Dataset Information

High-sensitivity C reactive protein as a predictor of inhospital mortality in patients with cardiovascular disease at an emergency department: a retrospective cohort study.

ABSTRACT:

Objective

We investigated whether serum high-sensitivity C reactive protein (hs-CRP) levels measured in an emergency department (ED) are associated with inhospital mortality in patients with cardiovascular disease (CVD).

Design

A retrospective cohort study.

Setting

ED of a teaching hospital in Japan.

Participants

12 211 patients with CVD aged ?18 years who presented to the ED by an ambulance between 1 February 2006 and 30 September 2014 were evaluated.

Main outcome measures

Inhospital mortality.

Results

1156 patients had died. The inhospital mortality increased significantly with the hs-CRP levels (<3.0?mg/L: 7.0%, 95% CI 6.4 to 7.6; 3.1-5.4?mg/L: 9.6%, 95% CI 7.9 to 11.3: 5.5-11.5?mg/L: 11.2%, 95% CI 9.4 to 13.0; 11.6-33.2?mg/L: 12.3%, 95% CI 10.5 to 14.1 and ?33.3?mg/L: 19.9%, 95% CI 17.6 to 22.2). The age-adjusted and sex-adjusted HR for total mortality was increased significantly in the three ?5.5?mg/L groups compared with the <3.0?mg/L group (5.5-11.5?mg/L: HR=1.32, 95% CI 1.09 to 1.60, p=0.005; 11.6-33.2?mg/L: HR=1.38, 95% CI 1.14 to 1.65, p=0.001 and ?33.3?mg/L: HR=2.15, 95% CI 1.84 to 2.51, p<0.001). Similar findings were observed for the CVD subtypes of acute myocardial infarction, heart failure, cerebral infarction and intracerebral haemorrhage. This association remained unchanged even after adjustment for age, sex and white cell count and withstood Bonferroni adjustment for multiple testing. When the causes of death were divided into primary CVD and non-CVD deaths, the association between initial hs-CRP levels and mortality remained significant, but the influence of hs-CRP levels was greater in non-CVD deaths than CVD deaths. The percentage of non-CVD deaths increased with hs-CRP levels; among the patients with hs-CRP levels ?33.3?mg/L, non-CVD deaths accounted for 37.5% of total deaths.

Conclusion

Our findings suggest that increased hs-CRP is a significant risk factor for inhospital mortality among patients with CVD in an ED. Particular attention should be given to our finding that non-CVD death is a major cause of death among patients with CVD with higher hs-CRP levels.

SUBMITTER: Yoshinaga R

PROVIDER: S-EPMC5640037 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

High-sensitivity C reactive protein as a predictor of inhospital mortality in patients with cardiovascular disease at an emergency department: a retrospective cohort study.

Yoshinaga Ryo R Doi Yasufumi Y Ayukawa Katsuhiko K Ishikawa Shizukiyo S

BMJ open 20171006 10

<h4>Objective</h4>We investigated whether serum high-sensitivity C reactive protein (hs-CRP) levels measured in an emergency department (ED) are associated with inhospital mortality in patients with cardiovascular disease (CVD).<h4>Design</h4>A retrospective cohort study.<h4>Setting</h4>ED of a teaching hospital in Japan.<h4>Participants</h4>12 211 patients with CVD aged ≥18 years who presented to the ED by an ambulance between 1 February 2006 and 30 September 2014 were evaluated.<h4>Main outcom ...[more]

PMID: 28988163

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Project description:Many studies have shown the tendency for people without a regular care provider or primary physician to make greater use of emergency departments. We sought to determine the effects of three aspects of care provided by primary physicians (physician specialty, continuity of care and comprehensiveness of care) on their patients' use of the emergency department.Using provincial administrative databases, we created a cohort of 367,315 adults aged 18 years and older. Participants were residents of urban areas of Quebec. Affiliation with a primary physician, the specialty of this physician (i.e., family physician v. specialist), continuity of care (as measured using the Usual Provider Continuity index) and comprehensiveness of care (i.e., number of complete annual examinations) were measured among participants (n = 311,701) who had visited a physician three or more times during a two-year baseline period. We used multivariable negative binomial regression to investigate the relationships between measures of care and the number of visits to emergency departments during a 12-month follow-up period.Among participants under 65 years of age, emergency department use was higher for those not affiliated than for those affiliated with a family physician (incidence rate ratio [IRR] 1.11, 95% confidence interval [CI] 1.05-1.16) or a specialist (IRR 1.10, 95% CI 1.04-1.17). Among patients aged 65 years and older, having a specialist primary physician, as opposed to a family physician, predicted increased use of the emergency department (IRR 1.13, 95% CI 1.09-1.17). Greater continuity of care with a family physician predicted less use of the emergency department only among participants who made 25 or more visits to a physician during the baseline period. Greater continuity of care with a specialist predicted less use of the emergency department overall, particularly among participants with intermediate numbers of multimorbidities and admissions to hospital. Greater comprehensiveness of care by family physicians predicted less use of the emergency department.Efforts to increase the proportion of adults affiliated with a family physician should target older adults, people who visit physicians more frequently and people with multiple comorbidities and admissions to hospital.

Dataset Information

High-sensitivity C reactive protein as a predictor of inhospital mortality in patients with cardiovascular disease at an emergency department: a retrospective cohort study.

Objective

Design

Setting

Participants

Main outcome measures

Results

Conclusion

Publications

High-sensitivity C reactive protein as a predictor of inhospital mortality in patients with cardiovascular disease at an emergency department: a retrospective cohort study.

Similar Datasets

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