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Vol. 60. Issue 6.
Pages 344-349 (June 2024)
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Vol. 60. Issue 6.
Pages 344-349 (June 2024)
Original Article
C-reactive Protein and Risk of Right Ventricular Dysfunction and Mortality in Patients With Acute Symptomatic Pulmonary Embolism
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Marta Najarroa,, Carmen Rodríguezb,, Raquel Morillob,c, Luis Jara-Palomaresc,d, David R. Vinsone,f, Alfonso Murielg,h, Melchor Álvarez-Moni, Roger D. Yusenj, Behnood Bikdelik,l,m, David Jimenezb,c,i,
Corresponding author
djimenez.hrc@gmail.com

Corresponding author.
a Emergency Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
b Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
c CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
d Respiratory Department, Hospital Virgen del Rocío, Sevilla, Spain
e The Permanente Medical Group and Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
f Emergency Department, Kaiser Permanente Roseville Medical Center, Roseville, CA, USA
g Biostatistics Department, Hospital Ramón y Cajal, and Universidad de Alcalá (IRYCIS), Madrid, Spain
h CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
i Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain
j Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
k Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
l Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
m YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA
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Figures (3)
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Tables (4)
Table 1. Baseline Characteristics of the Study Cohort Divided by CRP Quartile.
Table 2. Observed Rates of Mortality by CRP Quartile.
Table 3. Adjusted Rates of Mortality by CRP Quartile.
Table 4. Sensitivity and Subgroup Analyses for Mortality Rates.*
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Additional material (1)
Abstract
Background

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.

Methods

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.

Results

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.

Conclusions

As an indicator of RV dysfunction, CRP may improve risk stratification algorithms for hemodynamically stable patients with acute symptomatic PE.

Keywords:
Pulmonary embolism
Prognosis
C-reactive protein
Right ventricle dysfunction

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