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Extremely high canine C-reactive protein concentrations > 100 mg/l - prevalence, etiology and prognostic significance
Sarah Hindenberg1, Natali Bauer2, Andreas Moritz2
1Department of Veterinary Clinical Sciences, Clinical Pathology and Clinical Pathophysiology, Justus-Liebig-University Giessen, Frankfurter Str. 114, 35392, Giessen, Germany. sarah.hindenberg@vetmed.uni-giessen.de.
Insights
Extremely high C-reactive protein (CRP) levels in dogs (>100 mg/L) indicate severe systemic disease but do not reliably identify bacterial infections. These high CRP concentrations are associated with a guarded prognosis and varied etiologies.
Area of Science:
- Veterinary Medicine
- Biochemistry
- Canine Health
Background:
- High C-reactive protein (CRP) concentrations (>100 mg/L) in human medicine suggest bacterial infection and guide antibiotic treatment.
- Similar thresholds are proposed for canine septic pneumonia but lack validation across other organ systems.
- This study aimed to determine the prevalence and clinical significance of elevated CRP in dogs.
Purpose of the Study:
- To investigate the prevalence of CRP concentrations exceeding 100 mg/L in dogs.
- To evaluate the underlying causes, affected organ systems, and prognostic implications of these high CRP levels.
- To assess if elevated CRP can predict bacterial infection in dogs.
Main Methods:
- Retrospective analysis of canine patient data from 2014-2016.
- Classification of dogs into disease categories: inflammatory, neoplastic, tissue damage, or diverse.
- Analysis of affected organ systems and 3-month survival/hospitalization rates for prognostic evaluation.
Main Results:
- A prevalence of 12% for CRP >100 mg/L was observed.
- Inflammatory conditions (59%) were the most common cause, followed by tissue damage (21%) and neoplastic diseases (12%).
- Elevated CRP did not correlate with specific disease groups or organ systems and could not identify bacterial infections; survival rate was 63%.
Conclusions:
- CRP concentrations >100 mg/L occur in a small percentage of canine patients.
- These high levels signify severe systemic disease with diverse origins and a guarded prognosis.
- Elevated CRP alone is insufficient for diagnosing bacterial infections or determining specific etiologies.
Background:
In human medicine, extremely high CRP (C-reactive protein) concentrations > 100 mg/l are indicators of bacterial infection and the need of antibiotic treatment. Similar decision limits for septic pneumonia are recommended for dogs but have not yet been evaluated for other organ systems. The aim of the retrospective study was to investigate the prevalence and evaluate dogs with CRP concentrations > 100 mg/l regarding the underlying etiology, the affected organ system and the prognostic significance.
Results:
Prevalence of CRP > 100 mg/l was investigated in dogs presented between 2014 and 2015 and was 12%. For evaluation of etiology and organ systems, dogs with CRP > 100 mg/l presented between 2014 and 2016 were enrolled. Dogs were classified into 4 main disease categories, i.e. inflammatory, neoplastic, tissue damage or "diverse". Diseases were assigned to the affected organ system. If an organ classification was not possible, dogs were classified as "multiple". 147 dogs with CRP 101-368 mg/l were included and classified into disease categories: 86/147 (59%) with inflammatory etiology (among these, 23/86 non-infectious, 44/86 infectious (33/44 bacterial), 19/86 inflammation non-classifiable), 31/147 (21%) tissue damage, 17/147 (12%) neoplastic (all malignant) and 13/147 (9%) diverse diseases. The affected organ systems included 57/147 (39%) multiple, 30/147 (20%) trauma, 21/147 (14%) gastrointestinal tract, 10/147 (7%) musculoskeletal system, 8/147 (5%) respiratory tract, 7/147 (5%) urinary/reproductive tract, 6/147 (4%) skin/subcutis/ear, 6/147 (4%) central/peripheral nervous system and 2/147 (1%) heart. The disease group (p = 0.081) or organ system (p = 0.17) did not have an impact on CRP. Based on CRP, a detection of bacterial infection was not possible. The prognostic significance was investigated by determining the 3-months survival and hospitalization rate in a subgroup with known outcome. The 3-months survival rate was 46/73 (63%) while the majority 66/73 (90%) of patients was hospitalized.
Conclusions:
CRP concentrations > 100 mg/l are occasionally seen in a clinic population. They indicate a severe systemic disease of various etiologies with guarded prognosis. Extremely high CRP concentrations do not allow a conclusion of the underlying etiology or an identification of bacterial inflammation.
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