title: Serum C-reactive protein: a non-invasive marker of alcoholic hepatitis.
abstract: OBJECTIVE
  To determine the diagnostic accuracy of C-reactive protein (CRP) for alcoholic hepatitis in heavy drinkers.
  
  
  METHODS
  A total of 101 heavy drinkers (67 M, 34 F) with elevated transaminase activity and negative HBsAg, anti-HCV and anti-HIV antibodies were included in the study. All patients underwent standard liver function tests, CRP determination and liver biopsies. None of the patients had signs of infection or inflammatory disease and none of them were taking antibiotics. The severity of alcoholic hepatitis was assessed semi-quantitatively using a Metavir-derived scoring system. The receiver operating curve (ROC) for CRP was constructed to assess different areas under the curve (AUCs) and the best threshold value for predicting alcoholic hepatitis (an AUC of 1.0 for an ideal test and of 0.5 for a less indicative test).
  
  
  RESULTS
  Pathological signs of alcoholic hepatitis were found in 29 patients (30%) and significant fibrosis (F > 1) in 46 (45.1%). CRP increased significantly with the severity of acute alcoholic hepatitis (p<0.001). Total bilirubin (OR = 1.03 CI 95% (1.01-1.06), p=0.04) and CRP (OR = 1.1 CI 95% (1.02-1.19), p=0.01) were independent factors for predicting alcoholic hepatitis. The area under the ROC curve of CRP was 0.78. Using optimized cut-off values (CRP > 19 mg/L), the sensitivity, specificity, positive, negative predictive value and diagnostic accuracy were 41%, 99%, 92%, 81% and 82%, respectively.
  
  
  CONCLUSIONS
  CRP is an accurate marker of alcoholic hepatitis.
authors.affiliation: Liver Unit, Hôpital L'Archet 2, Nice, France. geovbv@club-internet.fr
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Vanbiervliet
authors.forename: Frédèrique
authors.initials: F
authors.lastname: Le Breton
authors.forename: Maria-Alessandra
authors.initials: MA
authors.lastname: Rosenthal-Allieri
authors.forename: Eve
authors.initials: E
authors.lastname: Gelsi
authors.forename: Eugenia
authors.initials: E
authors.lastname: Marine-Barjoan
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Anty
authors.forename: Thierry
authors.initials: T
authors.lastname: Piche
authors.forename: Sylvia
authors.initials: S
authors.lastname: Benzaken
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Saint-Paul
authors.forename: Pierre-Michel
authors.initials: PM
authors.lastname: Huet
authors.forename: Albert
authors.initials: A
authors.lastname: Tran
mesh_terms: D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D006519:Hepatitis, Alcoholic / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D001663:Bilirubin