Kaura, Amit and Hartley, Adam and Panoulas, Vasileios and Glampson, Ben and Shah, Anoop S. V. and Davies, Jim and Mulla, Abdulrahim and Woods, Kerrie and Omigie, Joe and Shah, Anoop D. and Thursz, Mark R. and Elliott, Paul and Hemmingway, Harry and Williams, Bryan and Asselbergs, Folkert W. and O’Sullivan, Michael and Lord, Graham M. and Trickey, Adam and Sterne, Jonathan AC and Haskard, Dorian O. and Melikian, Narbeh and Francis, Darrel P. and Koenig, Wolfgang and Shah, Ajay M. and Kharbanda, Rajesh and Perera, Divaka and Patel, Riyaz S. and Channon, Keith M. and Mayet, Jamil and Khamis, Ramzi and Basu, Sanjay (2022) Mortality risk prediction of high-sensitivity C-reactive protein in suspected acute coronary syndrome: A cohort study. PLOS Medicine, 19 (2). e1003911. ISSN 1549-1676
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Abstract
Background
There is limited evidence on the use of high-sensitivity C-reactive protein (hsCRP) as a biomarker for selecting patients for advanced cardiovascular (CV) therapies in the modern era. The prognostic value of mildly elevated hsCRP beyond troponin in a large real-world cohort of unselected patients presenting with suspected acute coronary syndrome (ACS) is unknown. We evaluated whether a mildly elevated hsCRP (up to 15 mg/L) was associated with mortality risk, beyond troponin level, in patients with suspected ACS.
Methods and findings
We conducted a retrospective cohort study based on the National Institute for Health Research Health Informatics Collaborative data of 257,948 patients with suspected ACS who had a troponin measured at 5 cardiac centres in the United Kingdom between 2010 and 2017. Patients were divided into 4 hsCRP groups (<2, 2 to 4.9, 5 to 9.9, and 10 to 15 mg/L). The main outcome measure was mortality within 3 years of index presentation. The association between hsCRP levels and all-cause mortality was assessed using multivariable Cox regression analysis adjusted for age, sex, haemoglobin, white cell count (WCC), platelet count, creatinine, and troponin.
Following the exclusion criteria, there were 102,337 patients included in the analysis (hsCRP <2 mg/L (n = 38,390), 2 to 4.9 mg/L (n = 27,397), 5 to 9.9 mg/L (n = 26,957), and 10 to 15 mg/L (n = 9,593)). On multivariable Cox regression analysis, there was a positive and graded relationship between hsCRP level and mortality at baseline, which remained at 3 years (hazard ratio (HR) (95% CI) of 1.32 (1.18 to 1.48) for those with hsCRP 2.0 to 4.9 mg/L and 1.40 (1.26 to 1.57) and 2.00 (1.75 to 2.28) for those with hsCRP 5 to 9.9 mg/L and 10 to 15 mg/L, respectively. This relationship was independent of troponin in all suspected ACS patients and was further verified in those who were confirmed to have an ACS diagnosis by clinical coding. The main limitation of our study is that we did not have data on underlying cause of death; however, the exclusion of those with abnormal WCC or hsCRP levels >15 mg/L makes it unlikely that sepsis was a major contributor.
Conclusions
These multicentre, real-world data from a large cohort of patients with suspected ACS suggest that mildly elevated hsCRP (up to 15 mg/L) may be a clinically meaningful prognostic marker beyond troponin and point to its potential utility in selecting patients for novel treatments targeting inflammation.
Trial registration
ClinicalTrials.gov - NCT03507309
Item Type: | Article |
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Subjects: | Oalibrary Press > Medical Science |
Depositing User: | Managing Editor |
Date Deposited: | 04 Feb 2023 05:31 |
Last Modified: | 11 Jul 2024 07:24 |
URI: | http://asian.go4publish.com/id/eprint/483 |