SERIAL MEASUREMENT OF SERUM C-REACTIVE PROTEIN FACILITATES EVALUATIONIN ALCOHOLIC HEPATITIS

Background/Aims: An ability to measure inflammatory activity in alcoho lic hepatitis is desirable for assessing its natural history and thera peutic responses, but convenient and simple parameters are lacking. To determine whether acute phase proteins could be useful for this purpo se, we studied serum CRP and several other acute phase proteins in a s eries of patients with alcoholic hepatitis. Materials and Methods: We examined sequential sera from 72 patients with serum bilirubin greater than 5 mg/dl. Results: The short-term mortality during the approximat ely 30 day study period was 18%. There was moderate to marked elevatio n of serum c-reactive protein, at initial testing in all patients with alcoholic hepatitis. In consecutive sera within the first week of tes ting, a further rise in c-reactive protein, was noted significantly mo re frequently among patients that did not survive subsequently. Serum c-reactive protein levels gradually declined in, recovering patients b ut were still abnormal at the end of the study period. In. contrast, s erum haptoglobin, levels were subnormal initially, as well as througho ut the subsequent short-term course. Among other acute phase proteins, serum ceruloplasmin, transferrin, a-1 acid glycoprotein. and a-2 macr oglobulin, re- mained in the normal range. Conclusions: These results suggest that the expression. of c-reactive protein but not haptoglobin . is upregulated in alcohol-induced acute liver injury. Serial measure ments of serum c-reactive protein should be useful in assessing the cl inical activity of alcoholic hepatitis.