PCR - REACTIVE PROTEIN C

The C reactive protein or PCR (CRP from English C Reactive Protein) it is an acute phase protein, and is synthesized by our body during an inflammatory state. Analysis of the C reactive protein is then done to look for the presence of inflammation.

A match by high C-reactive protein it is associated with an inflammatory state. Usually the causes of high CRP they are bacterial and fungal infections, rheumatological, immuno-haematological and neoplastic (tumor) diseases. However, it should not be forgotten that the test for the Creattiva protein it is an examination that does not allow the diagnosis of a specific pathology, but is simply an "alarm bell" that our body is subject to an increase in inflammatory state.

PCR - C reactive protein normal values

C reactive protein in adults

Depending on the laboratory and the method of measurement, normal C reactive protein values may vary slightly.

A value of is considered normal CRP <6 mg / L (CRP <0.6 mg / dL).

C reactive protein in infants

In infants, CRP is known to rise nonspecifically in the first days of life: following a this study, the use of the following reference values in neonates has been proposed:

  • 0-12 h from birth: CRP <5 mg / L
  • 13-24 hours from birth: CRP <15 mg / L
  • 25-36 hours from birth: CRP <25 mg / L
  • 37-48 hours from birth: CRP <25 mg / L
  • 49-60 hours from birth: CRP <20 mg / L
  • 61-72 hours from birth: CRP <15 mg / L
  • 73-84 hours from birth: CRP <15 mg / L
  • 85-96 hours from birth: CRP <10 mg / L

PCR - C reactive protein mechanism of action

There PCR it is an acute phase protein, which is part of innate immunity, and is produced by the liver in the presence of an inflammatory stimulus. C reactive protein, ESR, procalcitonin and presepsin are the most commonly used tests as inflammatory markers, that is, as tests carried out during infections or other inflammatory processes.

C reactive protein is produced together with others acute phase proteins such as alpha and gamma globulins, interleukins, haptoglobin, serum amyloid protein, fibrinogen and alpha1-antitrypsin. The stimulation of PCR production is secondary to the production of another protein, interleukin 6 (IL-6), released by cells circulating in the blood, in particular by macrophages.

The levels of PCR in acute they can increase by tens or hundreds of times compared to normal values. The analysis allows the determination of PCR in the blood and is mainly used in acute cases such as in suspected infections and in chronic conditions for monitoring long-term pathologies.

The C reactive protein it works by binding to phosphorylcholine which is a protein expressed on damaged or dead cells, but also on the surface of microorganisms such as bacteria. PCR acts like opsonizing on bacteria and damaged or dead cells thanks to its bond with the phosphorylcholine exposed on the surface of the latter. The term opsonize means to coat the surface of a cell or microorganism, allowing the attack of complement proteins, and the activation of the classical complement pathway. It also allows the stimulation of the phagocytosis that is, the incorporation of cells or opsonized microorganisms by cells such as macrophages.

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In other words, PCR is part of the mechanism that allows our body to activate the response to an insult, be it infectious, autoimmune or ischemic.

PCR - C reactive protein because the test is performed

There C-reactive protein it is not a diagnostic test in the sense that it does not allow the diagnosis of any pathology with certainty. On the other hand, the analysis of the C reactive protein allows us to understand if an inflammatory state is present: this, combined with other clinical factors such as signs or symptoms found in the physical examination, or as other blood tests carried out together with PCR, allows to place everything in a situation of acute or chronic inflammation, or in a picture of acute exacerbation of a chronic disease.

C reactive protein is also used in the continuation of an infection to evaluate the response to antibiotic or antifungal therapy. Similarly, in chronic diseases it is used in the follow-up to evaluate the response to treatment. Unlike the other test used in inflammation diagnostics, that the ESR (erythro-sedimentation rate, i.e. the speed that red blood cells use to settle on the bottom of a test tube), the PCR changes only moderately during pregnancy, and the case of increased presence of globulins in the blood (hyperglobulinemia) does not change in the course of anemia. For these reasons, PCR is much more specific than ESR in the diagnosis and monitoring of inflammatory events.

Note: PCR is often indicated in blood test reports with the wording s-PCR or s-C reactive protein, where the "s" stands for serum, which derives from serum, that is the non-corpuscular liquid part of the blood.

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High CRP - High C reactive protein

A high C reactive protein (High CRP) is characteristic of acute inflammatory conditions such as bacterial and fungal infections, or in case of an ischemic event (e.g. myocardial infarction), but also in case of chronic inflammatory diseases. A High PCR, as indeed a high ESR, therefore gives the perception that there is an active inflammatory state, the nature of which must however be diagnostic by analyzing specific signs and symptoms, possibly with the help of other blood or radiological analyzes.

Ongoing inflammatory insult, the Creattiva protein begins to increase after about 6-12 hours from the start of the inflammatory stimulus, and reaches its highest peak within 24-48 hours. Once the inflammatory pathology has resolved, the CRP returns to baseline levels within 48 hours (in fact it has a half-life of about 19 hours).

High C Reactive Protein Causes - High CRP Causes

The feedback from high C reactive protein it is often associated with the presence of an inflammatory state in our body (infections, activations of the immune system and in any case everything that leads to the release of inflammatory cytokines in our body). Here are the possibilities acute causes of High CRP:

Bacterial infections: they are the most common type of infection ever, characterized by high fever (> 38 ° C) often accompanied by chills. Bacterial infections represent the most powerful stimulus for the increase of C-reactive protein values: was estimated that, regardless of whether the culprit is a gram + or gram - germ, a bacterial infection causes an increase in CRP greater than 100 mg / l in over 70% of cases. Here are the bacterial infections that most frequently cause high CRP:

Bacterial infections of the teeth and oral cavity: they are quite frequent, very painful infections that can lead to serious complications. Among the most frequent are the dental granulomas, which are infections of the apex of the dental root secondary to caries or ruptures of part of the tooth, and the pulpits, or the inflammation of the pulp of the teeth: if left untreated, they can worsen up to the development of a suppurative granuloma or a real abscess.

Tonsillitis: infection of the tonsils, two symmetrical lymphatic organs located in the oral cavity, in the nasopharynx. A well-known research by Dr. Putto showed an average CRP in bacterial pharyngotonsillitis of 65 mg / L, comparable to that of EBV (Epstein Barr Virus) tonsillitis, but significantly higher than adenovirus vviral tonsillitis).

Bacterial skin infections: are very common infections in elderly, overweight or obese people and not infrequently with circulation problems in the lower limbs (main site of skin and soft tissue infections). We list below the most frequent:

  • Erysipelas: Soft tissue infection involving the dermis and the superficial layers of the hypodermis, is characterized by high CRP levels, generally between 50 and 100 mg / L. For example this research conducted in a dermatology department showed mean C-reactive protein values of 78 mg / L.
  • Impetigo: infection by pyogenic germs, differs from other types of soft tissues as it is frequent even in the pediatric age. Almost always caused by gram positive bacteria such as Staffilococcus aureus or Pyogenes streptococcus (which is a group A beta hemolytic streptococcus). Characterized by high ESR and C reactive protein.
  • Cellulite: inflammation of the subcutaneous connective tissue: it can represent an evolution of a normal erysipelas and can lead to the feared involvement of the connective bands, fasciitis. ESR, CRP and procalcitonin (PCT) are constantly altered during cellulite, in particular CRP usually exceeds 40 mg / L.
  • Fasciitis: very serious pathology consisting in the infection of the deep soft tissues that spreads through the connective bands that envelop the tissues, giving deep necrosis, sepsis and septic shock with a high risk of poor prognosis. A score is used to calculate the risk of necrotizing fasciitis LRINEC, which among its parameters also uses the data of PCR> 150 mg / L. A recent study published in Plosone showed a mean C reactive protein of 254 mg / L in patients with necrotizing fasciitis.

Airway infections: they are among the most frequent infections, especially in children and the elderly. Here are the most frequent manifestations of respiratory tract infection:

    • Pneumonia: it is a pathology affecting the lung parenchyma. Pneumonia is characterized by inflammation in the alveoli, small “bag-shaped” cavities into which the bronchioles flow. The main cause of pneumonia is bacterial lung infection, during which the alveoli become filled with fluid and / or inflammatory material causing a lack of ventilation. Pneumonia is usually characterized by a productive cough (fat cough), fever, and, later on, difficulty breathing. In general, in bacterial pneumonia the ESR and CRP are very high, in particular CRP often exceeds 100 mg / L. For example, I study 2004 conducted by Almirall J et al. and published in Chest showed, in bacterial pneumonia, one Mean CRP of 110.7 mg / L, with Legionella pneumoniae pneumonia and Streptococcus pneumoniae pneumonia which showed the highest mean CRP values (178 mg / L and 166 mg / L respectively) .The following table shows the study data instead C-reactive protein levels in community-acquired pneumonia, by E. García Vázquez et al. 2003, published in the European Respiratory Journal. According to this article, for example, a value of is considered predictive of S. pneumoniae bacterial pneumonia CRP greater than 250 mg / L. Below are the average levels of Creattiva protein based on the germ responsible for the infection.
Bacterial agent No. of patients Mean CRP (mg / L)
Typical lung bacteria 141 160
Streptococcus pneumoniae 80 171,5
Haemophilus influenzae 26 129,3
Others 35 156
Legionella pneumophila pneumonia 30 252,3
Atypical pneumonia 52 126,4
Chlamydia pneumoniae 20 117,4
Mycoplasma pneumoniae 17 160,2
Coxiella burnetii 15 100,2
Viral 35 144,5
Totals 258 161,8
Patients with more than one identified pathogen 80
Purulent pneumonia 38 188,2
Purulent pneumonia + Legionella 2 149
Purulent pneumonia + atypical bacteria 12 138
Purulent + viral pneumonia 17 167,6
Viral pneumonia + Legionella 1 339,8
Viral pneumonia + atypical bacteria 6 129
Atypical bacteria + Legionella 4 270,3
Pneumonia of unknown etiology 383 140,1
  • Bronchitis: it is a very frequent bacterial infection at a young age, it also returns very widespread in elderly patients, as an exacerbation of COPD (Chronic Obstructive Pulmonary Disease). It is characterized by cough and bronchospasm signs and symptoms. The indices of inflammation (CRP, ESR, procalcitonin, presepsin) are easily altered from the first respiratory manifestations.
  • Pharyngitis: it's the classic "sore throat", consists of inflammation of the pharynx, the terminal part of the oral cavity that connects it with the nasal cavity, esophagus and larynx. The larynx, in turn, can become inflamed, giving rise to the lherringitis. Both of these pathologies are predominantly viral, with a modest increase in inflammation indices. Less often they are of bacterial etiology, with a conspicuous rise in Reactive Protein C, not rarely greater than 50 mg / L.
  • Sinusitis: inflammation of the mucous membrane of the paranasal sinuses (which are divided into frontal sinuses, maxillary sinuses, ethmoid sinuses and sphenoid sinuses) of the cavities located in our facial massif and which have important functions such as moistening and warming the inhaled air, protecting the skull from sudden changes in temperature and trauma and allergen the overall bone weight. There bacterial sinusitis (sinusitis purulent, to distinguish it from viral sinusitis, called serous) is mainly caused by and is characterized by a major increase in ESR and a raising of the C-reactive protein, which is usually between 50 mg / L and 100 mg / L.

CRP and bacterial urinary infections: urinary tract infections are the most frequent infections in women and among the most frequent of all. We pass from asymptomatic bacteriuria (i.e. from the presence of bacteria in the urine without associated symptoms) to classic bacterial cystitis (inflammation of the bladder linked to bacterial infection) to urethritis (inflammation of the urethra, i.e. the tract that connects the bladder with the external) up to "higher" infections such as cystopyelitis and pyelonephritis. The IVU (urinary tract infections, also called UTI, Urinary Tract Infection) can also be not complicated, i.e. cystitis in nonpregnant, non-immunocompromised women without functional or anatomical abnormalities of the urinary tract and who have no signs of systemic infection or tissue invasion, or complicated, that is when they show signs of systemic infection or that in any case do not fall within the criteria previously described. The treatment of complicated infections will be much stronger and "aggressive" than the uncomplicated forms of cystitis. The analysis of the C-reactive protein, as well as the other indices of inflammation (especially procalcitonin) is very useful for assessing the extent of the infection and the course of antibiotic therapy. The germs most frequently responsible are E. coli (Escherichia Coli) in 80-90% of cases, and a heterogeneous group of other microorganisms (Staphylococcus saprophyticus, Staphylococcus epidermidis, Enterococcus fecium and fecalis, Klebsiella pneumoniae and Proteus Mirabilis) in the remaining 10 -20% of cases. Here are the most frequent urinary infections.

Cystitis and C reactive protein: bladder infection, it is very frequent especially in women. It is favored by poor intimate hygiene or by an exaggerated use of detergent products that alter the intestinal bacterial flora, by cold, by the presence of anatomical anomalies such as urinary tract stenosis, stones, uterine or bladder prolapse, or by diseases associated with diabetes, neurological pathologies, from the use of contraceptive devices such as the diaphragm, and, in incontinent or hospitalized patients, from the presence of a bladder catheter. LPCR examination it is very useful as it allows, in a person with urinary symptoms (For example dysuria, i.e. difficulty urinating, pollakiuria, i.e. need to urinate frequently, hematuria, i.e. blood in the urine, or stranguria, i.e. painful urination) to check for the presence of an inflammatory (probably infectious) state of the urinary tract). L'analysis of C reactive protein it is also useful for monitoring the progress of antibiotic therapy. The CRP values can vary from minimal alterations (15-20 mg / L) up to values over 250 mg / L in urosepsis,  that is, in complicated cystitis with spread of the infection throughout the body.

Urethritis and PCR: Urethritis is an inflammation of the urethra, the small channel that carries urine from the bladder to the outside of our body. It is often of bacterial origin, linked to a non-optimal intimate hygiene, and the most frequent germs that cause it are Chlamydia Trachomatis, and the Trichomonas and Mycoplasma species. It is associated with a positive urine culture, and with an alteration of the indices of inflammation, C reactive protein and ESR.

Prostatitis and PCR: prostatitis is the inflammation of the prostate, a gland present only in males, essential for fertility and reproduction. If linked to a bacterial infection, it presents with fever, groin pain and difficulty urinating. It often leads to C-reactive protein levels 10-20 times higher than normal levels.

Abdominal and gastrointestinal bacterial infections: they are very frequent infections, and of very variable severity. CRP levels in this type of infections can reach very high values. Here are the most frequent infections of the abdomen and gastrointestinal tract:

  • Cholecystitis: inflammation of the gallbladder, more commonly called the gallbladder. This inflammation can be the result of a stone wedged in the infundibulum (the terminal part of this sac-like organ), which prevents the normal outflow of bile and can cause a state of inflammation and tension of the organ, up to superinfection of the gallbladder. Lithiasic cholecystitis (i.e., calculotic, related to gallstones) accounts for more than 85% of cases of gallbladder inflammation. In the remaining 15% the causes are different, and we speak of alitiasic cholecystitis. There cholecystitis it is a very serious acute disease, which is treated with antibiotic and pain relieving therapy, complete fasting and adequate intravenous hydration. Complications of cholecystitis are the spread of the infection through the blood throughout the body (sepsis), with the possible development of SIRS (systemic inflammatory response syndrome). Another fearful complication is the perforation of the gallbladder, with the dissemination of its infected contents into the abdominal cavity, invariably causing peritonitis. In the course of cholecystitis, very high values of the inflammation indices can be recorded, such as ESR, PCR and above all procalcitonin. In particular, CRP often exceeds the threshold of 200 mg / l. One study conducted in Japan found variable C-reactive Protein values in relation to the severity of the disease: CRP around 20 mg / l in uncomplicated cholecystitis, CRP values greater than 130 mg / l in intermediate severity cholecystitis and an average CRP greater than 230 mg / l in complicated severe cholecystitis. Another research highlighted theusefulness of protein C reactive in predicting what type of surgical approach to use: patients with low CRP were operated in most cases laparoscopically (i.e. with minimal surgery, with small surgical wounds), while patients with high CRP (greater than 36 mg / l showed a high risk of laparotomic cholecystectomy (ie with the classic opening of the abdomen with a scalpel).
  • Cholangitis: infection of the biliary tract, it is almost always linked to a bacterial superinfection in a situation of reduced biliary outflow, that is when there is a stone or a stenosis of the biliary tract that causes the bile to stagnate. More rarely, it results from congenital anomalies of the biliary tract or from previous abdominal surgery. In some cases, cholangitis can develop as a result of other abdominal infections (pancreatitis, diverticulitis). THE C reactive protein values in cholangitis they often exceed the 100 mg / L threshold.
  • Infectious pancreatitis: inflammation of the pancreas, often linked to the presence of stones in the biliary tract or pancreatic tract, which cause a stagnation of the bile and pancreatic juices, which begin to attack the pancreas itself, initially producing local inflammation, then a real necrosis . Other less frequent causes are linked to infections of the biliary tract, to congenital anomalies of the biliary tract. Alcoholics are predisposed to pancreatitis, as are people with hypertriglyceridemia, and those who suffer from impaired calcium metabolism (hypercalcemia with or without primary hyperparathyroidism). In the course of pancreatitis, the inflammatory process is very important and is not uncommon to observe CRP levels above 200 mg / L.

Genital and reproductive system infections: they are infections often transmitted sexually or linked to poor personal hygiene. Here are the most frequent.

  • Salpingitis: inflammatory process usually of infectious origin affecting the salpingi (fallopian tubes): the germs most commonly involved are streptococci, staphylococci, and gonococci (Neisseria gonorrhoeae). Scientific evidence have shown relevant changes in PCR in the course of salpingitis, with a mean of 11 mg / l and peaks up to 97 mg / l CRP in salpingitis caused by Chlamydia trachomatis, and a mean C reactive protein of 104 mg / l with peaks up to 250 mg / l in progress of Neisseria gonorrhoeae infection.
  • Orchitis: inflammation of the testicles, very painful and accompanied by high values of the indexes of inflammation.
  • Epididymitis: an inflammation of the epididymis, the thin, twisted duct that connects each testicle to its vas deferens. Painful disorder, which if left untreated can lead to infertility, is associated with a significant increase in c-reactive protein.
  • Balanitis: inflammation, often of infectious origin, of the glans head. Often the values of the phlogosis indices are high, and are accompanied by pain, redness and swelling of the distal (thermal) part of the penis.
  • Vulvitis
  • Vaginitis.

Other typical young age infections:

  • Ear infection: ear inflammation, mainly manifested by ear pain, hearing loss, fever. At the laboratory level there is a marked increase in ESR and CRP.
  • Scarlet fever: infectious disease caused by the toxins of Streptococcus Pyogenes (Group A Streptococcus), manifested by rash (punctate exanthema), pharyngodynia (sore throat), pyrexia (fever) and alteration of the signs of inflammation, with high CRP.

Fungal infections: they are less frequent, most are caused by urinary tract infections caused by fungi (fungi), the most common is Candida.

Viral infections: infections caused by viruses are usually accompanied by lower inflammation index levels than bacterial infections. Normally the CRP does not exceed 50 mg / L, and the fever does not exceed 39 ° C (as always there are exceptions in this case too). Here are the most frequent viral infections with high CRP:

  • Influenza and rhinovirus infections (syndrome from cooling or cold): It has been demonstrated a modest increase in CRP in the first week of illness, with a peak towards the 4th day and average values ranging from 10 mg / L to 40 mg / L.
  • Measles: viral infection caused by Morbillivirus, is characterized by a modest rise in CRP (<20 mg / L), unless there is underlying bacterial superinfection.

Chronic inflammatory bowel diseases in the initial and active phase, Such as ulcerative colitis or Crohn's disease.

Rheumatological pathologies: the most frequent are rheumatic polymilagia, rheumatoid arthritis, systemic lupus erythematosus (SLE), as well as systemic vasculitis. Being inflammatory pathologies they involve an activation of the inflammatory cascade with activation of IL-6, TNF and consequent increase of the inflammation indices, in particular of ESR and PCR. Here are the most common rheumatological diseases:

Systemic lupus erythematosus (SLE): lupus is a pathology chronic inflammatory autoimmune, which affects the serosa and tissues of various organs in our body. In our country it affects 1500-200 people annually, of which 90% belongs to women. At the biohumoral level, anti-nucleus antibodies, anti-phospholipid antibodies and anti-DNA antibodies are often found. In the phases of inactivity or in active SLE but without affecting the serosa, the values usually do not exceed 20 mg / l, while in the phases of active lupus with serositis, the finding of high CRP is the rule, with values on average above 60 mg / l.

Rheumatoid arthritis: it is a chronic disease that causes pain, swelling (swelling) and joint stiffness with limitation of the range of motion and function of the affected joints. Although the joints are the most involved parts of the body, inflammation can also develop in other organs or areas. It is accompanied by positivity for the rheumatoid factor, a particular antibody directed towards our own organism. In the course of rheumatoid arthritis, the finding of C-reactive protein is rheumatoid factor altered is very common.

Vasculitis of the great vessels: 

  • Giant cell arteritis
  • Takayasu's arteritis

Vasculitis of medium caliber vessels:

  • Polyarteritis nodosa
  • Kawasaki disease
  • Primary granulomatous vasculitis of the central nervous system

Small vessel vasculitis:

  • ANCA-associated vasculitis
  • Microscopic polyangiitis
  • Wegener's granulomatosis
  • Churg-Strauss syndrome
  • Drug-induced and ANCA-associated vasculitis
  • Immune complex vasculitis
  • Henoch-Schönlein purpura
  • Cryoglobulinemic vasculitis
  • Lupus vasculitis
  • Rheumatoid vasculitis
  • Sjögren's syndrome vasculitis
  • Hypocomplementemic urticarial vasculitis
  • Behçet's disease
  • Goodpasture syndrome
  • Serum sickness vasculitis
  • Drug-induced vasculitis
  • Post-infectious immune complex vasculitis
  • Paraneoplastic vasculitis
  • Vasculitis induced by lymphoproliferative disease
  • Vasculitis induced by myeloproliferative diseases
  • Vasculitis associated with carcinoma
  • Vasculitis from chronic inflammatory bowel diseases

Pelvic inflammatory disease (Pelvic Inflammatory Disease or PID)

Non-infectious pancreatitis: even in the course of non-infectious pancreatitis, which is the most common form of inflammation of the pancreas, due to the activation of pancreatic enzymes following the occlusion or spasm of the Wirsung duct (stones, alcoholism the most frequent causes), there is an important increase in inflammatory indices. Furthermore, the fact remains that a lithiasic pancreatitis (from stones) can evolve and become overinfected if not treated properly.

Acute joint rheumatism,  or rheumatic fever.

Acute arthritis

Gout

Burns

Trauma or surgery

Ischemic insults (i.e. related to the reduced blood supply in a certain area of the body), such as myocardial infarction or cerebral ischemia (stroke).

Hematological diseases: lymphomas and multiple myeloma can be characterized by High ESR is high C reactive protein.

Not always the feedback of high C reactive protein it is associated with an acute pathology: often, the CRP is elevated even during chronic inflammatory diseases. Here are some possible ones chronic causes characterized by a High CRP:

Chronic arthritis

Chronic inflammatory bowel diseases (Crohn's disease and ulcerative colitis) in the chronic phase

Terminal pregnancy (minimum increase)

Obesity: Obese people have increased baseline CRP values compared to people of normal weight: in this study a C-reactive protein value greater than 2.2 mg / l has been documented in over 60% of obese people, with about 20% having a CRP even more than 10 mg /l, in the absence of any other inflammatory pathologies in progress.

Neoplasms

Neurological diseases such as multiple sclerosis

High C Reactive Protein Symptoms - High CRP Symptoms

Symptoms that may be associated with a High CRP they are mainly those found in the case of a bacterial or fungal (fungal) infection.

The symptoms in the acute phase that may accompany the finding of high c reactive protein will mainly be:

  • temperature
  • articolar pains
  • sweating alternating with a feeling of cold sometimes accompanied by chills
  • possible signs of infection / inflammation in one or more parts of the body, such as:
  • redness or swelling (swelling) of the skin in soft tissue infections such as erysipelas or cellulitis (involving the deeper subcutaneous layers),
  • problems with urination such as dysuria (burning when urinating) or stranguria (pain when urinating) if there is a urinary tract infection, such as cystitis or pyelonephritis
  • cough produced sometimes accompanied by breathing difficulties in case of an airway infection (pneumonia, bronchitis, bronchopulmonary, bronchiolitis in children)
  • abdominal pain, nausea, jaundice in the case of a biliary tract or gallbladder infection (cholangitis or cholecystitis)
  • sensation of swelling and pain in the oral cavity (to exclude the presence of granuloma or abscess at the dental level)
  • Pelvic or groin pain that is accentuated with sexual intercourse and at the end of each menstrual cycle: these are typical symptoms of pelvic inflammatory disease.
  • In case theincreased CRP is linked to a chronic inflammatory disease the most common symptoms can be:
  • mild fluctuating fever (low-grade fever)
  • joint pain with or without swelling (swelling), redness and warmth in the joints
  • recurrent diarrhea and abdominal pain in the case of chronic intestinal diseases.
  • Weight loss (weight loss), loss of appetite (hyporexia) and energy (asthenia): these are symptoms that must be investigated because they are present in the course of cancer.

Hs-PCR - High sensitivity C reactive protein

High-sensitivity PCR (hs PCR, from English HS-CRP, High Sensivity C-reactive protein) is an analysis that measures the blood values of C reactive protein with an ultrasensitive method, so that even small quantities of this protein can be detected precisely. Unlike the classic PCR test, which is carried out in the suspicion of infections or inflammatory diseases, the hs-PCR is measured in the context of cardiovascular diseases, to understand the risk of a subject, even healthy, of encountering acute ischemic heart (myocardial infarction) and cerebral (ischemic stroke) ischemic problems. In fact, it is believed that even modestly altered levels of hs-PCR are associated with the presence of atheroscelrosis or, in any case, damage to the vascular level. The article by Steven Black, reports that CRP levels between 3 and 10 mg / dl can lead to an increased risk of developing cardiovascular complications (myocardial infarction, ischemic stroke, multiple district vasculopathy), metabolic syndrome is colon cancer.

The levels of hs PCR are divided into bands, with increasing cardiovascular risk from the first (low-zero risk) to the fourth (high risk).

hs-CRP less than 0.48 mg / L

hs-CRP between 0.49 and 1.2 mg / L

hs-CRP between 1.2 and 3.1 mg / L

hs-CRP between 3.1 mg / dL and 10 mg / L

Caution: for highly sensitive Ca-reactive protein values greater than 10 mg / dL the test is not considered significant for the purposes of determining the cardiovascular risk, since such high values probably imply an inflammatory state of another origin (infectious or inflammatory of another nature).

According to the American Heart Association, hs-PCR analysis is very useful for people with intermediate cardiovascular risk (therefore with probability ranging from 10 to 20 %, having a heart attack in the next 10 years). This risk level is defined based on the presence of risk behaviors (smoking, incorrect diet), on the physical condition (obesity, diabetes, cholesterol or excess triglycerides) and on familiarity (presence in the family of people who have suffered from cardiovascular disease or diabetes.

For people with low cardiovascular risk, hs-PCR analysis is less useful, as it does not add information about the future risk of cardiovascular disease. Finally, even in people with a high risk of heart or vascular disease there is no indication of the dosage of the hs-PCR, as all the precautions must be implemented to reduce the risk of heart attack or stroke, regardless of the altered or not values of the highly sensitive C reactive protein.

The hs-PCR dosage must be accompanied by that of the other analyzes that help to frame the cardiovascular risk of an individual: ctotal cholesterol, HDL and LDL cholesterol, triglycerides, homocysteinemia, Lp (a) dosage.

Curiosity

There C-reactive protein was discovered in 1930 by William S. Tillett and Thomas Francis, Jr., who noted how this substance reacted against the pneumococcal polysaccharide C (Streptococcus Pneumonie). The substance was called Fraction C, and in subsequent experiments it was clear how this protein was found in large quantities in the serum of those who had an acute event such as rheumatic fever and infections.

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64 Comments
  1. Patrizia 4 years ago

    The c-reactive protein values are 1.73. Okay or not ...

  2. pink 4 years ago

    good morning! I was operated on 3 times in 6 days in laparoscopy for an endometriosis on the rectum, which required first a resection and then a colostomy. At 20 days from the intervention I did a blood test, reporting an ESR after the first hour equal to 100, the Pcr 6.4 (max 5) normal white blood cells. hematocrit 33 and hemoglobin at 11. The fever yesterday was at 37 at 19 in the evening and in the previous days at 37.2 in the evening hours. The attending physician says not to worry because the course is normal. What do you say?

    • Testlevels 4 years ago

      Hi, the CRP is usually high limits, normal white blood cells, a temperature of 37 ° C is not fever. I agree with the attending physician, if the clinical picture should change and new symptoms appear, go to the doctor again. Best regards.

  3. joseph 4 years ago

    Goodmorning doctor
    I underwent a Morgan method hemorrhoid operation. about 1 month, everything went well except for the last few days with small bleeding during the defection, perhaps concomitant but I had 1 day of fever with a peak of 38.5 resolvable with 2 tachipirina tablets, the next day, made tests for pcr 91, neufrocytes 77, lymphocytes 9.9 rest values normal, negative urine tests, may depend on intervention

    • Testlevels 4 years ago

      Hi, surely it could also be a consequence of the surgery he underwent. You will need to check again if fever or other symptoms or signs of infection still appear. Please refer to your doctor in any case. Best regards.

  4. Matilde 4 years ago

    Hello Doctor,
    I withdrew the exams everything is normal except VES which is at 48 and PRC at 7.4 .. I state that the evening before taking the exams I had a fever and took tachipirina.
    I am a 54 year old woman recently in menopause and I took exams because I have had a fever for a few weeks and I often sweat a lot even at night.
    lung ultrasound everything ok.
    Colon exams all ok.
    now I am about to do the kidney scan because I often have a discomfort in the left kidney.
    I had a penicillin treatment for 8 days, but after about a week from the end of the treatment the fever returned.
    what would you recommend?
    I thank you infinitely.

    • Testlevels 4 years ago

      Hi, given that the units of measurement are missing and that it is difficult to answer without visiting her and without viewing the complete blood tests, I would recommend that you make a haematological examination. However, please contact your doctor. Best regards.

  5. Franco 4 years ago

    I am 55 years old and I did the control tests, I slightly altered the P-LCR and Albumin, in addition to the usual cholesterol, in this period I am suffering with a metarsalgia on the sole of the foot and various ailments.
    pending the consultation with my doctor, should i worry?
    Thanks

    • Testlevels 4 years ago

      The alteration of the PCR could be linked to a possible inflammation at the level of the painful metatarsus, but keep in mind that slight increases in ESR and PCR can occur in various situations and are not very specific. There are no warning signs in the data you have reported, in any case always rely on your doctor. Best regards.

  6. Annamaria bruni 5 years ago

    Hello. After + 1 month of pain in the hips and legs for 2 weeks I have very strong pain in my knees too. I have done interventions like Arnold Chiari 1, with uncoarthrosic protrusions. right 8 neuroma, c3 herniaectomy and removal of the gallbladder in videolaparoscopy with consequent pancreatic treatment for 3 years. With consequent strong abdominal pain and frequent hospitalizations. I have done the exams and I have the PCR at 14. What could it be ?? I thank. Anmr63

    • Testlevels 5 years ago

      It is not possible to answer it precisely, PCR is simply an indicator of inflammatory status. Please contact your doctor.

  7. Lorenzo 5 years ago

    Good morning
    my doctor prescribed a series of blood tests after pneumonia.
    The values are normal with the exception of the C reactive protein which is <10 mg / dl. What can it mean?
    Thanks and good afternoon
    Lorenzo

    • Testlevels 5 years ago

      CRP below 10 mg / L means negative (therefore normal) CRP. Show the tests to your doctor and follow his instructions. Best regards.

  8. Marco 5 years ago

    question mark was the possibility of arthritis

  9. Marco 5 years ago

    good evening, I would like to submit the following analysis results
    AST \ GOT 30
    ALT \ GPT 36
    GT 25 RANGE
    URIC ACID 5.8
    URIC ACID 24H AC UR CONCENTRATION 70
    Q ELIMINATED 770
    PROTEIN c reactive 0.7
    possible psoriasis arthritis

    • Testlevels 5 years ago

      Hi, difficult to give you an answer, biohumoral tests do not show particular indicators of active inflammation. Show the tests to your doctor who will be able to interpret them together with your clinical situation. Best regards

  10. Alexander 5 years ago

    Hello, I'm a 29-year-old boy with hereditary hypercholesterolemia and MTHFR mutation hyperhomocysteinemia. I had superficial venous thrombosis in September, and I suffer from gastroesophageal reflux. After noticing some slightly swollen lymph nodes in my neck (I suffer from stiff neck and rare dizziness), I performed ultrasound (nothing to worry about the report) and blood test: normal blood count, ESR: 2 mm / 1h (reference interval 1- 15);
    ASLO *: 407 IU / ml (0-250);
    EBV antibodies:
    - VCA IgG positive
    - EBV IgM negative
    - EA IgG negative
    EBNA IgG positive
    Possible previous infection.
    Thyroglobulin antibodies <1 * Ul / ml (1-4)
    Reactive Protein C <0.10 * mg / dl (0.10 - 0.75)

    Not being able to request a consultation from my doctor in the next few days, I would like to know roughly what they could mean. Did I have mononucleosis?

    • Testlevels 5 years ago

      Antibodies to EBV indicate previous contact. So he shouldn't have had mononucelosis recently. The PCR looks absolutely negative to me (and that's okay, it's not altered). Altered ASLO may indicate a more or less recent streptococcal infection, but it is very little specific. Ultimately nothing particular. In any case, always refer to the attending physician, who knows the general picture and will give you the most appropriate information. Best regards

  11. Rick 5 years ago

    Hi I'm a 27 year old boy, I have been treating epicondylitis with ultrasound and laser for 4 months and about a month ago, after doing some leg exercises at home I started feeling pain in my knees, so I have been taking dicloreum for about 1 week now i severe pain has passed and I can walk even if it still hurts from time to time. From this event, many inflammations began to appear in different parts of the body: the shoulders, the back, the thumbs of the hand, are not strong but still very annoying pains that make it difficult to go away. I did a blood test and I have: Rheumatoid factor 20 IU / ml, ESR 10 on 12max, TAS 133 on 200max and REACTIVE protein C 7.50 mg / l on 6max. A year ago I had tonsillitis but doing the swab has not been found to date pathogenic bacterial flora. How can I make myself go through all these continuous pains that come to me for even trivial movements? Thanks.

    • Testlevels 5 years ago

      Hi, it is difficult to give you an answer based on these data, surely your doctor visiting you and knowing you will be able to address you in the most appropriate way. Best regards

  12. BOLOGNESE PANTALEO 5 years ago

    Hi, after a weekend spent with swollen right foot, low back pain (near the kidneys) and a fever of 38 ° I did all regular blood tests, except PCR 74.9 and ESR 20, what may be the cause …thanks

    • Testlevels 5 years ago

      Hi, these are blood tests indicative of a fairly consistent inflammatory process in progress. Have you already performed a urine culture? Show these tests to your doctor right away. Best regards

  13. joseph 5 years ago

    hi, I did a complete picture of tests, all regular, except the PCR which shows a value of 17.
    I often suffer from sore throat due to tonsils that never fully recovered from mononucleosis I had 5 years ago, at the same time I also suffer from extensive back acne, so could this alteration be caused by these things? they are the only ones that come to mind, then I wanted to know if 17 as a value is worrying, thanks in advance

    • Testlevels 5 years ago

      Hi, why did you take the exams? In any case, a slightly altered condition like this can be linked to multiple causes, including inflammation of the oropharyngeal cavity. Always show the tests to your doctor

  14. Silvana Zendrini 5 years ago

    Hello Doctor, from the analyzes carried out a couple of days ago, some values are out of range: PCR 5.50 mg / L (up to 5) -VES 33mm / h (up to 30) - Red Gl. 4.19 (from 4 , 20 to 5.50) - Mean Global Vol. (MCV) 98.6 (80 to 97) - Total cholesterol. 223mg / dl - PTH (Parathormone) Basal 91 pg / ml (12-72). I would like to point out that I am a 64-year-old woman and at the time of the blood sample I had a sore throat and cold symptoms, without fever (I hardly get my temperature).
    Thank you for your kind reply.

    • Testlevels 5 years ago

      They are all minimally altered analyzes or at the limits of the norm, nothing sensational. Given the high PTH, vitamin D should also be measured. Just altered ESR and CRP may depend on the symptoms you describe. Always show the tests to your doctor, please. Best regards.

  15. Alice 5 years ago

    Buondí.
    I have pcr at 42 and a sore throat.
    I had a fever of 40 for two days but not anymore. In your opinion, is the antibiotic necessary?

    • Testlevels 5 years ago

      Hi, considering the high CRP and high fever, a bacterial inflammatory process is probably underway, in any case a doctor's prescription is required before taking the antibiotic.

  16. Lucilla 5 years ago

    My son did the exams, I state that as a child he had anaphylactic rheumatoid purpura, pcr test 0.59 and rheumatoid factor 88.9 ... Who should he address? What does tt mean this? Thanks

    • Testlevels 5 years ago

      Hi, the CRP values are normal, the rheumatoid factor is slightly elevated, you have to understand why and by whom the blood tests were prescribed.

  17. gabriele 5 years ago

    Hi I have the values of the c reactive proteins 10.40 and beta blood cells 7.2 and high what can I have .. thanks

    • Testlevels 5 years ago

      Hi, you describe a just elevated PCR and normal leukocytes, why did you do these tests? do you have any symptoms? Best regards

  18. Sabrina 5 years ago

    Hello
    I had an endometriosis cyst operation 10 years ago with high C reactive protein II
    Day after surgery. I also did the analysis of the Ca 125 marker and everything is negative
    Do you think I need to check the C reactive protein to see if I have infections regarding outbreaks of endometriosis? thanks a lot

    • Testlevels 5 years ago

      Hi, an isolated PCR check so far from surgery and in the absence of symptoms doesn't make much sense.

  19. antonio 5 years ago

    hi following knee trauma (wearer of unicompartmental prosthesis) I had problems with swelling and articulation.RX excluded bone lesions, I decided to perform PCR the result today is well 165.70
    ESR of 77
    would you recommend a CT scan at this point?

    • Testlevels 5 years ago

      A medical consultation is certainly necessary, it is a high PCR value that requires further investigation.

  20. Paul 5 years ago

    I'm a polar bear, I take baths everywhere and in any season, despite my 57 years ...
    For this, I scrupulously check my health.
    Last spring he pinched my foot in something murky water.
    Nothing happened right away. After a month I had the first manifestation of spontaneous abscess in the testicles, quickly incised.
    Subsequently, and after an operation in the hospital, in August (and 15 days) other abscesses of the same nature were added in no particular order near the inguinal areas.
    When I realized it was a blood staph infection, (C reactive protein 4.37) in an infectious ward they gave me 2 boxes of 500 antibiotic.
    Later, and simultaneously with the administration of the antibiotic, a tumor appeared under the tongue, which I had been aware of for a couple of years.
    The medical staff of odontostomatology and otolaryngology of an accredited hospital is planning an operation to remove it.
    Should I propose to have protein C re-evaluated in tests?
    Except for the head physician of odontostomatology, to date, no one has ever thought that there was a link between the onset of the first staphilococcal infection and the tumor.

    • Testlevels 5 years ago

      Dear user, undoubtedly the presence of a tumor may have lowered the immune defenses. However, the dynamic that you are describing seems to suggest that the infection has spread haematogenously (ie through the bloodstream) from a skin lesion following the "pinch" that she reports to have felt in the water. There is a lack of elements to be able to make more precise assumptions. The etiology of the infection (staphylococcus) supports the cutaneous departure. Reactive Protein C values are elevated although not as high as would be expected in the presence of multiple abscesses. Repeating the PCR analysis is pointless if you have no other symptoms of infection: fever, cough, burning in urination, skin tightness and warmth, etc.

  21. Daniel 5 years ago

    Hello Dr.
    I have swollen knee and ankle and the CRP is 4.7 val. (0-0.5), iron 47 val (56-160), ves 10 val 0-15. What can it be? Should I worry about high CRP and low iron?
    Thank you in advance

    • Testlevels 5 years ago

      As for the high CRP, if it has no other symptoms or signs of infection, the osteoarricular picture at the level of the lower limb should be investigated. Show the examinations to the attending physician who will eventually prescribe an X-ray and / or ultrasound of the soft tissues and any biohumoral studies.

  22. Sergio Fenelli 5 years ago

    Hi! I have the ESR - 1 ^ H -9- and ABSENT CRP
    I did this research because my belly is swollen with air very often and this causes me quite painful discomfort. I thought I had inflamed diverticula. I was advised to take “vegetable charcoal” tablets. Do you think it will be enough? Thanks! Best regards

    • Testlevels 5 years ago

      The ESR and CRP values you report are within normal range (laboratory reference values permitting). Vegetable charcoal helps to reabsorb excess intestinal air so it can be useful, in any case if the symptoms persist, a gastroenterological study could be useful, to be agreed with the doctor. Best regards.

  23. Marzia 5 years ago

    I have Ves: 25 AND PCR: 16, for the rest I do not have major changes in triglycerides and cholesterol slightly exceeding 200. Also I often have pain in the lumbar sacral area and I had pain in a heel this summer. What could it be?

    • Testlevels 5 years ago

      With these data it is difficult to give an answer, certainly there are no major changes, except for a slight increase in ESR and CRP. Your doctor can see you, correlate your blood tests with your physical examination, and certainly give you a more complete picture. Best regards

  24. Roberta 5 years ago

    Hi I have had 4 episodes of skin redness in the last 9 months this rash has a maximum duration of 10 hours but the last one was accompanied by severe nausea. The results of the basic analyzes are all regular except for the PCR which is 68.00. It seems clear to me an intestinal infection but I don't understand the rash. Thanks

    • Testlevels 5 years ago

      Hi, in fact, you only report an isolated episode of nausea about intestinal .. Do you speak of intestinal infection because you also had other symptoms? as for the redness, you should know where it is located (always in the same part of the body, all over the body, etc.), what kind of redness it was (diffuse erythema, small or large "spots" ..), if it was accompanied by fever or pain on the affected skin. Difficult to give you an answer with this data.

      • Roberta 5 years ago

        You are right, forgive me ... No fever I gave up my stomach for a whole day, in the evening these little pink dots without itching only on the bust and continuing ... .. Just today I believe inflammation at the dental level ... All the jaw with very strong pain. In the emergency room there was talk of pulpitis. I repeated the PCR analysis the levels are now normal. It seems absurd to me to have had 3 manifestations that apparently do not enter anything with each other within four days. Never had any particular problems And I don't take any medications other than the common painkillers. Intestinal virus allergy and dental inflammation. Everything at once !

  25. Gianna 5 years ago

    Hi I did the exams and PCR 50.9 came out in my opinion and high.

    • Testlevels 5 years ago

      I confirm that it is a high PCR value. Do you have any symptoms or signs of infection? Fever, productive cough (“fat” cough), dysuria (burning when urinating) ..?

  26. Wedding ring 5 years ago

    Hi! I was found to have a 7 cm inflammatory liver adenoma. At the same time, the blood tests showed a high CRP value. Can the two facts be connected?
    Thanks.
    Best regards.

    • Testlevels 5 years ago

      Hi, it should be clarified what he means by "inflammatory adenoma", given that the adenoma is a benign formation usually not inflammatory. In any case, in the absence of further data, I feel I can rule out the association between adenoma and high CRP. Always refer to the doctor who will recommend any further analyzes, best regards

  27. antonietta 5 years ago

    hello, I just collected the analysis reports:
    PCR 7.2 VALUES 0-10
    ESR 2 VALUES 0-16
    I wanted to know if the CRP with these values is a bit high, as I always have pain in the knee and always a bit swollen above the patella and on the outside.
    thanks

    • Testlevels 5 years ago

      Hi, CRP is normal and so is ESR.

  28. tony 5 years ago

    PCR is slightly altered, 12 (max 10) I admit to having taken for three / four days an anti-inflammatory (evening aulin sachet) climate change and post-surgery of “Right hip arthroplasty. What do you advise me about the PCR values? Thanks and regards Tony

    • Testlevels 5 years ago

      Hi, if you have no signs or symptoms of inflammation, nothing. In any case, always show the tests to your doctor

  29. Alberto 5 years ago

    in the last two weeks I found myself with an annoying low-grade fever 37 °, severe pain in the cervical spine and hands. The CRP value is 0.55, Uricemia 8.20, Ves 44. I am 73 years old and I suffer from various pathologies that have been controlled up to now. Is there a relationship between the above values and the severe pain that has tormented me up to now?
    thanks

    • Testlevels 5 years ago

      Hi, with the PCR values probably not. The uric acid values are instead high, I recommend a rheumatological evaluation if you have not already done it.

  30. Marco 5 years ago

    I did analysis for heartburn like pulsations ... but I have a strong cough and pharyngitis. pcr is 10 and ves is normal. what do you recommend? what causes? which investigations?

    • Marco 5 years ago

      I forgot to write that I often feel a pinch in my heart ... it passes in a few moments but it is sometimes frequent

      • Testlevels 5 years ago

        The PCR is slightly altered, it could depend on an upper respiratory tract infection of which you describe compatible symptoms .. for this and for the sensation in the heart, contact your doctor who will advise you on the most appropriate strategy.

  31. Luca 5 years ago

    Hello . I suffer from joint pain concentrated on the neck and feet ... After having done the blood tests the value of c reactive protein is 3.65 mg / dl .. Quite high .. Do you think it is due to a rheumatic disease? …. Thanks .. Hi

    • Testlevels 5 years ago

      Hi, the CRP values you described are moderately high. Given the symptoms you complain about, I think it is right to investigate with a rheumatological evaluation.

  32. Charles 5 years ago

    Hi, my doctor made me do some tests since I had cough and fever for some day .. the blood count seems fine to me but the ESR and the C reactive protein are high .. in particular the CRP = 47 mg / dl . is a CRP that high? there may be an infection. thanks and congratulations for your great articles

    • admin 5 years ago

      Hi, from the symptoms you describe and the C reactive protein values you report, it would seem a picture of airway infection (the most common respiratory tract infections are bronchitis and pneumonia). Are you a smoker? show the tests to your doctor immediately, who will prescribe the appropriate treatment

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