Surgery and postoperative infections, trauma |
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Tissue injury
Serum CRP concentration is significantly elevated in extensive burns. CRP decreases by the third day in burn
patients who do not develop infection and tends to fall progressively with healing over one month. A second
peak will develop if infection occurs as a later complication of the burn, suggesting a role for CRP determinations
in monitoring the course of healing.
An increase in CRP levels can predict septicaemia in patients with burns, allowing the treatment of septicaemia
to be started sooner.
Preoperative and postoperative infections
CRP usually rises within 6 h after surgery. In the absence of complications, CRP values then decline and normalise
within a couple of days. On the other hand, CRP remains elevated much longer if the postoperative course is
complicated by infection.
The incidence of postoperative infections has been found to be significantly higher in patients with increased
preoperative CRP levels than in those with normal preoperative levels. Patients with higher preoperative CRP
levels also remain in hospital significantly longer than those with normal preoperative levels.
Transplantation
CRP is a useful marker in monitoring the posttransplant period. After an increase during
the first three days after transplantation, CRP concentration starts to decrease. If CRP
concentration does not decrease, early rejection can be suspected. Pretransplant measurement of
CRP baseline concentration is recommended as a reference for posttransplant values. CRP
concentrations should be evaluated on a withinpatient basis rather than by application of a fixed
range window.
CRP assay is rapid, simple and economical, and the samples are stable.
Acute appendicitis is usually diagnosed on the basis of a surgeon's clinical impression. Today,
the negative laparotomy rate because of clinical diagnosis is still 15% to 25%. Patients with
perforated appendixes have high CRP values exceeding approx. 100 mg/l. In nonperforated
appendicitis, CRP is slightly elevated (>20 mg/l). The presence of acute appendicitis is unlikely
in a patient with normal WBC and CRP value, even if clinical symptoms and signs suggest acute
appendicitis.
Serum CRP levels can be used to support a clinical diagnosis regarding acute appendicitis, thereby
reducing the number of unnecessary laparotomies. It is advisable to observe atypical patients with
serial clinical examinations and CRP tests when in doubt about the diagnosis. CRP measurements as a
routine laboratory test are recommended in patients with a suspected diagnosis of acute appendicitis.
CRP values exceeding approx. 100 mg/l suggest a perforated appendix.
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