Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (851 page)

   hs-CRP may be useful as an independent marker of prognosis for recurrent events in patients with stable coronary disease or acute coronary syndrome. Recent evidence supporting this potential application has shown that high baseline values of CRP in individuals without a history of cardiac disease were associated with an increased incidence of subsequent cardiac events.

   Determining risk of hypotension: hs-CRP has been reported as a risk factor for hypotension.

   Interpretation

   hs-CRP appears within 24–48 hours, peaks at 72 hours, and becomes negative after 7 days; it correlates with peak CK-MB levels, but the CRP peak occurs 1–3 days later.

   Failure of CRP to return to normal indicates tissue damage in the heart or elsewhere. The absence of a CRP increase raises the question of necrosis in prior 2–10 days. CRP is usually normal in patients with unstable angina in the absence of tissue necrosis and a normal troponin T (<0.1 ng/mL).

   Peak hs-CRP correlates with peak CK-MB following AMI. CRP may remain increased for at least 3 months following AMI.

Increased In

   Acute or chronic inflammatory change

   Tissue injury or necrosis

   Ischemia or infarction of other tissues

   Infections, inflammation, tissue injury, or necrosis (possible)

   Metabolic syndrome

   Elevated blood pressure

   Malignant (but not benign) tumors, especially of the breast, lung, and GI tract