eprintid: 10146389 rev_number: 10 eprint_status: archive userid: 699 dir: disk0/10/14/63/89 datestamp: 2022-04-05 14:04:51 lastmod: 2024-10-22 10:41:54 status_changed: 2022-04-05 14:04:51 type: article metadata_visibility: show sword_depositor: 699 creators_name: Kaura, Amit creators_name: Hartley, Adam creators_name: Panoulas, Vasileios creators_name: Glampson, Ben creators_name: Shah, Anoop SV creators_name: Davies, Jim D creators_name: Mulla, Abdulrahim R creators_name: Woods, Kerrie creators_name: Omigie, Joe creators_name: Shah, Anoop creators_name: Thursz, Mark W creators_name: Elliott, Paul creators_name: Hemmingway, Harry M creators_name: Williams, Bryan creators_name: Asselbergs, Folkert creators_name: O'Sullivan, Michael O creators_name: Lord, Graham creators_name: Trickey, Adam P creators_name: Sterne, Jonathan AC creators_name: Haskard, Dorian M creators_name: Melikian, Narbeh creators_name: Francis, Darrel creators_name: Koenig, Wolfgang S creators_name: Shah, Ajay M creators_name: Kharbanda, Rajesh creators_name: Perera, Divaka creators_name: Patel, Riyaz creators_name: Channon, Keith creators_name: Mayet, Jamil creators_name: Khamis, Ramzi title: Mortality risk prediction of high-sensitivity C-reactive protein in suspected acute coronary syndrome: A cohort study ispublished: pub subjects: UCH divisions: UCL divisions: DD4 divisions: B02 divisions: GA3 divisions: D14 keywords: CARDIOVASCULAR-DISEASE, AUGSBURG COHORT, HEART-DISEASE, TROPONIN-T, INFLAMMATION, ELEVATION abstract: 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. date: 2022-02-01 date_type: published publisher: PUBLIC LIBRARY SCIENCE official_url: https://doi.org/10.1371/journal.pmed.1003911 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1941340 doi: 10.1371/journal.pmed.1003911 medium: Electronic-eCollection pii: PMEDICINE-D-21-03948 lyricists_name: Shah, Anoop lyricists_name: Williams, Bryan lyricists_name: Patel, Riyaz lyricists_name: Hemingway, Harry lyricists_id: ASHAH69 lyricists_id: BWILL10 lyricists_id: RSPAT27 lyricists_id: HHEMI65 actors_name: Patel, Riyaz actors_id: RSPAT27 actors_role: owner funding_acknowledgements: FS/20/18/34972 [British Heart Foundation]; FS/19/17/34172 [British Heart Foundation]; CH/1999001/11735 [British Heart Foundation]; FS/14/76/30933 [British Heart Foundation]; FS/17/16/32560 [British Heart Foundation]; WIII_P67144 [Wellcome Trust]; [THIS Institute postdoctoral fellowship]; NF-SI-0611-10168 [National Institute for Health Research]; RE/18/4/34215 [British Heart Foundation Imperial Centre for Research Excellence] full_text_status: public publication: PLoS Medicine volume: 19 number: 2 article_number: e1003911 pages: 17 event_location: United States citation: Kaura, Amit; Hartley, Adam; Panoulas, Vasileios; Glampson, Ben; Shah, Anoop SV; Davies, Jim D; Mulla, Abdulrahim R; ... Khamis, Ramzi; + view all <#> Kaura, Amit; Hartley, Adam; Panoulas, Vasileios; Glampson, Ben; Shah, Anoop SV; Davies, Jim D; Mulla, Abdulrahim R; Woods, Kerrie; Omigie, Joe; Shah, Anoop; Thursz, Mark W; Elliott, Paul; Hemmingway, Harry M; Williams, Bryan; Asselbergs, Folkert; O'Sullivan, Michael O; Lord, Graham; Trickey, Adam P; Sterne, Jonathan AC; Haskard, Dorian M; Melikian, Narbeh; Francis, Darrel; Koenig, Wolfgang S; Shah, Ajay M; Kharbanda, Rajesh; Perera, Divaka; Patel, Riyaz; Channon, Keith; Mayet, Jamil; Khamis, Ramzi; - view fewer <#> (2022) Mortality risk prediction of high-sensitivity C-reactive protein in suspected acute coronary syndrome: A cohort study. PLoS Medicine , 19 (2) , Article e1003911. 10.1371/journal.pmed.1003911 <https://doi.org/10.1371/journal.pmed.1003911>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10146389/7/Patel_journal.pmed.1003911.pdf