title: Diagnostic strategies for C-reactive protein.
abstract: BACKGROUND
  Serum C-reactive protein (CRP) has been identified in prospective epidemiological research as an independent risk marker for cardiovascular disease. In this paper, short-term biological variation of CRP is documented and a strategy to test the reliability of a single CRP sample is proposed.
  
  
  METHODS
  Data were obtained from three groups of healthy volunteers: men, no oral contraceptives (OC-)using women and OC-using women. Blood samples were obtained 3 times in men and twice in women during a workweek.
  
  
  CONCLUSIONS
  CRP values were highest in the OC-using women, followed by the men, and lowest in the no OC-using women. Averaged over the three groups the within-subject coefficients of variation (CVi) was 49.24% for CRP, and 29.90% for lnCRP. Using the repeated measures, individual samples were identified that reflected a 'suspicious' unreliable high value, i.e. a value that was more than 2 standard deviations higher than the lowest value obtained from the same subject. In an a posteriori analysis, three strategies to identify these suspicious high CRP values were then tested. In terms of maximizing detection of suspicious values and minimizing unnecessary resampling, best results were obtained for the most pragmatic criterion of using an absolute level, stratified for gender, and OC-use, to decide whether a second sample should be obtained.
  
  
  CONCLUSIONS
  A single high CRP value must be followed by re-sampling when it is above 1.75 mg/l for men, above 1.00 mg/l for no OC-using women, and above 2.00 mg/l for OC-using women.
authors.affiliation: Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands. h.riese@psy.vu.nl
authors.forename: Harriëtte
authors.initials: H
authors.lastname: Riese
authors.forename: Tanja G M
authors.initials: TG
authors.lastname: Vrijkotte
authors.forename: Piet
authors.initials: P
authors.lastname: Meijer
authors.forename: Cees
authors.initials: C
authors.lastname: Kluft
authors.forename: Eco J C
authors.initials: EJ
authors.lastname: de Geus
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001800:Blood Specimen Collection / Q000379:methods; D002097:C-Reactive Protein / Q000032:analysis* / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000097:blood*; D003276:Contraceptives, Oral / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012016:Reference Values; D012044:Regression Analysis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors
chemical_list: D015415:Biomarkers; D003276:Contraceptives, Oral; D002097:C-Reactive Protein