Preanalytic and analytic sources of variations in C-reactive protein measurement: implications for cardiovascular disease risk assessment.

Abstract:

BACKGROUND:C-reactive protein (CRP) is a widely recognized indicator of inflammation and is known to play an important role in atherogenesis. Recent prospective studies have demonstrated that increased CRP concentrations within the reference interval are a strong predictor of myocardial infarction, stroke, sudden cardiac death, and peripheral vascular disease in apparently healthy adults. On the basis of available evidence, the American Heart Association and the CDC have issued guidelines for the utility of CRP in the primary prevention of coronary heart disease and in patients with stable coronary disease or acute coronary syndromes. Nevertheless, there remains considerable work to optimize the utility of this marker for risk assessment. ISSUES:Most traditional CRP tests designed to monitor acute and chronic inflammation have inadequate sensitivity for risk stratification of coronary disease. Thus, manufacturers have had to develop tests with higher sensitivity. Because an individual's CRP concentration will be interpreted according to fixed cut-points, issues related to the preanalytic and analytic components of CRP measurement must be considered and standardized where possible to avoid potential misclassification of cardiovascular risk. CONCLUSIONS:Efforts to define performance criteria for high-sensitivity CRP applications coupled with growing awareness of the physiologic aspects of CRP most likely will lead to refinements in standardization, improved performance in quality-assessment schemes, and enhanced risk prediction.

journal_name

Clin Chem

journal_title

Clinical chemistry

authors

Ledue TB,Rifai N

doi

10.1373/49.8.1258

subject

Has Abstract

pub_date

2003-08-01 00:00:00

pages

1258-71

issue

8

eissn

0009-9147

issn

1530-8561

journal_volume

49

pub_type

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