C-reactive protein concentration as a guide to antibiotic therapy in acute leukaemia.

Abstract

SUMMARY Serial monitoring of the serum C-reactive protein (CRP) concentration was performed, using a one-hour laser-immunonephelometric assay, during 29 episodes of infection in 22 neutropenic patients with acute leukaemia. Serum CRP increased to above a diagnostic level of 100 mg/l in all 29 episodes and continued to rise progressively until appropriate antibiotics, or granulocytes, were given when it fell with a half-life of approximately three days. Serial study of the serum concentration was of value in detecting occult or unresolved bacterial infection and provided an objective means of monitoring the response to antibiotic and granulocyte therapy.Infection, when unrecognised or treated ineffectively, is the commonest cause of death in neutropenic patients with acute leukaemia. Because of the lack of granulocytes, clinical and radiological signs of infection are often inadequate and the diagnosis of potentially-fatal infection may be delayed. Empirical treatment with a broad-spectrum antibiotic combination, given intravenously, may be life saving but there are few objective guidelines to indicate when bacterial infection is responding and for how long intravenous antiobiotics should be continued. An objective method for quantifying the inflammatory response might therefore be of clinical value in guiding antibiotic policy and indicating when granulocytes should be given. ' Acute infection, and other causes of an inflammatory response, will induce hepatic synthesis2 of C-reactive protein (CRP) and other acutephase reactant proteins so that a rise in serum concentration occurs within a few hours or days.3 C-reactive protein has been widely studied as an acute-phase reactant4 and the rise in serum concentration may be detected within one hour of experimentally-induced endotoxaemia.5 Rapid measurement of CRP is now possible using laser immunonephelometric6 or rate immunonephelometric7 assays and the present study was designed to investigate the value of the one-hour laser immunonephelometric assay as a guide to the effectiveness of antibiotic therapy in acute leukaemia.

Hepatocyte Growth Factor Is a Better Indicator of Therapeutic Response than C-Reactive Protein within the First Day of Treatment in Pneumonia

“…Levels of CRP rise in serum 6-8 h after organ injuries and reach the maximal levels within 48-72 h. Following the CRP levels during treatment of infection gives information about the status of disease at an early stage [12,13] . Nevertheless, due to the long half-life (8-21 h) [11][12][13][14] it might take more than 24 h before the levels rise or decrease at the beginning or after the effective treatment has been initiated. We could not fi nd a convincing advantage using HGF compared to CRP after 48-72 h of treatment in our previous study [6] , but we observed in this study that HGF was signifi cantly better than CRP in the identifi cation of nonresponders after only 24 h of treatment ( table 1 , fi g. 1 ).…”

Clinical Relevance of Serum Amyloid a Protein Monitoring in Urinary Tract Infections

“…16,17 Although some 30 plasma proteins show acute phase behaviour, 18 they differ considerably in the rate of their response and incremental increase in plasma concentration. The criteria for a reliable marker of the acute phase response are: rapid and substantial increase in concentration following an inflammatory stimulus, and a short half-life WBC, CRP and AGP on day 6.…”

C-reactive protein as an indicator of infection in the immunosuppressed child

“…A complicating factor in the immunosuppressed child is the difficulty of diagnosing an infection [3,6,8,9]. Fever is not a valuable sign, since many non-infectious processes may result in fever [6].…”

“…Bone marrow depression is an unavoidable consequence of aggressive therapy and infections and suspicion of infection are perhaps the most common problems in an oncology ward. Rapid therapy with broad spectrum antibiotics has resuited in a significant improvement and reduction in early mortality, but infections still remain the main cause of morbidity and mortality during induction therapy [6,9,10].…”

“…CRP is known to be a specific and sensitive indicator Of infection [1,4]. After several reports in the literature [3,6,8,9, 10] we decided to measure CRP in children admitted to our ward with a malignant condition. Our results show that CRP is indeed a very sensitive and specific indicator of the presence of an infection, and also aids in monitoring the effect of antibiotic therapy.…”