C-reactive protein: Difference between revisions
From IDWiki
Content deleted Content added
added note about dialysis |
mNo edit summary |
||
| Line 77: | Line 77: | ||
=== Hemodialysis === |
=== Hemodialysis === |
||
* Theoretically removed with hemodialysis[[CiteRef::honore2019th]], but CRP is often elevated in stable patients on hemodialysis and peritoneal dialysis[[CiteRef::borazan2004th]] |
|||
* Theoretically removed with hemodialysis<ref>Honore, P.M., De Bels, D., Attou, R. ''et al.'' The challenge of removal of sepsis markers by continuous hemofiltration. ''Crit Care'' 23, 173 (2019). https://doi.org/10.1186/s13054-019-2464-z</ref>, but CRP is often elevated in stable patients on hemodialysis and peritoneal dialysis<ref>Borazan A, Aydemir S, Sert M, Yilmaz A. The effects of hemodialysis and peritoneal dialysis on serum homocysteine and C-reactive protein levels. Mediators Inflamm. 2004 Dec;13(5-6):361-4. doi: [https://doi.org/10.1080/09629350400008786 10.1080/09629350400008786]. PMID: 15770053; PMCID: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1781575/ PMC1781575].</ref> |
|||
==Further Reading== |
==Further Reading== |
||
Latest revision as of 17:24, 19 September 2024
Normal Values
- Post-spinal surgery, it peaks at 15 ± 25 mg/L a few days after OR
- Post-stroke, it can go up to 25 ± 10 mg/L
- Post-TKA, it can go up to 155 mg/L
Interpretation
- The higher the value, the more likely to be a bacterial infection
- Non-infectious chronic inflammation, such as from smoking, uremia, or cardiac ischemia: 2 to 10 mg/L
- Mild to moderate infection such as SSTI, cystitis or bronchitis: increases to 50 to 100 mg/L within 6 hours
- Typically begins to rise after 12 to 24 hours and has a half-life of about 19 hours
| Condition | Cutoff | Sensitivity | Specificity | Notes |
|---|---|---|---|---|
| Diabetic foot osteomyelitis | >10 | 0.85 | 0.59 | near-normal by day 7 to 21 of treatment1 |
| >14 | 0.84 | 0.83 | ||
| >17 | 0.77 | 0.89 | ||
| Necrotizing SSTI | >150 | included in LRINEC score | ||
| Prosthetic joint infection | >10 | 0.96 | 0.92 | 2 |
| Spondylodiscitis | normalizes within 3 months of treatment | |||
| Septic arthritis | ≥20 | 0.92 | 3 |
Comparison to ESR
| ESR | CRP | Clinical Scenarios |
|---|---|---|
| high | low | rheumatoid arthritis, infection, low albumin, elevated creatinine |
| low | high | low albumin |
- CRP less effected by older age than ESR
Hemodialysis
- Theoretically removed with hemodialysis4, but CRP is often elevated in stable patients on hemodialysis and peritoneal dialysis5
Further Reading
- Acute Phase Reactants in Infections: Evidence- Based Review and a Guide for Clinicians. Open Forum Infect Dis. 2015;2(3):ofv098. doi: 10.1093/ofid/ofv098.
Spine
- Serum C-reactive protein levels correlate with clinical response in patients treated with antibiotics for wound infections after spinal surgery. Spine J. 2006;6(3):311-315.
- CRP better than ESR
Joints
- Serial measurement of the C-reactive protein is a poor predictor of treatment outcome in prosthetic joint infection. J Antimicrob Chemo. 2011;66(7);1590-1593.
- Although the population of patients with failure had higher CRP on average, CRP measurement was not useful for predicting failure in individual patients.
- C-Reactive Protein, Erythrocyte Sedimentation Rate and Orthopedic Implant Infection. PLoS ONE. 2010:5(2):e9358.
- ESR and CRP have poor Sn and Sp for diagnosing hardware infections
- C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections. International Orthopaedics. 2017.
- 1/3 of culture-positive PJIs had normal CRP and 1/4 had normal ESR.
- Most common associated organisms were coagulase-negative staphylococci and C. acnes
- Seronegative infections in hip and knee arthroplasty: periprosthetic infections with normal erythrocyte sedimentation rate and C-reactive protein level
- 4% of PJI have normal CRP and ESR
- CoNS was more common, Staph. aureus less common
Other
- Prognostic Value of Serial C-Reactive Protein Measurements in Left-Sided Native Valve Endocarditis. Arch Intern Med. 2008;168(3):302-307.
- After 1 week following starting therapy, a CRP over 122 predicts failure (OR 10)
- Utility of C-reactive protein measurements for empyema diagnosis after pneumonectomy. Annals Thoracic Surg. 1994;57(4):933-936.
- Post-operative rise or high-plateau of CRP predicted postoperative infection (empyema)
- Diagnostic Accuracy of C-reactive Protein for Intraabdominal Infections After Colorectal Resections. J Gastrointest Surg. 2009;13(9):1599-1606.
- Post-resection day 3 (or 5 or 7) CRP predicts intraabdominal infection, with Sn 82% and Sp 73% using a cutoff of 190 mg/L (normal <10)
