Q: Most of the C-reactive Protein (CRP) gets synthesized in (One best answer)? 

A) Kidney 
B) Muscles 
C) Endothelium 
D) Liver 
E) Macrophages


Answer:  CRP is mostly synthesized in the liver.

Clinical significance: CRP production gets unreliable in liver failure.  Any moderate CRP increase in patients with  liver insufficiency should get consideration to start empiric antibiotics. 



 Reference / further reading: 

1. Pepys MB, Hirschfield GM (Jun 2003). "C-reactive protein: a critical update". The Journal of Clinical Investigation 111 (12): 1805–12.

2. Bota DP, van Nuffelen M, Zakariah AH, Vincent JL. Serum level of C-reactive protein and procalcitonin in critically ill patients with cirrhosis of the liver. J Lab CLin Med. 2005;146:347–351

3. Janum SH, Søvsø M, Gradel KO, Schønheyder HC, Nielsen H. C-reactive protein level as a predictor of mortality in liver disease patients with bacteremia. Scand J Gastroent. 2011;46:1478–1483

4. Mackenzie I, Woodhouse J. C-reactive protein concentrations during bacteraemia: a comparison between patients with and without liver dysfunction. Intensive Care Med. 2006;32:1344–1351.

5. Li CH, Yang R, Pang JH, et al. Procalcitonin as a biomarker for bacterial infection in patients with liver cirrhosis in the emergency department. Acad Emerg Med. 2011;18:121–126