Abstract :

Acute phase reactants have a supplementary role in the management of hospitalized patients with fever. While not perfect tools, they have some role in formulating a diagnostic and therapeutic plan and may improve antimicrobial stewardship. The Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), while not specific enough to establish a diagnosis, can be helpful in guiding the intensity and duration of anti-infective therapy. However, they have different dynamics during inflammations and infections.

---

Keywords :

Acute phase reactants, C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR)

---

References :

1. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999; 340:448–54.
2. Dowton SB, Colten HR. Acute phase reactants in inflammation and infection. Semin Hematol 1988; 25:84–90.
3. Bedell SE, Bush BT. Erythrocyte sedimentation rate. From folklore to facts. Am J Med 1985; 78:1001–9.
4. Grzybowski A, Sak JJ. Who discovered the erythrocyte sedimentation rate? J Rheumatol. 2011;38(7):1521–1522; author reply 1523. doi:10.3899/jrheum.101312
5. Shusterman N, Kimmel PL, Kiechle FL et al. Factors influencing erythrocyte sedimentation in patients with chronic renal failure. Arch Intern Med 1985; 145:1796–9.
6. Bitik B, Mercan R, Tufan A, et al. Differential diagnosis of elevated erythrocyte sedimentation rate and C-reactive protein levels: a rheumatology perspective. Eur J Rheumatol 2015; 4:131–4.
7. Husain TM, Kim DH, C-reactive protein and erythrocyte sedimentation rate in orthopaedics. Univ Pennsylvania Orthop J. 2002; 15:13–16.
8. Wilson DA. Immunologic tests. In: Walker HK, Hall WD, Hurst JW, eds. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Boston, MA: Butterworth-Heineman; 1990.
9. Batlivala SP. Focus on diagnosis: the erythrocyte sedimentation rate and the C-reactive protein test. Pediatr Rev. 2009;30(2):72–74. doi:10.1542/pir.30-2-72
10. C Gabay, I Kushner. “Acute-Phase Proteins and Other Systemic Responses to Inflammation.” New England Journal of Medicine 340.17 (1999): 1376. Web.
11. Fincher, R. M. “Clinical Significance of Extreme Elevation of the Erythrocyte Sedimentation Rate.” Archives of Internal Medicine 146.8 (1986): 1581-583. Web.
12. Fincher RM, Page MI. Clinical significance of extreme elevation of the erythrocyte sedimentation rate. Arch Intern Med 1986; 146:1581–3.
13. Rafael L. Jurado. Why Shouldn’t We Determine the Erythrocyte Sedimentation Rate? Clin Inf Dis, Volume 33, Issue 4, 15 August 2001, Pages 548–549, https://doi.org/10.1086/322605
14. Jurado, Rafael L. “Why Shouldn’t We Determine the Erythrocyte Sedimentation Rate?” Clinical Infectious Diseases 33.4 (2001): 548-49. Web.
15. Brigden ML. Clinical utility of the erythrocyte sedimentation rate. Am Fam Physician. 1999;60(5):1443–1450.
16. Melissa Kaori Silva Litao, Deepak Kamat. Erythrocyte Sedimentation Rate and C-Reactive Protein: How Best to Use Them in Clinical Practice. Pediatric Annals. 2014;43(10):417-420https://doi.org/10.3928/00904481-20140924-10
17. Glass R. Factitiously low ESR in chronic lymphocytic leukemia, N Engl J Med, 1971, vol. 285 pg. 921
18. Hutchinson RM, Clay CM, Shapiro MR, Wood JK. Lowered ESR with sodium valproate, Lancet, 1978, vol. 2 pg. 1309
19. Silvestre JP, Coelho LM, Povoa PM. Impact of fulminant hepatic failure in C-reactive protein?J Crit Care. 2010;25(4): 657.e7–12. doi: 10.1016/j.jcrc.2010.02.004
20. Shanbrom E, Berger RH. Observations on the inhibition of erythrocyte sedimentation rate by low molecular weight dextran, Am J Med Sci, 1963, vol. 246 pg. 289
21. Jandl JH. Jandl JH. Physiology of red blood cells, Textbook of hematology, 19962d ed.New YorkLittle, Brown(pg. 153-4)
22. Bunting H. Sedimentation rates of sickled and nonsickled cells from patients with sickle cell anemia, Am J Med Sci, 1939, vol. 198 (pg. 191-3)
23. Alende-Castro, Vanessa MDa; Alonso-Sampedro, Manuela PhDa,b; Vazquez-Temprano, Nuria MDa; Tuñez, Carmen MDc; Rey, Daniel MDc; García-Iglesias, Carmen MDc; Sopeña, Bernardo MD, PhD a; Gude, Francisco MD, PhDb; Gonzalez-Quintela, Arturo MD, PhD a,∗ Factors influencing erythrocyte sedimentation rate in adults, Medicine: August 2019 – Volume 98 – Issue 34 – p e16816 doi: 10.1097/MD.0000000000016816
24. Morris MW, Davey FR. Henry JB. Basic examination of blood, Clinical diagnosis and management by laboratory methods, 199619th ed. Baltimore WB Saunders
25. Rafael L. Jurado, Why Shouldn’t We Determine the Erythrocyte Sedimentation Rate? Clin Inf Dis, Volume 33, Issue 4, 15 August 2001, Pages 548–549, https://doi.org/10.1086/322605
26. Shusterman N, Kimmel PL, Kiechle FL, et al. Factors influencing erythrocyte sedimentation in patients with chronic renal failure, Arch Intern Med, 1985, vol. 145 (pg. 1796-17)
27. Shusterman N, Morrison G, Singer I, Kimmel P, Kielchle F. The erythrocyte sedimentation rate and chronic renal failure, Ann Intern Med, 1985, vol. 105 pg. 801
28. Warner DM, George CRP. Erythrocyte sedimentation rate and related factors in end stage renal failure, Nephron, 1991, vol. 57 pg. 248
29. Penchas S, Stern Z, Bar-Or D. Heparin and the ESR, Arch Intern Med, 1978, vol. 138 (pg. 1864-5)
30. Pasulka PS, Bistrian BR, Blackburn GL. Obesity and erythrocyte sedimentation rate, Ann Intern Med, 1985, vol. 103 pg. 304
31. Grace CS, Goldrick RB. Fibrinolysis and body build, J Atheroscler Res, 1968, vol. 8 (pg. 705-19)
32. Fahreaus H. The suspension stability of the blood, Acta Med Scand, 1958, vol. 161 pg. 151
33. Shearn MA, Kang IJ. Effect of sex and age on erythrocyte sedimentation rate, J Rheumatol, 1986, vol. 13 pg. 297
34. Bottiger LE, Svedberg CA. Normal erythrocyte sedimentation rate and age, Br Med J, 1967, vol. 2 pg. 85
35. Zauber NP, Zauber AG. Hematologic data of healthy very old people, JAMA, 1987, vol. 257 pg. 1281
36. Newburger JW, Takahashi M, Gerber MA, et al. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics. 2004;114(6):1708–1733. doi:10.1542/peds.2004-2182
37. Nimmerjahn F, Ravetch JV. The antiinflammatory activity of IgG: the intravenous IgG paradox. J Exp Med. 2007; 204(1): 11–15. doi:10.1084/jem.20061788
38. Salehzadeh F, Noshin A, Jahangiri S. IVIg effects on erythrocyte sedimentation rate in children. Int J Pediatr. 2014; 2014:981465. doi:10.1155/2014/981465
39. Wintrobe MM, Landsberg JW. A standardized technique for the blood sedimentation, Am J Med Sci, 1935, vol. 189 (pg. 101-115)
40. Visser M, Bouter LM, McQuillan GM, et al. Elevated C-reactive protein levels in overweight and obese adults. JAMA 1999;282(22):2131–2135.
41. Tillett WS, Francis T. Serological reactions in pneumonia with a non-protein somatic fraction of pneumococcus. J Exp Med 1930; 52:561–71.
42. Vermeire S, Van Assche G, Rutgeerts P. C-reactive protein as a marker for inflammatory bowel disease. Inflamm Bowel Dis. 2004;10 (5):661–665. doi:10.1097/00054725-200409000-00026
43. Bray C, Bell LN, Liang H, Haykal R, Kaiksow F, Mazza JJ, Yale SH. Erythrocyte Sedimentation Rate and C-reactive Protein Measurements and Their Relevance in Clinical Medicine. WMJ. 2016 Dec;115 (6):317-21.
44. Pepys MB, Gideon MH. C-reactive protein: a critical update. J Clin Invest 2003; 111:1805–11.
45. Jaye DL, Waites KB. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J. 1997;16(8):735–746; quiz 746–747. doi:10.1097/00006454-199708000-00003
46. Litao, Melissa Kaori Silva, and Deepak Kamat. “Erythrocyte Sedimentation Rate and C-Reactive Protein: How Best to Use Them in Clinical Practice.” Pediatric Annals Pediatr Ann 43.10 (2014): 417-20. Web.
47. Kushner, Irving, Debra Rzewnicki, and David Samols. “What Does Minor Elevation of C-Reactive Protein Signify?” The American Journal of Medicine 119.2 (2006): n. pag. Web.
48. Wenner M, Daum P, McQuillan G. The influence of age, sex, and race on the upper reference limit of serum C-reactive protein concentration. J Rheumatol 2000; 27(10):2351.
49. Vanderschueren S, Deeren D, Knockaert DC et al. Extremely elevated C-reactive protein. Eur J Intern Med 2006; 17:430–3.
50. Vanderschueren, Steven, Dries Deeren, Daniël C. Knockaert, Herman Bobbaers, Xavier Bossuyt, and Willy Peetermans. “Extremely Elevated C-reactive Protein.” European Journal of Internal Medicine 17.6 (2006): 430-33. Web.
51. Anurag Markanday. Acute Phase Reactants in Infections: Evidence-Based Review and a Guide for Clinicians. Open Forum Infect Dis. 2015 Sep; 2(3): ofv098. Published online 2015 Jul 3. doi: 10.1093/ofid/ofv09852.
52. Silvestre J, Coelho L, Povoa P. Impact of fulminant hepatic failure in C-reactive protein. J Crit Care 2010; 25: e7–12.
53. Silvestre JP, Coelho LM, Povoa PM. Impact of fulminant hepatic failure in C-reactive protein?J Crit Care. 2010;25(4): 657.e7–12. doi: 10.1016/j.jcrc.2010.02.004
54. Ohsawa M, Okayama A, Nakamura M, Onoda T, Kato K, Itai K, Yoshida Y, Ogawa A, Kawamura K, Hiramori K. CRP levels are elevated in smokers but unrelated to the number of cigarettes and are decreased by long-term smoking cessation in male smokers. Prev Med. 2005 Aug;41(2):651-6. doi: 10.1016/j.ypmed.2005.02.002. PMID: 15917065.
55. Dana E. King, Arch G. Mainous III, Thomas A. Buchanan, William S. Pearson. C-Reactive Protein and Glycemic Control in Adults with Diabetes. Diabetes Care 2003 May; 26(5): 1535-1539. https://doi.org/10.2337/diacare.26.5.1535
56. Chae CU, Lee RT, Rifai N, Ridker PM. Blood pressure and inflammation in apparently healthy men. Hypertension. 2001; 38: 399–403.
57. Cho HJ, Seeman TE, Bower JE, Kiefe CI, Irwin MR. Prospective association between C-reactive protein and fatigue in the coronary artery risk development in young adult study. Biol Psychiatry. 2009;66(9):871-878. doi:10.1016/ j.biopsych. 2009.06.008
58. Wium-Andersen MK, Ørsted DD, Nielsen SF, Nordestgaard BG. Elevated C-Reactive Protein Levels, Psychological Distress, and Depression in 73 131 Individuals. JAMA Psychiatry. 2013;70(2):176–184. doi:10.1001/2013.
59. Wyczalkowska-Tomasik A, Czarkowska-Paczek B, Zielenkiewicz M, Paczek L. Inflammatory Markers Change with Age, but do not Fall Beyond Reported Normal Ranges. Arch Immunol Ther Exp (Warsz). 2016; 64(3):249-254. doi:10.1007/s00005-015-0357-7
60. Michael Harrison. Erythrocyte sedimentation rate and C-reactive protein. Aust Prescr. 2015 Jun; 38(3): 93–94. Published online 2015 Jun 1. doi: 10.18773/austprescr.2015.034
61. A Osei-Bimpong 1, J H Meek, S M Lewis. ESR or CRP? A comparison of their clinical utility. Hematology. 2007 Aug;12(4):353-7. doi: 10.1080/10245330701340734.
62. igal LH. Molecular biology and immunology for clinicians: the acute phase reaction, J Clin Rheumatol, 1997, vol. 3 (pg. 28-34)
63. Stephanie Sbong, Mark Feldman. Frequency and causes of C‐reactive protein and erythrocyte sedimentation rate disagreements in adults. International Journal of Rheumatic Diseases. First published: 31 December 2014.
https://doi.org/10.1111/1756-185X.12537Citations: 9
64. Colombet I, Pouchot J, Kronz V et al. (2010) Agreement between erythrocyte sedimentation rate and C‐reactive protein in hospital practice. Am J Med 123, 863.e7–e13
65. Felman M, Aziz B, Kang G, et al. C-reactive protein and erythrocyte sedimentation rate discordance: frequency and causes in adults. Translational Research 2013; 161:37–43.
66. Harrison M. Australian Prescriber 2015; 38:93–4.
67. Buess T, Ludwig C. Diagnostic value of C-reactive protein in comparison with erythrocyte sedimentation as routine admission diagnostic test. Schweiz Med Wochenschr. 1995 Jan 28;125 (4):120-4.
68. Ahmed MS, Jadhav AB, Hassan A, Meng QH. Acute phase reactants as novel predictors of cardiovascular disease. ISRN Inflamm. 2012 May 06; 2012:953461.