Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
BMJ Open. 2020 Dec 29;10(12):e041068. doi: 10.1136/bmjopen-2020-041068.
To examine the association of a high C-reactive protein (CRP) level at discharge from an acute decompensated heart failure (ADHF) hospitalisation with the 1-year clinical outcomes.
A post-hoc subanalysis of a prospective cohort study of patients hospitalised for ADHF (using the Kyoto Congestive Heart Failure (KCHF) registry) between October 2014 and March 2016 with a 1-year follow-up.
A physician-initiated multicentre registry enrolled consecutive hospitalised patients with ADHF for the first time at 19 secondary and tertiary hospitals in Japan.
Among the 4056 patients enrolled in the KCHF registry, the present study population consisted of 2618 patients with an available CRP value both on admission and at discharge and post-discharge clinical follow-up data. We divided the patients into two groups, those with a high CRP level (>10 mg/L) and those with a low CRP level (≤10 mg/L) at discharge from the index hospitalisation.
The primary outcome measure was all-cause death after discharge from the index hospitalisation. The secondary outcome measures were heart failure hospitalisations, cardiovascular death and non-cardiovascular death.
The high CRP group and low CRP group included 622 patients (24%) and 1996 patients (76%), respectively. During a median follow-up period of 468 days, the cumulative 1-year incidence of the primary outcome was significantly higher in the high CRP group than low CRP group (24.1% vs 13.9%, log-rank p<0.001). Even after a multivariable analysis, the excess mortality risk in the high CRP group relative to the low CRP group remained significant (HR, 1.43; 95% CI, 1.19 to 1.71; p<0.001). The excess mortality risk was consistent regardless of the clinically relevant subgroup factors.
A high CRP level (>10 mg/L) at discharge from an ADHF hospitalisation was associated with an excess mortality risk at 1 year. TRIAL REGISTRATION DETAILS: https://clinicaltrials.gov/ct2/show/NCT02334891 (NCT02334891) https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000017241 (UMIN000015238).
探讨急性失代偿性心力衰竭（ADHF）出院时高 C 反应蛋白（CRP）水平与 1 年临床结局的关系。
这是一项对 2014 年 10 月至 2016 年 3 月期间在日本 19 家二级和三级医院首次住院的 ADHF 患者进行前瞻性队列研究的事后亚组分析，随访时间为 1 年。
这是一项由医生发起的多中心登记研究，纳入了来自日本 19 家二级和三级医院首次住院的 4056 例 ADHF 患者。
在 KCHF 登记处登记的 4056 例患者中，本研究人群由 2618 例在入院时和出院时以及出院后临床随访数据时均有 CRP 值的患者组成。我们将患者分为两组，一组出院时 CRP 水平较高（>10mg/L），另一组 CRP 水平较低（≤10mg/L）。
主要结局测量指标为出院后全因死亡。次要结局测量指标为心力衰竭再住院、心血管死亡和非心血管死亡。
高 CRP 组和低 CRP 组分别包括 622 例（24%）和 1996 例（76%）患者。中位随访 468 天后，高 CRP 组 1 年累积主要结局发生率显著高于低 CRP 组（24.1%比 13.9%，对数秩检验 p<0.001）。即使进行多变量分析后，高 CRP 组相对于低 CRP 组的死亡风险仍显著增加（HR，1.43；95%CI，1.19 至 1.71；p<0.001）。无论临床相关亚组因素如何，死亡风险均一致增加。
ADHF 出院时 CRP 水平升高（>10mg/L）与 1 年时的超额死亡风险相关。
