mentioned medical centers. Initially, the medical records of all patients attending these medical centers for diagnosis and treatment of MS were reviewed. Then, the medical records of patients with acute attacks of MS diagnosed by a neurologist who met the inclusion criteria and were available at the time of the study were selected. Data were collected using a form designed by the investigator; it included personal characteristics, laboratory results of ESR, CRP, prognosis assessment (score), and clinical symptoms of the patients. The current prognosis score of the patients was determined based on the most recent medical examination. Data analysis was performed using logistic regression models and SPSS-16 statistical software. Results — Our data showed that ESR increased statistically significantly in individuals over 35 years of age vs. those under 35 years of age (P=0.024). In females, the changes in Expanded Disability Status Scale (EDSS) score were more significant than in males (P=0.018). ESR increased significantly in clinical syndrome of hemiparesis (P=0.018) and spinal syndrome (P=0.007). In women with clinical evidence of the optic neuritis syndrome, there was a significant increase in CRP (P=0.020). In women with clinical evidence of the hemiparesis syndrome, the changes in EDSS score were statistically significant (P=0.043). Conclusion — The likelihood of increasing the level of the inflammatory biomarker ESR during acute attacks of MS is higher compared with CRP. Moreover, the increase in ESR and CRP was found to be useful for the differentiation and diagnosis of various clinical syndromes.