The conditions associated with high levels of CRP:
Normal levels increase with aging. Higher levels are found in late pregnant women, mild inflammation and viral infections (10–40 mg/L), active inflammation, bacterial infections (40–200 mg/L), severe bacterial infections and burns (>200 mg/L).
The meaning of high C-reactive protein level:
A high CRP test result is a sign of acute inflammation. It may be due to serious infection, injury or chronic disease.It can cause pain, redness, and swelling in the injured or affected area. Some autoimmune disorders and chronic diseases can also cause inflammation. Normally, there are low levels of C-reactive protein in the blood. High levels may be sign of a serious infection or other disorder.CRP plays a role in innate immunity as an early defense system against infections.
The high sensitivity CRP (hs-CRP) detects CRP in the range of 0.5 to 10 mg/L. hs-CRP can detect cardiovascular disease risk when in excess of 3 mg/L, whereas below 1 mg/L would be low risk.
Normal value of CRP: In healthy adults, the normal concentrations of CRP varies between1.0 mg/L and 3.0 mg/L. However, some healthy adults show elevated CRP at 10 mg/L. CRP concentrations also increase with age, possibly due to subclinical conditions. There is also no seasonal variations of CRP concentration
CRP is usually measured in milligrams of CRP per liter of blood (mg/L). Normal CRP levels are typically below 3.0 mg/L .Keep in mind that the normal reference range often varies between labs. A high-sensitivity CRP (hsCRP) test can detect levels below 10.0 mg/L.
The various conditions associated with high CRP:
(1) Severe infections and Autoimmunity: Significantly high CRP levels of more than 350
mg per liter (mg/L) are nearly always a sign of a serious underlying medical condition. The most common cause is a severe infection, but a poorly controlled autoimmune disease or severe tissue damage can also lead to high CRP levels.
(2) CRP levels in Covid-19 cases:
CRP elevations were observed in up to 86% in severe COVID‐19 cases. Another study reported that while those who had severe symptoms had on average CRP levels of 39.4 mg/L; those with mild symptoms had an average CRP levels of 18.8 mg/L.
Increased blood CRP levels were higher in people with avian flu H7N9 compared to those with H1N1 (more common) influenza,with a review reporting that severe H1N1 influenza had elevated CRP.In 2020, people infected with COVID-19 in Wuhan, China had elevated CRP level.
On the other hand viral infection without bacterial involvement is very improbable if CRP is > 40 mg/l. The results suggest that high CRP values rule out viral infection as a sole aetiology of infection; bacterial infection and antibiotic treatment should be considered in these cases.Primary infection is caused by specific virus followed by secondary bacterial infection.CRP is used mainly as an inflammation marker. Apart from liver failure, there interferon alpha produced during virus infection also interfere with CRP production.Alpha interferon is a cytokine produced by the innate immune system in response to viral infections. Interferon alpha inhibits CRP production from liver cells which may explain the relatively low levels of CRP found during viral infections compared to bacterial infections .
(3) C-Reactive Protein and risk of Heart disease :
CRP plays a role in innate immunity as an early defense system against infections.
The high sensitivity CRP (hs-CRP) detects CRP in the range of 0.5 to 10 mg/L. hs-CRP can detect cardiovascular disease risk when in excess of 3 mg/L, whereas below 1 mg/L would be low risk.
CRP seems to predict the chance of having cardiovascular problems at least as well as cholesterol levels. A recent study found that elevated levels of C-reactive protein were associated with three-times-greater risk of a heart attack.If CRP levels are elevated, one should take that as an important sign that it is time to get serious about reducing all cardiac risk factors by the following steps.The approaches for reducing CRP levels includes
Exercising.Increasing your aerobic exercise (e.g, running, fast walking, cycling)
Quitting smoking.Not smoking,
Losing body weight.
Eating a heart-healthy diet.Watching your diet,
and controlling the blood pressure.
This can be challenging, but it is necessary.
(4) High CRP as predictor of cardiac death:
CRP was a strong predictor of death of all causes due to its strength as predictor of cardiac death. The RR of cardiac death was doubled with increasing CRP quartiles, and patients in the top quartile had six times as high risk of cardiac death as patients in the lowest quartile.
Regarding the critical level of CRP, several reports regard CRP levels ≥40 mg/dL as a panic value with imminent mortality risk .CRP level is an independent risk factor for atherosclerotic disease. Patients with high CRP concentrations are more likely to develop stroke, myocardial infarction, and severe peripheral vascular disease.
(5) The stress can cause high CRP levels:
CRP is elevated in chronic stress and may be the link between stress and low-grade inflammation-related diseases. Scientists found that both psychological and social stress significantly impacts CRP.
(6) High CRP level in acute inflammation:
In acute inflammation, CRP can increase as much as 50 to 100 mg/L within 4 to 6 hours in mild to moderate inflammation or an insult such as skin infection, cystitis, or bronchitis. It can double every 8 hours and reaches its peak at 36 to 50 hours following injury or inflammation. CRP between 100 and 500 mg/L is considered highly predictive of inflammation due to bacterial infection. Once inflammation subsides, CRP level falls quickly because of its relatively short half-life.
(7) CRP level in Chronic inflammation:
CRP concentrations between 2 and 10 mg/L are considered as metabolic inflammation affecting metabolic pathways that cause arteriosclerosis and type II diabetes mellitus.
(8)Elevations of CRP in the absence of clinically significant inflammation can occur in kidney failure.
(9) Elevated level of CRP can also be observed in inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis.
(10)The high CRP levels and cancers:
In a recent meta-analysis of 12 prospective studies,3 elevated hs-CRP was associated with an increased risk of incident cancer of any type, lung cancer, and, possibly, colorectal, breast, and ovarian cancers, but not prostate cancer.
CRP as a tumor marker:
A few biologic compounds meet the criteria for an ideal tumor marker; C-reactive protein (CRP) is one . It is a non-specific acute phase reactant which reflects tissue damage. Serum concentration depends upon synthesis rate. Serum CRP is a sensitive and stable marker of inflammation.
The role of inflammation in cancer is not well understood.It is reported that some organs of the body show greater risk of cancer when they are chronically inflamed. While there is an association between increased levels of C-reactive protein and risk of developing cancer.In a 2004 prospective cohort study on colon cancer risk associated with CRP levels, people with colon cancer had higher average CRP concentrations than people without colon cancer. It can be noted that the average CRP levels in both groups were well within the range of CRP levels usually found in healthy people. However, these findings may suggest that low inflammation level can be associated with a lower risk of colon cancer, concurring with previous studies that indicate anti-inflammatory drugs could lower colon cancer risk.
(11) High CRP in obstructive sleep apnea:
C-reactive protein (CRP), a marker of systemic inflammation, is also increased in obstructive sleep apnea (OSA). CRP and interleukin-6 (IL-6) levels were significantly higher in patients with OSA compared to obese control subjects.
(12)The high CRP level is also found during the pregnancy.
Thus CRP test is a non-specific test and the high level of CRP is found in different conditions. Therefore the CRP test alone can't help but the other requisite tests are also to be performed for definite diagnosis.
The medicine is used for reducing CRP level:
Angiotensin receptor blockers (ARBs) (valsartan, irbesartan, olmesartan, telmisartan) markedly reduce serum levels of CRP. The findings with other ARBs (losartan and candesartan) were inconsistent. Antidiabetic agents (rosiglitazone and pioglitazone) reduce CRP levels, while insulin is ineffective.
Dr Bhairavsinh Raol
The stress can cause high CRP levels:
CRP is elevated in chronic stress and may be the link between stress and low-grade inflammation-related diseases. Scientists found that both psychological and social stress significantly impacts CRP.
High CRP level in acute inflammation:
In acute inflammation, CRP can increase as much as 50 to 100 mg/L within 4 to 6 hours in mild to moderate inflammation or an insult such as skin infection, cystitis, or bronchitis. It can double every 8 hours and reaches its peak at 36 to 50 hours following injury or inflammation. CRP between 100 and 500 mg/L is considered highly predictive of inflammation due to bacterial infection. Once inflammation subsides, CRP level falls quickly because of its relatively short half-life.
CRP level in Chronic inflammation:
CRP concentrations between 2 and 10 mg/L are considered as metabolic inflammation affecting metabolic pathways that cause arteriosclerosis and type II diabetes mellitus.
CRP plays a role in innate immunity as an early defense system against infections.
The high sensitivity CRP (hs-CRP) detects CRP in the range of 0.5 to 10 mg/L. hs-CRP can detect cardiovascular disease risk when in excess of 3 mg/L, whereas below 1 mg/L would be low risk.
Normal value of CRP:In healthy adults, the normal concentrations of CRP varies between 0.8 mg/L and 3.0 mg/L. However, some healthy adults show elevated CRP at 10 mg/L. CRP concentrations also increase with age, possibly due to subclinical conditions. There is also no seasonal variations of CRP concentrations.
Elevations of CRP in the absence of clinically significant inflammation can occur in kidney failure. CRP level is an independent risk factor for atherosclerotic disease. Patients with high CRP concentrations are more likely to develop stroke, myocardial infarction, and severe peripheral vascular disease. Elevated level of CRP can also be observed in inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis.
The high CRP levels and cancers:
In a recent meta-analysis of 12 prospective studies,3 elevated hs-CRP was associated with an increased risk of incident cancer of any type, lung cancer, and, possibly, colorectal, breast, and ovarian cancers, but not prostate cancer
CRP as a tumor marker:
A few biologic compounds meet the criteria for an ideal tumor marker; C-reactive protein (CRP) is one . It is a non-specific acute phase reactant which reflects tissue damage. Serum concentration depends upon synthesis rate. Serum CRP is a sensitive and stable marker of inflammation.
The role of inflammation in cancer is not well understood.It is reported that some organs of the body show greater risk of cancer when they are chronically inflamed. While there is an association between increased levels of C-reactive protein and risk of developing cancer.In a 2004 prospective cohort study on colon cancer risk associated with CRP levels, people with colon cancer had higher average CRP concentrations than people without colon cancer. It can be noted that the average CRP levels in both groups were well within the range of CRP levels usually found in healthy people. However, these findings may suggest that low inflammation level can be associated with a lower risk of colon cancer, concurring with previous studies that indicate anti-inflammatory drugs could lower colon cancer risk.
High CRP in obstructive sleep apnea:
C-reactive protein (CRP), a marker of systemic inflammation, is also increased in obstructive sleep apnea (OSA). CRP and interleukin-6 (IL-6) levels were significantly higher in patients with OSA compared to obese control subjects.
.The medicine is used for reducing CRP level:
Angiotensin receptor blockers (ARBs) (valsartan, irbesartan, olmesartan, telmisartan) markedly reduce serum levels of CRP. The findings with other ARBs (losartan and candesartan) were inconsistent. Antidiabetic agents (rosiglitazone and pioglitazone) reduce CRP levels, while insulin is ineffective.
Dr Bhairavsinh Raol
