Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1, DaHua Road, Dong Dan, Beijing 100730, PR China; Peking University Fifth School of Clinical Medicine, No. 1, DaHua Road, Dong Dan, Beijing 100730, PR China.
Department of Cardiology, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing 100039, PR China.
Exp Gerontol. 2021 Apr;146:111235. doi: 10.1016/j.exger.2021.111235. Epub 2021 Jan 13.
Chronic inflammation is associated with major adverse cardiovascular events (MACEs), mortality, and frailty. Our aim was to add high-sensitivity C-reactive protein (hsCRP) to the frailty assessment to predict its association with prognosis of older adults with cardiovascular disease (CVD).
A comprehensive geriatric assessment was conducted at baseline in 720 in-patients aged ≥65 years with CVD. We divided the population into frailty and non-frailty groups according to the Fried phenotype, and hsCRP was further combined with frailty to stratify all patients into c-frailty and non-c-frailty groups. Predictive validity was tested using Cox proportional hazards regression model analysis and the discriminative ability was evaluated by receiver operating characteristic (ROC) curves.
Of all the subjects enrolled, 51.0% were male and the mean age was 75.32 ± 6.52 years. The all-cause death and MACE rate was 6.4% at the 1-year follow-up. Frailty and c-frailty were independent predictors of all-cause death and MACE (hazard ratio [HR]: 2.55, 95% confidence interval [CI]: 1.35-4.83, p = 0.004; HR: 3.67, 95% CI: 1.83-7.39, p < 0.001). Adding hsCRP to the frailty model resulted in a significant increase in the area under the ROC curve from 0.74 (95% CI: 0.70-0.77) to 0.77 (95% CI: 0.71-0.84) (p = 0.0132) and a net reclassification index of 7.9% (95% CI: 1.96%-12.56%, p = 0.012).
Adding hsCRP to the frailty assessment is helpful to identify a subgroup of older CVD patients with a higher risk of death and MACE over a period of 1 year.
ChiCTR1800017204; date of registration: 07/18/2018. URL: http://www.chictr.org.cn/showproj.aspx?proj=28931.
慢性炎症与主要不良心血管事件（MACEs）、死亡率和虚弱有关。我们的目的是在衰弱评估中增加高敏 C 反应蛋白（hsCRP），以预测其与老年心血管疾病（CVD）患者预后的关系。
对 720 名年龄≥65 岁的 CVD 住院患者进行全面老年评估。根据 Fried 表型将人群分为虚弱组和非虚弱组，并进一步将 hsCRP 与虚弱相结合，将所有患者分为 c-虚弱组和非 c-虚弱组。使用 Cox 比例风险回归模型分析测试预测有效性，并通过接收者操作特征（ROC）曲线评估判别能力。
在所有入组的受试者中，51.0%为男性，平均年龄为 75.32±6.52 岁。在 1 年随访时，全因死亡和 MACE 发生率为 6.4%。虚弱和 c-虚弱是全因死亡和 MACE 的独立预测因素（风险比[HR]：2.55，95%置信区间[CI]：1.35-4.83，p=0.004；HR：3.67，95%CI：1.83-7.39，p<0.001）。将 hsCRP 添加到衰弱模型中，ROC 曲线下面积从 0.74（95%CI：0.70-0.77）增加到 0.77（95%CI：0.71-0.84）（p=0.0132），净重新分类指数增加 7.9%（95%CI：1.96%-12.56%，p=0.012）。
将 hsCRP 添加到衰弱评估中有助于识别出在 1 年内死亡和 MACE 风险较高的老年 CVD 患者亚组。
ChiCTR1800017204；注册日期：2018 年 7 月 18 日；网址：http://www.chictr.org.cn/showproj.aspx?proj=28931。
