Associations between admission C-reactive protein and in-hospital mortality amongst patients with cardiogenic shock

Systemic inflammation in cardiogenic shock is associated with increased disease severity and mortality. C-reactive protein (CRP) is a widely accessible inflammatory biomarker that may aid phenotyping and risk stratification. We evaluated the association between admission CRP and in-hospital mortality in patients with cardiogenic shock.

Using a multicentre, nationally representative database, we identified adults with a discharge diagnosis of cardiogenic shock from 2015 to 2023 who had CRP measured within 2 days of hospital admission; patients with sepsis were excluded. C-reactive protein was analysed in tertiles. Inverse probability weighting (IPW) was used to assess associations with in-hospital mortality. Secondary outcomes included intensive care unit (ICU) and hospital length of stay and total cost. We identified 26 525 patients; median (interquartile ranges) CRP was 18.4 mg/L (5.0-67.0 mg/L). The in-hospital mortality was 28.7, 32.7, and 42.3% across tertiles 1-3. In-hospital mortality increased by 19% for each 50-unit increase in CRP [odds ratio (OR) 1.19; 95% confidence interval (CI): 1.16-1.21, P < 0.001). After IPW, tertiles 2 and 3 had higher absolute mortality risks compared with tertile 1 by 3.9% (95% CI: 2.4-5.3%) and 12.4% (95% CI: 10.9-13.9%), respectively (both, P < 0.001). Findings were consistent in sensitivity analyses restricted to Day 1 CRP measurement, primary diagnoses of heart failure or myocardial infarction, and among patients requiring early mechanical circulatory support (all, P < 0.05). The median ICU and hospital stay increased significantly across tertiles (all, P < 0.001); total cost was not statistically different.

In patients with cardiogenic shock, a readily available biomarker, elevated CRP was associated with higher in-hospital mortality.