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C-reactive protein and mortality in patients with acute aortic disease
Martin Schillinger1, Hans Domanovits, Keywan Bayegan
1Department of Internal Medicine II, Division of Angiology, Vienna General Hospital, University of Vienna, Medical Faculty, Waehringer Guertel 18-20, 1090 Vienna, Austria. martin.schillinger@akh-wien.ac.at
Objective:
The association of acute-phase reaction and outcome of patients with acute vascular diseases is controversial. The prognostic value of admission C-reactive protein (CRP) in patients with acute aortic aneurysm or dissection has not yet been investigated.
Design And Setting:
Cohort study including 255 consecutive patients from an aneurysm registry with symptomatic thoracic or abdominal aortic aneurysm and/or dissection in an emergency department of a tertiary care university hospital.
Patients:
Patients were included who had symptoms of aortic disease admitted between 1 January 1992 and 31 November 1998 and were followed up until 31 December 1999 for survival.
Measurements:
Admission CRP (mg/dl) levels were categorized in quartiles: quartile 1, less than 0.5; quartile 2, 0.50-1.30; quartile 3, 1.31-6.30; quartile 4, higher than 6.30. Each group contained about 60 patients.
Results:
Cumulative mortality 1, 3, and 6 months after presentation was 32%, 37%, and 40%, respectively. Increased CRP levels were independently associated with mortality, adjusted for age, sex, hemodynamic shock, mechanical ventilation, coronary artery disease, aortic rupture, hemoglobin, diabetes, and treatment strategy (surgery vs. conservative). Hazard ratios in patients with CRP levels in quartiles 2-4 compared to quartile 1 were 0.7, 1.8, and 2.6, respectively.
Conclusions:
Elevated admission CRP values in patients with symptomatic aortic aneurysm/dissection were independently associated with poor prognosis. CRP levels higher than 6.3 mg/dl indicate a high risk for short-term mortality.