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