From the Guidelines
A CRP level of 11.4 mg/L indicates a high risk of cardiovascular disease and warrants further evaluation and management to reduce this risk. According to the study by 1, a CRP level above 10 mg/L should prompt a search for an obvious source of infection or inflammation, and if none is found, the level should be remeasured in 2 weeks. The study also recommends using hs-CRP as an independent predictor of increased coronary risk, particularly in patients at intermediate risk (10% to 20% risk of coronary heart disease over 10 years).
The patient's CRP level of 11.4 mg/L falls into the high-risk category, which corresponds to an approximate tertile of hs-CRP in the adult population, with a 2-fold increase in relative risk compared to the low-risk tertile. The Writing Group endorses the optional use of hs-CRP to identify patients without known CVD who may be at higher absolute risk than estimated by major risk factors.
Key considerations for managing this patient include:
- Evaluating for obvious sources of infection or inflammation
- Remasuring CRP in 2 weeks if no source is found
- Assessing traditional cardiovascular risk factors and calculating an absolute risk score
- Considering further evaluation or therapy, such as imaging, exercise testing, or drug therapies with lipid-lowering, antiplatelet, or cardioprotective agents, for patients at intermediate risk. The study by 1 also highlights the importance of CRP as a predictor of all-cause and cardiovascular mortality in patients with cardiovascular disease, further emphasizing the need for careful management of this patient's elevated CRP level.
From the Research
CRP Levels and Associated Conditions
- A CRP level of 11.4 mg/L is considered elevated, but not as high as the levels (≥500 mg/L) studied in 2, which were associated with bacterial infections and a high mortality rate.
- Elevated CRP levels are also associated with cardiovascular disease, as shown in 3 and 4, where high-sensitivity CRP was used as a predictor of in-hospital mortality in patients with cardiovascular disease.
- The study in 2 found that CRP values above 500 mg/L were highly related to bacterial infections, with 63% of cases being respiratory infections, 17% urinary infections, and 16% abdominal infections.
CRP Levels and Mortality
- The study in 2 reported a one-month mortality rate of 27% in patients with CRP levels above 500 mg/L.
- In 4, the in-hospital mortality rate increased significantly with higher hs-CRP levels, with a mortality rate of 19.9% in patients with hs-CRP levels ≥33.3 mg/L.
- The association between CRP levels and mortality was also observed in patients with cardiovascular disease, as shown in 4, where increased hs-CRP was a significant risk factor for in-hospital mortality.
CRP Levels and Other Conditions
- Elevated CRP levels have also been associated with bipolar disorder, as shown in 5, where a meta-analysis found that CRP levels were significantly elevated in patients with bipolar disorder compared to controls.
- The study in 3 discussed the effects of various cardiovascular drugs on CRP levels, including cyclooxygenase inhibitors, platelet aggregation inhibitors, and lipid-lowering agents, which were found to reduce serum levels of CRP.