What Should We Regard as an “Elevated” C-Reactive Protein Level?

Letters18 August 2015What Should We Regard as an "Elevated" C-Reactive Protein Level?Irving Kushner, MD and Maria J. Antonelli, MDIrving Kushner, MDFrom Case Western Reserve University, MetroHealth Campus, Cleveland, Ohio. and Maria J. Antonelli, MDFrom Case Western Reserve University, MetroHealth Campus, Cleveland, Ohio.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-5126 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Clinicians have long used serum C-reactive protein (CRP) levels to reflect the presence and degree of inflammation. More than 3 decades ago, investigators proposed that CRP levels greater than 10 mg/L indicate clinically significant inflammatory processes (1); this recommendation has stood the test of time (2). Recently, it was proposed that levels greater than 3 mg/L indicate a high degree of cardiovascular risk in patients judged to be at intermediate risk (2). Consequently, confusion regarding what constitutes an "elevated" CRP level has arisen.This confusion has been compounded because reference ranges for CRP differ greatly between laboratories and because ...References1. Morley JJ, Kushner I. Serum C-reactive protein levels in disease. Ann N Y Acad Sci. 1982;389:406-18. [PMID: 6953917] CrossrefMedlineGoogle Scholar2. Myers GL, Rifai N, Tracy RP, Roberts WL, Alexander RW, Biasucci LM, et al; CDC. CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: report from the laboratory science discussion group. Circulation. 2004;110:e545-9. [PMID: 15611379] CrossrefMedlineGoogle Scholar3. Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006;444:860-7. [PMID: 17167474] CrossrefMedlineGoogle Scholar4. Medzhitov R. Origin and physiological roles of inflammation. Nature. 2008;454:428-35. [PMID: 18650913] doi:10.1038/nature07201 CrossrefMedlineGoogle Scholar5. Kushner I, Rzewnicki D, Samols D. What does minor elevation of C-reactive protein signify? Am J Med. 2006;119:166. [PMID: 16443421] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Case Western Reserve University, MetroHealth Campus, Cleveland, Ohio.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L15-0146. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySerum Inflammatory Markers and Integrity of the Superior Longitudinal Fasciculus and the Inferior Longitudinal Fasciculus in Schizophrenia, from Prodromal Stages to Chronic Psychosis—A Cross-Sectional StudyClinical characteristics of influenza with or without Streptococcus pneumoniae co-infection in childrenDo Serum C-Reactive Protein Trends Predict Treatment Outcome in Patients with Knee Periprosthetic Joint Infection Undergoing Two-Stage Exchange Arthroplasty?RSV pneumonia with or without bacterial co-infection among healthy childrenPattern of change of C-reactive protein levels and its clinical implication in patients with acute poisoningTrend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control studyDiagnosis of Anastomotic LeakSex Differences in Hemoglobin A1c Levels Related to the Comorbidity of Obesity and DepressionRecent Progress in Lyme Disease and Remaining ChallengesBiomarkers in Rheumatoid ArthritisMediation effect of C-reactive protein in the relationship between abdominal obesity and intermediate hyperglycemia in Kuwaiti adolescentsClinical Difference between Acute Appendicitis and Acute Right-Sided Colonic DiverticulitisC-reactive protein clustering to clarify persistent inflammation, immunosuppression and catabolism syndromeCan the Need for Invasive Intervention in Tubo-ovarian Abscess Be Predicted? The Implication of C-reactive Protein MeasurementsSystems immunology reveals a linked IgG3–C4 response in patients with acute rheumatic feverC-reactive protein as a marker of persistent Chlamydia trachomatis infection is not associated with tubal factor infertility—an independent clinical validation studyPredicting hepcidin level using inflammation markers and iron indicators in patients with anemia of chronic diseaseEntzündungszeichen richtig interpretierenThe P2X7 Receptor Is Shed Into Circulation: Correlation With C-Reactive Protein LevelsC-Reactive Protein Stimulates Nicotinic Acetylcholine Receptors to Control ATP-Mediated Monocytic Inflammasome ActivationIt's time to redefine inflammationGold Nanoparticle-Based Methods for Detection of Oxidative Stress Biomarkers 18 August 2015Volume 163, Issue 4Page: 326KeywordsC-reactive proteinsConflicts of interestCytokinesDisclosureInflammationInsulin resistanceObesityTranscription factors ePublished: 18 August 2015 Issue Published: 18 August 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...