Abstract
BackgroundConventional C-reactive protein assays have been used to detect or guide the treatment of acute sepsis. The objective of this study was to determine the association between elevated baseline high-sensitivity C-reactive protein (hsCRP) and the risk of future sepsis events.MethodsWe studied data from 30,239 community dwelling, black and white individuals, age ≥45 years old enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Baseline hsCRP and participant characteristics were determined at the start of the study. We identified sepsis events through review of hospital records. Elevated hsCRP was defined as values >3.0 mg/L. Using Cox regression, we determined the association between elevated hsCRP and first sepsis event, adjusting for sociodemographic factors (age, sex, race, region, education, income), health behaviors (tobacco and alcohol use), chronic medical conditions (coronary artery disease, diabetes, dyslipidemia, hypertension, chronic kidney disease, chronic lung disease) and statin use.ResultsOver the mean observation time of 5.7 years (IQR 4.5–7.1), 974 individuals experienced a sepsis event, and 11,447 (37.9%) had elevated baseline hsCRP (>3.0 mg/L). Elevated baseline hsCRP was independently associated with subsequent sepsis (adjusted HR 1.56; 95% CI 1.36–1.79), adjusted for sociodemographics, health behaviors, chronic medical conditions and statin use.ConclusionElevated baseline hsCRP was associated with increased risk of future sepsis events. hsCRP may help to identify individuals at increased risk for sepsis.
Highlights
IntroductionElevated C-reactive protein (CRP) levels detected using high-sensitivity assay techniques have been associated with risk of cardiovascular disease, stroke and all-cause mortality.[7,8,9] While often used to detect or guide the treatment of acute sepsis, there have been few efforts linking CRP level at a stable phase of health with risk of future sepsis events.[10,11,12,13,14,15,16,17,18] As with cardiovascular disease, if baseline CRP levels were associated with future sepsis events, this finding could motivate strategies to mitigate disease severity or mortality, or to prevent the onset of the condition
Covariates We considered covariates correlated with high-sensitivity C-reactive protein (hsCRP) including sociodemographic characteristics, health behaviors and chronic medical conditions
Among the 30,239 REGARDS participants, from February 5, 2003 through July 30, 2012, we identified 2,151 hospitalizations for a serious infection, encompassing 1,179 sepsis events among 974 individuals
Summary
Elevated CRP levels detected using high-sensitivity assay techniques have been associated with risk of cardiovascular disease, stroke and all-cause mortality.[7,8,9] While often used to detect or guide the treatment of acute sepsis, there have been few efforts linking CRP level at a stable phase of health with risk of future sepsis events.[10,11,12,13,14,15,16,17,18] As with cardiovascular disease, if baseline CRP levels were associated with future sepsis events, this finding could motivate strategies to mitigate disease severity or mortality, or to prevent the onset of the condition. The objective of this study was to determine the association between elevated baseline high-sensitivity C-reactive protein (hsCRP) and the risk of future sepsis events
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