C-reactive protein in general practice - how commonly is it used and why?

Dahler-Eriksen, Bjarne Steen; Lassen, Jens Flensted; Lund, Elizabeth M.; Lauritzen, Torsten; Brandslund, Ivan

doi:10.3109/02813439709043427

Cited by 13 publications

(4 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As a component of the "acute phase response" associated with infection, inflammation, and tissue damage, it is not surprising that in the general clinical setting CRP is used to diagnose new disease, monitor chronic inflammatory disease or screen for unknown infections and malignancies [53,54]. In an evaluation of tests ordered in general practice, 27% of 1056 tests were ordered for screening purposes, and about 66% of the measured values of all tests were less than 10 mg/L, the partition value indicative of acute inflammation.…”

Section: Crp As a Biomarker For Assessment Of Cardiovascular Riskmentioning

confidence: 99%

Use of BNP and CRP as Biomarkers in Assessing Cardiovascular Disease:Diagnosis Versus Risk

Miller¹,

Redfield²,

McConnell³

2007

CVP

View full text Add to dashboard Cite

Biomarkers are used in medicine to facilitate diagnosis, assess risk, direct therapy and determine efficacy of treatment. Sensitivity and specificity are essential in order for a biomarker to be useful. Brain natriuretic peptide (BNP) and C-reactive protein (CRP) are considered biomarkers of cardiovascular disease. However, they differ in function, sensitivity and specificity. BNP is released from the myocardium in response to myocardial stretch, a clear cause and effect relationship; therefore, it is useful in the diagnosis of heart failure when patients present with dyspnea of unknown origin and to assess treatment in high risk patients with diagnosed heart failure. Sex and age based reference ranges and partition values are established from clinical trials and from populations screened for the absence of cardiovascular disease. Highly sensitive and reproducible methods are also available to measure CRP. However, although CRP is associated with adverse cardiovascular events, unlike BNP, multiple stimuli increase production of CRP. Therefore, elevation in CRP is not specific to cardiovascular disease. Partition values for CRP and cardiovascular risk based on epidemiological studies predict risk for populations but may not always be useful when used alone to predict individual risk or to direct therapy. Given the non-specific stimuli which affect circulating concentrations of CRP, using CRP to monitor treatment to reduce cardiovascular risk may provide little benefit without understanding or targeting the underlying causes for its elevation.

show abstract

Section: Crp As a Biomarker For Assessment Of Cardiovascular Riskmentioning

confidence: 99%

Use of BNP and CRP as Biomarkers in Assessing Cardiovascular Disease:Diagnosis Versus Risk

Miller¹,

Redfield²,

McConnell³

2007

CVP

View full text Add to dashboard Cite

show abstract

“…Scandinavian studies in the 1990s suggested inflammatory markers are measured in approximately 4% of GP consultations, for a range of indications, with 44–47% for specific diagnostic purposes, 27–33% for monitoring disease, and 14–28% for non-specific diagnostic purposes. 1 , 2 Testing rates have since significantly increased: CRP testing in the UK rising by 85.8% between 2005 and 2009. 3 Large regional variations in testing rates have been noted, particularly with regard to PV.…”

Section: Introductionmentioning

confidence: 99%

“…There is also considerable inter-practice variation in GPs’ responses to abnormal inflammatory markers. 2 , 4 , 5 Total costs of testing must be considerable; for example, over 120 000 primary care requests for inflammatory markers were processed in 2014 at North Bristol NHS Trust, costing £177 000, for a population of 500 000 (P Virgo, personal communication, 2015). In 2006 overall annual pathology testing was estimated at £2.5 billion, nearly 4% of NHS expenditure.…”

Section: Introductionmentioning

confidence: 99%

‘I’m fishing really’ — inflammatory marker testing in primary care: a qualitative study

et al. 2016

View full text Add to dashboard Cite

BackgroundInflammatory markers can be helpful as part of the diagnostic workup for specific diseases or for monitoring disease activity. A third use is as a screening and/or triage tool to differentiate between the presence or absence of disease. Most research into inflammatory markers looks at diagnosis of specific diseases and comes from secondary care. Qualitative studies to explore when and why clinicians use these tests in primary care are lacking.AimTo identify clinicians’ approaches to inflammatory marker testing in primary care.Design and settingQualitative study with 26 GPs and nurse practitioners.MethodInterviews were conducted using a semi-structured topic guide. Clinicians reviewed recent cases of inflammatory marker testing in their pathology inbox. Interviews were audiorecorded and transcribed. Qualitative analysis was conducted by two of the authors.ResultsClinicians are uncertain about the appropriate use of inflammatory markers and differ in their approach to testing patients with undifferentiated symptoms. Normal or significantly elevated inflammatory markers are seen as helpful, but mildly raised inflammatory markers in the context of non-specific symptoms are difficult to interpret. Clinicians describe a tension between not wanting to ‘miss anything’ and, on the other hand, being wary of picking up borderline abnormalities that can lead to cascades of further tests. Diagnostic uncertainty is a common reason for inflammatory marker testing, with the aim to reassure; however, paradoxically, inconclusive results can generate a cycle of uncertainty and anxiety.ConclusionFurther research is needed to define when inflammatory marker testing is useful in primary care and how to interpret results.

show abstract

“…15,16 In general medical practice, inflammatory marker assays, such as C-reactive protein (CRP) assays, are ordered in 4% of all consultations. 17 Although these inflammatory markers are nonspecific (e.g., cancer, cardiovascular disease, infectious viral or bacterial disease), 40% to 50% of assays are requested for a specific diagnostic purpose, 27% to 33% are requested for disease diagnostics, and 14% to 28% are requested for nonspecific diagnostic aims. Having multiplexed assays for the 70% of targeted assays would lead to faster and more accurate diagnostics.…”

Section: Introductionmentioning

confidence: 99%