Emergency Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain.
Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain.
Arch Bronconeumol. 2024 Jun;60(6):344-349. doi: 10.1016/j.arbres.2024.03.024. Epub 2024 Apr 6.
Right ventricle (RV) dysfunction increases the risk of death from pulmonary embolism (PE). C-reactive protein (CRP) might identify RV inflammation and dysfunction in patients with PE.
This cohort study enrolled consecutive stable patients with acute PE between 2017 and 2023. We stratified patients by quartiles of CRP. We evaluated the association between CRP quartiles and the presence of RV dysfunction, and used multivariable models to assess for an association between CRP and the outcomes of all-cause and PE-specific mortality during the 30 days of follow-up after PE diagnosis.
The study included 633 stable patients with PE. Patients without RV dysfunction had significantly lower median (IQR) CRP levels compared with patients with RV dysfunction (n=509, 31.7 [10.0-76.4]mg/L vs n=124, 45.4 [16.0-111.4]mg/L; P=0.018). CRP showed a statistically significant positive association with the presence of RV dysfunction (P<0.01). On multivariable analysis, CRP level was not significantly associated with 30-day all-cause mortality (adjusted odds ratio [OR] per mg/L increment, 1.00; 95% CI, 1.00-1.01; P=0.095), but higher CRP was associated with significantly higher PE-related mortality (adjusted OR, 1.01; 95% CI, 1.00-1.01; P=0.026). Compared with patients in CRP quartile 1, patients in quartiles 2, 3, and 4 had a stepwise increase in the adjusted odds of 30-day all-cause death of 2.41 (P=0.148), 3.04 (P=0.062), and 3.15 (P=0.052), respectively.
As an indicator of RV dysfunction, CRP may improve risk stratification algorithms for hemodynamically stable patients with acute symptomatic PE.
右心室（RV）功能障碍会增加肺栓塞（PE）死亡的风险。C 反应蛋白（CRP）可能可以识别患有 PE 的 RV 炎症和功能障碍。
本队列研究纳入了 2017 年至 2023 年期间连续稳定的急性 PE 患者。我们根据 CRP 的四分位数对患者进行分层。我们评估了 CRP 四分位数与 RV 功能障碍之间的关系，并使用多变量模型评估 CRP 与 PE 诊断后 30 天内全因死亡率和 PE 特异性死亡率之间的关系。
本研究纳入了 633 例稳定的 PE 患者。无 RV 功能障碍的患者 CRP 中位数（IQR）明显低于 RV 功能障碍患者（n=509，31.7[10.0-76.4]mg/L 与 n=124，45.4[16.0-111.4]mg/L；P=0.018）。CRP 与 RV 功能障碍的存在呈显著正相关（P<0.01）。多变量分析显示，CRP 水平与 30 天全因死亡率无显著相关性（每增加 1mg/L 的校正优势比[OR]，1.00；95%CI，1.00-1.01；P=0.095），但 CRP 较高与明显较高的 PE 相关死亡率相关（校正 OR，1.01；95%CI，1.00-1.01；P=0.026）。与 CRP 四分位 1 组相比，CRP 四分位 2、3 和 4 组 30 天全因死亡的校正优势比分别逐步升高 2.41（P=0.148）、3.04（P=0.062）和 3.15（P=0.052）。
作为 RV 功能障碍的指标，CRP 可能改善急性有症状 PE 血流动力学稳定患者的风险分层算法。
