Showing papers on "C-reactive protein published in 1993"

Metabolic and scintigraphic studies of radioiodinated human C-reactive protein in health and disease.

Abstract: Plasma and whole-body turnover studies of human C-reactive protein (CRP), isolated from a single normal healthy donor and labeled with 125I, were undertaken in 8 healthy control subjects and 35 hospitalized patients including cases of rheumatoid arthritis, systemic lupus erythematosus, infections, and neoplasia. Plasma clearance of 125I-CRP closely approximated to a monoexponential function and was similar in the control and all patient groups. There was no evidence for accelerated clearance or catabolism of CRP in any of the diseases studied. The 19-h half-life was more rapid than that of most human plasma proteins studied previously, and the fractional catabolic rate was independent of the plasma CRP concentration. The synthesis rate of CRP is thus the only significant determinant of its plasma level, confirming the validity of serum CRP measurement as an objective index of disease activity in disorders associated with an acute-phase response. Approximately 90% of injected radioactivity was recovered in the urine after 7 d, and scintigraphic imaging studies with 123I-labeled CRP in 10 patients with different focal pathology showed no significant localization of tracer. The functions of CRP are thus likely to be effected predominantly in the fluid phase rather than by major deposition at sites of tissue damage or inflammation.

Role of interleukin-6 in mediating the acute phase protein response and potential as an early means of severity assessment in acute pancreatitis.

Abstract: A number of laboratory and clinical studies have shown that interleukin-6 is the principal mediator of the acute phase protein response. In this study the relationship between serum concentrations of interleukin-6 and C-reactive protein in acute pancreatitis are examined and the ability of interleukin-6 to discriminate between severe and mild attacks is assessed. We have studied 24 patients (10 severe and 14 mild). Serum samples were collected on admission, six hourly for 48 hours and then 12 hourly for a further three days. When the areas under the curves of individual patients were compared there was a strong correlation between the total production of interleukin-6 and C-reactive protein (r = 0.73) (Spearman rank correlation) and peak interleukin-6 and C-reactive protein concentrations (r = 0.75), suggesting a close relationship between interleukin-6 and C-reactive protein production. Both on admission and peak interleukin-6 concentrations were significantly higher in patients with severe than mild disease. There was no significant difference in on admission C-reactive protein concentrations, although significant differences were seen when peak concentrations were considered. Utilising a peak interleukin-6 concentration of > 130 u/ml, we were able to distinguish between severe and mild attacks of acute pancreatitis with a sensitivity of 100% and specificity of 71%. These figures were comparable with those for peak C-reactive protein, a C-reactive protein of > 150 mg/l detecting severe attacks of acute pancreatitis with a sensitivity of 90% and specificity of 79%. In view of the fact that interleukin-6 concentrations peaked earlier than those of C-reactive protein, interleukin-6 is capable of providing comparable, but earlier severity prediction than C-reactive protein.

Monitoring both serum amyloid protein A and C-reactive protein as inflammatory markers in infectious diseases.

Abstract: We examined serum amyloid protein A (SAA) and C-reactive protein (CRP) as inflammatory markers of viral and bacterial infections. Both acute-phase reactants increased in the acute stage and thereafter decreased in the convalescent stage. In viral infections, the mean serum concentrations of SAA during the acute stage were 141 mg/L in infections with adenovirus, 77 mg/L with measles virus, 63 mg/L with influenza virus, 55 mg/L with parainfluenza virus, 31 mg/L with respiratory syncytial virus, and 31 mg/L in aseptic meningitis. The mean serum concentration of CRP was 19 mg/L for adenovirus infection and < 7 mg/L in all other viral infections. The SAA concentrations were 5- to 11-fold greater than the CRP concentrations. Both the SAA and the CRP concentrations were higher in bacterial infections than in viral infections. Changes in the concentrations of serum SAA paralleled those in serum CRP in bacterial infection; during the course of viral infection, however, serum SAA tended to disappear more quickly than CRP did. SAA appears to be a clinically useful marker of inflammation in acute viral infections, with or without significant changes in the CRP concentration.

Changes in serum C-reactive protein levels in dogs with various disorders and surgical traumas

Abstract: The serum levels of C-reactive protein (CRP) produced as an inflammatory response in dogs with various disorders and surgical traumas were measured by enzyme-linked immunoabsorbent assay and slide reversed passive latex agglutination test (RPLA). The CRP levels were greatly increased 1–2 days after surgery in most of the dogs (n=29) subjected to surgery. These levels had markedly decreased by the time the sutures were removed. In dogs with various disorders (n=58), the serum CRP levels at first diagnosis were high in infectious diseases. In dogs from which paired serum samples were examined, the serum CRP usually showed a decrease with improvement in the condition (n=11) or a terminal increase (n=4) but, conversely, some showed an increase with improvement in the condition (n=3).

Serum C-reactive protein and infarct size in myocardial infarct patients with a closed versus an open infarct-related coronary artery after thrombolytic therapy

Abstract: Serum C-reactive protein rises in acute myocardial infarction, correlating positively with infarct size if thrombolytic treatment is not given. This correlation disappears if thrombolytic treatment is given, although the serum C-reactive protein concentration is still associated with the clinical outcome of the patient. We studied the effect of early coronary recanalization induced by thrombolytic treatment alone or combined with coronary angioplasty on the infarct related rise in serum C-reactive protein concentration. The C-reactive protein response caused by the myocardial infarct was lower in patients with an open infarct-related coronary artery than in patients with a closed infarct-related coronary artery, or in control patients who did not receive thrombolytic therapy. In control patients we found the expected strong positive correlation between infarct size and serum C-reactive protein (r = 0.58; P < 0.001, n = 48), which was similar to that in patients with a closed infarct-related coronary artery (r = 0.62; P < 0.001, n = 17). In patients with an open infarct-related coronary artery the correlation between infarct size and serum C-reactive protein was much weaker (r = 30; P < 0.01, n = 91). Consequently infarct size explained approximately 35% of the variation in serum C-reactive protein values in the control patients and 36% in the patients with a closed infarct-related coronary artery, but only 9% of the variation in the patients with an open infarct-related artery. Ejection fraction correlated negatively with serum C-reactive protein in both control and recanalized patients. The association was again much stronger in the control patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Calprotectin in patients with systemic lupus erythematosus: relation to clinical and laboratory parameters of disease activity

Abstract: Calprotectin (L1) is a granulocyte and monocyte cytosolic protein released during activation of these cells. The plasma level of L1 has been shown to be a good marker of disease activity in rheumatoid arthritis. In this cross-sectional study of 100 patients with systemic lupus erythematosus (SLE), the serum level of L1 was found to be higher in patients than in matched controls (3661 micrograms/l versus 1051 micrograms/l; P < 0.001). The serum level of L1 was the only laboratory parameter with significant association to the disease activity index SLEDAI (r = 0.28; P < 0.01). Furthermore, the serum level of L1 was significantly higher in SLE patients with anti-DNA antibodies compared to patients without anti-DNA antibodies (4501 micrograms/l versus 3279 micrograms/l; P = 0.01). SLE patients with arthritis had higher serum levels of L1 than patients without arthritis (7652 micrograms/l versus 2811 micrograms/l; P < 0.01), indicating that the serum level of L1 also reflects arthritis activity in SLE.

C-reactive protein increases production of IL-1 alpha, IL-1 beta, and TNF-alpha, and expression of mRNA by human alveolar macrophages.

Abstract: The concentration of C-reactive protein (CRP) increases in human plasma up to a thousandfold during inflammatory states. Because tissue macrophages have been shown to have receptors for CRP, the question arises of whether these cells may respond to increased local concentrations of CRP by producing cytokines capable of participating in the inflammatory response. Accordingly, we examined the capacity of alveolar macrophages--relatively accessible human macrophages--to produce interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF-alpha) in response to CRP. We found that production of IL-1 alpha, IL-1 beta, and TNF-alpha, as measured by bioassay and immunoassay, increased in a dose-dependent manner after stimulation by CRP and that the levels of the respective mRNAs analyzed by Northern blot increased proportionally. These findings suggest that one of the functions of CRP may be to stimulate the production of IL-1 and TNF by macrophages at inflammatory sites where alterations of capillary permeability combined with an increased serum level lead to enhanced local concentrations of this acute-phase protein.

Validity of single variables and indices to measure disease activity in rheumatoid arthritis.

Abstract: We compared the sensitivity of several variables in 2 trials between second-line agents in our clinic. In a trial comparing sulfasalazine with hydroxychloroquine significant differences were found in favor of sulfasalazine by the Ritchie score, number of swollen joints, disease activity score (DAS), physical disability and radiographic damage. This could not be determined by number of tender joints, patient's global assessment, pain, morning stiffness, or erythrocyte sedimentation rate (ESR). In a trial comparing methotrexate with azathioprine significant differences could be found in favor of methotrexate by the variables of pain, DAS, ESR, C-reactive protein, hemoglobin and thrombocytes; not by Ritchie score, number of tender joints and number of swollen joints. Combining the results of the various validation procedures leads to relative quality of the variables.

Absence of correlation between interleukin 6 and C-reactive protein blood levels in systemic lupus erythematosus compared with rheumatoid arthritis.

Abstract: To investigate if the low C-reactive protein (CRP) response frequently observed in systemic lupus erythematosus (SLE) is related to an impaired expression of interleukin 6 (IL-6), considered its main inducer, we studied serum IL-6 and CRP levels in 37 patients with SLE and 22 with rheumatoid arthritis (RA). Results show that in contrast to CRP, IL-6 levels are significantly higher in SLE than in RA. A linear regression analysis shows a positive correlation between levels of these 2 molecules in RA but not in SLE. Similarly, levels of fibrinogen, another acute phase protein mainly induced by IL-6, did not correlate with IL-6 in SLE. Our results suggest an impairment of part of the acute phase response to IL-6 that might play a role in the pathogenesis of SLE.

Activation of the complement system in baboons challenged with live Escherichia coli: correlation with mortality and evidence for a biphasic activation pattern.

Abstract: Activation of the complement system was studied in baboons that were challenged with live Escherichia coli. In the group challenged with a lethal dose (n = 4), the complement activation parameters C3b/c, C4b/c, and C5b-9 increased 13, 5, and 12 times the baseline value, respectively, during the first 6 h after the E. coli infusion, whereas in the group challenged with a sublethal dose (n = 10), they increased only moderately, by 2 to 3 times the baseline value. However, in this latter group, a more pronounced activation occurred at 24 h. Subsequent experiments showed that this second phase in complement activation started at 6 h after the challenge, at which time infused microorganisms had been cleared from the circulation. The simultaneous increase in C-reactive protein with this second phase suggested an endogenous activation mechanism involving this acute-phase protein. Levels of inactivated (modified) C1 inhibitor also increased in both groups, with peak levels of 2.5 times the baseline value at 24 h in the sublethal group and of 4 times at 6 h after the challenge in the lethal group. Thus, activation of complement in this animal model for sepsis occurs in a biphasic pattern, the initial phase mediated by the bacteria and the later phase mediated by an endogenous mechanism possibly involving C-reactive protein. The differences in complement activation between animals with lethal or sublethal sepsis support the hypothesis that complement activation contributes to the lethal complications of sepsis.

C-reactive protein and its cytokine mediators in intensive-care patients.

Abstract: C-reactive protein (CRP) is an acute-phase protein produced by the liver during bacterial infections and inflammation. The cytokines interleukin (IL)-1 beta, IL-6, and tumor necrosis factor (TNF) are widely reported to induce synthesis of CRP by hepatocytes both in vitro and in vivo. We investigated the relation between CRP and its cytokine mediators in 64 critically ill patients during their treatment in the intensive-care unit. Plasma CRP and IL-6 concentrations were significantly lower in patients without any evidence of infection than in those with clinical infection; plasma IL-1 beta concentrations showed no significant difference between any of the groups, but plasma TNF concentrations were lower in patients with evidence of infection. Significant correlation was seen between plasma concentrations of CRP and IL-6 when the latter was measured by bioassay; however, IL-6 showed, at best, only a 50% predictive value for a change in CRP concentration.

Monitoring of serum proteinase--antiproteinase balance and systemic inflammatory response in prognostic evaluation of acute pancreatitis. Results of a prospective multicenter study.

Abstract: With the aim of studying the clinical usefulness and applicability of circulating levels of protease inhibitors, complement factors, acute phase reactants, and leukocytic enzymes in the prognostic evaluation of acute pancreatitis (AP), the present prospective multicenter study has been carried out. A total of 182 patients with AP have been included, to whom an exhaustive evolutive protocol has been applied from the time of their hospital admission (2–12 hr from the onset of the disease) until the 15th day of evolution in order to clearly define them. The severe episodes exhibit a greater consumption of α2-macroglobulin, and C3 and C4 complement factors, as well as a greater increase of α1-protease inhibitor, C-reactive protein and polymorphonuclear elastase than mild events, with regards to the underlying pathophysiological condition. The determination of the plasma levels of leukocytic elastase in the first hours of evolution allows a prediction of the severity of the acute pancreatitis event with a high reliability (predictive values that become higher than 90%). The clinical value of the remaining parameters analyzed, in this aspect, is less, being applicable to the monitoring of the disease.

C reactive protein in the diagnosis of acute appendicitis.

Abstract: OBJECTIVE To find out if the C reactive protein concentration is of any value in the diagnosis of acute appendicitis, either alone or in combination with other laboratory tests. DESIGN Open study. SETTING Drechtsteden Hospital, Dordrecht, and Spaarne Hospital, Heemstede, The Netherlands. SUBJECTS 209 consecutive patients admitted with suspected appendicitis. MAIN OUTCOME MEASURES Correlation of C reactive protein concentration with age, sex, body temperature, duration of abdominal pain, anorexia, nausea, vomiting, white cell count, neutrophil count, erythrocyte sedimentation rate, and histological appearance of the appendix. RESULTS 125 patients of the 209 patients had their appendixes removed, and of these 101 had histologically confirmed appendicitis: A C reactive protein concentration of > or = 6 mg/1 alone had a sensitivity of 87% and a specificity of 50%. When the selected variables were subjected to multivariate analysis the most important, in decreasing order, were white blood cell count, female sex, and C reactive protein concentration. Combining the variables was of no additional value. CONCLUSION measurement of the C reactive protein concentration can increase the accuracy in the diagnosis of acute appendicitis.

Variation in serum C-reactive protein across the clinical spectrum of meningococcal disease

Abstract: In a multicentre prospective study, 124 cases of meningococcal disease were classified into the clinical categories, meningitis alone (n = 15), meningitis and septicaemia (n = 79) and septicaemia alone (n = 30). A further 60 children referred with other illnesses served as controls. Serial measurements of serum C-reactive protein (admission, day 1, day 2, days 5-7) were compared. Children with septicaemia had significantly lower C-reactive protein levels on admission than those with meningitis alone or meningitis and septicaemia which were unexplained by differences in the duration of the presenting illness or severity of the disease. Within each clinical category of meningococcal disease, significant changes in C-reactive protein concentration occurred during the course of the disease. Four control children had other types of septic meningitis: admission C-reactive protein concentrations did not differ from those with meningitis or meningitis and septicaemia, but were significantly higher than those with septicaemia alone. The other 56 patients had a significantly lower admission C-reactive protein concentration compared with all cases of meningococcal disease. For the diagnosis of meningococcal disease, admission C-reactive protein levels of > or = 40 mg/l had a sensitivity of 79%, specificity of 80% and positive predictive value of 87%. For the prognostic prediction of death in meningococcal disease (or meningococcal disease with shock) CRP < 100 mg/l on admission had a sensitivity of 69% (69%), specificity of 50% (56%) and positive predictive value of 18% (53%). In children with suspected meningococcal disease, serum C-reactive protein, measured on admission, has diagnostic value but not prognostic value.(ABSTRACT TRUNCATED AT 250 WORDS)

Complement (C3, C4) and C-reactive protein responses to cardiopulmonary bypass and protamine administration.

Abstract: Complement activation has been deemed responsible for the damaging effects of cardiopulmonary bypass (CPB) in patients undergoing open heart surgery. We studied C3, C4 and C-reactive protein (CRP) in 22 patients undergoing CPB. In Group 1 (11 patients), protamine was given intravenously and in Group 2 (11 patients), via the aortic root after CPB. Significant decreases were observed in C3 and C4 during CPB in both groups indicating complement activation primarily by the classic pathway. Protamine did not lead to further activation of the complement system. In both groups, C3 levels gradually returned toward baseline within 24 hours but C4 levels were still lower than baseline 24 hours postoperatively. CPB and protamine administration did not cause any significant changes in CRP levels, but CRP increased abruptly 24 hours after operation. Although activation of complement system during CPB is expected to invoke an acute phase response, we conclude that this period is not long enough to induce an increased production of CRP in response to tissue injury or inflammation.

Clinical relevance of serum amyloid A protein monitoring in urinary tract infections

Abstract: SUMMARY. We have evaluated the clinical relevance of monitoring acute phase proteins in severe urinary tract infection. Body temperature, white blood cell count, erythrocyte sedimentation rate, serum amyloid A protein (SAA), C-reactive protein (CRP), a-1-antichymotrypsin (ACT) and ee-l-acid glycoprotein (AGP) were determined daily in sera from 18 treated patients. Two patterns of response could be identified: responders and non-responders whose therapy had to be changed. Mean values for each acute phase protein were calculated daily in both responders and non-responders. Statistical evaluation of the significance between the means for each protein was also performed on a daily basis and showed P

Serum cytidine deaminase as a measure of disease activity in rheumatoid arthritis and systemic lupus erythematosus

Abstract: Serum cytidine deaminase (CD) as a marker of disease activity was assessed in 100 patients with rheumatoid arthritis (RA) and in 102 assessments of 85 patients with systemic lupus erythematosus (SLE) In RA CD levels correlated well with clinical assessment of disease activity, but were not influenced by varying dosages of ibuprofen as therapy In SLE significant correlations were found between CD and anti-DNA antibody titers, as well as C3 complement levels A subset of clinically active patients with SLE with elevated CD levels but normal anti-DNA titers was identified Serum CD levels may be a clinically useful marker in RA and in certain subgroups of patients with SLE

[Value of C-reactive protein determination in small cell lung cancer].

Abstract: A prospective analysis of serum levels of C-reactive protein (CRP) has been conducted on a series of 39 small cell lung cancer (SCLC) patients during the first course of chemotherapy in order to evaluate the predictive value of this marker on tumoral extension at diagnosis and response to therapy. Serum levels of CRP were measured before chemotherapy (day 0) and during the first two days of treatment (day 1, day 2). Twenty-three of 32 evaluable patients (71%) had extensive disease. The mean pre-treatment CRP level was significantly higher in this group than in the group of patients with limited disease (52.3 mg/l vs 15.8 mg/l, P = 0.02). Twenty-three patients responded to treatment and nine did not. The evolution of serum CRP levels in both groups was compared between day 0 and day 2. A more than two-fold increase of initial CRP levels showed a 100% predictive value for response. On the other hand, a decrease by more than 50% of initial serum levels was associated with a negative predictive value of 75% for response. We conclude that the follow-up of CRP levels during initial chemotherapy of SCLC might be useful in the initial evaluation of tumoral extension and in the early prediction of response to therapy.

Hepatic cirrhosis showing false-positive serum C-reactive protein reaction.

Abstract: A 58-year-old male who had been diagnosed as hepatic cirrhosis four years previously was admitted to our hospital because his serum C-reactive protein (CRP) level had gradually risen, reaching 139 mg/dl. No inflammation findings were observed subjectively or objectively. Close examination revealed his CRP reaction to be false positive. His serum CRP showed positive only in a latex agglutination method using goat anti-CRP IgG. This false-positive reaction was thought to be owing to the abnormally glycosylated IgM, which has an affinity for the goat serum IgG.

Nutritional management of Crohn's disease with a peptide-based enteral formula.

Abstract: We examined a nutritional approach to the therapy of Crohn's disease with an enteral formula ('Enterued', Terumo Corporation, Tokyo, Japan) which contains low molecular weight peptides as a protein source. Total protein, albumin, transferrin, prealbumin and retinol-binding protein levels were significantly increased as indices of the nutritional status, when compared with those observed before treatment. White blood cell count (WBC), erythrocyte sedimentation rate and C reactive protein (CRP) as the indices of inflammation levels were reduced significantly after the termination of the treatment, when compared with those observed before treatment. The International Organization for the Study of Inflammatory Bowel Disease (IOIBD) assessment scores decreased in all cases, except for one case out of 51 cases evaluated. Deterioration in nutritional status was not observed in any patient, but rather was maintained or improved; 42 out of the total 51 cases (82.4%) exhibited at least moderate improvement. Treatment was discontinued on account of side effects such as abdominal distension, abdominal pain and diarrhoea in five cases (8.1%). The enteral formula 'Enterued', utilizing low molecular weight peptides as a nitrogen source, appears to improve nutritional status and encourage remission of the inflammatory process with minimal side effects.

Clinical significance of serum C-reactive protein measurements among patients on chronic hemodialysis.

Abstract: 慢性血液透析患者の急性炎症の指標として, 白血球数, 血沈, CRPの信頼性について検討を加えた. 白血球数は非炎症時と炎症合併時とで差がなく, また血沈は非炎症時にすでに正常値よりも亢進していたが, 炎症の発現によりさらに亢進した. CRP値は非炎症時に非透析患者よりもやや高いもののなお低値にとどまっており, 炎症とともに上昇した (p<0.05). また非炎症時のCRP値は, 慢性糸球体腎炎, 糖尿病性腎症炎, その他の主な基礎疾患の間で差を認めなかった. さらに, 非炎症時には血液透析前後でCRP値に変動はなく, 血液透析期間とCRP値との間にも相関を認めなかった. 使用ダイアライザーで比較するとPMMA膜に比してクプロファン膜で有意に高値を示した (p<0.05) が, その程度は急性炎症の存在をマスクするほどではなかった. また, 炎症症状が存在しない状態でCRP値が高値を示したのは0.6%のみであり, さらに炎症発現早期においてもCRP値は全例が高値を示した. 以上より慢性透析患者の急性炎症の指標として白血球数は適切ではないと判断された. CRP値は透析によりある程度影響を受けるものの, なお低いままで, 炎症とともに変動するので急性炎症の指標として血沈よりも有用と判断された.

Post-Prandial Chylomicron Creaming, C-Reactive Protein and Enhanced Complement Activation

Abstract: The acute-phase reactant, c-reactive protein (CRP): 1) activates human complement (Volanakis, J.E., 1982); 2) causes creaming in vitro of lipid micro-emulsions (Rowe, I.1Z, Soutar, AID and Pepys MB, 1986); 3) is thought to underlie fat micro-embolism in vivo in sick patients receiving parenteral nutrition containing lipid (Hulman, G. et al., 1982) as a chronic high saturated fat intake is a risk factor for ischemic heart disease, acute myocardial infarction (MI) frequently follows large meals, and complement activation has been shown to take place during MI (Langlots, P.F., and Gawry4 M.S., 1992), we wondered whether chylomicrons (CM) might potentiate CRP-induced complement activation.