title: Peak C-reactive protein level predicts long-term outcomes in type B acute aortic dissection.
abstract: Acute aortic dissection (AAD) is associated with an inflammatory reaction, as evidenced by elevated inflammatory markers, including C-reactive protein (CRP). The association between the peak CRP level and long-term outcomes in type B AAD has not been systematically investigated. The purpose of this study was to investigate whether the peak CRP level during admission predicts long-term outcomes in type B AAD. We conducted a clinical follow-up study of type B AAD. We divided the study population into 4 groups according to the tertiles of peak CRP levels (T1: 0.60 to 9.37 mg/dL; T2: 9.61 to 14.87 mg/dL; T3: 14.90 to 32.60 mg/dL; and unavailable peak CRP group). Multivariate Cox regression analysis was applied to investigate whether the tertiles of peak CRP predict adverse events even after adjusting for other variables. A total of 232 type B AAD patients were included in this analysis. The median follow-up period was 50 months. CRP reached its peak on day 4.5+/-1.7. Mean peak CRP values in T1, T2, and T3 were 6.4+/-2.4, 12.0+/-1.5, and 19.5+/-4.0 mg/dL, respectively. There were 65 events (39 deaths and 26 aortic events) during the follow-up. T3 and T2 (versus T1) were strong predictors of adverse events (T3: hazard ratio: 6.02 [95% CI: 2.44 to 14.87], P=0.0001; T2: hazard ratio: 3.25 [95% CI: 1.37 to 7.71], P=0.01) after controlling for all of the confounding factors. In conclusion, peak CRP is a strong predictor for adverse long-term events in patients with type B AAD.
authors.affiliation: Division of Cardiovascular Medicine, Department of Integrated Medicine I, Jichi Medical University Saitama Medical Center, Omiya, Saitama, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sakakura
authors.forename: Norifumi
authors.initials: N
authors.lastname: Kubo
authors.forename: Junya
authors.initials: J
authors.lastname: Ako
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Wada
authors.forename: Naoki
authors.initials: N
authors.lastname: Fujiwara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Funayama
authors.forename: Nahoko
authors.initials: N
authors.lastname: Ikeda
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Nakamura
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Takanori
authors.initials: T
authors.lastname: Yasu
authors.forename: Masanobu
authors.initials: M
authors.lastname: Kawakami
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Momomura
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality; D017545:Aortic Aneurysm, Thoracic / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D018836:Inflammation Mediators; D002097:C-Reactive Protein