C-reactive protein concentrations across the mood spectrum in bipolar disorder: a systematic review and meta-analysis

Fernandes, Brisa S, Steiner, Johann, Molendijk, Marc L., Dodd, Seetal, Nardin, Patricia, Gonçalves, Carlos-Alberto, Jacka, Felice, Köhler, Cristiano A., Karmakar, Chandan, Carvalho, André F. and Berk, Michael 2016, C-reactive protein concentrations across the mood spectrum in bipolar disorder: a systematic review and meta-analysis, Lancet psychiatry, vol. 3, no. 12, pp. 1147-1156, doi: 10.1016/S2215-0366(16)30370-4.

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Title C-reactive protein concentrations across the mood spectrum in bipolar disorder: a systematic review and meta-analysis
Author(s) Fernandes, Brisa SORCID iD for Fernandes, Brisa S orcid.org/0000-0002-3797-7582
Steiner, Johann
Molendijk, Marc L.
Dodd, SeetalORCID iD for Dodd, Seetal orcid.org/0000-0002-7918-4636
Nardin, Patricia
Gonçalves, Carlos-Alberto
Jacka, FeliceORCID iD for Jacka, Felice orcid.org/0000-0002-9825-0328
Köhler, Cristiano A.
Karmakar, ChandanORCID iD for Karmakar, Chandan orcid.org/0000-0003-1814-0856
Carvalho, André F.
Berk, MichaelORCID iD for Berk, Michael orcid.org/0000-0002-5554-6946
Journal name Lancet psychiatry
Volume number 3
Issue number 12
Start page 1147
End page 1156
Total pages 10
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2016-12
ISSN 2215-0366
Summary BACKGROUND: Inflammatory processes and neural-immune interactions have been implicated in the pathogenesis of psychiatric conditions, but studies in bipolar disorder are inconclusive so far. We aimed to investigate whether peripheral concentrations of C-reactive protein (CRP), an acute-phase response protein of inflammatory activity, are increased in bipolar disorder across the mood spectrum. METHODS: In this systematic review and meta-analysis, we searched MEDLINE, the Cochrane Library, Scopus, and Web of Knowledge from database inception to Aug 14, 2016, for studies that measured serum and plasma CRP concentrations in adult patients with bipolar disorder (as defined by DSM-IV-TR) and healthy controls. We extracted data from published reports. We did three between-group meta-analyses comparing CRP concentrations in patients in mania, depression, or euthymia, with those in healthy controls (cross-sectional studies), and two within-group meta-analyses comparing changes in CRP concentrations before and after treatment of an index manic or depressive episode (longitudinal studies). We used Hedges' adjusted g to calculate effect sizes and pooled results using random-effect models. We also did meta-regression analyses by mood state to investigate possible moderators of CRP concentrations. FINDINGS: We identified 27 studies representing 2161 patients with bipolar disorder and 81 932 healthy controls. Compared with healthy individuals, CRP concentrations were moderately increased in people with bipolar disorder during depression (g 0·67, 95% CI 0·23 to 1·11; p=0·003) and euthymia (0·65, 0·40 to 0·90; p<0·0001) and more substantially increased during mania (0·87, 0·58 to 1·15; p<0·0001). The extent of the increases in CRP concentrations in mania and depression was not related to symptom severity (p=0·256 for mania and p=0·626 for depression). CRP concentrations were moderately decreased after resolution of an index manic episode (-0·36, -0·66 to -0·05; p=0·022) and slightly decreased after resolution of an index depressive episode (-0·18, -0·30 to -0·07; p=0·002). INTERPRETATION: CRP concentrations are increased in bipolar disorder regardless of mood state, but are higher during mania than in depression and euthymia, suggesting an increased inflammatory burden in mania.
Language eng
DOI 10.1016/S2215-0366(16)30370-4
Field of Research 111714 Mental Health
080109 Pattern Recognition and Data Mining
Socio Economic Objective 920410 Mental Health
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2016, Elsevier
Persistent URL http://hdl.handle.net/10536/DRO/DU:30090240

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