Extremely elevated C-reactive protein.
BACKGROUND
C-reactive protein (CRP) is a widely used inflammatory marker. Yet, the clinical significance and outcome of extremely elevated CRP levels are poorly characterized.


METHODS
We collected all patients seen at a university hospital in 2004 with at least one CRP level above 500 mg/l and retrospectively analyzed their electronic files, focusing on patient characteristics, clinical diagnosis, microbiology and vital outcome.


RESULTS
CRP was above 500 mg/l in 130 patients with a median age of 62 years. Patient characteristics, settings, etiologies of inflammation, comorbidities and microbiology varied widely. Infections, mainly bacterial, accounted for 88% of episodes. Outcome was fatal in 36% of all patients and in 61% of patients with active malignancies.


CONCLUSIONS
A wide variety of infections, especially bacterial, that are generally readily identified account for the majority of instances of extreme CRP elevation. Mortality is high, certainly in oncological patients.
Vanderschueren
Steven
S
Department of General Internal Medicine, University Hospital, Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Deeren
Dries
D
Knockaert
Daniël C
DC
Bobbaers
Herman
H
Bossuyt
Xavier
X
Peetermans
Willy
W