TY - JOUR
T1 - Mortality risk prediction of high-sensitivity C-reactive protein in suspected acute coronary syndrome
T2 - A cohort study
AU - Kaura, Amit
AU - Hartley, Adam
AU - Panoulas, Vasileios
AU - Glampson, Ben
AU - Shah, Anoop S.V.
AU - Davies, Jim
AU - Mulla, Abdulrahim
AU - Woods, Kerrie
AU - Omigie, Joe
AU - Shah, Anoop D.
AU - Thursz, Mark R.
AU - Elliott, Paul
AU - Hemmingway, Harry
AU - Williams, Bryan
AU - Asselbergs, Folkert W.
AU - O'Sullivan, Michael
AU - Lord, Graham M.
AU - Trickey, Adam
AU - Sterne, Jonathan Ac
AU - Haskard, Dorian O.
AU - Melikian, Narbeh
AU - Francis, Darrel P.
AU - Koenig, Wolfgang
AU - Shah, Ajay M.
AU - Kharbanda, Rajesh
AU - Perera, Divaka
AU - Patel, Riyaz S.
AU - Channon, Keith M.
AU - Mayet, Jamil
AU - Khamis, Ramzi
N1 - Funding Information:
This paper reports independent research led and funded by the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC), as part of the NIHR Health Informatics Collaborative with NIHR Oxford BRC, NIHR University College London Hospitals BRC, NIHR Guy?s & St Thomas? BRC, NIHR Cambridge BRC, NIHR Bristol BRC, NIHR Birmingham BRC, NIHR Leeds BRC, NIHR Leicester BRC, NIHR Manchester BRC, NIHR Royal Marsden BRC, and NIHR Southampton BRC.
Publisher Copyright:
© 2022 Public Library of Science. All rights reserved.
PY - 2022/2/22
Y1 - 2022/2/22
N2 - Background AU There: Pleaseconfirmthatallheadinglevelsarepresentedcorrectly 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.
AB - Background AU There: Pleaseconfirmthatallheadinglevelsarepresentedcorrectly 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.
UR - http://www.scopus.com/inward/record.url?scp=85125157154&partnerID=8YFLogxK
U2 - 10.1371/journal.pmed.1003911
DO - 10.1371/journal.pmed.1003911
M3 - Article
C2 - 35192610
AN - SCOPUS:85125157154
SN - 1549-1277
VL - 19
SP - e1003911
JO - PLoS Medicine
JF - PLoS Medicine
IS - 2
M1 - e1003911
ER -
