Yoshinaga R, et al. - A retrospective cohort study is carried out to research whether serum high-sensitivity C reactive protein (hs-CRP) levels measured in an emergency department (ED) are related to in-hospital mortality in patients with cardiovascular disease (CVD). These outcomes propose that increased hs-CRP is a significant risk factor for in-hospital mortality among patients with CVD in an ED. Specific attention ought to be given to these outcomes that non-CVD death is a major cause of death among patients with CVD with higher hs-CRP levels.

Methods

• For this research, they designed a retrospective cohort study.
• This study was conducted at the ED of a teaching hospital in Japan.
• Between 1 February 2006 and 30 September 2014, total 12211 patients with CVD aged ≥18 years who presented to the ED by an ambulance were assessed.

Results

• They observed that the total 1156 patients had died.
• The in-hospital mortality increased significantly with the hs-CRP levels (<3.0 mg/L: 7.0%, 95% CI 6.4 to 7.6; 3.1-5.4 mg/L: 9.6%, 95% CI 7.9 to 11.3: 5.5-11.5 mg/L: 11.2%, 95% CI 9.4 to 13.0; 11.6-33.2 mg/L: 12.3%, 95% CI 10.5 to 14.1 and ≥33.3 mg/L: 19.9%, 95% CI 17.6 to 22.2).
• The age-adjusted and sex-adjusted HR for total mortality was increased significantly in the three ≥5.5 mg/L groups compared with the <3.0 mg/L group (5.5-11.5 mg/L: HR=1.32, 95% CI 1.09 to 1.60, p=0.005; 11.6-33.2 mg/L: HR=1.38, 95% CI 1.14 to 1.65, p=0.001 and ≥33.3 mg/L: HR=2.15, 95% CI 1.84 to 2.51, p<0.001).
• Similar findings were seen for the CVD subtypes of acute myocardial infarction, heart failure, cerebral infarction and intracerebral haemorrhage.
• This association remained unchanged even after adjustment for age, sex and white cell count and withstood Bonferroni adjustment for multiple testing.
• When the causes of death were divided into primary CVD and non-CVD deaths, the relationship between initial hs-CRP levels and mortality remained significant, however the impact of hs-CRP levels was greater in non-CVD deaths than CVD deaths.
• The percentage of non-CVD deaths increased with hs-CRP levels; among the patients with hs-CRP levels ≥33.3 mg/L, non-CVD deaths accounted for 37.5% of total deaths.