Serum C-reactive protein

Clinical improvement, especially the disappearance of fever or defervescence, is the best parameter to judge the response to therapy. However, clinical improvement can be difficult to monitor objectively in critically ill patients with multi-system disease. Also, clinical improvement can be very slow for certain infections, e.g. tuberculosis. The peripheral blood leukocyte count including the presence of early stages in leucocyte differention and the level of serum C-Reactive Protein (CRP, an acute phase protein) are parameters that can be sequentially determined to monitor improvement. For monitoring the effect of treatment of chronic infections such as endocarditis or osteomyelitis, weekly determination of the erythrocyte sedimentation rate has been proven useful. 

P5. Pezzilli, R., Billi, P., Miniero, R., Fiocchi, M., Cappelletti, O., Morselli-Labate, A. M., Barakat, B., Sprovieri, G., and Miglioli, M., Serum interleukin 6, interleukin 8, and beta-2 microglobulin in early assessment of severity of acute pancreatitis. Comparison with serum C-reactive protein. Dig. Dis. Sci. 40, 2341-2348 (1995). 

Patients require close observation and monitoring of vital signs during treatment to ensure response to therapy. Serum C-reactive protein and white... 

Of 52 patients with colorectal cancer treated with a median of six 3-weekly cycles of raltitrexed 1.5-3.0 mg/m combined with oral carmofur 300-400 mg/m on cycle days 2-14, 39 had a fever on days 2-9 after receiving raltitrexed, 49 had fatigue, and 49 had a raised serum C-reactive protein concentration without a documented infection (6). Median concentrations of C-reactive protein, interleukin-6, interleukm-8, and tumor necrosis factor-alfa were higher 7 days after raltitrexed or raltitrexed + carmofur than at baseline. The authors suggested that patients with colorectal cancer treated with raltitrexed may develop drug-related systemic inflammation, which may be difficult to distinguish from infection. 

Data from Ford ES, Giles WH, et al. Population distribution of high-sensitivity C-reactive protein among US men findings from National Health and Nutrition Examination Survey 1999-2000. Clin Chem 2003 49 686-90 Yamada S, Gotoh T, et aJ. Distribution of serum C-reactive protein and its association with atherosclerotic risk factors in a Japanese population Jichi Medical School Cohort Study, Am J Epidemiol 2001 153 1183-90. 

Koenig W, Sund M, et al. Refinement of the association of serum C-reactive protein concentration and coronary heart disease risk by correction for within-subject variation over time the MONICA Augsburg studies, 1984 and 1987. Am ] Epidemiol 2003 158 357-64. 

Yamada S, Gotoh T, et al. Distribution of serum C-reactive protein and its association with atherosclerotic risk factors in a Japanese population Jichi Medical School Cohort Study. Am J Epidemiol 2001 153 1183-90. 

Reminiscent of the above experimental studies, inflammatory responses are also seen in those clinical scenarios where coronary microembolization is likely to occur, i.e. nuclear factor - v.B is activated in patients with unstable angina79 and serum C-reactive protein is increased in patients who died from an acute coronary syndrome80. Interleukin-6 was higher up to 48 h in patients with unstable angina who experienced a major adverse cardiac event.81 These markers of inflammation were assumed to originate from... 

Morley, J.J. and Kushner, I. (1982) Serum C-reactive protein levels in disease. Annals ofthe New York Academy ofSciences, 389, 406-18. 

Examples of positive and negative acute phase proteins are given in Table VI-1. C-reactive protein and serum amyloid A are elevated in serum by as much as 1000-fold from their basal values. Serum amyloid A is an apolipoprotein it is synthesized in hepatocytes in response to inflammatory stimuli and associated with HDL. The function of serum amyloid A is not clear and it is not commonly measured as an acute phase reactant. However, serum C-reactive protein (so named because it reacts with pneumococcal C-jK)lysaccharide) is measured. It binds with phospho-choline of pathogens, phospholipid constituents of damaged blood cells, and phagocytic cells, and it activates the complement system. All of the functions of C-reactive protein modulate inflammatory conditions of the body. These... 

Pepys, M. B. Serum C-reactive protein, serum amyloid P-componant and semm amyloid A protein in autoimmune disease. Clin. Immunol. Allergy 77-101 (1981). 

Kuribayashi, T. et al. 2003. Determination of serum C-reactive protein in healthy beagle dogs of various ages and pregnant beagle dogs. Experimental Animals 52 387-390. 

The ratios of TIMP-1 MMP-1 and TIMP-LMMP-3 in blood have been reported to be significantly lower in patients with rheumatoid arthritis versus patients with nonrheumatoid arthritis (CIO). In rheumatoid arthritis patients, serum C-reactive protein correlated with MMP-3 and TIMP-1 levels, but not with MMP-1 levels. The number of erosions noted on X-rays correlated with baseline levels of MMP-3, but not TIMP-1. Cunnane et al. (CIO) postulated that treatment which inhibits the production and activation of MMP-1 may preferentially limit the formation of new joint erosions and improve the clinical outcome of patients with rheumatoid arthritis. In contrast to circulating levels of MMP-1, Keyszer et al. reported that MMPrTIMP complexes in blood correlate with rheumatoid activity scores (modified Lansbury Index and Keitel Function Index) in rheumatoid arthritis nonetheless, this relationship to disease activity was weaker than that of MMP-3 or C-reactive protein (K4). 

Morin-Papunen L, Rautio K, Ruokonen A et al. Metformin reduces serum C-reactive protein levels in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003 88 4649-4654. 

Low-grade inflammation is closely associated with the metabolic syndrome and is an accepted new cardiovascular risk factor. Reductions in postprandial glucose excursion by treatment with acarbose in patients with type 2 diabetes have shown to reduce the activity (p = 0.045) and nuclear localization (p = 0.02) of the proinflammatory transcription factor NFkB, suggesting a mechanism by which the anti-inflammatory effects of acarbose may be mediated [8]. This mechanism would be consistent with reductions in the level of coagulation factors seen with acarbose treatment. For example, acarbose has been shown to reduce the level of fibrinogen in patients with type 2 diabetes (p = 0.013 vs. placebo) [42] and serum C-reactive protein levels in individuals with IGT (p < 0.01 vs. placebo) [43]. We found a significant reduction in postprandial leukocyte excursion another indicator... 

Wang X, Lu J, Pan C. Comparison of serum C-reactive protein level in different glucose tolerance subjects and the change in serum CRP level in IGT subjects with acarbose. EASD 2003. Published in Chinese Lu JM et al. Chin J Endocrinol Metab 2003 19 254-256. 

The host response to infection is monitored by measurement of serum C-reactive protein levels and antibody development against various GAS antigens (21,22,23,24). C-reactive protein concentrations are determined by ELISA with commercially available anti-C-reactive protein antibodies. Antibody production is assayed by ELISA using purified streptococcal proteins (e.g., SLO Subheading 3.2.2.). 

Chun OK, Chung S-J, Claycombe KJ, Song WO. Serum c-reactive protein concentrations are inversely associated with dietary flavonoid... 

Nozoe, T., Matsumata, T., and Sugimachi, K., 2000, Preoperative elevation of serum C-reactive protein is related to impaired immunity in patients with colorectal cancer. Am. J. Clin. Oncol. 23 263-266. 

Neyestani, T.R., Shariatzade, N., Kalayi, A. Gharavi, A., Khalaji, N., Dadkhah, M., et al. 2010. Regular daily intake of black tea improves oxidative stress biomarkers and decreases serum C-reactive protein levels in type 2 diabetic patients , Ann. Nutr. Metab., 57 40 9. 

Gray BN, Anderson JE, Burton MA et al (1992) Regression of liver metastases following treatment with yttrium-90 microspheres. Aust N Z J Surg 62 105-110 Hashimoto K, Ikeda Y, Korenaga D et al (2005) The impact of preoperative serum C-reactive protein on the prognosis of patients with hepatocellular carcinoma. Cancer 103 1856-1864... 

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