C-reactive protein is a strong predictor of mortality in hemodialysis patients

BACKGROUND: To establish the baseline cutoff value of C-reactive protein (CRP) that would predict increased overall and cardiovascular mortality in patients with end-stage renal disease (ESRD). METHODS: A cohort of 270 prevalent hemodialysis patients treated at Rijeka University Hospital was eligible for the study. Monthly CRP measurements were performed for three consecutive months. Only the patients with CRP values varying <20% were included (n=256). During the follow-up, 24 patients were transplanted and therefore excluded from the analysis. The CRP cutoff point of 6.2 mg/L was established by Receiver Operating Characteristic curve. The patients were divided into four groups according to their CRP values. Group 1 included 80 (34.5%) patients with CRP <3.0 mg/L, group 2 included 23 (9.9%) patients with CRP 3.0-6.1 mg/L, group 3 consisted of 18 (7.7%) patients with CRP 6.2-10.0 mg/L, and group 4 included 111 (47.9%) patients with CRP >10.0 mg/L. The survival was evaluated by Kaplan-Meier curve. RESULTS: During the two-year follow-up, 59 patients died. The major cause of death was cardiovascular disease (64%). Significantly higher overall and cardiovascular mortality was observed in group 3 when compared with groups 1 and 2 (chi2=11.97; P < 0.001) and in group 4 when compared with groups 1 and 2 (chi2=14.40; P<0.001). Compared with survivors, non-survivors had a higher median CRP value (19.0 [1.5-99.7] mg/L vs. 2.3 [0.1-49.1] mg/L, respectively; P<0.001). CONCLUSION: Serum concentration of CRP above 6.2 mg/L is a strong predictor of overall and cardiovascular mortality in patients with ESRD.     

C-reactive protein as a predictor of mortality in critically ill patients: a meta-analysis and systematic review

C-reactive protein is a marker of inflammatory response and has been widely investigated in cardiovascular and infectious diseases, especially to monitor therapeutic success. However, its role as a predictor of clinical outcome in critically ill patients remains uncertain and controversial. The objective of this study was to investigate the predictive value of C-reactive protein in critically ill patients. The databases of PubMed, the Cochrane clinical trial database and EMBASE (from inception to August 2010) were searched. Prospective non-randomised clinical studies comparing C-reactive protein concentrations between survivors and non-survivors were included. Pooled mean difference in C-reactive protein concentrations between survivors and non-survivors was calculated. Heterogeneity was analysed by I2. Sensitivity and subgroup analyses were conducted to explore the heterogeneity. Fourteen studies containing a total of 1969 patients were finally included in our analysis. The weighted mean difference in the C-reactive protein levels between survivors and non-survivors was 9.15 mg/l (95% confidence interval -6.50 to 24.81). The heterogeneity was large with I2 = 92%. Subsequent investigation of the heterogeneity with sensitivity analyses yielded no significant differences. The subgroup analysis showed that the weighted mean difference in early (within 48 hours) C-reactive protein levels between survivors and non-survivors was not significantly different, in contrast to the late (beyond 48 hours) C-reactive protein level. This was significantly greater in non-survivors with a weighted mean difference of 63.80 mg/l (95% confidence interval 35.67 to 91.93). Our systematic review shows that while the early C-reactive protein concentration is not a good predictor of survival in critically ill patients, the late C-reactive protein concentration may help to identify patients who are at risk of death.     

Serum C-reactive protein as predictor of infected arthroplasty

The objective of the study is to determine the usefulness of C-reactive protein (CRP) as a predictor of postoperative evolution after total joint arthroplasty (TJA). One hundred and three consecutive patients underwent TJA were included. CRP was determined at baseline, +2, +5 and +15 days. We defined three groups: normal (NP), early (EC) and late complications (LC). Postoperative complications were developed in 19 patients. On +5 day, the CRP in NP was significantly lower than in the EC group. A CRP< 6 mg/dl on day +5 had 60% sensitivity and 92% specificity to predict an uncomplicated postoperative course. A CRP<6 on +5 day is a useful marker to predict an uncomplicated postoperative course and, with the clinical evolution, could help us to suggest that these patients could be discharged sooner.     

Prediction of in-hospital mortality and morbidity using high-sensitivity C-reactive protein after burr hole craniostomy

Background

The purpose of this study was to assess whether preanesthetic laboratory values can predict in-hospital mortality and morbidity in patients who have undergone burr hole craniostomy due to chronic subdural hematoma.

Methods

From January 2007 to February 2016, the records of 502 consecutive patients who underwent burr hole craniotomy were analyzed. All cases of burr hole craniostomy were fitted with a drain, as required by our institutional protocol.

Results

Patients’ demographic data and preoperative laboratory values were subjected to logistic regression analysis to predict in-hospital mortality and morbidity after burr hole craniostomy. Hemoglobin, prothrombin time, activated partial thromboplastin time, serum glucose, and high-sensitivity C-reactive protein (hsCRP) were found to be significantly associated with in-hospital mortality and morbidity by univariate regression analysis, but of these, only hsCRP (hazard ratio 1.210, 95 % confidence interval 1.089–1.345, P < 0.001) was found to significantly predict in-hospital mortality and morbidity by multivariate regression analysis. Areas under the curve for predicting in-hospital mortality and morbidity were 0.765 (95 % confidence interval 0.624–0.906, P = 0.002) and 0.646 (0.559–0.733, P = 0.001), respectively.

Conclusions

Preoperative hsCRP was found to be an independent predictor of in-hospital mortality and morbidity after burr hole craniostomy due to chronic subdural hematoma.

     

C-reactive protein elevation is associated with increased morbidity and mortality in elderly burned patients

BackgroundC-reactive protein (CRP) is an acute-phase protein produced in response to inflammation after traumatic injury. We posit that C-reactive protein (CRP) is reliable in predicting morbidity and mortality following severe burn. In this study, we explored the relationship between serum CRP values and clinical outcomes in the severely burned.MethodsUsing the Research Network within the TriNetX database, we queried de-identified burn patient data across the United States and enrolled 36,556 burn patients with reported CRP values from 2006 to 2020.ResultsCirculating CRP levels were elevated significantly in patients ≥60 years as well as in males and African Americans (p < 0.05). CRP levels reached the zenith on the first day after burn, and were highest when burn size reached 60% total body surface area (TBSA). After bisecting the data at 10 mg/L of CRP, we compared clinical findings between patient groups (n = 16,284/18,647 in high/low CRP levels). The risk of patient death doubled in the high CRP group from 4.687% to 9.313%, with higher incidences of sepsis, skin infection, and myocardial infarction (p < 0.05). Moreover, mortality increased from 0.9% to 1.926% in those younger than 20 years when comparing the low and high CRP groups, whereas mortality significantly increased from 8.84% to 15.818% in those ≥60 years old (p < 0.05). Both elderly and paediatric groups had significant increases in the diagnosis of sepsis-associated with increased CRP expression. However, incidences of skin infection, pneumonia, and acute kidney injury increased significantly only in the elderly group (p < 0.05).ConclusionElevated CRP expression is common in burn patients. The factor of age influenced the association of CRP expression to clinical outcomes.     

Interleukin-6 is a stronger predictor of total and cardiovascular mortality than C-reactive protein in haemodialysis patients.

BACKGROUND: Despite the well known association between interleukin-6 (IL-6) and cardiovascular mortality, no study has so far verified whether IL-6 adds prognostic information to that provided by C-reactive protein (CRP). METHODS: A cohort of 218 haemodialysis patients from four different dialytic centres was followed-up retrospectively. Plasma IL-6 and CRP concentrations were determined. Full information on co-morbidities was available in 162 patients. RESULTS: With respect to the lowest quartile (< 3.6 pg/ml for IL-6, and < 2.2 mg/l for CRP), the crude relative risk (RR) of death from all causes of the upper quartile (> 13.9 pg/ml for IL-6, and > 12.8 mg/l for CRP) was 5.20 (95% confidence interval 2.06-13.011) for IL-6 and 3.16 (1.41-7.12) for CRP. When both variables were included, the estimates were 4.10 (1.30-12.96) for IL-6 and 1.29 (0.47-3.57) for CRP. As to continuous variables, the relationship between both variables and mortality tended to level off for the highest values, but became fairly linear after log transformation of the variables. For one unit SD of the log (variable), the RR was 2.09 (1.52-2.88) for IL-6 and 1.66 (1.23-2.24) for CRP. When they were included in the same model, the estimates were 1.90 (1.18-2.82) for IL-6 and 1.16 (0.81-1.66) for CRP. CONCLUSIONS: IL-6 has a stronger predictive value than CRP for cardiovascular mortality and provides independent prognostic information, while conveying most of that provided by CRP.     

C-reactive protein as a predictor of total arteriosclerotic outcomes in type 2 diabetic nephropathy

BACKGROUND: The inflammatory marker C-reactive protein (CRP) has been found in most, but not all, prospective studies to be associated with future cardiovascular outcomes. However, CRP has not been tested in the high-cardiovascular risk population of type 2 diabetic nephropathy. METHODS: We studied the independent relationship between CRP and the subsequent development of incident or recurrent arteriosclerotic outcomes (primary) and congestive heart failure events (secondary) in 1560 individuals with diabetic nephropathy, overt proteinuria, and hypertension enrolled in the prospective Irbesartan Diabetic Nephropathy Trial. RESULTS: Traditional cardiac risk factors were highly prevalent, CRP levels were high overall [quintiles (mg/L) 1st, 0 to 1.2; 2nd, 1.3 to 2.5; 3rd, 2.6 to 5.0; 4th, 5.1 to 10.0; and 5th, >10), and subsequent cardiovascular events were very common. A univariate relationship existed between CRP and total arteriosclerotic outcomes (P < 0.0001). However, after adjusting for study intervention and traditional risk factors, the relationship no longer remained. In fact, controlling for previous cardiovascular disease alone caused the association to become nonsignificant. The secondary analysis found a significant univariate relationship between CRP and congestive heart failure events (P= 0.007) that persisted in multivariate analyses (P= 0.006). However, this relationship was confined to the highest CRP quintile [RR (95% CI) 2.0 (1.27, 3.16)]. CONCLUSION: In diabetic patients with nephropathy, CRP does not add predictive information above and beyond that provided by traditional established risk factors. Whether this holds true for other populations with similar risk burdens is an important public health question that should be addressed. A secondary finding of a link between CRP and congestive heart failure requires further confirmation.     

C-reactive protein as predictor for poor outcome after aneurysmal subarachnoid haemorrhage

Background  

Aneurysmal subarachnoid haemorrhage (SAH) is a severe disease with high case-fatality and morbidity rates. After SAH, the value of C-reactive protein (CRP)—an acute phase sensitive inflammatory marker—as a prognostic factor has been poorly studied, with conflicting results. In this prospective study, we tested whether increased CRP levels increase independently the risk for cerebral infarct and poor outcome.     

Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery

PURPOSE: To determine preoperative risk factors predictive of adverse outcomes after gastric bypass surgery. SUMMARY BACKGROUND DATA: Gastric bypass results in sustained weight loss for seriously obese patients, but perioperative complications can be formidable. Preoperative risk assessment is important to establish the risk-benefit ratio for patients undergoing these operations. METHODS: Data for 10 risk factors predictive of adverse outcomes were collected on 1,067 consecutive patients undergoing gastric bypass surgery at the UCLA Medical Center from December 1993 until June 2000. Univariate analyses were performed for individual risk factors to determine their potential significance as predictors for complications. All 10 risk factors were entered into a logistic regression model to determine their significance as predictors for complications. Sensitivity analysis was performed. RESULTS: Univariate analysis revealed that male gender and weight were predictive of severe life-threatening adverse outcomes. Multistep logistic regression yielded only male gender as a risk factor. Male patients were heavier than female patients on entry to the study, accounting for weight as a potential risk factor. Patients older than 55 years had a threefold higher mortality from surgery than younger patients, although the complication rate, 5.8%, was the same in both groups. Sensitivity analysis demonstrated that the risk for severe life-threatening adverse outcomes in women increased from 4% for a 200-lb female patient to 7.5% for a 600-lb patient. The risk increased from 7% for a 200-lb male patient to 13% for a 600-lb patient. CONCLUSIONS: Large male patients are at greater risk for severe life-threatening complications than smaller and/or female patients. Risk factors thought to be predictive of adverse outcomes, such as a history of smoking or diabetes, proved not to be significant in this analysis. Older patients had the same complication rate but a threefold higher mortality, suggesting that they lack the reserve to recover from complications when they occur.     

C‐reactive protein as a predictor of postoperative infective complications following elective colorectal resection

Aim C‐reactive protein (CRP) may be useful in predicting postoperative complications [ 1 ]. We investigated the sensitivity and specificity of postoperative CRP for infective complications after elective colorectal surgery. Method One hundred and sixty consecutive patients (72 years old; interquartile range, 63–79) undergoing elective resection for colorectal cancer treated between September 2003 and October 2006 were studied. Details of the postoperative course were prospectively entered into a database. Of the 160 patients, 10 had incomplete CRP data and were excluded from further analysis. Results Infective complications occurred in 21%, with an overall complication rate of 29%. Infective complications occurred as follows: respiratory (10), wound (9), urinary tract (2) and central line infection (1), anastomotic leakage (5), intra‐abdominal abscess (3) and septicaemia of unknown origin (2). There were three postoperative deaths. The positive predictive value for infection of CRP > 145 mg/l on postoperative day 4 was 61%. The negative predictive value of CRP < 145 mg/l on postoperative day 4 for an infective complication was 96%. Conclusion A CRP > 145 mg/l on day 4 has high specificity and sensitivity for infective complications following elective colorectal resection.     

C-reactive protein as a predictor of cardiovascular events in elderly patients with chronic kidney disease

Background: Few studies have evaluated the relationship between high-sensitivity C-reactive protein (hs-CRP) and vascular events in the elderly with chronic kidney disease (CKD). Methods: The association of hs-CRP with vascular events was examined according to CKD status in 3,166 participants of the Intervention Project on Cerebrovascular Diseases and Dementia in the Community of Ebersberg, Bavaria (INVADE study). CKD was defined as a creatinine clearance <60 ml/min estimated by the Cockcroft-Gault formula. hs-CRP was used as a binary variable > or <2.1 mg/L (median value). Vascular events were defined as a composite of myocardial infarction, stroke and vascular death. Results: After 4 years of follow-up, 204 participants (6.4%) experienced a major cardiovascular event. High hs-CRP levels and CKD at baseline were associated with a greater risk of vascular events. Compared with patients with low hs-CRP and non-CKD, the adjusted hazard ratio (95% confidence interval) for vascular events was 1.42 (1.11-2.21) for low hs-CRP and CKD, 1.57 (1.21-2.34) for high hs-CRP and non-CKD and 1.93 (1.45-2.89) for high hs-CRP and CKD. Conclusions: These results suggest that high hs-CRP levels provide prognostic information in patients with CKD.     

Evaluation of Charlson-Age comorbidity index as predictor of morbidity and mortality in patients with colorectal carcinoma

The Charlson-Age Comorbidity Index (CACI) is a validated tool used to predict patient outcome based on comorbid medical conditions. We wanted to determine if the CACI would predict morbidity and mortality outcomes in patients undergoing surgery for colorectal carcinoma. Records of 279 consecutive colorectal cancer patients who underwent laparotomy by a single surgical group between 1997 and 2001 were reviewed in a retrospective fashion for patient demographics, stage at diagnosis, operation, surgeon, perioperative complications, tumor characteristics, comorbid diseases, performance status, length of stay (LOS), disposition, and mortality. Using the preoperative history and physical, all patients were assigned a score for the CACI. Perioperative morbidity and mortality were recorded and graded to account for severity. The University Statistical Consulting Center and SPSS software were used to analyze the results. The patients were primarily white (97.1%) with a male-to-female ratio of 1:1.2 and a median age of 72 years. AJCC stage at presentation was stage 0 (3.2%), stage I (28.3%), stage II (24.4%), stage III (24.4%), or stage IV (19.7%). Median LOS was 7.0 days. Perioperative mortality was 17 of 279 (6.1%), and overall mortality was 32.6% at a median follow-up of 18.5 months. Higher CACI scores and AJCC stage at presentation correlated with longer LOS and overall mortality. Only the CACI correlated with perioperative mortality and disposition. No correlation was observed with location of tumor, type of surgery, or surgeon. Patients with higher cumulative number of weighted comorbid conditions as indicated by the CACI are at higher risk for perioperative and overall mortality. This simple scoring system is also a significant predictor of disposition (home versus extended care facility) and LOS. The CACI can be a useful preoperative tool to assess and counsel patients undergoing surgery for colorectal carcinoma. Presented at the Forty-Fourth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Florida, May 18–21, 2003 Presented at the Forty-Fourth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Florida, May 18–21, 2003     

Is obesity a predictor of mortality,morbidity and readmission after cardiac surgery?

INTRODUCTION: Obesity has been described as a risk factor for the development of coronary artery disease, but it has not been determined whether obesity is associated with adverse outcomes after cardiac surgery. Therefore, we analyzed a large cohort of patients who had undergone cardiac surgery to determine whether obesity is a predictor of mortality, morbidity or early readmission to hospital. METHODS: At the London Health Sciences Centre, an academic tertiary care centre, we prospectively entered data from the cardiac surgical database from July 1999 to April 2002. We collected data on 1310 consecutive, unselected patients who underwent cardiac surgery during that time. We assessed the degree of obesity using the body mass index (BMI), and we prospectively documented the occurrence of 10 major complications after surgery. They included stroke, reoperation for bleeding, life-threatening cardiac arrest or arrhythmia, new renal failure requiring dialysis, septicemia, mediastinitis, sternal dehiscence, respiratory failure, postoperative myocardial infarction and low cardiac output necessitating intra-aortic balloon pump use. Univariable and multivariable analyses were conducted to determine the factors associated with and predictive of postoperative death and major complications. RESULTS: An increased BMI did not increase the risk of early postoperative death. Furthermore, increased BMI was not a predictor of a patient experiencing any of the major complications, except sternal dehiscence. An increased BMI was associated with a higher likelihood of readmission to hospital within 30 days of discharge. CONCLUSION: Obesity was not associated with adverse outcomes after cardiac operations, aside from the increased risks of sternal dehiscence and early hospital readmission.     

Kidney function as a predictor of noncardiovascular mortality

Chronic kidney disease is associated with a higher risk for cardiovascular mortality, as well as all-cause mortality. Whether chronic kidney disease is a predictor of noncardiovascular mortality is less clear. To further explore the latter, the association of kidney function with total noncardiovascular mortality and cause-specific mortality was assessed in the Cardiovascular Health Study, a community-based cohort of older individuals. Kidney disease was assessed using cystatin C and estimated GFR in 4637 participants in 1992 to 1993. Participants were followed until June 30, 2001. Deaths were adjudicated as cardiovascular or noncardiovascular disease by committee, and an underlying cause of death was assigned. The associations of kidney function with total noncardiovascular mortality and cause-specific mortality were analyzed by proportional hazards regression. Noncardiovascular mortality rates increased with higher cystatin C quartiles (16.8, 17.1, 21.6, and 50.0 per 1000 person-years). The association of cystatin C with noncardiovascular mortality persisted after adjustment for demographic factors; the presence of diabetes, C-reactive protein, hemoglobin, and prevalent cardiovascular disease; and measures of atherosclerosis (hazard ratio 1.69; 95% confidence interval 1.33 to 2.15, for the fourth quartile versus the first quartile). Results for estimated GFR were similar. The risk for noncardiac deaths attributed to pulmonary disease, infection, cancer, and other causes was similarly associated with cystatin C levels. Kidney function predicts noncardiovascular mortality from multiple causes in the elderly. Further research is needed to understand the mechanisms and evaluate interventions to reduce the high mortality rate in chronic kidney disease.