scott@vtx-cpd.com

Replying to Neus E. 18/02/2022 - 09:04

Hello everyone.

It really was an excellent presentation Neus!

I am looking forward to seeing everyone’s thoughts on this case!

Scott x

Hello.

I hope you are safe and well. CRP is really interesting and definitely has growing use in small animal practice.

CRP is an acute-phase protein that is associated with inflammation/infection.

Acute-phase proteins (APP) are sensitive markers that change their concentration as a reaction to a systemic inflammatory process and are known to increase in response to infectious diseases, immune-mediated diseases, neoplasia, and surgery. This is one of the biggest issues with APP, they are non-specific. APPs react more rapidly and with a shorter half-life period than classic markers of inflammation. C-reactive protein (CRP) is an important major APP in dogs, which increases within the first 8-24 h after an inflammatory stimulus and reaches up to 100-fold of the baseline levels. This wide range permits a more detailed evaluation of an inflammatory process than leukocyte counts. The CRP range of healthy dogs is below ~ 10–20 mg/l CRP. Canine CRP value increases of up to > 900 mg/l are reported in extremely rare cases. Different cut-off values have been discussed as medical decision limits for human and canine CRP. While there is no general definition, which medical decision limits should be utilized to classify an inflammation as low grade or moderate, there is consent that CRP values above 100 mg/l indicate a high-grade inflammation.

For humans, some inflammatory disease etiologies have proven to present with extremely increased CRP values more often than others. Another critical point in a patient with severe inflammation of unknown origin is the question as to whether antibiotic treatment is required. Although acute-phase-proteins are relatively unspecific markers of different types of inflammation in human as well as in veterinary medicine, extremely high CRP concentrations > 100 mg/L in association with specific symptom complexes (e.g. signs of pneumonia or signs of meningitis) are indicative of bacterial inflammation and thus a decision criterion for antibiotic treatment in human medicine. In dogs, the use of decision limits for CRP concentrations to recognize potential bacterial aetiology have been rarely investigated.

Immune-mediated disease is definitely when I use it the most. Clinical signs often guide us, but it is a useful marker to measure, especially when we start to wean the steroid dose.

The main thing is that it is really non-specific. There are a couple of interesting papers that also suggest it may be useful in the management of respiratory disease:

The Utility of Acute-Phase Proteins in the Assessment of Treatment Response in Dogs With Bacterial Pneumonia

Background: Acute-phase proteins (APPs) are sensitive markers of inflammation, and serum C-reactive protein (CRP) recently has been shown to be a useful diagnostic marker in dogs with bacterial pneumonia (BP). In humans with community-acquired pneumonia, APPs also have great utility as follow-up markers aiding in the assessment of treatment response.

Objectives: The aim of our study was to investigate the applicability of APPs as markers of treatment response in dogs with BP.

Animals: Nineteen dogs diagnosed with BP and 64 healthy dogs.

Methods: The study was conducted as a prospective longitudinal observational study. Serum CRP, serum amyloid A (SAA), and haptoglobin concentrations were followed during a natural course of BP. Normalization of serum CRP was used to guide the duration of antibiotic treatment (treatment was stopped 5-7 days after CRP normalized) in 8 of 17 dogs surviving to discharge; 9 of 17 dogs were treated according to conventional recommendations.

Results: All measured APPs initially were significantly increased, but the magnitude of increase was not correlated to disease severity. C-reactive protein and SAA concentrations decreased rapidly after initiation of antimicrobial treatment. When normalization of serum CRP was used to guide the duration of antibiotic treatment, treatment duration was significantly (P = .015) decreased without increasing the number of relapses.

Conclusions and clinical importance: Serum CRP and SAA reflected the recovery process well and therefore may be used as markers of treatment response. According to the results, the normalization of serum CRP may be used to guide the duration of antibiotic treatment in dogs with BP.

Serum C-reactive protein as a diagnostic biomarker in dogs with bacterial respiratory diseases

Background: C-reactive protein (CRP) is a major acute-phase protein in dogs. Serum concentrations are low in healthy animals, but increase rapidly after inflammatory stimuli.

Objective: The aim of the study was to investigate CRP concentrations in various respiratory diseases of dogs and to determine if CRP can be used as a biomarker in the diagnosis of bacterial respiratory diseases.

Animals: A total of 106 privately owned dogs with respiratory diseases (17 with bacterial tracheobronchitis [BTB], 20 with chronic bronchitis [CB], 20 with eosinophilic bronchopneumopathy [EBP], 12 with canine idiopathic pulmonary fibrosis [CIPF], 15 with cardiogenic pulmonary edema [CPE], and 22 with bacterial pneumonia [BP]) and 72 healthy controls.

Methods: The study was conducted as a prospective cross-sectional observational study. CRP was measured in serum samples. Diagnosis was confirmed by clinical and laboratory findings, diagnostic imaging, and selected diagnostic methods such as cytological and microbiological analysis of respiratory samples, echocardiography, and histopathology.

Results: Dogs with BP had significantly higher CRP concentrations (median, 121 mg/L; interquartile range, 68-178 mg/L) than dogs with BTB (23, 15-38, P = .0003), CB (13, 8-14, P < .0001), EBP (5, 5-15, P < .0001), CIPF (17, 10-20, P < .0001), or CPE (19, 13-32, P < .0001) and healthy controls (14, 8-20, P < .0001). Dogs with BTB had significantly higher CRP concentrations than dogs with CB (P = .001) or EBP (P < .0001) and healthy controls (P = .029). Conclusion and clinical importance: These results indicate that CRP has potential for use as an additional biomarker, especially in the diagnostics of BP. Hope that helps. Scott

Hello.

I hope you are safe and well. I am really sorry about this.

I will get Andy to have a look at it and get back to you ASAP.

Scott 🙂

Hello everyone.

My name is Scott. I am one of the founders of vtx and a European and RCVS Veterinary Specialist in Small Animal Internal Medicine. I am so excited that we have Neus and Kerry delivering the course ad I can get a chance to watch and learn rather than being the one behind the webinar!

I will be here on the discussion forum to help where I can. Make sure to use the discussion forum. Feel free to share any interesting cases too.

Thank you all again for your support and I hope you enjoy the course.

Scott 🙂