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

Currie, C. J.; Poole, C. D.; Conway, P.
April 2008
Heart;Apr2008, Vol. 94 Issue 4, p457
Academic Journal
Objective: To evaluate the association between vascular inflammation as measured by subacute C-reactive protein (CAP; 1-10 mg/I) and all-cause mortality and the association between change in CAP status (normal ⩽ 3 mg/I and elevated >3 mg/I) 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: 22962 patients had their first CAP measurement in the subacute range (1-10 mg/I). Analysis grouped by each additional unit increase in CAP across the subacute range was associated with a 7.3% (95% Cl 5.4% to 9.2%) increase in the hazard ratio (HA) of death over 4 years, after controlling for confounding factors (p<0.001). Repeated CAP observations around 1 year apart were recorded in 5811 subjects. After controlling for confounding factors, in patients whose CAP changed from normal (⩽3 mg/I) to elevated (>3 mg/I), the HA increased 6.7-fold (p<0.001) relative to cases whose CAP remained normal. By comparison, among those subjects whose CAP 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: CAP level predicted all-cause mortality, and additional inclusion of prior change in CAP level and current CAP level more so. Increasing vascular inflammation, as measured by CAP, increases the likelihood of death.


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