Introduction C-reactive protein (CRP), one of the acute-phase proteins, is considered to be a sensitive systemic marker of inflammation following tissue damage. 1 CRP synthesis in liver (hepatocytes) and its rate of expression primarily increases in response to injury or infection. Expression is induced predominantly by interleukin (IL-6), and also by IL-1 and tumour necrosis factor a (TNF-a). 2,3 In healthy subjects, CRP concentration is very low in the blood, with a reference range between 0-5mg/L. The concentrations of CRP dramatically rise during inflammatory processes occurring in the body. A raised CRP concentration is unequivocal evidence of an inflammatory response; however, viral infections do not usually cause a raised CRP and neither do some autoimmune diseases i.e. systemic lupus erthematosus (SLE). 4 Following an acute-phase stimulus, the concentration may rise by about 6 hours, with a peak value around 48 hours, and may further increase depending on the severity of infection. 2 In most diseases, the CRP value indicate ongoing inflammation more accurately than do other laboratory parametres of inflammation response such as plasma viscosity, erythrocyte sedimentation rate (ESR) and leucocyte count (LC). 2,3 In recent, years the role of CRP in relation to cancer has been extensively investigated. It is widely accepted that chronic inflammation increases the risk of cancer. For instance, inflammatory bowel diseases, human immune-deficiency virus (HIV), viral hepatitis B, human papilloma virus and rheumatoid arthritis are all associated with an increased risk of specific types of cancers. 5 Given that cancer is related to several forms of inflammation, plasma CRP concentrations have also been measured in cancer patients. High serum concentration has been demonstrated in malignant melanoma, choroid meningioma, lymphoma, gastric adenoma and mucosal carcinoma, colorectal, lung, ovarian and renal cancers. 3,6-12 Furthermore, it has also been shown that increased plasma CRP concentrations are independently associated with an increased risk of colorectal cancer, suggesting an association between chronic inflammation and colorectal J Pak Med Assoc 271 ORIGINAL ARTICLE Pre- and post-operative values of serum CRP in patients undergoing surgery for brain tumour Talat Syeda, 1 Abdul Sattar Hashim, 2 Husan Afroz Rizvi, 3 Syed Murtaza Hadi 4 Abstract Objective: To determine the concentration of C-reactive protein in pre- and post-operative serum samples of brain tumour patients in order to detect the potential risks of post-operative infections. Methods: Serum C-reactive protein was measured on pre- and post-operative Day1, Day 2 and Day 7 in 18 patients who underwent surgery for brain tumours. The study was performed at the Neurosurgical Ward, Jinnah Postgraduate Medical Centre, Karachi, from May 2007 to April 2008. Mean pre-operative patients and control values were compared using Mann-Whitney or Wilcoxon tests for comparing between pre- and post-operative values. P- value was considered significant at <0.05. Results: Five (27.7%) of the 18 pre-operative patients had elevated serum concentrations i.e. >5.0mg/L but no statistically significant difference was found when compared with healthy controls, with mean 4.4±6.6 and 0.9±0.7, respectively. Significantly raised serum concentrations were observed in all post-operative samples when compared with pre-operative samples. Serum CRP concentrations significantly increased post-operatively on Day 1, with mean value of 102.9±82.0mg/L (p<0.0005), and further increased on Day 2 with mean value of 166.9±128.1mg/L (p<0.0005), but declined on Day 7, with mean value of 42.7±63.6mg/L (p<0.005). Conclusion: Pre-operative serum C-reactive protein concentrations of 28% of the patients were elevated, suggesting an association with brain tumours. Post-operative serum concentrations were significantly higher than those noted before the surgery. Absence of a fall of concentration from peak value on post-operative Day 2 or a secondary rise from post-operative Day 7 could be alarming for inter-current infection. Keywords: C-reactive protein, Brain tumour, Pre- and Post-operative infections. (JPMA 64: 271; 2014) 1,3 Department of Biochemistry, Jinnah University for Women, Karachi, 2 Department of Neurosurgery, Jinnah Post Graduate Medical Centre, Karachi, 4 Post-Doctoral Research Fellow, Haematological & Molecular Medicine, Rayne Institute, King's College London, UK. Correspondence: Syed Murtaza Hadi. Email: murtazahadi@hotmail.com