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The Difficulty in Interpreting the Value of C-Reactive Protein in the Context of Acute Medicine

  • Hiroshi Ito
    Correspondence
    Requests for reprints should be addressed to Hiroshi Ito, MD, Division of Hospital Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan.
    Affiliations
    Division of Hospital Medicine, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
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      To the Editor:
      I read with great interest the article by Eckart et al
      • Eckart A
      • Struja T
      • Kutz A
      • et al.
      Relationship of nutritional status, inflammation, and serum albumin levels during acute illness: a prospective study.
      entitled “Relationship of Nutritional Status, Inflammation, and Serum Albumin Levels During Acute Illness: A Prospective Study.” The result of this study suggests the possibility of predicting the outcomes of the patients with acute illness by nutritional status and inflammation. However, there is a concern about this study that should be pointed out: how can we interpret the value of C-reactive protein (CRP)?
      In contrast to nutritional status and serum albumin levels, CRP values can fluctuate by the day. Blood samples in this study were collected in emergency departments.
      • Schuetz P
      • Hausfater P
      • Amin D
      • et al.
      Optimizing triage and hospitalization in adult general medical emergency patients: the triage project.
      Thus, the CRP values shown in this study may be those before elevation; concentrations of CRP have been known to reach their peak between 36 and 50 hours after the onset of infection.
      • Lelubre C
      • Anselin S
      • Zouaoui Boudjeltia K
      • Biston P
      • Piagnerelli M
      Interpretation of C-reactive protein concentrations in critically ill patients.
      Besides, it seems complicated to assess whether high CRP values reflect acute inflammation or chronic inflammation. Increases in CRP values can represent various noninfectious diseases, such as cardiovascular diseases, cirrhosis, graft vs host disease, systemic lupus erythematosus, and deep venous thrombosis.
      • Lobo SM
      Sequential C-reactive protein measurements in patients with serious infections: does it help?.
      The difficulty in assessing the elevated CRP values seems to make it hard to apply the result of this study into clinical practice. Further research is needed to evaluate whether baseline CRP values are associated with patient outcomes.

      References

        • Eckart A
        • Struja T
        • Kutz A
        • et al.
        Relationship of nutritional status, inflammation, and serum albumin levels during acute illness: a prospective study.
        Am J Med. 2020; 133: 713-722
        • Schuetz P
        • Hausfater P
        • Amin D
        • et al.
        Optimizing triage and hospitalization in adult general medical emergency patients: the triage project.
        BMC Emerg Med. 2013; 13: 12
        • Lelubre C
        • Anselin S
        • Zouaoui Boudjeltia K
        • Biston P
        • Piagnerelli M
        Interpretation of C-reactive protein concentrations in critically ill patients.
        Biomed Res Int. 2013; 2013124021
        • Lobo SM
        Sequential C-reactive protein measurements in patients with serious infections: does it help?.
        Crit Care. 2012; 16: 130