Esr and crp
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Esr and crp

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Esr and crp Esr and crp Presentation Transcript

  • ESR AND CRP IN ORTHOPEDICS Suhas
  • ►They are known as acute phase reactants ►They reflect the acute phase response to local and systemic inflammatory response.
  • Causes or Stimuli ►Infection , ►injury or trauma, ►Surgery, ►Hypoxic injury, ►thermal injury, ►allergic reaction, ►malignancy .
  • Other acute phase reactants ►haptoglobin, ►Ceruloplasmin, ►fibrinogen, ►Prothrombin, ►Complement components (C3, C4, C5, etc.).
  • Why CRP and ESR ►increase in concentration relatively high compared to basal concentration ►relatively short lag time from the moment of stimulus ►cost-effective
  • CRP ►Discovered in 1930 ►Till 1970 only qualitative estmation after that now its quantitative estimation. ►Synthesized in the liver by hepatocytes ►Cytokines IL-6 induces the synthesis of crp. ►The clearance rate of CRP is constant.
  • ►therefore the level of CRP in the blood is regulated solely by synthesis. ►The plasma levels of CRP 1 mg/L with normal being <10 mg/L. ►levels begin increasing 4-6 hr after initial tissue injury ►Doubles every 8-9 hr exponentially. ►Returns to normal with restoration of tissue structure and function.
  • ESR ►It’s a measure of the vertical column in the westergen tube. ►Response of acute phase reactants increase fibrinogen in the plasma which increase positively charged RBC’S ►Increased rouleaux formation thereby increasing ESR.
  • FACTORS EFFECTING ► Size ► shape of red blood cells, ► plasma composition ► fluid status ► Age temperature ► Pregnancy ► drugs ► CRP is independent of the physical properties.
  • Clinical Significance of CRP and ESR ►Predicting post-op infection before the development of clinical symptoms. ►Common clinical symptoms are masked by the effects of the procedure itself. ►Pain, fever, tachycardia and elevated WBC can be due to surgery or infection.
  • Larsson et al ►Sample- 193 ►Studied the the natural CRP course for uncomplicated surgery. ►Once the natural CRP response after uncomplicated surgery is known, then deviation from normal should raise clinical suspicion that a complication may be surfacing.
  • -condt ► 193 pts 4 types of surgeries were done. ► THR, TKR, Revision Hip, discectomy ► CRP levels were measured days 0, 5, 10, 14, 21, and 42. ► All four procedures had a peak CRP response 2 to 3 days after surgery ► biphasic rapid decline. ► Day 3-5 1st decline ► Day 14-21 2nd decline ► ESR was high to 42 days, in rev hip upto 1 year.
  • conclusions ►The conclusion from the study is that a normalized CRP response that follows a typical biphasic response seems to indicate an uneventful recovery. ►Any deviation from the normal response curve indicates an chance of post op infection.
  • Mustard et al. ► Study size-108 ► Measured the levels of CRP pre and post op. ► Positive CRP response - level on day 3 or 4 > 80% of day 2 - after day 4, inc on two consecutive days ► Subjects who had postive crp response had later developed post op infection.
  • Waleczek et al ►Study group 107. ►Compared esr, crp, wbc, body temp, clinical features. ►7 out of 107 had abnormal crp patterns and all of them developed wound infections
  • Meyer et al ► 400 patients underwent discectomy out of which 15 had post op infection and all 15 had crp level on day 5 was more than day 1. ►The sensitivity of CRP was thus determined to be 100%, specificity 95.8%
  • Conclusion ► CRP is better than ESR in diagnosis and monitoring treatment of infection in post op pts. ► Single CRP reading holds very limited value. ► Trend must be observed for its usefulness. ► CRP rises early and before the onset of clinical symptoms, and declines with the resolution of infection. ► It is a biologic warning sign that should raise an index of suspicion for infection if a rising trend.