Inflammatory markers, amino-terminal pro-brain natriuretic peptide, and mortality risk in dyspneic patients.
Dyspnea is a common emergency department (ED) complaint, and it may be associated with significant mortality risk. We studied 599 dyspneic subjects enrolled in an ED. At 1 year, the role of inflammatory markers (including C-reactive protein [CRP]) and amino-terminal pro-brain natriuretic peptide (NT-proBNP) as independent predictors of mortality was assessed. By 1 year, 91 subjects (15.2%) had died. Among patients who died, the median CRP concentration at admission was significantly higher than in survivors: 47.2 mg/L (449.5 nmol/L; interquartile range [IQR], 10.2-101.9 mg/L [97.1-970.5 nmol/L]) vs 7.25 mg/L (69.5 nmol/L; IQR, 2.2-29.6 mg/L [21.0-281.9 nmol/L]; P < .001). For 1-year mortality, CRP had an area under the receiver operating characteristic curve of 0.76 (95% confidence interval [CI], 0.69-0.80; P < .001). In multivariable analysis, a CRP concentration greater than 14 mg/L was a strong predictor of mortality at 1 year (hazard ratio, 2.47; 95% CI, 1.51-4.02; P < .001). In multivariable models, CRP and NT-proBNP demonstrated independent and additive prognostic value. Among dyspneic patients, CRP levels are significantly associated with mortality at 1 year and show additive value to natriuretic peptide testing for prognosis.
Rehman
Shafiq
S
Cardiology Division and Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
Lloyd-Jones
Donald M
DM
Martinez-Rumayor
Abelardo
A
Januzzi
James L
JL
D000368:Aged; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis*; D004417:Dyspnea / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D007249:Inflammation / Q000175:diagnosis*; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D011379:Prognosis; D012306:Risk
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein