Burnout and c-reactive protein levels: an integrative literature review

This is an integrative literature review of articles published in Portuguese, Spanish and English, with no date limit, with different study designs, available electronically in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), National Library of Medicine, National Institutes of Health (PubMed), Scopus, Latin American and Caribbean Center on Health Sciences Information (LILACS), Science Direct, and Springer Link databases. The selected articles were analyzed according to the Agency for Healthcare Research and Quality.

Results

Seven articles were analyzed. In most studies, there was a positive association between Burnout and high c-reactive protein levels, despite the general results being contradictory. Most articles that met the selection criteria were in English and indexed in the CINAHL database. The European continent concentrated most of studies. There was a predominance of cross-sectional study design.

Conclusion

Despite the positive association between Burnout and high c-reactive protein levels, the results of this review suggest that new, more robust studies be carried out in an attempt to explain the relationship between BS and CRP.

Burnout; C-Reactive Protein; Occupational health; Epidemiology

Year of publication/author/journal	Study type and country/level of evidence	Thematic considerations	Summary of conclusions
2005 Toker S, Shirom A, Shapira I, Berliner S, Melamed S(²²22. Toker S, Shirom A, Shapira I, Berliner S, Melamed S. The association between burnout, depression, anxiety, and inflammation biomarkers: c-reactive protein and fibrinogen in men and women. J Occup Health Psychol. 2005 Oct;10(4):344–62.) Journal Occupational Health Psychology	Cross-sectional Israel Level VI	They investigated the possibility that one of the mechanisms linking Burnout, assessed by the Shirom-Melamed Burnout Measure (SMBM) questionnaire, to cardiovascular morbidity is microinflammation, assessed in this study by ultrasensitive CRP (us-CRP) and fibrinogen concentrations. The sample included employees (630 women and 933 men) who performed routine tests at the center where the study took place.	They suggest that in women Burnout is associated with low-grade inflammation, as indicated by the association with hs-CRP and fibrinogen concentrations. This suggests that women with burnout may be at greater risk for diabetes and future cardiovascular events compared to those without Burnout. However, it does not rule out the possibility that exhausted men may also have a higher risk for the same outcomes of the disease.
2011 Danhof-Pont M, Veen T, Zitman F(²³23. Danhof-Pont MB, van Veen T, Zitman FG. Biomarkers in burnout: a systematic review. J Psychosom Res. 2011 Jun;70(6):505–24.) Journal of Psychosomatic Research	Systematic review Netherlands Level V	They assessed the evidence accumulated in international literature on potential biomarkers for Burnout.	Of the 38 biomarkers found in the 31 studies, none presented potential for Burnout. However, there was incompatibility of studies due to differences in the methods used.
2012 Fernández J, Clavero F, Gutiérrez M, Segura I, Bagur M, Fernández J(²⁴24. Domínguez Fernández JM, Herrera Clavero F, Villaverde Gutiérrez MC, Padilla Segura I, Martínez Bagur ML, Domínguez Fernández J. Síndrome de desgaste profesional en trabajadores de atención a la salud en el área sanitaria de Ceuta. Aten Primaria. 2012;44(1):30–5.) Atención Primaria	Cross-sectional Spain Level VI	They investigated Burnout levels in 200 voluntary participants, who attended their periodic health examinations at the Occupational Risk Prevention Service of the Hospital Universidad de Ceuta, using the Maslach Burnout Inventory (MBI).	BS was present in 17.2% of workers. There was a significant relationship between work and emotional exhaustion, depersonalization and professional achievement. CRP had a higher average in professionals with Burnout than in the others.
2013 Almadi T, Cathers I, Chow C(²⁵25. Almadi T, Cathers I, Chow CM. Associations among work-related stress, cortisol, inflammation, and metabolic syndrome. Psychophysiology. 2013;50(9):821–30.) Psychophysiology	Cross-sectional Jordan Level VI	They examined the relationship between occupational stress, cortisol and CRP in predicting metabolic syndrome (MS). Self-reported job stress measured by effort-reward imbalance ratio (ERI), anthropometric data, CRP, and salivary cortisol were collected from 204 healthy male workers.	The odds of MS in men with high ERI and cortisol were significantly higher than in men with low ERI and cortisol. CRP significantly was associated with MS. The odds of MS were significantly higher in obese men with elevated ERI and CRP levels. Thus, elevated ERI with high cortisol or CRP increases the risk of MS, especially among men with central obesity.
2017 Viljoen M, Claassen N (²⁶26. Viljoen M, Claassen N. Cynicism as subscale of burnout. Work. 2017;56(4):499–503.) WORK: A Journal of Prevention, Assessment & Rehabilitation	Cross-sectional South Africa Level VI	They investigated associations between scores on the cynicism (depersonalization) subscale of the Maslach Burnout Inventory-General Survey (MBI-GS) with levels of stress, anxiety, physical health based on a questionnaire and a series of risk indicators for physiological health, in 27 volunteer workers with a workload varying between 40 and 80 hours per week.	Cynicism, as reflected by the MBI-GS, increases with increasing stress and is positively correlated with CRP and may contribute to the health decline reported in the MBI.
2018 Metlaine A, Sauvet F, Merino D, Boucher T, Elbaz M, Delafosse J, et al(²⁷27. Metlaine A, Sauvet F, Gomez-Merino D, Boucher T, Elbaz M, Delafosse JY, et al. Sleep and biological parameters in professional burnout: A psychophysiological characterization. PLoS One. 2018;13(1):e0190607.) Plos ONE	Case-control study France Level IV	They analyze chronic exposure to stress (Burnout), sleep quality and biological repercussions with metabolic and inflammatory responses among 140 employees of a financial company, from different positions (assistant, assistant, director, senior and senior manager).	Participants with Burnout had higher HbA1C, blood glucose, CRP levels, lower vitamin D levels, increased numbers of leukocytes, neutrophils and monocytes and higher total cholesterol.
2020 González-Moret YA, Guzmán-Cuárez NE (²⁸28. González-Moret YA, Guzmán-Cuárez NE. Relación entre niveles de proteína c-reactiva y Síndrome de Burnout en médicos de postgrado. MEDUNAB. 2021;23(3):423–33.) MEDUNAB	Cross-sectional Venezuela Level VI	They assess the relationship between BS and hs-CRP levels in 174 physicians residing at a university hospital in Caracas.	Residents with Burnout had higher CRP levels compared to the group without Burnout. Likewise, female individuals, those who slept less than 8 hours a day and those who were subjected to family stress showed a statistically significant association with the development of the syndrome.

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[1] Corresponding author: Deborah Monize Carmo Maciel E-mail: deborahmonizecm@gmail.com