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Introduction: C-reactive protein (CRP) is an acute-phase reactant with an increasing number of clinical functions. Studies in recent years have identified several social, economic, demographic, and psychological factors that contribute to baseline inflammation. Psychosocial stress represents a significant contributor to baseline inflammation. Given the importance of understanding background drivers of CRP levels, we conducted this review to assess the impact of chronic psychosocial stress on CRP levels., Methods: Medline was searched through February 2013 for human studies examining CRP levels with respect to chronic psychosocial stress., Results: The initial search identified 587 articles from which 129 potentially appropriate articles were reviewed. Of these 129 articles, 41 articles were included in the review. These studies were published between 2003 and 2013. Of these studies, 6 analyzed employment stress, 2 analyzed unemployment stress, 6 analyzed burnout and vital exhaustion, 6 analyzed caregiver stress, 3 analyzed interpersonal stress, 17 analyzed socioeconomic position, and 2 analyzed discrimination., Conclusion: We conclude that psychosocial stress significantly impacts CRP and should be considered when interpreting the meaning of CRP elevations.

C-reactive protein (CRP), an acute phase reactant, is associated with systemic inflammation. Many studies have demonstrated that CRP levels have important prognostic implications for patients. For example, individuals with elevated CRP levels have an increased risk of cardiovascular events. The JUPITER study showed that reducing CRP levels can mitigate this risk. Various trials have investigated the effect of lifestyle modifications on serum CRP levels. Specifically, the impact of different exercise-based protocols on CRP levels has been researched. This review article evaluates the response of CRP levels to aerobic-based, resistance-based, and combination exercise protocols. Furthermore, it examines the impact of such regimens in children, adults, and the elderly. No definitive answers exist regarding the relationship between exercise and CRP levels. Significant reductions in CRP levels were noted in 11 of 25 trials of aerobic-based regimens, two of five studies of combination protocols, and neither of two trials of resistance-based regimens. Similar findings were seen across all age groups. There were significant CRP reductions in nine of 18 adult studies, four of ten child studies, and one of three elderly studies. Mixed results reflect uncertainty about the ability of exercise to reduce inflammation. Various mechanisms, including increased protein synthesis and fat loss, have been proposed to explain the potential anti-inflammatory effects of exercise. While exercise-based regimens have produced inconsistent results, lifestyle modifications do appear to have significant anti-inflammatory effects. This was particularly evident in studies that utilized combined diet/exercise programs. Significant CRP reductions were seen in five of seven such trials. Interestingly, both studies with failed combination protocols achieved substantial CRP reductions in their diet-only groups. These findings suggest that weight loss is important in reducing inflammation. Additionally, they indicate that combined diet/exercise protocols should be part of any lifestyle intervention program. Further research will be needed to identify optimal regimens for achieving anti-inflammatory benefits.

Purpose: C-reactive protein (CRP), an acute phase reactant, is a non-specific marker of inflammation. Elevations in CRP levels are linked with trauma, infection, autoimmune disease, malignancy, and lifestyle factors, such as smoking and obesity. Previously, we noted a significant association between the preoperative CRP level, 1-year relapse-free survival, and 1-year overall relative survival in patients with localized renal cell carcinoma (RCC). This study sought to determine what effect, if any, lifestyle factors have on the prognostic value of preoperative CRP level for overall survival in individuals with localized RCC., Methods: 257 patients with localized RCC who underwent nephrectomy were included in the study. Patients were enrolled between November 2006 and February 2010. The impact of tumor characteristics, lifestyle factors, and preoperative CRP level on overall survival was assessed through univariate and multivariate analyses., Results: During the study, 15.2% of patients died. Univariate analysis found that tumor size (p < 0.001), tumor stage (p < 0.001), Fuhrman nuclear grade (p < 0.001), Charlson Comorbidity Index score (p < 0.001), smoking status (p = 0.038), and preoperative CRP level (p < 0.001) were significantly associated with overall survival. Only the preoperative CRP level (odds ratio 1.035; 95% confidence interval 1.007, 1.064) remained significantly associated with overall survival upon multivariate analysis., Conclusions: Prognostic tools serve an important role in cancer management. Thirty percent of patients with localized RCC ultimately develop metastatic disease despite having potentially curative nephrectomy. Previous research has identified the preoperative CRP level as a significant predictor of overall survival in patients with localized RCC. This study demonstrated that the CRP level remained a robust predictive tool when the analysis was controlled for lifestyle factors, including smoking and obesity. Consequently, clinicians should consider taking preoperative CRP levels into account when treating patients with localized RCC.

Purpose: Elevations in C-reactive protein (CRP) levels predict metastasis and mortality in a number of malignancies. However, the impact of non-malignant factors on CRP levels in patients with cancer remains unknown. To address this issue, we conducted an investigation of the National Social Life, Health, and Aging Project (NSHAP) cohort., Methods: NSHAP participants with a history of malignancy were included. The 222-participant cohort was subdivided by CRP levels into low-risk (CRP <3 mg/L) and high-risk (CRP ≥3 mg/L) groups. Univariate and multivariate binary logistic regression analyses examined the impact of variables spanning social factors, demographic characteristics, and past medical history on high-risk CRP levels., Results: Of the cohort, 42.3% exhibited high-risk CRP levels. These participants were more likely to be unmarried (p = 0.013), to be a racial/ethnic minority (p = 0.012), to not use HMG-CoA reductase inhibitor (statin) medications (p = 0.032), and to be obese (p = 0.002). On multivariate logistic regression analysis, these variables were also significant predictors of high-risk CRP levels. For example, compared with participants who had a normal body mass index (BMI), obese participants were nearly 5 times more likely (odds ratio 5.725; 95% CI 1.848, 12.079; p = 0.001) to exhibit high-risk CRP levels., Conclusions: CRP remains an important prognostic biomarker in the management of known malignancies. However, patients with a known history of cancer can also exhibit elevated CRP levels due to non-malignant factors such as race and ethnicity, statin use, marital status, and BMI. Consequently, further studies are needed to assess the predictive potential of CRP levels for cancer prognostication in the face of these social and biologic variables before use of this biomarker is widely adopted in clinical practice.

C-reactive protein (CRP) is an acute-phase reactant that can increase dramatically in response to a variety of pathologic states. Elevated pre- and postoperative CRP levels have been associated with an increased tumor burden and metastasis in kidney cancer. We report on a case that serves to highlight a potentially novel use for CRP monitoring in the postoperative management of renal cell carcinoma. Recently, we treated a patient who presented with a localized renal cell carcinoma and an elevated preoperative CRP level. Surgical pathology demonstrated negative surgical margins and absence of nodal metastasis. Postoperatively, the patient's serum CRP levels remained relatively low, consistent with his continued negative staging on CT scans. However, at 6 months postoperatively, the patient's CRP level increased 13-fold. His subsequent CT scan revealed "multiple pulmonary nodules consistent with progression of metastatic disease." This case demonstrates the potential for monitoring CRP in addition to, or instead of, standard restaging imaging.