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@article{Kaura:2022:10.1371/journal.pmed.1003911,
author = {Kaura, A and Hartley, A and Panoulas, V and Glampson, B and Shah, ASV and Davies, J and Mulla, A and Woods, K and Omigie, J and Shah, AD and Thursz, MR and Elliott, P and Hemmingway, H and Williams, B and Asselbergs, FW and O'Sullivan, M and Lord, GM and Trickey, A and Sterne, JA and Haskard, DO and Melikian, N and Francis, DP and Koenig, W and Shah, AM and Kharbanda, R and Perera, D and Patel, RS and Channon, KM and Mayet, J and Khamis, R},
doi = {10.1371/journal.pmed.1003911},
journal = {PLoS Medicine},
title = {Mortality risk prediction of high-sensitivity C-reactive protein in suspected acute coronary syndrome: a cohort study},
url = {http://dx.doi.org/10.1371/journal.pmed.1003911},
volume = {19},
year = {2022}
}

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TY  - JOUR
AB  - BACKGROUND: 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
AU  - Kaura,A
AU  - Hartley,A
AU  - Panoulas,V
AU  - Glampson,B
AU  - Shah,ASV
AU  - Davies,J
AU  - Mulla,A
AU  - Woods,K
AU  - Omigie,J
AU  - Shah,AD
AU  - Thursz,MR
AU  - Elliott,P
AU  - Hemmingway,H
AU  - Williams,B
AU  - Asselbergs,FW
AU  - O'Sullivan,M
AU  - Lord,GM
AU  - Trickey,A
AU  - Sterne,JA
AU  - Haskard,DO
AU  - Melikian,N
AU  - Francis,DP
AU  - Koenig,W
AU  - Shah,AM
AU  - Kharbanda,R
AU  - Perera,D
AU  - Patel,RS
AU  - Channon,KM
AU  - Mayet,J
AU  - Khamis,R
DO  - 10.1371/journal.pmed.1003911
PY  - 2022///
SN  - 1549-1277
TI  - Mortality risk prediction of high-sensitivity C-reactive protein in suspected acute coronary syndrome: a cohort study
T2  - PLoS Medicine
UR  - http://dx.doi.org/10.1371/journal.pmed.1003911
UR  - https://www.ncbi.nlm.nih.gov/pubmed/35192610
UR  - http://hdl.handle.net/10044/1/95383
VL  - 19
ER  -

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