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Vol. 155. Issue 2.
Pages 51-56 (July 2020)
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Vol. 155. Issue 2.
Pages 51-56 (July 2020)
Original article
DOI: 10.1016/j.medcle.2019.09.009
C-reactive protein level predicts 30-day mortality and bleeding in patients with venous thromboembolism: A prospective single-center study
Proteína C reactiva como predictor de mortalidad y hemorragia a 30 días en pacientes con enfermedad tromboembólica venosa: estudio prospectivo, monocéntrico
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Pablo Demelo-Rodrígueza,b,c,1, Francisco Galeano-Vallea,b,c,1,
Corresponding author
paco.galeano.valle@gmail.com

Corresponding author.
, Almudena Marcelo-Ayalaa, Eduardo Fernández-Carracedoa, Alicia Cuenca-Zarzuelab, Marina Gómez-Moralesb, Luis Antonio Alvarez-Sala-Waltherb,c, José María Bellón-Canod, Jorge del-Toro-Cerveraa,b,c
a Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain
c Instituto de investigación Sanitaria Gregorio Marañón, Madrid, Spain
d Department of Statistics, Instituto de investigación Sanitaria Gregorio Marañón, Madrid, Spain
Article information
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Figures (1)
Tables (3)
Table 1. Baseline characteristics of the sample.
Table 2. VTE complications during the first 30 days.
Table 3. Sensitivity, specificity and predictive values (95% confidence intervals) of different cutoffs of CRP levels for 30-day mortality and 30-day bleeding prediction.
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Abstract
Aims

The association of on-admission CRP and early adverse outcomes in acute venous thromboembolism (VTE) has not been investigated. We hypothesized that increased on-admission CRP levels would correlate with adverse outcomes in patients with acute VTE.

Method

In this prospective observational study, consecutive patients with acute VTE were enrolled and CRP levels were measured within the first 24h after diagnosis. Mortality, bleeding and recurrence were recorded during a 30-day follow-up.

Results

586 patients were included. Higher CRP levels were found in patients with mortality (7.5 vs 4.0mg/dL; p=0.01) and bleeding (7.8 vs 3.9mg/dL; p=0.03). Multivariable logistic regression showed that CRP levels >5mg/dL were associated with higher mortality (OR 6.25; 95% CI, 2.1–18.6) and bleeding (OR 2.7; CI 95% 1.3–5.7). These results were independent to ESC risk score and simplified PESI score for mortality prediction. The predictive capacity of CRP showed an area under the ROC curve – AUC – of .7 (CI 95% .56–.85) for mortality and .65 (CI 95% .54–.75) for bleeding. The prognostic capacity of the ESC risk score and simplified PESI score was improved after adding the CRP cutoff of 5mg/dL (AUC of .87 CI 95% .79–.95).

Conclusion

Our findings suggest that on-admission CRP level may be a simple, widely available and valuable biomarker to identify high-risk VTE patients for early mortality and bleeding. CRP ≥5mg/dL was independently associated with 30-day VTE related death and bleeding.

Keywords:
C-reactive protein
Venous thromboembolism
Biomarkers
Mortality
Bleeding
Resumen
Objetivos

La asociación de la medición de PCR al ingreso y las complicaciones precoces en la enfermedad tromboembólica venosa (ETV) aguda no ha sido evaluado. Nuestra hipótesis es que los niveles elevados de PCR al ingreso podrían estar correlacionados con complicaciones precoces en pacientes con ETV aguda.

Métodos

Estudio observacional prospectivo, en el que se incluyeron pacientes consecutivos con ETV aguda en los que se midió la PCR en las primeras 24h del diagnóstico. La mortalidad, el sangrado y la recurrencia fueron registrados durante el seguimiento a 30 días.

Resultados

Se incluyeron 586 pacientes. Se encontraron niveles más elevados de PCR en pacientes que fallecieron (7,5 vs. 4mg/dl; p=0,01) y que sangraron (7,8 vs. 3,9mg/dl; p=0,03). Una regresión logística multivariante mostró que niveles de PCR>5mg/dl se asociaron significativamente con mayor mortalidad (OR: 6,25; IC 95%: 2,1-18,6) y sangrado (OR: 2,7; IC 95%: 1,3-5,7). Estos resultados fueron independientes de las escalas pronósticas de mortalidad ESC y PESI simplificada. La capacidad predictiva de la PCR mostró un área bajo la curva (ABC) ROC de 0,7 (IC 95%: 0,56-0,85) para mortalidad y 0,65 (IC 95%: 0,54-0,75) para sangrado. La capacidad pronóstica de las escalas pronósticas ESC y PESI simplificada mejoró de forma significativa al añadir el punto de corte de PCR>5mg/dl (ABC de 0,87; IC 95%: 0,79-0,95).

Conclusión

La medición de PCR al ingreso puede ser un marcador sencillo y ampliamente disponible para identificar a pacientes con ETV aguda y alto riesgo de mortalidad y sangrado precoces. Niveles de PCR5mg/dl se asociaron de forma independiente con mayor mortalidad y sangrado a 30 días en pacientes con ETV aguda.

Palabras clave:
Proteína C reactiva
Enfermedad tromboembólica venosa
Biomarcadores
Mortalidad
Sangrado

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