C-反应蛋白作为主动脉瓣狭窄经导管主动脉瓣植入术后 1 年死亡率的预后标志物。
C-reactive Protein as a Prognostic Marker of 1-Year Mortality after Transcatheter Aortic Valve Implantation in Aortic Stenosis.
机构信息
Universidade Federal Fluminense - Hospital Antonio Pedro - Cardiologia, Niterói, RJ - Brasil.
Hospital Pró-Cardíaco - Hemodinâmica, Rio de Janeiro, RJ - Brasil.
出版信息
Arq Bras Cardiol. 2021 Nov;117(5):1018-1027. doi: 10.36660/abc.20190715.
BACKGROUND
C-reactive protein (CRP) is an inflammation biomarker that can be a predictor of adverse events in cardiovascular procedures. Its use in the assessment of long-term prognosis of transcatheter aortic valve implantation (TAVI) is still incipient.
OBJECTIVE
To evaluate CRP as a prognostic marker in the first year after TAVI in aortic stenosis (AoS).
METHODS
CRP was assessed on the first postoperative week in a retrospective cohort of patients with AoS. Pre- and post- CRP levels were correlated with mortality, and predictors of 1-year mortality were investigated. Multivariate Cox regression was performed to identify independent factors of 1-year mortality.
RESULTS
This study evaluated 130 patients who underwent TAVI, with median age of 83 years, and 49% of women. High pre-TAVI CRP (> 0.5 mg/dL) was observed in 34.5% of the cases. Peak CRP was 7.0 (5.3-12.1) mg/dL no quarto dia. The rate of 1-year mortality was 14.5% (n = 19), being greater in the groups with high pre-TAVI CRP (68.8% vs 29.1%; p = 0,004) and with peak CRP ≥ 10.0 mg/dL (64.7% vs 30.8%; p = 0,009). Independent predictors of mortality were acute renal failure (ARF) (hazard ratio [HR] = 7.43; 95% confidence interval [95%CI], 2.1-24.7; p = 0,001), high pre-TAVI CRP (HR 4.15; 95%CI, 1.3-12.9; p = 0.01), and large blood transfusion [HR 4,68; 1,3-16,7; p = 0.02].
CONCLUSIONS
High pre-TAVI CRP showed to be an independent predictor of 1-year mortality, as well as the presence of ARF and large blood transfusions.
背景
C 反应蛋白（CRP）是一种炎症生物标志物，可预测心血管手术中的不良事件。其在经导管主动脉瓣植入术（TAVI）长期预后评估中的应用仍处于初期阶段。
目的
评估 CRP 作为主动脉瓣狭窄（AS）患者 TAVI 后 1 年的预后标志物。
方法
回顾性分析了一组 AS 患者的术后第 1 周 CRP 情况。比较了 CRP 水平与死亡率之间的相关性，并探讨了 1 年死亡率的预测因素。采用多变量 Cox 回归分析确定 1 年死亡率的独立因素。
结果
本研究共评估了 130 例接受 TAVI 的患者，中位年龄为 83 岁，女性占 49%。术前 CRP 升高（>0.5mg/dL）者占 34.5%。术后第 4 天 CRP 峰值为 7.0（5.3-12.1）mg/dL。1 年死亡率为 14.5%（n=19），术前 CRP 升高组（68.8% vs 29.1%；p=0.004）和 CRP 峰值≥10.0mg/dL 组（64.7% vs 30.8%；p=0.009）死亡率更高。死亡率的独立预测因素为急性肾损伤（ARF）（危险比[HR] = 7.43；95%置信区间[95%CI]，2.1-24.7；p=0.001）、术前 CRP 升高（HR 4.15；95%CI，1.3-12.9；p=0.01）和大量输血（HR 4.68；1.3-16.7；p=0.02）。
结论
术前 CRP 升高是 1 年死亡率的独立预测因素，与 ARF 和大量输血有关。
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