Prognostic Value of High-Sensitivity C-Reactive Protein in Patients with Acute Pulmonary Embolism – From the PERT Registry (Pulmonary Embolism Registry in Tel Hashomer)

Background:

Inflammation, as measured by high-sensitivity C-reactive protein (hsCRP) concentration, is associated with future vascular events, independent of usual risk markers. Previous studies have shown that CRP is a trigger for venous thromboembolism (VTE). Similar results were found with inflammatory triggers other than infection.The prognostic value of hsCRP in patients who presented with acute pulmonary embolism (PE) is unclear.

Methods:

In this prospective cohort study, we evaluated peak hsCRP measurements in patients hospitalized with acute PE. Baseline characteristics, symptoms at presentation, laboratory and imaging (CTA and Echo) finding, measures of PE severity, short term (in-hospital) as well as up-to 12 months outcomes were prospectively studied.

Results:

A total of 546 patients with a confirmed diagnosis of PE between 2015-2019 were evaluated. In 228 (42%) patients (median age 68 [IQR 56,77]) hsCRP was analyzed. The median value for hsCRP was 110 mg/l (IQR 40,175). Subsequently, the group was separated to either below or above 110 mg/l. 147 (51%) were below 110mg/l, and 81 (49%) were above. No differences in baseline characteristic were found, except increased history of malignancy in the high group (33.3% Vs 48.2% p=0.05).There were no significant difference regarding PE severity index (p=0.5) nor echocardiographic or CTA findings (p=0.7). hsCRP above 110 mg/l were found to be a predictor of worse outcomes, including composite endpoint of hemodynamic instability, mechanical ventilation, shock, CPR and in-hospital mortality (p=0.002), as well as increased mortality at 12 months (p<0.001, HR 3.11). Sub-group analysis of hsCRP by quartiles (40,110 and 175) showed a linear relationship between a rise in hsCRP and mortality (p=0.00015).

Conclusion:

Increased hsCRP is a biomarker that associate with in-hospital adverse outcome and was independently associated with 1-year mortality in a Cox-regression model adjusted for age, gender, heart failure, shock or need for CPR and a history of malignancy, HR 2.1, (95%CI 1.4-3.2).