Inflammation levels: What they say about your life
Persistent fatigue and pain can indicate inflammation in the body. By looking at the inflammation levels in our blood, we can uncover the cause - and take early action.
Table of contents
Inflammation markers in the blood: CRP, ESR, and leukocytes
In case of acute illnesses, a visit to the doctor rarely happens without determining the inflammatory parameters. However, it often looks different: In case of persistent weakness, pain, or depression, even doctors hardly think of inflammation as a cause. It is becoming increasingly clear that even complaints that do not seem to be related to inflammatory processes at first glance can play a role. In fact, inflammatory causes are being found for more and more diseases – such as atherosclerosis, heart attack, COPD, chronic pain, and even neurological diseases like dementia. Some doctors are even certain: Inflammation is the actual cause of aging.
Therefore, it is worth keeping an eye on your inflammatory values. Interpreting them correctly is not quite easy – especially with the so-called silent inflammations. Find out in this article what you need to pay attention to, what the most important inflammatory values are, and what values are still considered normal.
Inflammatory markers in the blood: CRP, ESR, and Leukocytes
To find out whether there is an acute inflammation in the body, these three laboratory values are most commonly determined:
CRP (C-reactive protein)
ESR (erythrocyte sedimentation rate)
Number of leukocytes (white blood cells)
Often all three values are elevated simultaneously. To differentiate between bacterial infections and viral ones, another parameter in the blood can be consulted: the Acute Phase Protein Procalcitonin. Especially in the diagnosis of bacterial sepsis, Procalcitonin is extremely important.
Overview of all inflammation values
Inflammation values: The following normal values apply for adults:
CRP: 5 mg/l or 0.5 mg/dl
ESR > 50 years: 25 mm/h (women) or 20 mm/h (men)
ESR < 50 years: 20 mm/h (women) or 15 mm/h (men)
Leukocytes: 4 – 10 x 109/l or 4,000 – 10,000/μl
(The values may vary depending on the analysis method used in the laboratory)
Important notes on interpreting the inflammation values:
Do not be unsettled by deviating values. Ask a doctor to explain your values to you personally.
A single laboratory parameter for interpretation is not very meaningful. It is better to assess the course based on several values.
Be sure to pay attention to the units in which the results are given.
The results may vary from one laboratory to another.
Individual fluctuations are not automatically equated with inflammation and/or disease. For example, natural fluctuations may occur depending on the time of day or season.
CRP (C-reactive protein): Most important inflammation value
Doctors attach the greatest importance to the so-called CRP among the inflammation parameters. Particularly meaningful is the observation of several values over time. CRP is a protein produced by the body and is formed in the liver.
In a healthy adult, the values are below 5 mg/l or 0.5 mg/dl. In severe infections and burns, CRP values can rise to up to 400 mg/l. CRP provides particularly clear indications of inflammation: Before body temperature (fever) and leukocytes react, the increase in CRP in the blood is already measurable. If inflammations are detected, repeated CRP measurements also show how well the therapy is working. For example, if the correct antibiotic is administered for acute inflammations, the CRP level decreases.
Erythrocyte Sedimentation Rate ESR: Limited Diagnostic Value
The erythrocyte sedimentation rate provides clues as to whether inflammatory processes are occurring in the body. However, it is often replaced by other more specific tests, such as the determination of CRP. The erythrocyte sedimentation rate (Synonyms: ESR, Sed Rate) measures the speed at which red blood cells (erythrocytes) settle in the blood. Inflammations cause red blood cells to clump together, causing them to settle more quickly. In combination with other inflammation markers, determining the ESR can make sense, but in no case does the ESR alone lead to a diagnosis.
ESR Reference Values for a Healthy Adult
Gender, Age | ESR |
|---|---|
Women < 50 years | 20mm/h |
Women > 50 years | 25mm/h |
Men < 50 years | 15mm/h |
Men > 50 years | 20mm/h |
In clinical practice, the ESR is usually determined additionally, but the CRP measurement has more informative value and sensitivity.
What does it mean when ESR values are too high?
Regardless of diseases, ESR can naturally be slightly elevated in some cases, e.g. when taking hormonal contraceptives (the Pill), during pregnancy, during menstruation, and after an operation. ESR can be elevated in all types of inflammation:
< 50 mm/h: Anemia, acute and chronic inflammations, increase in blood lipid levels
50 – 100 mm/h: Liver and kidney diseases, rheumatic diseases (e.g. rheumatoid arthritis), infections
> 100 mm/h: e.g. in sepsis, autoimmune diseases with vascular inflammation (e.g. polymyalgia rheumatica)
Leukocytes: How stressed is our immune system?
When our immune system is stressed by inflammatory processes, this happens, among other things, through the increased release of white blood cells to combat pathogens. So, if the leukocytes in the blood are elevated, this usually indicates an infection or an inflammatory disease.
The normal values of the leukocyte count depend on age:
Age | SI unit in I | Old unit in µI |
|---|---|---|
Newborns | 9 - 30 × 10⁹/I | 9,000 - 30,000 |
Toddlers | 6 - 17.5 × 10⁹/I | 6,000 - 17,500 |
Schoolchildren | 5 - 15 × 10⁹/I | 5,000 - 15,000 |
Adults | 4 - 10 × 10⁹/I | 4,000 - 10,000 |
What do high white blood cell counts mean?
The number of white blood cells (leukocytes) can increase to up to 30,000/µl in severe inflammations, even higher in leukemias. Also, leukocytes can have a too low value (medical leukopenia). If there are too many or too few leukocytes in our blood, it can have various causes:
Leukocytes too high? Possible indication of...
Infections (especially bacterial)
Leukemia
after spleen removal
Tumors
Autoimmune disease
Pregnancy
Smoking
Heart attack
Idiopathic leukocytosis (chronically elevated leukocyte count without identifiable cause)
Leukocytes too low? Possible indication of...
Infections (especially viral)
Anemia
Overactive spleen
Immune suppression (suppression of the immune system by e.g. chemotherapeutics): < 2000/µl poses a risk of infection
Initial, persistent, or resolving inflammation?
To gain more precise knowledge about the phase of the disease, a so-called differential blood count can be done. In this process, the white blood cells are divided into their individual subgroups in the laboratory (neutrophilic, eosinophilic, basophilic granulocytes, lymphocytes, and monocytes). Through this division, doctors can determine how long diseases have been present, for example, at the beginning of an inflammation, the number of neutrophilic granulocytes is particularly high. Certain results also provide clues to typical diseases, for example, eosinophilic granulocytes are particularly elevated in worm diseases.
Silent inflammation: Only these inflammation markers are meaningful (CRP, AA/EPA ratio, homocysteine)
While the five signs of inflammation mentioned above are usually visible in acute inflammation (especially pain), silent inflammation can remain hidden for years. However, silent inflammation can often be recognized by typical signs—sickness behavior: fatigue, listlessness (work, social activities), lack of concentration, withdrawal, and listlessness. Smokers, overweight individuals (especially those with abdominal fat), individuals with chronic sleep disorders, high stress levels, diets high in processed foods, low in omega-3 fatty acids (e.g., from flaxseed oil or fish), low in fruits and vegetables, and those who are physically inactive are at particular risk for developing silent inflammation. Environmental factors such as fine dust and regular medication also promote silent inflammation.
While the CRP value can rise to over 100 mg/l in cases of flu-like infections, for example, blood tests often show no abnormalities in cases of silent inflammation. Typical for silent inflammation: the CRP value is not abnormally high. It is often within the reference range – but tends to be permanently at the upper end of the normal range of 5 mg/l.
The AA/EPA ratio can also be used to measure silent inflammation in the blood. This measures the ratio between pro-inflammatory omega-6 fatty acids (AA: arachidonic acid) and anti-inflammatory omega-3 fatty acids (EPA: eicosapentaenoic acid) in our blood. Put simply, it reflects the body's susceptibility to inflammation. The optimal values for the AA/EPA ratio are < 4. The higher the ratio, the higher the risk of the consequences of silent inflammation in various organs.
Another indicator of silent inflammation is homocysteine, a substance in the metabolism that is completely broken down in healthy individuals. Vitamins B6, B9 (folic acid), and B12 are particularly important for its breakdown. The normal homocysteine level in adults is 6-12 µmol/l. Over time, homocysteine damages the cells of the vessel walls and leads primarily to arteriosclerotic diseases such as strokes, coronary heart disease, and venous thrombosis.
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