CRP Levels in Liver Disease

Mechanism of Decreased CRP Production

• CRP is synthesized exclusively by hepatocytes in the liver, making it entirely dependent on hepatic synthetic capacity, and when liver disease progresses, the defective hepatic synthetic capacity results in decreased plasma levels of multiple proteins, including CRP 3, 4
• The liver is the sole site of CRP synthesis, and impaired hepatic synthetic function directly reduces the production of this acute-phase protein, particularly in advanced or decompensated cirrhosis, and IL-6 normally stimulates CRP production by the liver, but in severe liver dysfunction, even adequate cytokine stimulation cannot overcome the impaired synthetic machinery 1, 2

Clinical Implications

• The American Association for the Study of Liver Diseases recommends that clinicians consider the limitations of CRP as a marker of infection in patients with liver disease, as CRP levels can be decreased in liver disease due to impaired hepatic synthetic function 4