In:
PLOS Medicine, Public Library of Science (PLoS), Vol. 19, No. 2 ( 2022-2-22), p. e1003911-
Abstract:
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
Type of Medium:
Online Resource
ISSN:
1549-1676
DOI:
10.1371/journal.pmed.1003911
DOI:
10.1371/journal.pmed.1003911.g001
DOI:
10.1371/journal.pmed.1003911.g002
DOI:
10.1371/journal.pmed.1003911.g003
DOI:
10.1371/journal.pmed.1003911.g004
DOI:
10.1371/journal.pmed.1003911.t001
DOI:
10.1371/journal.pmed.1003911.t002
DOI:
10.1371/journal.pmed.1003911.s001
DOI:
10.1371/journal.pmed.1003911.s002
DOI:
10.1371/journal.pmed.1003911.s003
DOI:
10.1371/journal.pmed.1003911.s004
DOI:
10.1371/journal.pmed.1003911.s005
DOI:
10.1371/journal.pmed.1003911.s006
DOI:
10.1371/journal.pmed.1003911.s007
DOI:
10.1371/journal.pmed.1003911.s008
DOI:
10.1371/journal.pmed.1003911.s009
DOI:
10.1371/journal.pmed.1003911.s010
DOI:
10.1371/journal.pmed.1003911.s011
DOI:
10.1371/journal.pmed.1003911.s012
DOI:
10.1371/journal.pmed.1003911.r001
DOI:
10.1371/journal.pmed.1003911.r002
DOI:
10.1371/journal.pmed.1003911.r003
DOI:
10.1371/journal.pmed.1003911.r004
DOI:
10.1371/journal.pmed.1003911.r005
DOI:
10.1371/journal.pmed.1003911.r006
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2022
detail.hit.zdb_id:
2164823-2
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