Hs-CRP and NLR as Markers of Perioperative Stress

Study Overview
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Brief Summary
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The stress response to surgery is a result of tissue injury with local and systemic inflammation that contributes to the postoperative outcome. Anesthesia is known to effect perioperative stress response Regional anesthesia modifies stress response through afferent blockage whereas general anesthesia affects the stress response via central modulation. High sensitive C-reactive protein and neutrophil to lymphocyte ratio are used for evaluation of inflammation. The aim of this study was to document the value hs-CRP and NLR in perioperative stress response in two different anesthesia methods applied to term pregnant women undergoing elective ceserean section (C/S).

Detailed Description
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The stress response to surgery is a result of tissue injury with local and systemic inflammation that contributes to the postoperative outcome. Anesthesia is known to effect perioperative stress response. Regional anesthesia modifies stress response through afferent blockage whereas general anesthesia affects the stress response via central modulation. High sensitive C-reactive protein and neutrophil to lymphocyte ratio are used for evaluation of inflammation. The degree of systemic inflammation has been determined by numerous pro- and anti-inflammatory cytokines.The cytokines control the release of C -reactive protein (CRP) which is an acute phase reactant produced by the liver. CRP is a widely used marker of inflammation and tissue damage. High sensitive C -reactive protein (hs-CRP), is a more sensitive assay for detection of inflammation measured by particle-enhanced immunonephelometry . A rapid increase in hs-CRP may indicate inflammation and tissue damage . Another well-known indicator of inflammation is neutrophil-to-lymphocyte ratio (NLR). NLR correlates strongly with elevated plasma levels of circulating proinflammatory cytokineS. The aim of this study was to document the value hs-CRP and NLR in perioperative stress response in two different anesthesia methods applied to term pregnant women undergoing elective ceserean section (C/S).

Official Title
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Hs-CRP and NLR as Markers of Perioperative Stress in Maternal And Fetal Blood in Different Anesthesia Techniques

Conditions
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Cesarean Delivery Affecting Newborn, Anesthesia, Inflammatory Response

Intervention / Treatment
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* Diagnostic Test: HSCRP and NLR


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Healthy pregnant women without chronic diseases at term (36-41 weeks of pregnancy) Exclusion Criteria: refusal to participate, chronic diseases (diabetes mellitus, hypertension, heart disease, renal disease, hypo/hyperthyroidism) any infections, smoking contraindications for central neuraxial anesthesia. Pregnancies complicated with rupture of membranes, placenta previa, eclampsia/preeclampsia, and abruptio placenta fetal anomalies, abnormality detected at fetal well-being tests

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 42 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Group G<br>Patients undergoing general anesthesia HSCRP and NLR measurement | Diagnostic Test: HSCRP and NLR<br>* hs-CRP levels and NLR values will be studied from routine blood samples.<br>|
| Group R<br>Patients undergoing spinal anesthesia HSCRP and NLR measurement | Diagnostic Test: HSCRP and NLR<br>* hs-CRP levels and NLR values will be studied from routine blood samples.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluation of the change in HSCRP levels | Measurement of high sensitive C reactive protein levels in different time points in order to evaluate the change in HSCRP levels | preoperative, postoperative 2nd and 4th hours, fetal cord blood sample (following delivery) | 
| Evaluation of the change in NLR | Measurement of the Neutrophil to Lymphocyte Ratio in different time points in order to evaluate the change in the Neutrophil to Lymphocyte Ratios | preoperative, postoperative 2nd and 4th hours, fetal cord blood sample (following delivery) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cesarean section, anesthesia, hs-CRP, NLR