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Question about CPR blood tests

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Crohn's Disease
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Posted 1/16/2011 2:43 PM (GMT 0)
What levels are normal and what levels indicate inflammation? When I got my tests done before Xmas when I was sick my CPR was 114 and ESR was 71 which wasn;t good at all obviously. What levels usually indicate that you're back to normal? What should they be?

Any info would be much appreciated.
Posted 1/16/2011 4:08 PM (GMT 0)
You would think the same tests that showed your CRP and Sed rate were down. My docs always run CBC with differentials, sed rate as the usual gages of whats going on with me. Hugs!
Posted 1/16/2011 4:09 PM (GMT 0)
I'm assuming you mean CRP (C-reactive Protein). The "norm" varies from lab to lab. Also, there are many variables that can elevate CRP other than inflammation. However, a good example of one lab's norm is 0–1.0 mg/dL or less than 10 mg/L (SI units). ESR norms are as follows:

* Men under 50 years old: less than 15 mm/hr
* Men over 50 years old: less than 20 mm/hr
* Women under 50 years old: less than 20 mm/hr
* Women over 50 years old: less than 30 mm/hr
Posted 1/16/2011 4:13 PM (GMT 0)
That being said, my Sed Rate is always normal, even at my very sickest with active CD from my esophagus to my anus.
Posted 1/16/2011 11:38 PM (GMT 0)
I agree with SaladShooter (love that name lol). It seems to vary from person to person, and a lot of things can trigger it to go higher. However for me, mine goes through the roof when I'm in a flare. Even my doctor was surprised. But then again the last flare I had I was swelling up all over the place too. So it didn't surprise me that it was high. But yep, there are people who are in bad shape and the numbers are normal. Very odd!
Posted 1/20/2011 12:28 AM (GMT 0)
From Dr. Glenn Reeves at John Hunter hospital:

"The median normal concentration of C-reactive protein is 0.8 mg/L, with 90% of apparently healthy individuals having a value less than 3 mg/L and 99% less than 12 mg/L."
Posted 1/20/2011 1:13 AM (GMT 0)
There are two different tests that measure CrP. One test is highly sensitive and the other less so. The results are given differently for each version of the test.

You need to post not just the number but the units of measure for that particular test. Each test has it's own "normal" range and each lab can establish it's own normal range as well. So it would be helpful if you posted that alongside the result that concerns you.

I am guessing that the 114 is from the less sensitive CrP test.

Regardless of which one they used, 114 is a pretty high result.

In normal healthy people of "normal" weight, there should be no or barely detectable CrP levels. Anything above the upper limit of the normal range given by the lab would indicate inflammation.

CrP is a measure of inflammation that is non-specific (doesn' tell you what's inflamed). It rises and falls over roughly 24 hours so it is a pretty good tool for measuring the amount of inflammation at the moment. But it can be elevated by other things like an infection, heart disease, trauma - to name a few.

ESR is an even more generalized measure of inflammation. It can be elevated by everything from a bruise to a cold to surgery. It can stay elevated for weeks after an injury or illness has healed.

It's best not to try to interpret labs out of context. If you are feeling well and have no signs or symptoms of illness, then elevated markers should be viewed within that clinical context.

If you're feeling lousy and the markers are "normal" you can still be pretty sick. My son's ESR never went above 20 which was only 5 points higher than the top of the normal range. That despite having a bleeding ulcer in the small bowel, extensive inflammatory stricturing and severe inflammation throughout the colon. His CrP never went over 1.2 (0.8 being the top of the normal range).

Hope that answers your question.

Patricia
Posted 1/20/2011 6:00 PM (GMT 0)
I'm also one of those who almost always has a normal CrP.  I had several joints visibly swollen at one time (and not just a little swollen either) and my levels still came back normal.  So, my docs don't put much faith in those numbers for me, but it depends on the person. 

Posted 1/20/2011 6:03 PM (GMT 0)
I'm like Zena. My highest CRP was something like 4. That was taken at a time when both my asthma and Crohn's were flaring.
Posted 1/21/2011 12:22 AM (GMT 0)
Kazbern, 4 is higher than normal, so it is consistent with a flare.

The beauty of the hs-CRP test is that it allows us, for the first time, to accurately measure CRP below 5 mg/L - this is a must, since many Crohn's patients have CRP below 5 but are not in remission. Docs are struggling to understand the relationship between CRP and Crohn's, and it is my belief that there will be a growing concensus saying Crohn's patients are not really in remission unless they can achieve CRP of below .8 mg/L.

Since my daughter can have no symptoms but NOT be in remission, the hs-CRP test is essential to find out the effects of changes in meds and diet. We know that any time her CRP rises above .8, she can have festering in her small intestine. By the time it gets to even 1 or 2, she is in the danger zone and symptoms can and have returned.

Her CRP has shot up, because of a cold, but not because of Crohn's. With Crohn's, it rises and falls within a very narrow range. So we have learned there is a world of difference between a CRP of .4 mg/L (remission) and a CRP of 1.4 mg/L (no remission).

CRP is supposed to be barely detectable - for instance, just .2 mg/L. This is why I would argue that as soon as CRP rises above .7, inflammation can be suspected, and once it is over 1, inflammation is very probable. Once it is over 3, inflammation is definite. 

And this is why even a seemingly low number like 4 is consistent with flares.

Posted 1/21/2011 1:13 AM (GMT 0)
Thanks, NJmom!
Posted 1/21/2011 4:24 PM (GMT 0)
There is a growing list of things that are now known to influence CrP levels. That's one reason I suggested that you need to look at the whole picture not just the numbers on the CrP test. These factors come into play more when you are talking about hs-CrP levels of 10 mg/L or less as a general rule. Obviously, extremely elevated CrP levels clearly indicate something is wrong.

Among the things that have been shown to have a statistically significant association with lower or higher CrP levels in otherwise healthy people are:

HRT in post-menopausal women (elevates)
Daily coffee consumption in post-menopausal women not taking HRT(lowers)
Obesity (elevates it to varying degrees according to degree of obesity)
Waist Circumference (elevates with greater WC)
high blood pressure (elevates)
metabolic syndrome (elevates to increasing degree according to # of MetS features)
depression (elevates)
Smoking (elevates)
Peridontal disease (elevates)
Consumption of dairy products (reduces with greater consumption)

Since these studies have not been performed on people with CD it is hard to say if they apply to that group. So taking the test results in context of your diet, degree of endoscopic inflammation, menopausal status, and your CD signs and symptoms may not be as straightforward as the lab results suggest.

CrP has not been studied this way in children which makes it even more important, in my opinion, to look at the entire clinical picture and trends over time in lab results.

Like NJMom has done, tracking your personal results over time is an excellent way of helping you and your doctor figure out what *your* body's response is to inflammation/flare and other changes in your health like starting HRT or going off coffee.

Patricia
Posted 1/21/2011 5:53 PM (GMT 0)
Last time my CRP was checked it was 8.6 MG/L which I guess is high. That was about 1 1/2 months ago after I starting flaring from being post partum. I am still flaring and its getting worse because Im waiting on my humira to be approved (been 2 months since 1st ordered and had to do an appeal) I had to call my GI and start prednisone because its the only thing that takes my symptoms away. Im sick of going 15 times a day
Posted 1/27/2017 2:55 AM (GMT 0)
Hi everyone,

I haven't been on site for a long time been up and down with crohn's. I have a c-reactive protein of <2.9mg/l now and in August I had a.06 with a sedimentation rate of 8. Do I have any inflammation or not? My GI says no inflammation. I don't know what to think. I am on Azathioprine and I am suppose to be in remission. Sometimes I don't feel like it.
Posted 1/27/2017 1:30 PM (GMT 0)

carnations4ever said...
Hi everyone,

I haven't been on site for a long time been up and down with crohn's. I have a c-reactive protein of <2.9mg/l now and in August I had a.06 with a sedimentation rate of 8. Do I have any inflammation or not? My GI says no inflammation. I don't know what to think. I am on Azathioprine and I am suppose to be in remission. Sometimes I don't feel like it.

rlsnights hit the nail on the post with her last thread in this topic, I reckon. In an ideal world you'd have a CRP of under 1 but in the real world other things such as depression, obesity, etc. can make it a bit higher (although not super high. For example, my highest ever CRP was 350 mg/L which is ultra, ultra high).

Your numbers are good in other words.

But some folks can have excellent numbers and still have inflammation. So if you think you are flaring you need more than blood tests to find out, e.g. a colonoscopy or MRI/CT scan.
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