Etiology and prognosis of highly elevated C-reactive protein levels (≥500 mg/L): a retrospective study about 168 measures in a series of 113 patients

The C-reactive protein (CRP) is a useful inflammatory marker with a rapid kinetics during the inflammatory process. The objective of this study was to determine the etiology and prognosis of extremely elevated CRP values greater or equal to 500 mg/L. We performed an exhaustive retrospective study fr...

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Bibliographic Details
Published in:La revue de medecine interne 2011-11, Vol.32 (11), p.663-668
Main Authors: Hajek, V, Pasquet, F, Karkowski, L, Lachenal, F, Gerôme, P, Pavic, M
Format: Article
Language:fre
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Biomarkers - analysis
Biomarkers - blood
Biomarkers - metabolism
Blood Specimen Collection - statistics & numerical data
C-Reactive Protein - analysis
C-Reactive Protein - metabolism
Female
Humans
Immune Tolerance - physiology
Infection - blood
Infection - complications
Infection - diagnosis
Leukocytosis - blood
Leukocytosis - diagnosis
Leukocytosis - etiology
Male
Middle Aged
Predictive Value of Tests
Prognosis
Retrospective Studies
Up-Regulation - physiology
Young Adult
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Summary:The C-reactive protein (CRP) is a useful inflammatory marker with a rapid kinetics during the inflammatory process. The objective of this study was to determine the etiology and prognosis of extremely elevated CRP values greater or equal to 500 mg/L. We performed an exhaustive retrospective study from January 2004 to July 2009, in a general hospital, of all patients with a CRP value above 500 mg/L, admitted in all clinical departments. Clinical data were collected by a single observer using a standardized questionnaire. One hundred and sixty-eight CRP values greater or equal to 500 mg/L were identified amongst 106,758 tests (0.16%) corresponding to 113 patients: 51% were men and their mean age was 59.5 years. Mean CRP value was 561 mg/L (500-772). An immunocompromised condition was observed in 52% of the patients. All but 13 patients presented an infectious disease. Microbiological analysis of the infected patients identified 59 Gram-positive cocci (20 Staphylococcus spp., 35 Streptococcus spp. including 21 Streptococcus pneumoniae), two Gram-negative cocci, 48 Gram-negative bacilli (including 19 Escherichia coli), three Gram-positive bacilli, 16 fungal infections, one viral infection. Site of infection was respiratory in 63%, urinary in 17% and abdominal in 16%. At day 30, mortality rate was 27% and only 41% of the patients were discharged at home. CRP value above 500 mg/L is highly related to bacterial infections, without over-representation of a given microorganism. One-month mortality is high (27%).
ISSN:1768-3122
DOI:10.1016/j.revmed.2011.04.001