Elsevier

Critical Care Clinics

Volume 27, Issue 2, April 2011, Pages 241-251
Critical Care Clinics

Biomarkers in the Critically Ill Patient: C-reactive Protein

https://doi.org/10.1016/j.ccc.2010.12.010Get rights and content

Section snippets

Structure and history

CRP was first described in 1930, when Tillet and Francis2 reported that serum from individuals acutely ill with lobar pneumonia was able to precipitate a substance derived from the C polysaccharide of Streptococcus pneumoniae, which they called fraction C. Importantly, they noted that when serum was taken from patients when they were acutely ill there was a strong precipitation reaction but the strength of the reaction decreased as the patients recovered. This observation suggested that this

Physiologic activities

The pentraxin family is highly conserved in evolution, suggesting that members have an important physiologic role. This theory is supported by the fact that there are no known deficiencies of CRP in humans. It has been suggested that CRP may act in a proinflammatory or in an antiinflammatory capacity to aid host defense. In vitro, CRP has been shown to increase release of the antiinflammatory cytokine IL-1011 and decrease synthesis of several proinflammatory cytokines including IL-12, tumor

CRP as a biomarker of disease

CRP is an acute phase protein and as such plasma levels are increased in most forms of acute and chronic inflammatory diseases. CRP is a recognized and widely used marker in rheumatology, with levels elevated in patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, polymyalgia rheumatica, to mention just a few. In such patients, CRP levels, especially when using new high-sensitivity CRP assays, can be used to assess the effectiveness of treatment and to monitor

CRP as a biomarker of infection

A useful biomarker of infection, or rather the host response to infection, should provide additional information to the clinical picture in the fields of diagnosis, disease severity stratification and prognosis, and therapeutic guidance.38 CRP has been investigated in all these 3 areas.

CRP versus procalcitonin

Several studies have suggested that procalcitonin (PCT) is a more reliable marker of sepsis than CRP,71, 72, 73, 74, 75 but not all studies support this.31, 76, 77 Luzzani and colleagues72 reported that PCT levels predicted infection and severity of disease more reliably than CRP levels in 70 critically ill patients, and 2 meta-analyses concluded that PCT was a better diagnostic indicator than CRP.73, 75 Castelli and colleagues74 reported that PCT reacts faster than CRP, thus allowing an

Summary

There is an indisputable need for better techniques to diagnose sepsis, to characterize patients with sepsis, and to monitor therapeutic effectiveness. Use of biomarkers has been suggested as a means of achieving these aims. CRP is one of the many biomarkers that have been proposed for use in patients with sepsis and has been widely studied. The main advantages of serum CRP levels as a biomarker are the availability, ease of use, and low cost of assays. The key disadvantages are that CRP is not

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      No interactions between variables were observed in the final model. Considering that selenoprotein P, CRP, and procalcitonin have different kinetics [38–40], they were not included in the analysis. The hypothesis of this study was that erythrocyte selenium is not affected by the systemic inflammatory response in critically ill children.

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