CRP vs ESR

[Tesscorm]

I'm almost certain I've asked this before??? :ybatty: but, if I did, can't find the answer on any of my threads... so, apologies for repeating myself (age, you know... )

I know elevated CRP is a more instant indicator of acute inflammation and will return to normal levels quickly once inflammation is treated; ESR takes longer to both rise and drop, even weeks.

However, if there have been no recent injuries/illnesses, what could cause normal CRP but elevated ESR? If there continued to be some simmering 'chronic' inflammation (even while on remicade), would CRP also be elevated (or does CRP react to 'acute' inflammation only)? S's ESR was elevated over the winter but not his CRP (unfortunately ESR wasn't tested with last labwork).

And, adding to the question in my mind re simmering inflammation is the relationship between inflammation and ferritin. His ferritin level has also been steadily increasing - however, the increase has been well within normal ranges, ie from 22 to 67, our normal is 10-170 - so this increase could simply be his body moving towards a more normal level as remicade heals his body. (If it's relevant??, his HGB is always fluctuating but has improved slightly since beginning remicade but only moving from a range of 125-131 pre-remicade to 134-148 (our normal is 135-170).)

His next GI apptmt is coming up so just trying to get my thoughts/questions together... :smile:

 

[Jmrogers4]

Good question. Jack's CRP has never been above .5 his ESR will fluctuate but only within normal levels.
What about a FC to test for simmering inflammation?

 

[Maya142]

I wouldn't worry about the ferritin. When M has active inflammation it is way above the upper limits. Our range is different, but just for reference her last one was 284 (when the range is 10-143). Hers has been high for two years because we can't seem to get the inflammation in her joints under control.
No idea about CRP and ESR, sorry! I agree with Jmrogers, a FC is a good idea.

 

[Tesscorm]

I asked his GI about FC before and he didn't think it was a good indicator of small bowel disease! :ymad: But, as everything I read here says it is, I'm going to ask him again (I don't think S will be too happy with me! :ack.

S's CRP has been well within normal since beginning remicade, 0.2 to 2.9 (our normal 0-5); his ESR has was 2 and 5 last summer but was up at 33 and 19 over the winter (normal is 1-10) - this is the level it had been pre-remicade. However, when it was 33, he had recently hurt his shoulder but, the 19 was two months later. (Unfortunate, I have nothing since.) But it was trending in the right direction so am going to ask him to run it again. Am thinking/hoping if there was chronic inflammation, then shouldn't his CRP also be high?

 

[Jmrogers4]

In regards to the FC, Jack's last flare was in small bowel and FC was elevated not to the levels of some here which I know have been in the thousands but I think anything 160 and under was considered normal range for us and first it was at 295 then 390 a couple of months later. His CRP never changed ESR went from 7 to 9. We did the MRE based on FC numbers as I said to his GI - they're not going in the right direction. Which then showed inflammation through small bowel. So I guess maybe FC is a little more sensitive to large bowel inflammation but it definitely showed inflammation present for us and large bowel was clean this time..

 

[my little penguin]

Every paper I have seen recently states FC is still a good indicator for small bowel just not a good as large bowel.
His normal gp could order the ESR and FC .
DS has had above normal esr - (up to 20 normal range ) at dx it was 28 and kept climbing to 34- so not too high . Crp ( 0.02--0.69) has always been normal again much higher at dx like 0.59 . Most of the time he stays around <<0.02.
His blood work crp at the beginning of the month was higher .

I think its the trend over time so you really need the same values -test.
DS had std bloodwork done with every infusion since they were in the vein anyways .
This makes tracking trends a little easier.

I don't think normal crp/esr are helpful but if you can track mre image / scope etc with crp/esr over time maybe .

 

[Tesscorm]

His last MRE, 6 months after starting remicade, showed 'significant small bowel improvement', there were still some areas of small concern but overall, it was good. His last scope all was clean except TI (mod inflammation).

I agree with you, MLP, that a trend is more indicative than one time - since remi, CRP and ESR both dropped immediately. While CRP has fluctuated, it has stayed 'normal' but his ESR rose in October and next result (Dec/Jan??) was still high. It may be normal now?? S has labs done every other infusion but ESR is not included. Spoke with nurse today who liases between remicade/infusion centre and our hospital's (or district's??) GIs and she said she can't add ESR to the orders (although I'm 99% certain she did it for me last time??), she took a quick look at other orders and said none of her other GIs order ESR either - all just order CRP. (Life would be a whole lot simpler for all of us here if every GI did the same thing! :lol

I also thought his HGB would have improved a bit more over the last year - it's only gone from an avg of 132 to 143 (normal 135-170) - but, maybe this level is good enough and not an issue at all. (Thanks Maya for info re ferritin.)

I don't want to make a mountain out of a molehill but as S doesn't have lots of outward signs (had very few symptoms for two years with 20-30 cm of TI inflammation), I don't want to ignore any subtle signs either.

So... going to ask for FC, I think GI will suggest a scope (not sure why I think this, maybe he mentioned it last time??) but going to request MRE to see small bowel if he doesn't mention it and will ask re CRP vs. ESR and why he doesn't track ESR. I think this is all reasonable.

 

[crohnsinct]

Certainly sounds reasonable to me! FC would be where I would start especially since he just had strep and I am pretty sure the strep would affect his ESR so an ESR pulled now probably wouldn't give you much to go on.

FWIW - O has always had normal CRP so her GI goes more on her ESR BUT her ESR had gone up and rose the next infusion. No colds but psoriasis so we assumed that was it. Psoriasis stuck around and didn't get better but ESR went down. For O the ESR seems to be a very sensitive test and probably not so easy to go on since so many things could affect it.

I hear ya on the lack of outward symptoms at the beginning so you want to be watchful....same here.

 

[Tesscorm]

Yep, had thought that strep would impact test now. :ymad: Also agree that ESR is difficult to use as a definitive indicator because so much can affect it and it can remain affected for a while! Ugh.

That's why I was, in a sense, trying to remove the influence of 'lingering' effects from injuries/illness in asking if CRP would be elevated due to chronic inflammation? But I'm thinking the answer will be 'it depends'... :ybatty: That's why the FC would be best!

 

[Mehita]

I think I already know the answer, but do we all have different normal ranges for tests because we all use different hospitals/clinics/labs?

If we're voting, I vote for a FC too.

 

[Tesscorm]

Yes, I've seen slightly different ranges. Also differ for kids/adults and, I think sometimes, for male/female.

 

[Catherine]

We have ferritin elevated due to chronic inflammation but normally only to the mid 30 to 50 but when read with the other iron numbers the gi knew there was a problem with her iron.

But we also had rising ferritin and falling haemoglobin while supplementing with iron.

 

[Tesscorm]

Catherine, out of curiosity, what is your 'normal' range for ferritin?

 

[xmdmom]

The C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are standard laboratory surrogates of the acute phase response to inflammation. The CRP broadly correlates with disease activity of CD assessed by standard indices and indicates serial changes in inflammatory activity because of its short half life of 19 hours.31,32,33,34,35,36 The ESR less accurately measures intestinal inflammation in CD by reflecting changes of plasma protein concentration and packed cell volume. The ESR increases with disease activity, but correlates better with colonic rather than ileal disease.3

according to http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1859998/

I vote for fecal calprotectin if the inflammatory markers are elevated and you are unsure if it represents Crohn's inflammation. (I was just about to get FC ordered for my son, whose lab work showed a CRP of 16. It had been between 1 and 3, but it turns out the lab just changed their units so 16 is like a 1.6... mildly elevated, but we'll take it!) My son's doctor said he just goes by clinical symptoms and I mentioned the forum and reading about people who had lots of inflammation but normal blood markers. He said it happens but rarely. For my son, I looked at Hgb, Plt, alb/prot which were all more normal than before and that was reassuring to me.

 

[my little penguin]

Of all the laboratory markers, CRP is the most studied and has been shown to have the best overall performance. CRP is an objective marker of inflammation and correlates well with disease activity in Crohn's disease (CD). Increased CRP levels are associated with better response rates and normal CRP levels predict high placebo response rates in clinical trials with biologicals. However, despite the advantages of CRP over other markers, it is still far from ideal. Furthermore, CRP correlates less well with disease activity in patients with ulcerative colitis (UC) as compared with CD

From
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856093/



Gut. Mar 2006; 55(3): 426–431.
doi: 10.1136/gut.2005.069476
PMCID: PMC1856093
Laboratory markers in IBD: useful, magic, or unnecessary toys?

S Vermeire, G Van Assche, and P Rutgeerts



So maybe that's why CRP

 

[Mehita]

Makes me grateful I have a CRP kid. Great info... Thanks!

 

[crohnsinct]

My son's doctor said he just goes by clinical symptoms and I mentioned the forum and reading about people who had lots of inflammation but normal blood markers. He said it happens but rarely. For my son, I looked at Hgb, Plt, alb/prot which were all more normal than before and that was reassuring to me.

O is scheduled for her first scopes since dx 2 1/2 years ago. I also asked the doc how often patient's bloods and symptoms all appear fine and he finds inflammation. I am concerned because of what I read here but also because we had no clue what so ever that our daughter had CD until her first major flare that hit fast and furious. Anyway, he said that rarelyhappens. Then went on to say the opposite happens more frequently...kid has loads of symptoms but they find nothing!

I think it is like we always say...the sicker, more difficult cases are usually found on the forums. We also come on here to warn others to keep their eyes out..forewarned is forearmed. The healthy, happy, text book cases are out enjoying their lives.

I promise when O's results come back clean, I will post!

 

[Catherine]

Our ferritin range is 20-200.

 

[DustyKat]

As mlp has posted, CRP is considered to be more sensitive to IBD whereas ESR is generally thought to be a better indicator for the arthritic type conditions. It goes without saying that there will always be exceptions to this rule whether it be that ESR is in fact the better indicator for some or that neither of the serum markers are useful. I personally do not believe that the serum markers not being an indicator is a rarity is false when it comes to children/adolescents. I am not suggesting that it is even close to common but to say it is a rarity is just as equal an exaggeration.

Faecal Calprotectin. Early studies did state that this was not a useful indicator of small bowel disease activity. However subsequent studies started to contradict that and it has now reached a point where the consensus is that it is reliable for small bowel disease.

NRR Ferritin for us is 20-300.

I think I already know the answer, but do we all have different normal ranges for tests because we all use different hospitals/clinics/labs?

Yes.

You may also find different values between countries. CRP and Vit D are two that immediately spring to mind between Aus and the US.

Dusty. xxx

 

[AZMOM]

I'm a fan of FC for being most specific (although the results have pissed me off lately :rof.

In all our mild and major incidents, Claire's CRP has never skyrocketed. Not even when we were inpatient getting blood transfusion. Craziness. Her ESR was very high though.

Her ESR, although no one gets too excited about it, has been a good indicator for me. And like MLP said, watching the trend on that one is best.

J.

 

[SupportiveMom]

I am just now starting to keep track of D's blood results. Where do I figure out what is normal & what is not? Anyone have a good blood range website they use for kids? 1/2 these tests are new to me (they did a more comprehensive workup last time in hospital) and google is confusing the hell out of me.

 

[xmdmom]

In general, you should use the normal range from the lab that analyzed the blood work. Sometimes, the lab only gives an adult normal and in those cases, you can google and look for pediatric (age or pubertal stage matched normal values). Some lab values are quite different in children vs adults and some are pretty much the same.

 

[Jmrogers4]

I keep a basic spread sheet and just list the results for each line, highlighting in yellow for low and red for high. You can also make notes about how she is feeling, disease activity on the dates of labs and pretty soon you will get a good idea of what her "normal" levels or trends are. Make sense?
Normal ranges are listed on our copy of lab results so I go off of those. For example
ESR is listed as 0-15 MM/HR on his labs, even if I just take the last year his results were 7, 7, 8, 9, 9, 6. The 8 coincided with c-diff and the 9's were during flares/symptoms so you can see while even though they are in "normal range" for him 9 are a signal.

 

[Tesscorm]

yes, that's what I've done... I think all the tests results I've received always include the normal range. Don't recall offhand right now but, perhaps the forum's wiki offers normal ranges as well.

 

[DustyKat]

If you are looking at the lab’s results they will always carry the NRR (Normal Reference Range) in brackets either after the name of the test or after the numerical result. For some tests like Vit D they will give an explanation below the result.

NRR will vary from lab to lab due to their own assay results.

Values for some tests vary from country to country.

Dusty.

 

[SupportiveMom]

There was not any normal range information from ger discharge papers so I'm starting from scratch. I will try wiki.

 

[xmdmom]

You should be able to get a copy of the official lab results and they should have the normal ranges next to the results. 2 shoulds.....