C-reactive protein: Difference between revisions

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== Normal Values ==
 +
==Normal Values==
   
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* Post-spinal surgery, it peaks at 15 ± 25 a few days after OR
 +
*Post-spinal surgery, it peaks at 15 ± 25 a few days after OR
−
* Post-stroke, it can go up to 25 ± 10
 +
*Post-stroke, it can go up to 25 ± 10
−
* Post-TKA, it can go up to 155 mg/L
 +
*Post-TKA, it can go up to 155 mg/L
   
−
== Interpretation ==
 +
==Interpretation==
   
−
* The higher the value, the more likely to be a bacterial infection
 +
*The higher the value, the more likely to be a bacterial infection
   
−
== Further Reading ==
 +
=== Comparison to ESR ===
  +
{| class="wikitable"
  +
!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
⚫
=== Spine ===
  
   
  +
==Further Reading==
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* [https://doi.org/10.1016/j.spinee.2005.07.006 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
  
   
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=== Joints ===
 +
===Spine===
   
−
* [https://doi.org/10.1093/jac/dkr182 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.
 +
*[https://doi.org/10.1016/j.spinee.2005.07.006 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
⚫
** Although the population of patients with failure had higher CRP on average, CRP measurement was not useful for predicting failure in individual patients.
  
−
* [https://doi.org/10.1371/journal.pone.0009358 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
  
−
* [https://doi.org/10.1007/s00264-017-3430-5 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''
  
⚫
* [https://doi.org/10.1302/0301-620X.97B7.35500 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 ===
 +
===Joints===
   
−
* [https://doi.org/10.1001/archinternmed.2007.73 Prognostic Value of Serial C-Reactive Protein Measurements in Left-Sided Native Valve Endocarditis]. ''Arch Intern Med''. 2008;168(3):302-307.
 +
*[https://doi.org/10.1093/jac/dkr182 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.
⚫
** After 1 week following starting therapy, a CRP over 122 predicts failure (OR 10)
  
−
* [https://doi.org/10.1016/0003-4975(94)90206-2 Utility of C-reactive protein measurements for empyema diagnosis after pneumonectomy]. ''Annals Thoracic Surg''. 1994;57(4):933-936.
 +
*[https://doi.org/10.1371/journal.pone.0009358 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
⚫
** Post-operative rise or high-plateau of CRP predicted postoperative infection (empyema)
  
−
* [https://doi.org/10.1007/s11605-009-0928-1 Diagnostic Accuracy of C-reactive Protein for Intraabdominal Infections After Colorectal Resections]. ''J Gastrointest Surg''. 2009;13(9):1599-1606.
 +
*[https://doi.org/10.1007/s00264-017-3430-5 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.
⚫
** 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)
  
  ⚫
**Most common associated organisms were coagulase-negative staphylococci and ''C. acnes''
  ⚫
*[https://doi.org/10.1302/0301-620X.97B7.35500 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===
  +
  +
*[https://doi.org/10.1001/archinternmed.2007.73 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)
  +
*[https://doi.org/10.1016/0003-4975(94)90206-2 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)
  +
*[https://doi.org/10.1007/s11605-009-0928-1 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)
   
 
[[Category:Diagnostics]]
  
[[Category:Diagnostics]]

Revision as of 13:52, 15 September 2020

Normal Values

  • Post-spinal surgery, it peaks at 15 ± 25 a few days after OR
  • Post-stroke, it can go up to 25 ± 10
  • Post-TKA, it can go up to 155 mg/L

Interpretation

  • The higher the value, the more likely to be a bacterial infection

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

Further Reading

Spine

Joints

Other

References

  1. ^  Marios Michail, Edward Jude, Christos Liaskos, Spyridon Karamagiolis, Konstantinos Makrilakis, Dimitrios Dimitroulis, Othon Michail, Nicholas Tentolouris. The Performance of Serum Inflammatory Markers for the Diagnosis and Follow-up of Patients With Osteomyelitis. The International Journal of Lower Extremity Wounds. 2013;12(2):94-99. doi:10.1177/1534734613486152.
  2. ^  MARK J. SPANGEHL, BASSAM A. MASRI, JOHN X. OʼCONNELL, CLIVE P. DUNCAN. Prospective Analysis of Preoperative and Intraoperative Investigations for the Diagnosis of Infection at the Sites of Two Hundred and Two Revision Total Hip Arthroplasties*. The Journal of Bone & Joint Surgery. 1999;81(5):672-83. doi:10.2106/00004623-199905000-00008.
  3. ^  Praveen Hariharan, Christopher Kabrhel. Sensitivity of Erythrocyte Sedimentation Rate and C-reactive Protein for the Exclusion of Septic Arthritis in Emergency Department Patients. The Journal of Emergency Medicine. 2011;40(4):428-431. doi:10.1016/j.jemermed.2010.05.029.

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