C-reactive protein and cardiorespiratory fitness in young adults.

BACKGROUND: Fitness and obesity are both independently associated with cardiovascular events and mortality. C-reactive protein (CRP), a predictor of cardiovascular events is associated with obesity; but its association with cardiorespiratory fitness in early adulthood is uncertain. The aim of this study was to examine the relationship between cardiorespiratory fitness and CRP, controlling for obesity in an unselected cohort of young adults. DESIGN: A cross-sectional study in a representative birth cohort. METHODS: We measured CRP levels, cardiorespiratory fitness, anthropometric variables, blood pressure and smoking in 26-year-old men (n=400) and women (n=315). Log CRP levels were compared across cardiorespiratory fitness with adjustment for body mass index (BMI), sex, blood pressure, smoking and combined oral contraceptive use. RESULTS: Geometric mean CRP levels were higher in women (3.23 mg/l, 95% CI 2.85-3.64) compared with men (1.70 mg/l, 1.52-1.89). Regression analysis adjusting for sex and weight showed an inverse association between fitness and CRP (beta=-0.16, P<0.001). This association held after statistical controls were added for BMI, systolic blood pressure and smoking and combined oral contraceptive use (P< or =0.01). CONCLUSIONS: Cardiorespiratory fitness levels are inversely associated with CRP levels in young adults independent of obesity, blood pressure, smoking and combined oral contraceptive use in women. Physical fitness may decrease the risk of cardiovascular events by reducing inflammation.     

超敏C-反应蛋白和C-反应蛋白的测定对SARS的诊断价值

目的　研究血清超敏C -反应蛋白 (hs -CRP )和C -反应蛋白 (CRP)对严重急性呼吸综合征 (SARS)的诊断价值。方法　SARS病人 2 0例、细菌性肺炎病人 2 0例、健康对照 2 0例 ,血清hs -CRP和CRP采用胶乳免疫比浊法全自动定量测定。结果　hs -CRP和CRP测定结果分别为 :健康对照组 (0 6 9± 0 6 2 )mg/L和 (4 4± 0 9)mg/L、细菌性肺炎组 (10 79± 1 36 )mg/L和 (98 0± 2 8 9)mg/L、SARS组 (3 16± 3 72 )mg/L和 (11 0± 9 6 )mg/L。三组间差异均有显著意义 (P <0 0 1)。结论　SARS病人和细菌性肺炎病人早期血清hs -CRP和CRP均升高 ,但细菌性肺炎病人升高更加显著 ,比SARS组分别增加 2 4倍和 7 9倍 ,对SARS与细菌性性肺炎的鉴别诊断有重要意义     

Coronary C-reactive protein distribution: its relation to development of atherosclerosis.

Two hundred and ninety-nine paraffin-embedded human coronary artery sections from 68 autopsies, both male and female and with various causes of death, were examined for distribution of C-reactive protein (CRP) using the indirect immunofluorescence technique and high-resolution confocal microscopy. The results demonstrate, for the first time, the existence of CRP in human coronary arteries, with evidence of CRP deposits being associated with lipids within in the artery walls. Grades of CRP immunoreactivity positively correlate with relative intimal thickness and negatively correlate with relative lumen size. It is suggested, therefore, that CRP may be related to the development of atherosclerosis and that the development of coronary atherosclerosis is associated with a relapsing inflammatory/necrotic process occurring within the coronary intima.     

C-reactive protein kinetics and its prognostic value after transfemoral aortic valve implantation

Transcatheter aortic valve implantation (TAVI) has become an established therapeutic option in high-risk patients with severe aortic valve stenosis. The potential threat of a postinterventional infection is one of several life-threatening complications. We have analyzed C-reactive protein levels in all patients who underwent successful transfemoral aortic valve implantation between July 2009 and January 2011. CRP and leukocyte counts were measured within 24 hours prior to implantation and daily up to 14 days after implantation. Patients with CRP levels above 109 mg/L (75th percentile; normal range <5 mg/L) were additionally analyzed. We performed 215 transfemoral aortic valve implantations (Edwards and CoreValve). The mean CRP increased after TAVI with a 7.5-fold peak on day 3, and was nearly normalized on day 14. Interestingly, mean leukocyte count remained within the normal range. To identify further independent predictors for post-TAVI elevation of CRP above the 75th percentile, multivariate logistic regression analysis was performed. This showed a significant relationship for patients with elevated baseline CRP values above 11.9 mg/L, for a body mass index above 25 kg/m2, for a logistic EuroSCORE ≥22% and for signs of postinterventional infection. Elevated baseline (>6.4 mg/L) and elevated peak (>102 mg/L) CRP values were associated with higher 30-day mortality. In conclusion, CRP elevation after TAVI should be expected to peak on day 3. An infection should be taken into account if CRP increases above 110 mg/L and if patients show other signs of infection. Elevated CRP at baseline and at day 3 is associated with higher 30-day mortality.     

C反应蛋白、触珠蛋白在胸腔积液鉴别诊断中的价值

目的 分析胸腔积液患者胸液及血清中C－反应蛋白（CRP）、触珠蛋白（HP）的水平,探讨其在胸腔积液鉴别诊断中的价值。方法 对77例不同病因边疆入院的胸腔积液患者的胸液及血清中CRP、HP的水平进行检测。结果 恶性胸液组、良性渗出液组和漏出液组的CRP、HP、胸水CRP／血清CRP、胸水HP／血清HP水平比较差异有显著性。结论 CRP和HP对于鉴别渗出液和漏出液有价值,对良、恶性积液也有良好的鉴别价值。     

Relationship between leptin and C-reactive protein in young Finnish adults

CONTEXT: Leptin and C-reactive protein (CRP) concentrations are increased in inflammation, and both have been linked to increased risk for cardiovascular diseases. OBJECTIVE: The objective of the study was to explore in a population-based sample whether the relation between leptin and CRP is independent of obesity level and whether genetic causes of CRP elevation contribute to leptin levels. DESIGN: This was a population-based study including 1862 young adults (971 women; 891 men) aged 24-39 yr. SETTING: The study was conducted at five centers in Finland. MAIN OUTCOME MEASURES: Associations between leptin and CRP adjusted for obesity indices, risk factors, genetic variables, and lifestyle variables were measured. RESULTS: Women had 3.0-fold higher median concentrations of leptin (12.5 vs. 4.1 ng/ml) and 1.3-fold higher median concentrations of CRP (0.75 vs. 0.56 mg/liter) than men (P < 0.0001 in both comparisons). In univariate analyses, CRP and leptin were significantly intercorrelated (r = 0.47, P < 0.0001 for women; r = 0.46, P < 0.0001 for men). In multiple regression analysis including age, body mass index, waist circumference, insulin, lipids, systolic and diastolic blood pressures, smoking status, and use of oral contraceptives in women, leptin was the main determinant of CRP in men (P < 0.0001) and the second most important determinant in women (P < 0.0001). A Mendelian randomization test based on genetic variants in the CRP gene (five single nucleotide polymorphisms) provided no support for CRP as a causal agent for leptin. CONCLUSIONS: Leptin, obesity, and oral contraceptive use in women were the main factors related to CRP. The relation between leptin and CRP was independent of obesity and cardiovascular risk factors.     

Prognostic value of C-reactive protein in parapneumonic effusions

Background and objective: Parapneumonic effusions (PPE) that require drainage are referred to as complicated parapneumonic effusions (CPPE). Following resolution of these effusions, residual pleural thickening (RPT) may persist. We hypothesize that the concentrations of CRP in pleural fluid (CRP_pf) and serum (CRP_ser) can be used to identify CPPE and to predict RPT. Methods: All patients with non‐purulent PPE, who were admitted to two tertiary hospitals during a 30‐month period, were enrolled in the study. Baseline CRP_pf and CRP_ser levels were compared between patients with complicated or uncomplicated PPE, as well as between patients with or without RPT of >10 mm, 6 months after discharge from hospital. Cut‐off values for identification of CPPE and prediction of RPT were determined by receiver operating characteristic curve analysis. Logistic regression analysis was performed to assess the association between CRP levels and RPT. Results: Fifty‐four patients were included in the study. Patients with CPPE (n = 23) had significantly higher levels of both CRP_pf and CRP_ser than those with uncomplicated PPE. For identification of CPPE, a CRP_pf level >78.5 mg/L and a CRP_ser level >83 mg/L gave 84% and 47% sensitivity, with 65% and 87% specificity, respectively. Classical criteria (pleural fluid pH <7.20, LDH >1000 IU/L, glucose <600 mg/L) were superior for this purpose. A combination of classical biomarkers with CRP levels using an ‘AND’ or ‘OR’ rule improved the positive and negative predictive values, respectively. CRP_ser was an independent predictor for development of RPT (adjusted OR 1.18). A CRP_ser level >150 mg/L had 91% specificity and 61% sensitivity for prediction of RPT. Conclusions: This study demonstrated the value of CRP_ser for prediction of RPT in patients with PPE. Moreover, when used in combination with classical biomarkers, CRP levels may be a useful adjunct for decision‐making in relation to treatment of patients with non‐purulent PPE.     

Diagnostic value of C-reactive protein in acute appendicitis

Serum C-reactive protein was measured in 56 patients hospitalized with a suspected diagnosis of acute appendicitis. Based on these determinations, four groups of patients were defined: Group A=26 patients with acute appendicitis who had a C-reactive protein level higher than 2.5 mg/dl. Group B=4 patients with a C-reactive protein level lower than 2.5 mg/dl who, after surgery based on a presumed diagnosis of acute appendicitis, were found to have a normal appendix. Group C=22 patients with nonspecific abdominal pain, 18 (72 percent) of whom had an elevated C-reactive protein level, although in only 4 (7.1 percent) were these levels higher than 2.5 percent mg/dl. Group D=4 patients who had diseases other than acute appendicitis. It is concluded that an increase in C-reactive protein levels to more than 2.5 mg/dl is not a definite indicator of acute appendicitis. However, if the C-reactive protein level in blood drawn 12 hours after the onset of symptoms is less than 2.5 mg/ dl, acute appendicitis can be excluded.     

Diagnostic value of C-reactive protein for predicting activity level of Crohn's disease.

BACKGROUND AND AIMS: Measuring Crohn's disease (CD) activity is useful in clinical trials as well as in clinical practice, but each available instrument to measure such activity has some limitations. C-reactive protein (CRP) is a sensitive marker for inflammation and tissue injury. The aims of the study were: to assess the diagnostic value of low level of CRP for predicting a low CD activity, and to calculate optimal CRP cutoff value for selecting patients with moderate or high CD activity. METHODS: One hundred fifty consecutive patients with active or nonactive CD were included in the study without any pre-selection criteria. CRP was measured, and CD activity was calculated by means of the van Hees index (VHI). RESULTS: The median VHI score was 154.4 (interquartile range, 126.0-193.4), and the median CRP was 19.1 mg/L (interquartile range, 6.1-50.1 mg/L; upper limit of normal [N], 4 mg/L). Forty-nine percent of our patients had CRP >20 mg/L. CRP was significantly correlated to VHI (P = .0001). The probability that VHI was <150 if CRP was below upper limit of normal was equal to 1 (confidence interval, 0.891-1.000). The diagnostic value for CRP predicting a VHI > or =150 was high; the area under the receiver operating characteristic curve was equal to 0.844 (confidence interval, 0.783-0.906; P = .0001) with an optimal cutoff value of 21.6 mg/L, about 5 x N. CONCLUSIONS: CRP appears useful to evaluate CD activity, especially to predict inactive or low activity CD.     

Predictive value of C-reactive protein and left ventricular diastolic filling pattern after a non-ST elevation myocardial infarction

BACKGROUND: Recent studies have shown that the odds ratio for high-sensitivity C-reactive protein (CRP) in predicting a coronary events in healthy subjects is 1.4, a value substantially less than previously reported. It is unclear whether this extends to acute coronary syndrome patients or if CRP would predict long-term events in this population. We evaluated the predictive value of CRP in patients with non-ST segment elevation myocardial infarction (NSTEMI) as their first manifestation of coronary artery disease and compared it with that of left ventricle diastolic function. METHODS: Serum CRP concentration measurement and left ventricle diastolic function evaluation were performed in 51 consecutive patients with NSTEMI 48 hours, 3 months, and 6 months after infarction. Patients were followed for 1 year and events comprising the endpoints of death, new myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting were reported. RESULTS: Thirty of 51 patients developed the endpoints. Mean CRP concentration in patients who developed any endpoint and those who did not was similar at 48 hours, 3 months, and 6 months. A strong correlation between the presence of impaired relaxation 6 months after the infarction and development of the combined endpoints was noted (P < 0.001). CONCLUSION: CRP has limited value in predicting future cardiovascular events in subjects with NSTEMI. Other biomarkers or a combination of other biomarkers may be needed to identify patients at high risk. Evaluation of diastolic left ventricular function not during the acute phase but 6 months later could predict adverse outcome in our series.     

C反应蛋白水平在冠心病中的意义

目的　探讨 C反应蛋白 (CRP)水平在冠心病中的变化及其预测预后的价值。方法　采用免疫透射比浊法测定 CPR水平 ,其中稳定型心绞痛组 38例 ,不稳定型心绞痛组 39例 ,急性心肌梗死组 2 9例和正常对照组 30例 ,采用交叉对照分析。结果　稳定型心绞痛组与正常对照组相比 ,CRP水平有所升高 ,但无统计学意义 (P>0 .0 5 ) ;不稳定型心绞痛组、急性心肌梗死组 CRP水平显著高于稳定型心绞痛组和正常对照组 (P<0 .0 1) ,且二者相比有差异性 (P<0 .0 5 )。 CRP>18m g/ L的患者 ,预后不良。结论　 CRP是冠心病形成的危险因子 ,并可作为冠心病患者判断预后的预测指标     

Asthma, body mass index, and C-reactive protein among US adults.

Obesity, a state that may be characterized by a low-grade inflammation, has been associated with asthma. C-reactive protein, an acute phase reactant, is elevated in obese people. However, little is known about how asthma affects C-reactive protein concentrations. Using data from 14,224 participants of the Third National Health and Nutrition Examination Survey (1988-1994), the author examined C-reactive protein concentrations among participants with current asthma (n = 651), who formerly had asthma (n = 303), and who never had asthma (n = 13,270). Compared with 21% of participants with current asthma, 11% with former asthma (P < .001) and 15% without asthma (P = .018) had C-reactive protein concentrations > or = 85th percentile of the sex-specific distribution. Compared with participants without asthma, the age-adjusted odds ratios for having an elevated C-reactive protein concentration was 1.49 (95% confidence interval [CI]: 1.11, 2.00) for persons with current asthma. After adjusting for age, sex, race or ethnicity, years of education, cotinine concentration, body mass index, waist-hip ratio, physical activity level, aspirin use, oral corticosteroid use, and inhaled corticosteroid use, the odds ratio decreased to 1.15 (95% CI: 0.83, 1.59). Body mass index was the main reason for the attenuation of the odds ratio. Whether the inflammatory activity associated with body mass index contributes to the pathophysiology of asthma is unknown.     

C-reactive protein in hypertension: clinical significance and predictive value

Mild elevations in C-reactive protein concentration predict myocardial infarction, stroke, and vascular death in a variety of clinical settings. Despite the lack of specific evidence that C-reactive protein levels are independently associated with cardiovascular risk in patients with hypertension, the prognostic value of C-reactive protein has proven to be complementary to that of blood pressure values.Recent epidemiological evidence has indicated a link between hypertension and increased C-reactive protein levels, and there are some indications that C-reactive protein may predict the future development of hypertension. Vessel wall inflammation is part of the vascular changes observed in animal models of hypertension. C-reactive protein is involved in the complex pathways leading to endothelial dysfunction, increased peripheral vascular resistance, and large artery stiffness in hypertension. In this regard, the role of C-reactive protein as a marker or a causal factor in promoting hypertension and its complications remains, however, to be elucidated.In this review, various aspects of the pathogenesis of inflammation in hypertension are summarized and connected with clinical studies that address the role of C-reactive protein in hypertensive disease.     

Fear and C-reactive protein cosynergize annual pulse increases in healthy adults

Recent international terror outbreaks notably involve long-term mental health risks to the exposed population, but whether physical health risks are also anticipated has remained unknown. Here, we report fear of terror-induced annual increases in resting heart rate (pulse), a notable risk factor of all-cause mortality. Partial least squares analysis based on 325 measured parameters successfully predicted annual pulse increases, inverse to the expected age-related pulse decline, in approximately 4.1% of a cohort of 17,380 apparently healthy active Israeli adults. Nonbiased hierarchical regression analysis among 27 of those parameters identified pertinent fear of terror combined with the inflammatory biomarker C-reactive protein as prominent coregulators of the observed annual pulse increases. In comparison, basal pulse primarily depended on general physiological parameters and reduced cholinergic control over anxiety and inflammation, together indicating that consistent exposure to terror threats ignites fear-induced exacerbation of preexisting neuro-immune risks of all-cause mortality.Recent international terror outbreaks involve mass psychological trauma, leading to long-term mental health risks in the exposed population (1, 2). Fear-induced reactions involve cortical and limbic brain regions that together enhance threat-predictive sensory stimuli (3) by interacting with cholinergic signaling pathways (4) in the hippocampus (5), the central amygdala (6), and the prefrontal cortex, especially in adults (7). Imminent fear may even cause immediate cardiac death [e.g., after an earthquake (8)]. However, whether fear exposure elevates cardiac risks of death to otherwise healthy civilians, and if so, what are the causes of such risks, remains unknown.Pulse is a promising modifiable predictor of cardiovascular and all-cause mortality. Elevated pulse associates with increased systemic inflammation and endothelial dysfunction in older adults (9) and predicts increased risk of death from ischemic heart disease (10). Changes in basal pulse and pulse variability are tightly associated with sudden cardiac death and all-cause mortality, also in asymptomatic men (11). Pulse reflects a complex trait, determined by multiple genetic, environmental, and other endogenous factors that play a substantial role in population variation (12). These include excessive inflammation, shown to associate with pulse increases (13), to be controlled by cholinergic imbalance (decreased vagal tone or increased sympathetic activity) (14), and to increase mortality (15). However, whether specific psychological factors determine the basal pulse and annual pulse changes in active adults is still unknown, perhaps because the intensity of psychological phenomena largely depends on external sources and is highly variable.Although fear of terror (FOT) is universal, Israel has been exposed to the repeated stress of multiple wars and terror attacks for more than 60 y, with a major impact on the entire society (16). To approach the health risks involved in FOT, we therefore explored the parameters determining resting heart rate (pulse) and its annual change in the Israeli population.     

Clinical value of C-reactive protein measurements in HIV-positive patients

The acute-phase protein C-reactive protein (CRP) is a sensitive marker of inflammation and tissue damage. We measured CRP in 109 HIV-1 antibody-positive patients admitted to hospital for investigation. In 67 patients with intercurrent infection (of whom 27 were afebrile at presentation) CRP levels were 2.2-483.5 mg/dL (normal value in the general population <3 mg/dL) and in 42 patients with alternative non-infection diagnoses CRP levels were 0.5-108.6 (median=5.9) mg/dL. Whereas in those with infections elevated CRP levels fell in response to specific therapy, values remained abnormal in those with non-infection diagnoses. CRP appears useful for diagnosis and monitoring of intercurrent infection in HIV-1 antibody-positive patients. In HIV-1 antibody-positive patients without intercurrent infection, CRP values higher than in the general population possibly reflect a sustained acute-phase response as a consequence of HIV infection per se.     

Diagnostic value of C-reactive protein in exudative pleural effusions

BACKGROUND: Tests able to help in the diagnostic work-up of pleural exudates are needed. C-reactive protein (CRP) may be useful for distinguishing between benign and malignant exudates. METHODS: A total of 123 consecutive patients diagnosed as having exudative pleural effusion (60 associated with malignancy and 63 benign effusions) were included in the study. Sensitivity, specificity, positive and negative predictive values (PV+, PV-), and positive and negative likelihood ratios (LR+, LR-) were established at different cut-off points. RESULTS: Pleural fluid CRP level was 23+/-12 mg/l (mean+/-S.D.) in pleural exudates associated with malignancy and 50+/-33 mg/l in benign effusions (P<0.001). With a cut-off point below 20 mg/l for malignancy, sensitivity of CRP was 0.50, specificity 0.89, PV+ 0.81, PV- 0.65, LR+ 4.50, and LR- 0.65. With a cut-off point above 45 mg/l for benign diseases, sensitivity was 0.44, specificity 0.95, PV+ 0.90, PV- 0.62, LR+ 8.89, and LR- 0.58. CONCLUSIONS: The pleural CRP level provides useful information for the study of pleural exudates. A level below 20 mg/l suggests a malignant origin and a level above 45 mg/l virtually rules out this possibility. Additional advantages of measuring CRP level are that it is an inexpensive test and is easy to perform.