What Should We Regard as an “Elevated” C-Reactive Protein Level?
Authors: Irving Kushner, Maria J. Antonelli
Journal: Annals of Internal Medicine (2015)

Letters18 August 2015What Should We Regard as an "Elevated" C-Reactive Protein Level?Irving Kushner, MD and Maria J. Antonelli, MDIrving Kushner, MDFrom Case Western Reserve University, MetroHealth Campus, Cleveland, Ohio. and Maria J. Antonelli, MDFrom Case Western Reserve University, MetroHealth Campus, Cleveland, Ohio.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-5126 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Clinicians have long used serum C-reactive protein (CRP) levels to reflect the presence and degree of inflammation. More than 3 decades ago, investigators proposed that CRP levels greater than 10 mg/L indicate clinically significant inflammatory processes (1); this recommendation has stood the test of time (2). Recently, it was proposed that levels greater than 3 mg/L indicate a high degree of cardiovascular risk in patients judged to be at intermediate risk (2). Consequently, confusion regarding what constitutes an "elevated" CRP level has arisen.This confusion has been compounded because reference ranges for CRP differ greatly between laboratories and because ...References1. Morley JJ, Kushner I. Serum C-reactive protein levels in disease. Ann N Y Acad Sci. 1982;389:406-18. [PMID: 6953917] CrossrefMedlineGoogle Scholar2. Myers GL, Rifai N, Tracy RP, Roberts WL, Alexander RW, Biasucci LM, et al; CDC. CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: report from the laboratory science discussion group. Circulation. 2004;110:e545-9. [PMID: 15611379] CrossrefMedlineGoogle Scholar3. Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006;444:860-7. [PMID: 17167474] CrossrefMedlineGoogle Scholar4. Medzhitov R. Origin and physiological roles of inflammation. Nature. 2008;454:428-35. [PMID: 18650913] doi:10.1038/nature07201 CrossrefMedlineGoogle Scholar5. Kushner I, Rzewnicki D, Samols D. What does minor elevation of C-reactive protein signify? Am J Med. 2006;119:166. [PMID: 16443421] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Case Western Reserve University, MetroHealth Campus, Cleveland, Ohio.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L15-0146. 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