Evaluation of the association between the first observation and the longitudinal change in C-reactive protein, and all-cause mortality

Currie, Craig John, Poole, Christopher David and Conway, P. 2007. Evaluation of the association between the first observation and the longitudinal change in C-reactive protein, and all-cause mortality. Heart 94 (4) , pp. 457-462. 10.1136/hrt.2007.118794

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Abstract

Objective: To evaluate the association between vascular inflammation as measured by subacute C-reactive protein (CRP; 1–10 mg/l) and all-cause mortality and the association between change in CRP status (normal ⩽3 mg/l and elevated >3 mg/l) and all-cause mortality. Methods: Probabilistic record linkage was used to match hospital episode data, laboratory reports and mortality statistics in a large urban population. Survival was evaluated using Cox proportional hazards regression models. Results: 22 962 patients had their first CRP measurement in the subacute range (1–10 mg/l). Analysis grouped by each additional unit increase in CRP across the subacute range was associated with a 7.3% (95% CI 5.4% to 9.2%) increase in the hazard ratio (HR) of death over 4 years, after controlling for confounding factors (p<0.001). Repeated CRP observations around 1 year apart were recorded in 5811 subjects. After controlling for confounding factors, in patients whose CRP changed from normal (⩽3 mg/l) to elevated (>3 mg/l), the HR increased 6.7-fold (p<0.001) relative to cases whose CRP remained normal. By comparison, among those subjects whose CRP was reduced from elevated to normal, the hazard ratio halved to 3.5 (p = 0.018). In an underpowered analysis of time to cardiovascular events, an identical pattern of risk emerged. Conclusions: CRP level predicted all-cause mortality, and additional inclusion of prior change in CRP level and current CRP level more so. Increasing vascular inflammation, as measured by CRP, increases the likelihood of death.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine
Subjects:	R Medicine > R Medicine (General)
Publisher:	BMJ Publishing Group
ISSN:	1355-6037
Last Modified:	04 Jun 2017 03:52
URI:	https://orca.cardiff.ac.uk/id/eprint/28281

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