High hs-CRP Group Research Articles

Abstract 14321: High Sensitivity C-Reactive Protein is Associated With Plaque Vulnerability and Increased Incidence of Adverse Events in Patients With Stable Coronary Disease

Introduction: Higher level of high sensitivity C-reactive protein (hsCRP) is associated with an increased risk of cardiovascular events in patients with coronary artery disease (CAD). However, the pathogenesis of the worse clinical outcomes in CAD patients with high hsCRP remains to be elucidated. Hypothesis: Higher hsCRP is associated with a higher prevalence of vulnerable characteristics in coronary plaques and an increased incidence of adverse events in patients with CAD. Methods: A total of 793 consecutive patients with stable CAD, who underwent intra coronary optical coherence tomography (OCT) imaging of the culprit vessel during percutaneous coronary intervention were included. Patients were classified into the higher hsCRP group (hsCRP ≥ 0.2 mg/dL, n=247) or the lower hsCRP group (hsCRP < 0.2 mg/dL, n=546). OCT characteristics and clinical outcomes were investigated according to the level of hsCRP. Results: The prevalence of thin-cap fibroatheroma (TCFA) (32.0% vs. 20.9%, p <0.001) and plaque with macrophage (53.9% vs. 46.2%, p =0.045) was significantly higher in the higher hsCRP group than in the lower hsCRP group (Panel A). The incidence of myocardial infarction was significantly higher in the higher hsCRP group than in the lower hsCRP group (log-rank p =0.006) during a median 938 days follow-up (Panel B) although the incidence of the composite of major adverse cardiac events was comparable (log-rank p =0.282). Among the four groups classified by the hsCRP level and the presence of TCFA, the incidence of myocardial infarction was the highest in the group with higher hsCRP and TCFA (log-rank p =0.017). Conclusions: Higher level of hsCRP was associated with a higher prevalence of vulnerable characteristics in coronary plaques and worse clinical outcomes in patients with stable CAD. The risk of recurrent myocardial infarction in patients with high hsCRP levels was further increased by the presence of TCFA.

Predictive role of pre-thrombolytic hs-CRP on the safety and efficacy of intravenous thrombolysis in acute ischemic stroke

PurposeTo investigate the predictive role of pre-thrombolytic high sensitivity C-reactive protein (hs-CRP) on the safety and efficacy of intravenous thrombolysis in patients with acute ischemic stroke (AIS).MethodsPatients with AIS who underwent intravenous thrombolysis with recombinant plasminogen activator (rtPA) or urokinase without endovascular therapy from June 2019 to June 2022 were retrospectively analysed. All patients were grouped into two groups (high or low hs-CRP group) according to the median value of hs-CRP before intravenous thrombolysis. The baseline NIHSS, NIHSS changes before and after thrombolysis (ΔNIHSS), the rate of good thrombolysis response (NIHSS decreased ≥ 2 points from baseline), the rate of any intracranial hemorrhage, age, sex, hypertension, diabetes, uric acid and platelet count were compared between the two groups. Logistic regression analysis was performed to identify possible prognostic factors for a good thrombolysis response.ResultsA total of 212 patients were included in the analysis, with a mean age of 66.3 ± 12.5 years. In total, 145 patients received rtPA, and 67 patients received urokinase. Patients were divided into a high hs-CRP group (> 1.60 mg/L) and a low hs-CRP group (≤ 1.60 mg/L) according to the median hs-CRP level (1.60 mg/L). The ΔNIHSS of the high hs-CRP group was significantly smaller than that of the low hs-CRP group (0 [-1 ~ 0] vs. -1 [-2 ~ 0], P < 0.05). The good rate of thrombolysis response in the high hs-CRP group was significantly lower than that in the low hs-CRP group (21.9% vs. 36.5%, P < 0.05). Similar results were shown in the rtPA subgroup between the high and low hs-CRP groups but not in the urokinase subgroup. Logistic regression analysis showed that hs-CRP > 1.60 mg/L was negatively correlated with a good thrombolysis response rate (OR = 0.496, 95% CI = 0.266–0.927, P = 0.028).Conclusionhs-CRP > 1.6 mg/L may serve as a poor prognosis predictive factor for patients with AIS receiving intravenous thrombolysis. However, due to the small sample size of this study, further studies are needed to verify our results.

Role of High-Sensitivity C-reactive Protein Levels in Predicting the Risk of Six-Month Event Rates in Patients With Chronic Stable Angina Undergoing Percutaneous Transluminal Coronary Angioplasty With a Drug-Eluting Stent.

Introduction This prospective observational study reports the association between baseline high-sensitivity C-reactive protein (hs-CRP) levels and adverse events at six months in patients who were diagnosed with symptomatic chronic stable angina and then underwent percutaneous transluminal coronary angioplasty (PTCA) with a drug-eluting stent (DES). Methods A total of 104 patients were examined with chronic stable angina over a period of six months. Before conducting percutaneous coronary intervention (PCI), the baseline levels of hs-CRP were measured, and based on the levels, the patients were grouped into high and low hs-CRP groups. Results The primary causes of death or the need for repeat revascularization or myocardial infarction or angina were concluded after assessing the patients for six months. A total of 104 patients were studied, amongwhich 72 (69.23%) had low hs-CRP and 32 (30.77%) had high hs-CRP levels. The number of males in this study was 68 (65.38%) and females were 36 (34.62%). The mean age of the patients was 55.26 ± 10.31 years. There were no significant differences among the groups in terms of gender, age, comorbidities, and risk factors except for certain predisposing factors like dyslipidemia and smoking. Moreover, we did not find any significant difference amongthe groups in the cause of death and myocardial infarction after a follow-up of six months. However, we observed a higher need for revascularization and angina outcomes in the group with high hs-CRP compared to low hs-CRP. Conclusion It can be concluded that a higher risk of angina and repeat revascularization is related to a high baseline hs-CRP but there is no evidence whether it is somehow linked to myocardial infarction and mortality or not.

Predictive value of high sensitivity C-reactive protein in three-vessel disease patients with and without type 2 diabetes

BackgroundDiabetes mellitus (DM) and atherosclerosis are multifactorial conditions and share a common inflammatory basis. Three-vessel disease (TVD) represents a major challenge for coronary intervention. Nonetheless, the predictive value of high-sensitivity C-reactive protein (hs-CRP) for TVD patients with or without type 2 DM remains unknown. Herein, we aimed to ascertain the long-term predictive value of hs-CRP in TVD patients according to type 2 DM status from a large cohort.MethodsA total of 2734 TVD patients with (n = 1040, 38%) and without (n = 1694, 62%) type 2 diabetes were stratified based on the hs-CRP (< 2 mg/L vs. ≥ 2 mg/L). Three multivariable analysis models were performed to evaluate the effect of potential confounders on the relationship between hs-CRP level and clinical outcomes. The Concordance index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to assess the added effect of hs-CRP and the baseline model with established risk factors on the discrimination of clinical outcomes. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE).ResultsThe median follow-up duration was 2.4 years. Multivariate Cox regression analyses showed that the incidence of MACCE (adjusted hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.01–1.35, p = 0.031) and all-cause death (HR 1.82, 95% CI 1.07–3.11, p = 0.026) were significantly higher in the diabetic group compared to the non-diabetic group. In the diabetic group, the incidence of MACCE (adjusted HR 1.51, 95% CI 1.09–2.10, p = 0.013) was significantly higher in the high hs-CRP group than in the low hs-CRP group; no significant difference was found for all-cause death (HR 1.63; 95% CI 0.58–4.58, p = 0.349). In the non-diabetic group, the prevalence of MACCE (adjusted HR 0.93, 95% CI 0.71–1.22, p = 0.613) was comparable between the two groups. Finally, the NRI (0.2074, p = 0.001) and IDI (0.0086, p = 0.003) for MACCE were also significantly increased after hs-CRP was added to the baseline model in the diabetic group.ConclusionsElevated hs-CRP is an independent prognostic factor for long-term outcomes of MACCE in TVD patients with type 2 diabetes but not in those without type 2 diabetes. Compared to traditional risk factors, hs-CRP improved the risk prediction of adverse cardiovascular events in TVD patients with type 2 diabetes.

Serum C-reactive protein levels are associated with clinical pregnancy rate after in vitro fertilization among normal-weight women.

To assess whether low-grade inflammation, measured by serum high-sensitivity C-reactive protein (hsCRP) levels, is associated with in vitro fertilization (IVF) outcomes. A retrospective study. University-affiliated IVF center. In the present study, 875 women of normal weight who underwent their first fresh embryo transfer (ET) cycles for IVF treatment were divided into three groups according to serum concentrations of hsCRP. Serum from women undergoing IVF was collected on days 2-4 of a spontaneous menstrual cycle prior to the commencement of ovarian stimulation. The IVF outcomes included implantation, biochemical pregnancy, clinical pregnancy, miscarriage and live birth rates. The women were divided into three groups according to the baseline serum levels of hsCRP as follows: low hsCRP (<1 mg/L; n=517), medium hsCRP (1-3 mg/L; n= 270), high hsCRP (>3 mg/L; n=88). The maternal age was similar among the three groups. The women in the high and medium hsCRP group had significantly higher BMI compared with those in the low hsCRP group. The protocol of controlled ovarian hyperstimulation, the gonadotropin dose administered, the serum estradiol levels, progesterone levels and the endometrial thickness on the day of triggering, as well as the number of retrieved oocytes, fertilized oocytes and good quality embryos, and the oocyte maturation rate were similar among the three groups. Implantation, biochemical pregnancy and clinical miscarriage rates did not differ significantly were not significantly different among three groups. The clinical pregnancy rate was significantly lower in the high hsCRP group compared with that in the low hsCRP group (50.0% versus 63.4%; P<0.0167), which contributed to a significant decrease in birth rate (39.8% versus 53.8%; P<0.0167). High serum hsCRP levels was found to be a factor affecting live birth rate. Among women of normal weight undergoing their first IVF treatment, it was found that low-grade inflammation was associated with reduced clinical pregnancy and live birth rates following fresh ET cycles.

ROLE OF HIGH- SENSITIVITY C REACTIVE PROTEIN (hs-CRP) IN ASSESSMENT OF ASTHMA CONTROL IN CHILDREN

Introduction: Data are scarce on hs-CRP as a biomarker for airway inflammation in pediatric asthma. We aimed to examine correlation between hs-CRP and asthma control levels. Methods: Children with physician- diagnosed asthma, ages 6 to 15 years, were enrolled. GINA-2016 criteria were used to assess the level of asthma control. The relationships between serum hs-CRP and each of asthma control measures (Asthma control criteria, spirometry, impulse oscillometry, eosinophil counts and Fractional exhaled nitric oxide (FeNO) were assessed. Results: 150 asthmatic children were enrolled; 52 (35%) had well controlled asthma, 76 (51%), and 22 (14%) children had partly controlled and uncontrolled asthma, respectively. Median (IQR) values of hs-CRP were 0.47 (0.1, 1.67) mg/L in well controlled, 0.30 (0.1, 1.83) mg/L in partly controlled, and 2.74 (0.55, 3.74) mg/L in uncontrolled asthma (p = 0.029). Using Receiver Operator Characteristic (ROC) curve analysis, area under curve for hs-CRP mg/L to discriminate between uncontrolled and (controlled + partly controlled) asthma was 0.67 (95% CI 0.55, 0.80) and a cutoff 1.1 mg/L of serum hs-CRP level had a sensitivity of 68.1% with specificity of 67.97%. In two groups of hs-CRP (< 3 mg/L) and hs-CRP (≥ 3 mg/L), high hs-CRP group had higher proportion of uncontrolled asthmatic children (p = 0.03). Conclusion: We observed higher serum hs-CRP values in children with uncontrolled asthma suggesting its potential role as a biomarker of asthma control.

Abstract 11923: High Sensitivity C-Reactive Protein is Associated With Vulnerable Characteristics in Coronary Plaques in Patients With Stable Coronary Disease

Introduction: Higher level of high sensitivity C-reactive protein (hsCRP) is associated with an increased risk of cardiovascular events in patients with coronary artery disease (CAD). However, the association between hsCRP and the characteristics of coronary plaques in patients with CAD remains to be elucidated. Hypothesis: Higher hsCRP is associated with a higher prevalence of vulnerable characteristics in coronary plaques in patients with CAD. Methods: A total of 793 consecutive patients with stable coronary disease (SCD), who underwent optical coherence tomography (OCT) imaging of coronary plaques were included. The characteristics of culprit or non-culprit plaque assessed by OCT were compared between the higher hsCRP group (hsCRP ≥ 0.2 mg/dL, n=247) and the lower hsCRP group (hsCRP &lt; 0.2 mg/dL, n=546). Results: In culprit plaques, the prevalence of thin-cap fibroatheroma (TCFA) was significantly higher in the higher hsCRP group than in the lower hsCRP group (23.8% vs. 14.9%, p=0.003) (Panel A). In non-culprit plaques, the prevalence of TCFA (28.6 vs. 18.2%, p=0.014) and plaque with marcophages (56.4 vs. 45.1%, p=0.029) was significantly higher in the higher hsCRP group than in the lower hsCRP group (Panel B). Conclusions: Higher level of hsCRP is associated with a higher prevalence of vulnerable characteristics in culprit and non-culprit plaques in patients with CAD. The present results may partly explain the pathogenesis of an increased incidence of ​recurrent cardiovascular events in patients with CAD.

Elevated HsCRP in Chronic Obstructive Pulmonary Disease: A Prospective Study of Long-Term Outcomes After Percutaneous Coronary Intervention.

ObjectiveAnti-inflammatory therapies are reported to have additional benefits beyond lipid control for patients with cardiovascular disease. However, no study has focused on the relationship between inflammation status and long-term outcomes for chronic obstructive pulmonary disease (COPD) patients, after percutaneous coronary intervention (PCI).Methods277 COPD-PCI patients were divided into two groups according to hsCRP status upon admission. Major adverse cardiac events (MACE) in high hsCRP patients were compared to patients with low hsCRP. Restricted cubic spline (RCS) analysis was performed using MACE hazard ratios (HR) to investigate interrelations with hsCRP, as a continuous variable.ResultsPatients in the high hsCRP group incurred more inflammation activation, in terms of higher white blood cell counts, neutrophil, lymphocytes, and had higher smoking rates, compared to those with lower hsCRPs. A significant increase in MACEs was observed in hsCRP high group, compared to the low hsCRP group (HR: 2.47, 95% CI: 1.22–5.00; p = 0.012). RCS curves suggest that HRs rise beyond 1.0, after the 0.24 juncture for Lg HsCRP (base 10 logarithm with hsCRP), HR per SD: 1.19 (95% CI: 0.96–1.48). Further subgroup analysis implies that elevated hsCRP is associated with a higher risk of MACEs across the sub-groups tested.ConclusionHsCRP could be a useful indicator for COPD-CAD patient prognosis, after PCI. This is because hsCRP highlights inflammation activation. More multi-center research, designed for COPD-CAD patients should be conducted to more accurately determine the cut-off value for hsCRP.

Synergistic effect of the commonest residual risk factors, remnant cholesterol, lipoprotein(a), and inflammation, on prognosis of statin-treated patients with chronic coronary syndrome

BackgroundCurrently, remnant cholesterol (RC), lipoprotein(a) [Lp(a)], and inflammation are considered the principal residual cardiovascular risk (RCVR) factors. This study sought to evaluate the combined impact of RC, Lp(a), and inflammation on prognosis of statin-treated patients with chronic coronary syndrome (CCS), which has not been investigated.MethodsA total of 6839 patients with CCS were consecutively enrolled. Baseline RC, Lp(a), and high-sensitivity C-reactive protein (hsCRP) concentrations were measured and their medians were used for categorizations. All patients were followed for the major adverse cardiovascular events (MACEs), including cardiovascular death, non-fatal myocardial infarction, and stroke. The individual and combined effects of RC, Lp(a), and hsCRP on MACEs were examined and stratification analysis according to low-density lipoprotein cholesterol (LDL-C) was performed.ResultsOver an average of 54.93 ± 18.59 months follow-up, 462 MACEs were recorded. Multivariate Cox analysis showed that elevated RC and Lp(a) levels were significantly associated with an increased risk of MACEs, while high hsCRP levels were related to a slightly but non-significantly increased MACEs risk. Moreover, when participants were subgrouped according to RC, Lp(a), and hsCRP levels together, only High RC-High Lp(a)-High hsCRP group had significantly higher risk of MACEs [hazard ratio (HR) 1.99, 95% confidence interval (CI) 1.15–3.47] compared with the reference group (Low RC-Low Lp(a)-Low hsCRP), especially in patients with LDL-C < 2.6 mmol/L.ConclusionsThe combination of elevated levels of RC, Lp(a), and hsCRP potentiated the adverse effect on MACEs among statin-treated patients with CCS, suggesting that multiple RCVR factors assessment may be a better strategy to improve stratification in very-high risk population.

High sensitivity C-reactive protein is associated with vulnerable characteristics in non-culprit plaques in patients with ST-segment elevation myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background Higher level of high sensitivity C-reactive protein (hsCRP) is associated with an increased risk of recurrent cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI). However, the association between hsCRP and the characteristics of non-culprit plaques in patients with STEMI remains to be elucidated. Purpose To clarify the morphological characteristics of non-culprit plaque in patients with STEMI according to the hsCRP levels using optical coherence tomography (OCT). Methods A total of 79 non-culprit plaques in 76 consecutive patients with STEMI, who underwent OCT imaging of the non-culprit plaques in a culprit vessel were included. The characteristics of non-culprit plaques assessed by OCT were compared between the higher hsCRP group (hsCRP ≥ 0.16 mg/dL, 38 plaques in 38 patients) and the lower hsCRP group (hsCRP &amp;lt; 0.16 mg/dL, 41 plaques in 38 patients). Results The prevalence of plaque with macrophage (63.2 vs. 31.7%, p = 0.006), plaque with large lipid (maximal lipid arc &amp;gt; 180 °) (57.9 vs. 31.7%, p = 0.018), healed plaque (50.0 vs. 26.8%, p = 0.045) and cholesterol crystal (18.4 vs. 2.4%, p = 0.045) was significantly higher in the higher hsCRP group than in the lower hsCRP group (Figure). In a multivariate analysis, the higher hsCRP was independently associated with the presence of plaque with macrophage (Odds ratio [OR], 3.031; 95% confidence interval [CI]: 1.112-8.264, p = 0.030), plaque with large lipid (OR, 2.897; 95% CI: 1.122-7.478, p = 0.026) and healed plaque (OR, 2.666; 95% CI: 1.030-6.896, p = 0.040). Conclusions Higher level of hsCRP is associated with a higher prevalence of vulnerable characteristics in non-culprit plaques in patients with STEMI. The present results may partly explain the pathogenesis of an increased incidence of recurrent cardiovascular events in patients with STEMI. Abstract Figure.

Relationship of Serial High-Sensitivity C-Reactive Protein Changes to Long-term Clinical Outcomes in Stabilised Patients After Myocardial Infarction.

Little is known about the association between serial high-sensitivity C-reactive protein (hsCRP) measurements and long-term outcomes in post-myocardial infarction (MI) patients. We aimed to investigate the usefulness of serial hsCRP measurements for risk stratification in stabilised post-MI patients after percutaneous coronary intervention (PCI). A total of 1018 patients who had hsCRP values at both baseline and 1 year after MI were included. High inflammatory status was defined as hsCRP > 2 mg/L. Patients were classified into 4 groups: persistently low, falling (first high then low hsCRP), rising (first low then high hsCRP), and persistently high hsCRP. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE: a composite of all-cause of death, MI, and cerebrovascular accident) within 4 years after the second hsCRP measurement. At 1 year after MI, the numbers of patients in the persistently low, falling, rising, and persistently high hsCRP groups were 394 (38.7%), 358 (35.2%), 69 (6.8%), and 197 (19.4%), respectively. The incidence of MACCE was progressively elevated from the persistently low to the falling, rising, and persistently high hsCRP groups (4.8%, 8.1%, 10.1%, and 13.2%, respectively; P= 0.004). Persistently high hsCRP was an independent predictor of MACCE (adjusted hazard ratio 2.55; 95% confidence interval 1.35-4.81; P= 0.004) and provided incremental prognostic value beyond that of the baseline clinical risk model (net reclassification improvement= 0.397; integrated discrimination improvement= 0.025; all P < 0.001). Among stabilised post-MI patients who underwent PCI, persistently high hsCRP was frequently seen 1 year after MI and was strongly associated with long-term adverse clinical outcomes. Serial measurements of hsCRP during clinical follow-up after MI may help to identify patients at higher risk for mortality and morbidity.

Abstract 12370: Prognostic Value of Inflammatory Markers in Recurrent Pericarditis

Background: Expert guidelines recommended the use of inflammatory markers for the confirmatory diagnosis of recurrent pericarditis (RP), however the prognostic role in management is unknown. Inflammatory marker levels in RP fluctuate, therefore measurement during flare is paramount. We attempt to assess the prognostic value of inflammatory markers (ESR, hs-CRP) taken during active flare in idiopathic/viral RP. Methods: We retrospectively reviewed 130 patients with established RP from 2015 to 2019 with inflammatory markers during flare. RP was diagnosed if two of these features were present; pleuritic chest pain, EKG changes, rub, and effusion. Active flare was defined as pleuritic chest pain with raised inflammatory markers. Clinical improvement (CI) and remission (CR) were assessed. CI was defined as symptom improvement on dual anti-inflammatory therapy. CR was established with symptom resolution and cessation of therapy. Results: Mean age was 46 ± 16, 57% were female, and a median number of recurrences was 3. The median follow-up time was 633 days, and median time to first recurrence was 263 days. Patients with lower hs-CRP &lt;10 mg/L were more likely to have CI as compared to the higher hs-CRP ≥10 mg/L group (79% vs 42%, p=0.012). Also, patients in the lower hs-CRP group showed a higher tendency to achieve CR (43% vs 20%, p = 0.081). ESR was statistically insignificant for the outcomes. The median time to CI in the low hs-CRP group was less compared to the high hs-CRP group (11 vs. 32 months). Majority of high hs-CRP patients did not achieve CR. The probability of CI and CR among low hs-CRP is higher as compared to high hs-CRP (log-rank p=0.001; log-rank p=0.034) [Figure 1]. Conclusion: Patients who had higher hs-CRP were less likely and required more time to achieve CI and CR as compared to patients with lower hs-CRP. This highlights the prognostic significance of hs-CRP that may assist management of RP even without a concurrent ESR level. Figure 1: Kaplan-Meier Analysis of CI and CR

Agreement between high-sensitivity C-reactive protein and C-reactive protein assays

Abstract Background High sensitivity C-reactive protein (hs-CRP) is a biomarker used for risk prediction for cardiovascular disease (CVD) by assessing low concentrations of inflammatory markers. Measurements of regular CRP assays have become very sensitive too with a detection limit of 0.03mg/dL, while also being more available and cheaper. The aim of this study is to compare the association between CRP and hs-CRP. Methods This study compared CRP and hs-CRP serum concentrations and data acquired by medical chart review of 590 patients from 11/2017 to 10/2018 of our cardiology outpatient clinic who were divided into hs-CRP and CRP risk groups for CVD events: low&amp;lt;0.1 mg/dL, average 0.1–0.3mg/dL, high&amp;gt;0.3mg/dL. The agreement of classification in hs-CRP and CRP risk groups was assessed by kappa statistic, with Kappa coefficient of &amp;lt;0.20, 0.21–0.40, 0.41–0.60, 0.61–0.80, 0.81–0.99 interpreted as slight, fair, moderate, substantial and almost perfect agreement, respectively. Bland-Altman (BA) analysis was used to assess agreement between hs-CRP and CRP by plotting the mean of the two measurements on the x-axis against the mean difference of CRP - hs-CRP on the y-axis. Results Out of all 590 patients, 37.7% were in low risk, 33.9% in average risk and 28.5% in high risk hs-CRP group. Some group changes occurred after reclassification of the patients according to CRP measurements. Eight percent of patients reclassified into a higher risk group, 0.7% into a lower risk group, while 91.4% remained in the same risk group as determined by hs-CRP (kappa: 0.87; p&amp;lt;0.001) (Tab. 1). Important to note, there was a 100% agreement between the high-risk CRP and hs-CRP group patient classification. BA-plot displayed a fixed bias with an average difference between the two laboratory tests for CRP and hs-CRP of 0.02 mg/dL±0.09SD with only sporadic outliers (Fig. 1). The upper limit of agreement was 0.12 and lower limit of agreement was −0.07. In the lower range of CRP values, measurements were tightly clustered around the average difference. Greater variability could be observed at higher serum level of the inflammatory biomarker in the BA-plot with a bias to higher CRP concentrations than hs-CRP concentrations at values greater than 0.5mg/dL. This proportional bias, which was further demonstrated by linear regression analysis, does not affect the risk predicting qualities of hs-CRP or CRP for CVD because the cut-off values for risk groups (0.1mg/dL for low risk, 0.3mg/dL for high risk) are all below this threshold. Conclusion A close agreement between measurements of hs-CRP and CRP assays was identified, therefore regular CRP assays could replace hs-CRP for cardiac risk assessment. Benefits for clinical implementation are: First, CRP assessment is routinely available in most laboratories compared to hs-CRP. Second, CRP is less costly than hs-CRP, since no further laboratory acquisitions are necessary, which is especially relevant in regions where cost efficiency is of importance. Funding Acknowledgement Type of funding sources: None. Table 1. Kappa statisticFigure 1. Bland-Altman plot

Association of triglyceride-glucose index and high-sensitivity C-reactive protein with asymptomatic intracranial arterial stenosis: A cross-sectional study

Background and aimsTriglyceride-glucose index (TyG) and high-sensitivity C-reactive protein (hsCRP) have been shown to play important roles in the pathophysiological mechanisms of atherogenesis. However, the cumulative value of TyG and hsCRP in identifying asymptomatic intracranial arterial stenosis (aICAS), as well as its severity and numerical burden, is uncertain. This study seeks to fill this knowledge gap. Methods and resultsThis study included 1938 participants aged ≥40 years who were free of stroke or transient ischemic attack. All participants were classified into four groups based on the participants’ TyG and hsCRP levels, including low-TyG and low-hsCRP, low-TyG and high-hsCRP, high-TyG and low-hsCRP, and high-TyG and high-hsCRP groups. The presence of aICAS was screened via transcranial Doppler ultrasound and confirmed by magnetic resonance angiography. The TyG was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. We used multinomial logistic regression analysis to investigate the cumulative value of TyG and hsCRP on identifying the severity of aICAS or its numerical burden. After adjustment for conventional confounders, isolated high-hsCRP, isolated high-TyG, and high-TyG combined with high-hsCRP were independently associated with moderate-to-severe aICAS. Compared with the low-TyG and low-hsCRP group, participants with high-TyG and high-hsCRP had a 2.6 times higher odds ratio (OR) of having a single moderate-to-severe aICAS and a 3.3 times higher OR of having multiple moderate-to-severe aICASs. ConclusionThe cumulative value of TyG and hsCRP may better identify moderate-to-severe aICAS as well as its numerical burden.

Relationship Between High-Sensitivity C-Reactive Protein and Long-Term Outcomes in Elderly Patients With 3-Vessel Disease.

The prognostic value of high-sensitivity C-reactive protein (hsCRP) in complex coronary artery disease has not been fully established. We aimed to determine the association between hsCRP and long-term outcomes in elderly patients with 3-vessel disease (TVD). From April 2004 to February 2011, 3069 patients aged ≥65 years with TVD were consecutively enrolled and received medical treatment alone, percutaneous coronary intervention, or coronary artery bypass grafting. The patients were divided into 2 groups according to their hsCRP levels: <3.00 mg/L (62.1%) and ≥3.00 mg/L (37.9%). The mean age was 71 ± 4 years. The high hsCRP group had more risk factors and more frequently received conservative treatment than the low hsCRP group. During a median follow-up period of 6.2 years, elevated hsCRP was significantly associated with increased all-cause death (19.5% vs 29.6%, P < .001), cardiac death (9.4% vs 15.2%, P = .001), and major adverse cardiovascular and cerebrovascular events (34.1% vs 42.5%, P = .001). Multivariable Cox regression analyses revealed that hsCRP was an independent predictor for all of these events. Combining hsCRP with Synergy between PCI with TAXUS and Cardiac Surgery score II further improved the predictive power of the score. The relationship between hsCRP and mortality was relatively consistent across subgroups. Overall, hsCRP could prove useful for risk prediction in elderly patients.

Long-term impact of high-sensitivity C-reactive protein in patients with intermittent claudication due to peripheral artery disease following endovascular treatment.

Little is known about the prognostic impact of high-sensitivity C-reactive protein (hs-CRP) levels on causes of death during long-term follow-up. We, therefore, investigated the associations between hs-CRP and clinical outcomes in the patients with intermittent claudication. Three hundred thirty-five consecutive patients (mean age, 72 ± 8years, 82% men) undergoing first intervention for de novo iliac and/or femoropopliteal artery lesions from 2009 to 2020 were studied. Patients were divided into 2 groups based on the optimal cutoff value of hs-CRP (> or ≤ 0.15mg/dL). The median follow-up duration was 3.6years (interquartile range, 1.0-6.2years). Although the cumulative incidence rate of major adverse cardiovascular limb events was not significantly different between the higher and lower hs-CRP groups (29.0 and 22.1%, respectively; log-rank test, p = 0.410), that of all-cause death was significantly higher in the higher hs-CRP group than in the lower hs-CRP group (18.7 vs. 5.8%, log-rank test, p = 0.007), even in cardiovascular-related death and malignancy-related death (log-rank test, p = 0.030 and 0.046, respectively). Higher hs-CRP levels at the time of intervention were significantly associated with higher frequency of all-cause death, even after adjusting for other risk factors (hazard ratio 2.79; 95% confidence interval 1.66-7.17, p = 0.024). In addition, malignancy-related death was most frequent as high as 60% (21/35 deaths), and elevated hs-CRP levels and the Brinkman index were strongly independent predictors of malignancy-related death. In conclusion, elevated hs-CRP levels were significantly associated with cardiovascular-related and malignancy-related deaths in patients with intermittent claudication. Furthermore, the result that cancer mortality exceeds cardiovascular mortality is different from previous reports, so the present findings warrant further investigation.

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in evaluation of inflammation in non-dialysis patients with end-stage renal disease (ESRD)

BackgroundNeutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been reported to be associated with inflammation in end-stage renal disease (ESRD) receiving dialysis. However, the value of NLR and PLR in non-dialysis patients with ESRD remains unclear.MethodsAmong 611 non-dialysis patients with ESRD in The First Affiliated Hospital of University of South China (2012–2018), we compared NLR and PLR in patients with high-sensitivity C-reactive protein (hs-CRP) levels of ≤3 mg/L vs. > 3 mg/L. Correlation of NLR and PLR to hs-CRP, PCT, ferritin were analyzed. Receiver operating characteristics (ROC) analysis was used for estimating sensitivity and specificity of NLR and PLR.ResultsNLR was higher in the patients with high hs-CRP levels (> 3 mg/L), compared to patients with low hs-CRP levels (≤ 3 mg/L) [5.74 (3.54–9.01) vs. 3.96 (2.86–5.85), p < 0.0001]. Additionally, PLR was higher in high hs-CRP group than in low group [175.28 (116.67–252.26) vs. 140.65 (110.51–235.17), p = 0.022]. In the current study, NLR and PLR were both positively correlated with hs-CRP (rs = 0.377, p = 0.000 for NLR; rs = 0.161, p = 0.001 for PLR), PCT, leukocytes, neutrophils, platelets, and age. NLR or PLR with a cut-off value of 5.07 or 163.80 indicated sensitivity and specificity were 65.67 and 66.37% (AUC = 0.69) or 57.21 and 57.52% (AUC = 0.55), respectively.ConclusionsNLR or PLR was positively correlated with hs-CRP in non-dialysis patients with ESRD. NLR might be better for identifying inflammation than PLR in this population.

Combination of Highly Sensitive C-Reactive Protein with R-ISS Is a Novel and Powerful Staging System in Multiple Myeloma

Introduction: Multiple myeloma (MM) is a hematological malignancy characterized by proliferation of abnormal plasma cells in bone marrow. Revised-International Staging System (R-ISS) is generally used as a predictor in newly diagnosed MM (NDMM) since 2015. R-ISS combines ISS with chromosomal abnormalities (CA) and serum lactate dehydrogenase (LDH). R-ISS I is defined as ISS I without high risk CA and normal LDH, R-ISS III is defined as ISS III with high risk CA or high level LDH, and R-ISS II includes all of the other possible combinations. Therefore, about 60% of NDMM are classified to R-ISS II. However, MM is a highly heterogeneous disease, so the clinical outcome of MM with R-ISS II also must be heterogeneous. Therefore, factors stratifying the majority of MM is needed. C-reactive protein (CRP) is a commonly used inflammatory marker. In particular, highly sensitive (hs) CRP detects lower concentration of CRP as compared with the conventional method, and has been reported to be associated with mortality of lung, breast, and renal cell cancers. In this study, we evaluated the predicting potential of hs-CRP in MM in the novel agent era to see if hs-CRP can develop the stratifying power of R-ISS. Materials and Methods: The retrospective study examined 80 patients with symptomatic NDMM who had been diagnosed at our institution between April 2006 and September 2019. Patients with infection and/or amyloidosis were excluded. Linkable anonymizing data, including age, gender, immunoglobulin type, symptoms, R-ISS, hs-CRP at diagnosis, time to next treatment (TNT) of the initial treatment, and overall survival (OS) were collected. The concentration of hs-CRP was measured by quantitative latex agglutination turbidimetric immunoassay. The lower detection limit of hs-CRP is 0.01 mg/dL, while that of conventional CRP was 0.10 mg/dL. We analyzed these data using the Kaplan-Meier method, Fisher's exact, multivariate cox proportional hazard models, and log-rank test. P-values ≤0.05 was considered to be statistically significant. This retrospective study was approved by institutional review board in University of Fukui, Japan (No. 20190101). Results: Among 80 patients, 39 (48.8%) were male. Median age at diagnosis was 71 years (range: 36-89 years). IgG, IgA, and BJP types were 56.8%, 25.9%, and 17.3%, respectively. Median follow-up was 29 months (range: 1-120 months). All of the patients were treated with bortezomib and/or lenalidomide-based regimens throughout their clinical courses. R-ISS I, II, and III were 7.3%, 76.4%, and 16.4%, and median OS in patients with R-ISS I, II, and III were unreached, 67, and 15 months, respectively (p&amp;lt;0.0001). Median hs-CRP was 0.10 mg/dL (range: 0.01-8.86 mg/dL), and the patients were divided into 2 groups according to median hs-CRP, consisting of low hs-CRP group (≤0.1 mg/dL, n=42) and high hs-CRP groups (&amp;gt;0.1 mg/dL, n=38). No significant difference in gender, age, immunoglobulin type was observed between 2 groups according to Fisher's exact test. The levels of hs-CRP appeared to be associated with the presence of bone lesions, not hypercalcemia, renal dysfunction, and anemia. There was not significant correlation between hs-CRP and TNT of the initial treatment, due to the variation of the used regimens. However, Kaplan-Meier curves showed that low hs-CRP group had significantly better OS than high hs-CRP group (64 months vs. 54 months, p=0.0116). Multivariate analysis indicated that both R-ISS (hazard ration (HR), 6.19) and hs-CRP (HR, 7.03) were independent prognostic factors for OS. Moreover, comparing the patients with R-ISS II divided by median hs-CRP, OS was significantly longer in R-ISS II with low hs-CRP than R-ISS II with high hs-CRP (median OS: 81 months vs. 54 months, p=0.0009) (Figure 1). Similarly, in the patients with R-ISS III, OS tended to be longer in low hs-CRP group than high hs-CRP group (median OS: 21 months vs. 5.5 months). All the patients with R-ISS I survived within the follow-up period. Conclusions: Hs-CRP enabled to detect 0.01-0.1 mg/dL, that is not measured by the conventional CRP method. The superiority of hs-CRP contributes to the role as a powerful predictor in MM. The novel staging system that combines hs-CRP and R-ISS may establish better understanding of prognosis in NDMM. Disclosures Yamauchi: Pfizer: Honoraria, Research Funding; Otsuka: Research Funding; Chugai: Honoraria; Abbie: Research Funding; Solasia Pharma: Research Funding; Daiichi Sankyo: Research Funding; Ono Pharmaceutical: Honoraria; Astellas: Research Funding.

Higher level of high sensitivity C-reactive protein is associated with more fibrocalcific plaque and longer lesion in patients with acute coronary syndrome

Abstract Background The association between the level of high sensitivity C-reactive protein (hsCRP) and coronary plaque characteristics in patients with acute coronary syndrome (ACS) remains to be elucidated. Purpose To clarify the morphological characteristics of culprit lesion in patients with ACS according to the hsCRP levels using optical coherence tomography (OCT). Methods A total of 215 consecutive patients with ACS, who underwent OCT imaging of culprit lesions were included. The patients were classified into either the higher hsCRP group (hsCRP ≥0.14 mg/dL, n=108) or the lower hsCRP group (hsCRP &amp;lt;0.14 mg/dL, n=107) according to the median preprocedural hsCRP level. The morphological characteristics of culprit lesion assessed by OCT were compared between the two groups. Results The higher hsCRP group had higher prevalence of insulin therapy (14 vs. 6%, p=0.037) and current smoker than the lower hsCRP group (37 vs. 18%, p=0.002). The prevalence of long lesion (≥25 mm, 67 vs. 53%, p=0.041) and fibrocalcific plaque (53 vs. 33%, p=0.003) was significantly higher in the higher hsCRP group than in the lower hsCRP group (Figure). On the other hand, the prevalence of plaque rupture (36 vs. 46%, p=0.174) and lipid-rich plaque (47 vs. 64%, p=0.011) was rather lower in the higher hsCRP group than in the lower hsCRP group (Figure). In a multivariate analysis, fibrocalcific plaque (odds ratio [OR]: 2.098, 95% confidence interval [CI]: 1.125–3.913, p=0.019), lesion length (mm, OR: 1.036, 95% CI: 1.010–1.061, p=0.004) and current smoker (OR: 2.757, 95% CI: 1.388–5.476, p=0.003) was independently associated with higher hsCRP level. Conclusions ACS patients with high hsCRP levels had more fibrocalcific plaque and longer lesion than those with low hsCRP levels. The association between high hsCRP levels and vulnerable characteristics of culprit plaque was not demonstrated. Funding Acknowledgement Type of funding source: None

Sex differences in the association between self-rated health and high-sensitivity C-reactive protein levels in Koreans: a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey

BackgroundNo studies have investigated the association between self-rated health (SRH) and high-sensitivity C-reactive protein (hs-CRP) levels in South Koreans. We explored this association and analyzed differences between sexes.MethodsUsing cross-sectional data from the 2015–2017 Korea National Health and Nutrition Examination Survey, we analyzed the association between SRH and high hs-CRP levels (> 1.0 mg/L) in 14,544 Koreans aged ≥ 19 years who responded to the SRH survey and had available hs-CRP test results. Differences in sociodemographic factors were analyzed using the Pearson’s chi-square test for categorical variables or the Mann–Whitney U test for continuous variables. Multiple logistic regression analysis was used to measure the association between hs-CRP levels and SRH according to sex while adjusting for other possible confounders.ResultsThe percentage of very poor to poor SRH was higher in the high hs-CRP group (22.4%) than in the low hs-CRP group (17.66%). Among men, the risk of a high hs-CRP level increased with worse SRH (adjusted for confounders; P for trend < 0.001). After adjusting for all confounders, including chronic diseases, men with very poor SRH showed a higher odds ratio (OR) for high hs-CRP levels than those with very good SRH (fully adjusted OR, 1.74; 95% CI, 1.04–2.90). Significant correlations were absent among women.ConclusionsPoor SRH was correlated with low-grade inflammation (high hs-CRP levels) among Korean male adults. These findings could be useful for developing health improvement programs and in goal setting at a national scale.