Figure 77-18 Hepatic acute-phase (AP) protein response after trauma in 10 septic and 16 nonseptic patients. Mean values are provided for C-reactive protein (CRP) (A), fibrinogen (B), α₁ -antitrypsin (C), and ceruloplasmin (D). Patients with sepsis developing after trauma are compared with patients with nonseptic post-trauma courses. Notice the early rise of CRP and α₁ -antitrypsin levels in patients who became clinically septic at 5 to 7 days. The fibrinogen response and ceruloplasmin response tend to be increased in sepsis, although only after the fully developed septic clinical picture is demonstrated. (Adapted from Sganga G, Siegel JH, Brown G, et al: Reprioritization of hepatic plasma protein release in trauma and sepsis. Arch Surg 120:187, 1985.)