Just a bit more (useless or otherwise)information.
I visited a hospital in Valencia, Spain, this morning
and their Immunology Dept. offer CRP (acute) and
hs-CRP (prognostic). I remarked that this was a
coincidence as it's value was being discussed by this
group, and was told by the Medical Specialist (a
clinical biochemist with a medical degree), "there is
sufficient evidence to provide it as a prognostic
test". I don't how they operate their budget....is any
lab in the UK being asked to offer it?



--- Gray Malcolm
<[log in to unmask]> wrote: >  In
this morning's London Times newspaper, there was
> an article on CRP and
> cardiac risk based on a paper due to be published
> this week in the journal
> CIRCULATION. Perhaps the answer as to how useful CRP
> would be in evaluating
> cardiovascular risk, with other factors already
> understood, will be there
> (but I doubt it). Expect a flood of new requests!
>
> Malcolm Gray
>
> -----Original Message-----
> From: Bruce Campbell
> To: [log in to unmask]
> Sent: 20/1/2003 11:16 PM
> Subject: Re: sensitive CRP and CHD
>
> Sensitive CRP assays can only discriminate between
> those with and
> without
> active atherosclerosis when there are couple of
> hundred subjects in each
> group.  Sensitive CRP measurements can't confidently
> discriminate
> between
> individuals.  Our calculations indicate that the
> number of samples
> required
> from an individual to obtain a clinically useful
> estimate of their true
> hs-CRP concentration lies between 10 and 50.  See
> our Ann Clin Biochem
> paper referenced below and the other articles as
> well which give more
> reasons why hs-CRP is not clinically useful.
>
> Ridker has suggested that we could just do a number
> of measurements over
> time and pick the lowest value.  However there are a
> number of untested
> assumptions inherent in this idea that would need to
> be validated.  The
> experiments required to identify and quantify the
> factors which
> contribute
> to both minor and major variation in plasma CRP
> concentrations are not
> going to be easy to perform.  We are setting up a
> study to follow
> subjects
> over time while they record a health diary to see
> whether clinically
> significant intra-individual variations in hs-CRP
> are subjectively or
> objectively identifiable.  It is our hypothesis that
> many such
> variations
> will be silent.
>
> Campbell B et al.  Limited clinical utility of
> high-sensitivity plasma
> C-reactive protein assays.  Ann Clin Biochem
> 2002;39:85-88
> Kushner I. C-reactive protein and atherosclerosis.
> Science
> 2002;297:520-21
> Kushner I, Sehgal AR. Is high-sensitivity C-reactive
> protein an
> effective
> screening test for cardiovascular risk? Arch Int Med
> 2002;162:867-9
> Levinson SS, Elin RJ. What is C-reactive protein
> telling us about
> coronary
> artery disease? Arch Int Med 2002;162:389-95
>
> Bruce Campbell
>
> ****************************************
> Bruce Campbell  FRCPA  FAACB
> Sullivan Nicolaides Pathology
> Ph 61 (0)7 3377 8672
> Fax 61 (0)7 3870 5989
> Email [log in to unmask]
> ****************************************
>
>
>
>                     Craig Webster
>                     <[log in to unmask]>
> To:
> [log in to unmask]
>                     Sent by: clinical
> cc:
>                     biochemistry discussion
> Subject:     Re:
> sensitive CRP and CHD
>                     list
>                     <ACB-CLIN-CHEM-GEN@JISCM
>                     AIL.AC.UK>
>
>
>                     21/01/03 04:28
>                     Please respond to Craig
>                     Webster
>
>
>
>
>
>
> Sensitive CRP was mentioned in a Plenary Lecture by
> Matt McQueen at the
> ICCC
> kyoto. Within individual variation data suggests
> that up to 5
> measurements
> of sensitive CRP may be neccessary to obtain a value
> that can be used in
> the
> assessment of CHD risk. WHich is probably even
> better news for
> manufacturers!
>
> The theory that atherlosclerosis is a chronic low
> grade inflammatory
> reaction underpins its measurement.
>
> I always thought that CRP was probably under
> requested in the past due
> to
> long turn around times etc. Now that we can turn the
> test around quickly
> surely we are seeing the benefits of all our
> execellent work on
> improving
> the service we provide :-)
>
> Craig Webster
> Principal Clinical Biochemist
> Nottingham City Hospital
>
> -----Original Message-----
> From: clinical biochemistry discussion list
> [mailto:[log in to unmask]]On Behalf
> Of David Brown
> Sent: 20 January 2003 17:25
> To: [log in to unmask]
> Subject: Re: [ACB-CLIN-CHEM-GEN] sensitive CRP and
> CHD
>
>
> Like everything else, apparently, new "sensitive"
> CRP
> is the same non specific CRP we have been measuring
> for years, only it is more sensitive in the lower
> range. There is sufficient interest in this assay as
> a
> cardiac risk factor, that there is more than one
> assay
> method on the market. My experience of assaying
> CRP's
> consisted of seeing - most below measurable range -
> and the rest so sky high, that I wondered if the
> test
> was really necessary (but that was a few years ago).
> Now I may be led to believe that it is as valuable
> as
> measuring a total cholesterol. There are several
> major
> studies indicating this. For those who are
> interested,this web page explains sensitive CRP
> (from
> a manufacturers point of view) and gives some
> references too.
>
> http://www.sonoraquest.com/documents/CardioCRP.pdf
>
>
> Best wishes
>
> David Brown
>
>  --- "Mainwaring-Burton Richard (RGZ)"
> <[log in to unmask]>
> wrote: > In the light of the significant numbers of
> raised
> > (non-sensitive) CRPs we
> > report for a plethora of reasons, how do we pick
> out
> > the significant
> > elevations of sensitive CRP ?
> >
> > Suggested stratigies :
> > 1.      do a low sensitivity assay first
> > 2.      apologise to potential CHD patients with
> > high CRP - test no good
> > until arthritis/crohns/flu/etc cleared up
> > 3.      wait for the cardio-specific version ?
> >
>
=== message truncated ===

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