Serial Serum C-reactive Protein Research Articles

Value of Serum C-Reactive Protein (CRP) Level in Early Detection of Anastomotic Leakage following Salvage Esophagectomy after Definitive Chemoradiation for Esophageal Squamous Cell Carcinoma

Background Definitive chemoradiation therapy is an alternative curative treatment for esophageal squamous cell carcinoma (ESCC). The prevalence of anastomotic leakage (AL) after salvage esophagectomy is significantly higher than planned esophagectomy after chemoradiation, which increases operative mortality. Minimizing AL-related mortality requires early detection. Several investigators have demonstrated the role of serum C-reactive protein (CRP) in early AL detection after esophagectomy for decades. However, its value in early AL detection after salvage esophagectomy is unknown. This study aims to evaluate the value of serial serum CRP levels for early AL detection in ESCC patients after salvage esophagectomy. Methods We retrospectively reviewed the medical record of 36 patients diagnosed with thoracic squamous cell esophageal carcinoma who underwent salvage esophagectomy at our hospital between December 2016 and May 2022. The CRP level was measured daily from postoperative day (POD) 1 to 5. Sensitivity, specificity, and receiver operating characteristic (ROC) curves were calculated to determine the optimal cutoff value. Results A total of 36 patients underwent salvage esophagectomy. Of these 36 patients, 3 patients (8.3%) were diagnosed with AL. The CRP level on POD 2 to 5 had been significantly associated with the presence of AL. The ROC curve showed the excellent diagnostic accuracy of CRP level on POD 2 to 5, with an area under the curve of 0.98, 0.98, 0.93, and 0.87, respectively. The optimal cutoff value of CRP on POD2 to 5 was 270, 250, 200, and 150 mg/L, respectively, with high sensitivity, specificity, and negative predictive value. Conclusion Postoperative serial CRP level after salvage esophagectomy is a reliable useful tool for early AL detection, similar to other settings of esophagectomy.

Postoperative serum C-reactive protein dynamics after pharyngolaryngectomy with jejunal free-flap reconstruction.

Pharyngolaryngectomy with jejunal free-flap (JFF) reconstruction can be offered for locally advanced hypopharyngeal cancer. However, the procedure carries significant morbidity. Postoperative serial serum C-reactive protein (CRP) has been shown to be a marker predicting postoperative complications, and the aim of this study was to describe the dynamics and value of CRP in this patient group. Retrospective analysis of pharyngolaryngectomies with JFF reconstruction was performed in our institution. Daily postoperative CRP values were analysed within the first 14 days, as were complications. Twenty-one cases were included. Total morbidity was 57.1% including 14.3% (temporary) anastomotic leaks and 14.3% flap failures. Patients in the normal group showed peak CRP levels around postoperative day 2 (2.2). Increased CRP levels on or after day 4 were associated with complications (p<0.01) with a sensitivity of 83.3% and specificity of 77.8%. In keeping with CRP kinetics from other surgical studies, peak CRP values on day 2 or 3 are expected, followed by a decline. Peaks in CRP on day 4 or later raise the suspicion of complications. CRP is not specific for any one complication but rather can help guide early appropriate clinical assessment and management. The natural postoperative CRP response peaks around postoperative day 2 (2.2) and declines thereafter. Rising CRP levels after postoperative day 3 are suspicious of surgical complications (p<0.01) with positive and negative predictive values of 83.3% and 77.8%, respectively. Therefore, serial postoperative CRP can be used as an adjunct to monitor outcomes in this group.

C-Reactive Protein Monitoring Can Predict Neutropenic Fever during Autologous Hematopoietic Stem Cell Transplantation for Mutliple Myeloma

BackgroundPost-auto transplantation in multiple myeloma, neutropenic infections typically occur earlier than engraftment.It may be difficult to distinguish between infection and other causes of neutropenic fever, such as engraftment syndrome.Early indication of a neutropenic fever helps to identify those patients who are more likely to benefit from a combination of antibiotics, while reducing unnecessary toxicity in patients with a low probability of a neutropenic fever. C-reactive protein (CRP) is an acute phase protein and an important marker of inflammation that is elevated with serious infections, but also with high levels of certain cytokines as typically seen post-transplantation. We retrospectively analyzed the role of serial serum CRP levels in predicting neutropenic fever.Materials and MethodsPatients included received auto transplants (first and/or second) for multiple myeloma between January 2014 and March 2017. IRB approval was obtained. One hundred and seventy consecutive transplants received by 121 patients were included. Serum CRP levels were measured regularly during transplant and those obtained between Day 0 and Day 14 post-transplant were analyzed. Patients were started on prophylactic Meropenem on day +5 post-transplant. To assess the prognostic effect of C-reactive protein on onset of neutropenic fever within 14 days post-transplant, a Cox regression model was applied. Time was calculated from transplant to onset of neutropenic fever, defined as neutropenia (ANC<500/µl or when ANC is expected to fall below 500 over the next 48 hrs.) and fever (one temperature reading > 101.0⁰ F or at least two temperature readings > 100.4⁰ F). CRP was analyzed as a time-dependent covariate. A robust sandwich estimator of the standard error was utilized to account for a clustering effect of multiple transplants within a patient. Estimated effects were reported as hazard ratios (HR) along with 95% confidence intervals (95% CI). Additionally, area under the curve and maximum CRP value (either before or after neutropenic fever) were compared between groups using mixed effects regression models.ResultsOf the 170 transplants, 49 developed neutropenic fever and 121 did not have neutropenic fever. On multivariable analysis, high levels (4.0-42.3 mg/dl) of CRP were associated with a 5.45 times increased risk of neutropenic fever (p-value = 0.02) compared to undetectable levels (<0.5 mg/dl). Patients had a nearly 3 times increased risk of neutropenic fever after the second transplant (p-value<.01). Area under the curve for consecutive CRP values was larger for those with neutropenic fever (p-value<.01). Those with neutropenic fever had higher max values of CRP (p-value<.01) which tended to occur after the onset of neutropenic fever.ConclusionCRP monitoring may provide important information about the risk for neutropenic fever during autologous hematopoietic stem cell transplantation for Multiple Myeloma. Serial CRPs may also help identifying low-risk patients, who can continue outpatient treatment. Therefore, in our opinion, CRP levels should be part of the daily routine laboratory workup post-autotransplants. DisclosuresNo relevant conflicts of interest to declare.

Evaluation of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis in Immunocompetent Patients: Experiences from a Tertiary Care Center.

Study DesignProspective clinical study.PurposeWe evaluated the challenges faced during diagnosis and management of patients with subacute pyogenic discitis and discussed various clues in clinical history, radiologic and hematologic parameters of these patients that helped in establishing their diagnosis.Overview of LiteraturePresent literature available shows that in patients with subacute spondylodiscitis and infection with less virulent organisms, the clinical picture often is confusing and the initial radiologic and hematologic studies do not contribute much toward establishing the diagnosis.MethodsDemographic pattern, predisposing factors, clinical presentation, comorbidities, microbiology, treatment, neurologic recovery, and complications of 11 patients were prospectively reviewed regarding their contribution toward the conformation of diagnosis of subacute pyogenic discitis.ResultsMean age at presentation was 46.0 years with average preoperative Oswestry Disability Index and Visual Analog Scale scores of 83.4 and 7.18, respectively. Mean follow-up duration was 12.0 months. The most common site of infection was the lumbar spine, followed by the thoracic spine (n=1). Infective organisms were isolated in only 45% of cases. Staphylococcus aureus was the most common causative organism isolated.ConclusionsDiagnosing subacute spondylodiscitis in a patient presenting with subacute low backache poses a diagnostic challenge. Clinical and radiologic picture are deceiving, and bacteriologic results often are negative, further complicating the picture. A detailed medical history along with clinical, radiologic, and biochemical parameters prevents missing the diagnosis. Serial serum Creactive protein and alkaline phosphatases were more reliable blood parameters in cases of subacute presentation.

The moderate predictive value of serial serum CRP and PCT levels for the prognosis of hospitalized community-acquired pneumonia

BackgroundTo predict the prognosis by observing the dynamic change of C-reactive protein (CRP) and procalcitonin (PCT) for hospitalized community-acquired pneumonia (CAP).MethodsThe data were collected from January to December 2017 from the first affiliated Hospital of Zhengzhou University. Demographic and clinical patient information including age, length of hospital stay and Charlson Comorbidity Index (CCI) were recorded. Blood samples were taken for CRP, PCT, and white blood cell count (WBC). Receiver Operating Characteristic (ROC) curve was used to verify each biomarker’s association with the prognosis of pneumonia.ResultsA total of 350 patients were enrolled in the study. The 30-day mortality was 10.86%. Serial serum CRP3, CRP5, PCT3, PCT5 and PCT5c levels were statistically lower in CAP survivors than non-survivors. CRP3c < 0, CRP5c < 0 and PCT5c < 0 were observed with a statistically lower frequency in patients with 30-day mortality and initial treatment failure. The AUC for 30-day mortality for serial CRP levels combined with CRP clearances was 0.85 (95% CI 0.77–0.92), as compared to an AUC of 0.81 (95% CI 0.73–0.9) for serial PCT levels combined with PCT clearances.ConclusionsSerum serial CRP and PCT levels had moderate predictive value for hospitalized CAP prognosis. The dynamic CRP and PCT changes may potentially be used in the future to predict hospitalized CAP prognosis.

C-Reactive Protein Monitoring Predicts Neutropenic Fever Following Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma

BackgroundNeutropenic fever (NF) is a known and common complication of autologous hematopoietic stem cell transplantation (ASCT). Early risk assessment may help direct treatment. We retrospectively analyzed the role of serial serum C-reactive protein (CRP) levels in predicting NF and assessed the clinical value of CRP within 14 days after transplantation.MethodsOne hundred twenty-one multiple myeloma (MM) patients received 170 first and/or second ASCT between January 2014 and March 2017. A Cox regression model was applied to assess the prognostic value of CRP as a time-dependent covariate at the onset of NF within 14 days post-transplant.ResultsForty-seven of 170 patients developed NF. High CRP levels (4.0–43.2 mg/dL) were associated with a 5.45-fold increased risk of NF (P = 0.02). Patients had a nearly three-fold increased risk of NF after the second transplant (P < 0.01), but this was not associated with increased mortality. Those with NF had higher maximum values of CRP (P < 0.01) which tended to occur at or after the onset of NF.ConclusionCRP monitoring provides important information about the risk for NF immediately after first MM ASCT, and even more so after the second.

Utility of serial serum C-reactive protein in the diagnosis of neonatal infection

Introduction: C-reactive protein (CRP) has been used as a biomarker to diagnose neonatal sepsis. Aim: The aim of the study was to study the utility of serial CRP levels in the neonatal infection/sepsis diagnosis. Materials and Methods: Neonates admitted to a tertiary care teaching hospital were classified into three groups: proven sepsis (culture positive from any body fluid), probable sepsis (culture negative but clinical and laboratory parameters suggestive of sepsis), and no sepsis (not suggestive of sepsis). CRP was measured as follows: CRP 1 at the time of clinical presentation and CRP 2 and 3 at 24 and 48 h, respectively. Sensitivity, specificity, predictive values, and likelihood ratios were calculated. Results: Suspected infection/sepsis was evaluated as earlyonset(?72 h) in 300 neonates and late-onset (LONS) (&gt;72 h) on 150 occasions in 100 neonates. There was a strong correlation etween the diagnoses of proven or probable sepsis and elevated CRP levels (?1.0 mg/dl), for both early- and LONS episodes, supporting the diagnostic utility of CRP. The sensitivity of CRP 2 was &gt; CRP 1, but maximum sensitivity was achieved by CRP 3 level only. A CRP level has a much higher predictive value in ruling out than ruling in neonatal infection/sepsis (reaching almost 99-100% for both sepsis types). Conclusions: Serial CRP measurements are useful in the diagnosis of neonatal infection/sepsis. The predictive value of CRP 1 level being normal at initial evaluation cannot justify discontinuing antibiotic therapy. CRP 3 level may virtually rule out or rule in the diagnosis of neonatal sepsis.

Significance of C-Reactive Protein and Transcranial Doppler in Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

ObjectiveCerebral vasospasm is a common and potentially devastating complication of aneurysmal subarachnoid hemorrhage (aSAH). Inflammatory processes seem to play a major role in the pathogenesis of vasospasm. C-reactive protein (CRP) constitutes a highly sensitive inflammatory marker. Elevation of serum CRP levels has been demonstrated in patients with aSAH. The purpose of the current study was to evaluate the possible relationship between CRP levels in the serum and transcranial Doppler (TCD) and the development of vasospasm in patients with aSAH.MethodsA total of 61 adult patients in whom aSAH was diagnosed were included in the study from November 2008 to May 2011. The patients' demographics, Hunt and Hess grade, Fisher grade, CT scans, digital subtraction angiography studies, and daily neurological examinations were recorded. Serial serum CRP measurements were obtained on days 1, 3, 5, 7, 9, 11 and 13 and TCD was measured on days 3, 5, 7, 9, 11 and 13. All patients underwent either surgical or endovascular treatment within 24 hours of their hemorrhagic attacks.ResultsSerum CRP levels peaked on the 3rd postoperative day. There were significant differences between the vasospasm group and the non-vasospasm group on the 1st, 3rd and 5th day. There were significant differences between the vasospasm group and the non-vasospasm group on the 3rd day in the mean middle cerebral artery velocities on TCD.ConclusionPatients with high levels of CRP on the 1st postoperative day and high velocity of mean TCD on the 3rd postoperative day may require closer observation to monitor for the development of vasospasm.

Serum C-reactive protein levels predict neurological outcome after aneurysmal subarachnoid hemorrhage

Our aim was to evaluate the relationship between serum C-reactive protein (CRP) levels and the neurological prognosis and development of vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). Eighty-two adult patients with aSAH diagnoses were prospectively evaluated. Glasgow Coma Scale (GCS) score, Hunt and Hess grade, Fisher grade, cranial CT scans, digital subtraction angiography studies and daily neurological examinations were recorded. Serial serum CRP measurements were obtained daily between admission and the tenth day. Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRS) were used to assess the prognosis. Serum CRP levels were related to severity of aSAH. Patients with lower GCS scores and higher Hunt and Hess and Fisher grades presented statistically significant higher serum CRP levels. Patients with higher serum CRP levels had a less favorable prognosis. Increased serum CRP levels were strongly associated with worse clinical prognosis in this study.

Utility of serum C-reactive protein in assessing the outcome of infective endocarditis

To evaluate the diagnostic usefulness of serial serum C-reactive protein determinations in monitoring the outcome of infective endocarditis (IE). C-reactive protein, erythrocyte sedimentation rate (ESR), and white blood cell count (WBC) were measured from admission until week 10 in 129 patients with 134 episodes of IE. Need for cardiac surgery and final outcome were assessed until 3 months from admission. Data were evaluated using extensive statistical analyses. The fall in serum C-reactive protein or WBC was significantly faster when a patient had an uncomplicated recovery than when complications developed or death ensued, but no such behaviour was observed in ESR. None of the 80 patients who had normal C-reactive protein by week 10 died of IE. Moreover, none of the 22 patients who had normal C-reactive protein by week 4 needed cardiac surgery and only two of the 33 patients who had normal C-reactive protein by week 6 needed cardiac surgery, both after successful medical treatment of IE. Of the 87 patients whose WBC normalized within 4 weeks, six died and 15 needed valve surgery. The normalization of C-reactive protein proved to be a good predictor of a favourable late outcome (surgery, death) of IE. Also WBC count proved useful in the assessment of patients with IE, but the value of ESR was negligible.

Fluctuating Inflammatory Markers in Patients With Stable Ischemic Heart Disease

C-reactive protein (CRP), a marker of inflammation, is increasingly measured to stratify coronary artery disease risk and guide clinical management. However, little is known about how inflammatory markers fluctuate over time in patients with stable ischemic heart disease. We examined serial serum CRP values in 159 patients with histories spanning the clinical spectrum of ischemic heart disease. Two to 8 CRP measurements were made at intervals varying from 15 days to 6 years. Successive interleukin (IL)-6 values were examined in 1 subgroup. Blood samples were always taken when patients were clinically stable, in the absence of any potentially confounding inflammatory condition. C-reactive protein values in individual patients fluctuated considerably when examined in the following ranges: less than 1 mg/L, 1 to 3 mg/L, and greater than 3 mg/L, proposed to indicate low, average, and high risk. Sixty-four patients (40.3%) changed risk category between the first and the second measurement. Within-patient variances of CRP and IL-6 levels were 1.79 mg/L (95% confidence interval, 1.60-2.00) and 2.69 pg/mL (95% confidence interval, 2.29-3.18), respectively. The variability of CRP was consistent over different times and across clinical groups, and independent of body mass index, smoking status, medication, and clinical events. Relatively important fluctuations in CRP levels in patients with stable ischemic heart disease may be problematic for risk stratification and treatment monitoring. A similar IL-6 variability suggests that these patients have a dynamic inflammatory status whose kinetics may modulate acute coronary risk.

Neonatal lipid utilization increases with injury severity: Recombinant human growth hormone versus placebo

Increased lipid oxidation has been observed in injured adult and pediatric patients who receive growth hormone (GH). In infants, whose bodies make fat more readily (de novo lipogenesis), this effect has not been tested. After surgery for necrotizing enterocolitis or gastroschisis, 22 neonates (average gestational age, 35 weeks; average postnatal age, 7 days) were provided basal protein-calorie parenteral repletion, and were prospectively randomized to receive either recombinant human GH (rhGH, 0.2 mg/kg/d) or placebo for 6 days. Injury severity was established by serial serum C-reactive protein (CRP) levels (high v low stress: CRP ≥ 6.0 mg/dl v < 6.0mg/dL). Indirect calorimetry was used to measure energy expenditure (MEE), respiratory quotient (RQ), net lipid oxidation (Fe), and lipid oxidative O2 consumption (Vo2f). Among the GH+ group, MEE, Fe, andVo2f were significantly higher for the high-stress patients (PMEE: 52.87 ± 13.35 v 42.57 ± 9.47 k cal/kg/d; P < .03; Fe: 18.32 ± 27.74 v 0.81 ± 13.47 kcal/kg/d; P < .02;Vo2f: 7.21 ± 9.86 v 0.01 ± 7.42L/d, P < .02), and RQnp was significantly lower in the high-stress patients (RQnp: 0.93 ± 0.14 v 1.05 ± 0.11; P < .02). In addition, Fe and RQnp were directly proportional to carbohydrate intake (CHO) in the high-stress patients (CHO to Fe: Pearson r = −.701; CHO to RQnp: Pearson r = .714; P < .05). Lipid oxidation was directly proportional to stress severity, was higher in the GH group (18.32 v 11.91 kcal/kg/d for the placebo group), and was depressed in response to increased CHO intake in all groups. Lipid is an important energy source in acutely injured, especially severely stressed neonates. Lipid substrate utilization is improved with GH supplementation during acute metabolic stress. In addition, excess carbohydrate delivery reduces the amount of lipid utilized for energy metabolism. An appropriately balanced, mixed-fuel formula should be used for caloric repletion in this infant population.

Actinomycotic brain abscess successfully treated by burr hole aspiration and short course antimicrobial therapy

Three cases of brain abscess caused by Actinomyces israelii are reported which were successfully treated by burr hole aspiration and a short course of antibiotics (3-4 weeks). The clinical response of the patients, as well as the serial serum C-reactive protein levels and CT findings were used as a guideline for stopping antimicrobial therapy relatively early.

The C-reactive protein (CRP) in patients with long bone fractures and after arthroplasty.

Between March 1991 and February 1992 serial serum C-reactive protein (CRP) levels were measured prospectively for three weeks in 57 consecutive patients with fractures of long bones, and also in 11 patients who had undergone primary total hip or knee arthroplasty. A semi-quantitative capillary floculation method was used for measuring the CRP level. The highest values were usually recorded 2-3 days after trauma or operation, and the CRP was nearly normal by three weeks. In the patients with long bone fractures the amplitude of CRP response was affected by the type of treatment. Lower values were observed in those patients treated conservatively than in those who underwent operation, but the profile of CRP response was similar, regardless of the type of treatment. The CRP response was also affected by the severity of the trauma in conservatively treated patients, but in those who underwent operation the CRP response was similar, regardless of the severity of the injury. In patients with primary total hip or knee arthroplasty the pattern of CRP response after operation was similar to that in the patients with long bone fractures who underwent surgical treatment. Awareness of the natural course of the CRP response after fracture and arthroplasty may help in the diagnosis of early post-traumatic and postoperative complications, especially infections.

Serial serum C-reactive protein levels as an aid to the management of melioidosis.

Of 46 patients with clinical melioidosis, 35 (22 culture-positive and 13 culture-negative) had relatively uneventful disease courses, with elevated serum C-reactive protein (CRP) concentrations (greater than 5 mg/dl) that decreased with the commencement of appropriate antibiotic therapy, and continued to show an uninterrupted decrease (mean 29.4 days, range 12-52 days) to the normal range (less than 1 mg/dl), with resolution of their infections. In five culture-positive patients with complicated disease courses, CRP concentrations remained elevated (greater than 5 mg/dl) until the underlying disorders were successfully managed, or until the antibiotic regimen was changed, and CRP values then decreased to the normal range. During surveillance, elevated CRP concentrations (greater than 10 mg/dl) led to the diagnosis of reactivation of infection in three afebrile patients, while the serum CRP values in other patients remained within the normal range in the absence of intercurrent complications. The CRP estimations may be helpful in ascertaining active infection in patients with low serum levels of specific IgM antibody, and serial measurements of serum CRP in patients with clinical melioidosis may be useful in determining the optimal duration of treatment and for detecting occult or unresolved infection with Pseudomonas pseudomallei.

C-reactive protein in tibial fractures. Natural response to the injury and operative treatment

Serial serum C-reactive protein (CRP) measurements were made, for three weeks, in 42 consecutive patients with solitary tibial fractures. The CRP response was related to the treatment: lower values were observed in 27 patients treated conservatively than in 15 operated patients. Open reduction and plating resulted in a greater response than closed intramedullary nailing. The timing of the CRP response was related to the timing of the treatment: the highest values were usually recorded two days after admission or operation. The timing of the operation did not affect the degree of CRP response. Neither the site, nor the type of fracture, nor the age of the patient played any role. Awareness of these natural CRP responses after fractures may help in the diagnosis of early post-traumatic and postoperative complications, especially infections.

Measurement of Serum C-Reactive Protein Concentration after Renal Transplantation

A prospective study of serial serum C-reactive protein (CRP) concentrations was made on 21 patients who had received renal allografts. CRP was raised during 27 of 32 rejection episodes and in all of five episodes of rejection associated with infection. CRP values were persistently elevated in three irreversible rejection episodes. Significantly raised CRP concentrations were documented in 14 of 20 episodes of infection. In some cases CRP was a predictive indicator of rejection or infection. In all cases of infection or rejection associated with a rise in CRP, CRP values fell following successful treatment with appropriate agents. Serial CRP measurement used in conjunction with other clinical and biochemical parameters appears to be valuable clinically following renal transplantation.

C-reactive protein as biochemical indicator of bacterial infection in neonates

Serial quantitative measurements of C-reactive protein (CRP) were performed, using an automated enzyme immunoassay method, in 127 neonates (114 premature and 13 full-term) classified in three groups: neonates with a normal postnatal course (group 1, n = 69), neonates with clinical suspicion of bacterial infection but with negative cultures (group 2, n = 49), and neonates with proven bacterial infection (group 3, n = 9). A total of 545 serial serum CRP concentrations were determined. In group 1, CRP concentrations were below the detection limit of the method (10 mg/L) except in one neonate who suffered from neonatal anoxia but whose clinical course was uncomplicated (CRP: 31 mg/L within 24 h of life). Thirty-three neonates of group 2 had CRP values consistently below 10 mg/L while 16 had elevated CRP concentrations at least on one occasion ranging from 10 to 70 mg/L. Diagnoses other than bacterial infection could explain the raised CRP concentrations in neonates of group 2. CRP concentrations were found to be elevated (greater than 80 mg/L) during the course of infectious diseases in all neonates with proven bacterial infection (septicemia (4), pneumonia (1), multiple micro-abscesses (1), urinary tract infection (3]. Serial measurement of CRP concentrations are shown to be valuable in detecting bacterial infection in neonates as well as in following the efficacy of antimicrobial therapy.