Battle of the Biomarkers of Systemic Inflammation

Abstract

Systemic inflammation is monitored with various biomarkers; of these, C-reactive protein (CRP) is widely used due to its cost effectiveness and widespread implementation. However, its lack of specificity and delayed kinetics have directed interest in cell-free DNA (cfDNA), which offers rapid responses to cellular damage. Our review compares the use of CRP and cfDNA in myocardial infarction, sepsis, and physical exercise, focusing on their origins, kinetics, and clinical utility. cfDNA release from apoptotic or damaged cells increases within minutes to hours, providing an early marker of cellular stress. In myocardial infarction, cfDNA peaks early, indicating acute injury, while CRP rises later, reflecting prolonged inflammation. In sepsis, cfDNA correlates strongly with disease severity and prognosis, outperforming CRP in early diagnosis. During physical exercise, cfDNA offers an immediate picture of cellular stress, whereas CRP's delayed response limits its utility in this context. The interaction between CRP and cfDNA suggests their combined application could improve diagnostic accuracy and prognostic assessments. As cfDNA testing becomes more widely available, researchers will need to develop standardized protocols and determine how it can best complement CRP measurements in clinical practice. This approach offers promise for improving the management of systemic inflammation across diverse medical conditions.

Keywords: C-reactive protein (CRP); biomarkers; cell-free DNA (cfDNA); exercise; myocardial infarction; sepsis; systemic inflammation.

Figure 1

Comparative kinetics of cfDNA and CRP in exercise. The orange dashed line represents cfDNA, while the solid blue line represents CRP. Data presented in Figure 1 are detailed in Supplementary Table S1.

Figure 2

Comparative kinetics of cfDNA and CRP in myocardial infarction. The orange dashed line represents cfDNA, while the solid blue line represents CRP. Data presented in Figure 2 are detailed in Supplementary Table S1.

Figure 3

Comparative kinetics of cfDNA and CRP in sepsis. The orange dashed line represents cfDNA, while the solid blue line represents CRP. Data presented in Figure 3 are detailed in Supplementary Table S1.