Objective

Chronic inflammation is associated with major adverse cardiovascular events (MACEs), mortality, and frailty. Our aim was to add high-sensitivity C-reactive protein (hsCRP) to the frailty assessment to predict its association with prognosis of older adults with cardiovascular disease (CVD).

Methods

A comprehensive geriatric assessment was conducted at baseline in 720 in-patients aged ≥65 years with CVD. We divided the population into frailty and non-frailty groups according to the Fried phenotype, and hsCRP was further combined with frailty to stratify all patients into c-frailty and non-c-frailty groups. Predictive validity was tested using Cox proportional hazards regression model analysis and the discriminative ability was evaluated by receiver operating characteristic (ROC) curves.

Results

Of all the subjects enrolled, 51.0% were male and the mean age was 75.32 ± 6.52 years. The all-cause death and MACE rate was 6.4% at the 1-year follow-up. Frailty and c-frailty were independent predictors of all-cause death and MACE (hazard ratio [HR]: 2.55, 95% confidence interval [CI]: 1.35–4.83, p = 0.004; HR: 3.67, 95% CI: 1.83–7.39, p < 0.001). Adding hsCRP to the frailty model resulted in a significant increase in the area under the ROC curve from 0.74 (95% CI: 0.70–0.77) to 0.77 (95% CI: 0.71–0.84) (p = 0.0132) and a net reclassification index of 7.9% (95% CI: 1.96%–12.56%, p = 0.012).

Conclusion

Adding hsCRP to the frailty assessment is helpful to identify a subgroup of older CVD patients with a higher risk of death and MACE over a period of 1 year.

Trial registration: ChiCTR1800017204; date of registration: 07/18/2018. URL: http://www.chictr.org.cn/showproj.aspx?proj=28931.

中文翻译：

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在衰弱评估中添加高敏感性C反应蛋白，以预测老年心血管疾病患者的死亡率和心血管事件

目的

慢性炎症与主要不良心血管事件（MACE），死亡率和体弱相关。我们的目标是在脆弱性评估中​​添加高敏C反应蛋白（hsCRP），以预测其与老年人心血管疾病（CVD）预后的关系。

方法

在基线时对720名≥65岁的CVD住院患者进行了全面的老年医学评估。我们根据弗里德表型将人群分为虚弱和非虚弱人群，并将hsCRP与虚弱进一步结合，以将所有患者分为c虚弱和非c虚弱人群。使用Cox比例风险回归模型分析测试了预测效度，并通过接收者工作特征（ROC）曲线评估了判别能力。

结果

在所有受试者中，男性占51.0％，平均年龄为75.32±6.52岁。在1年的随访中，全因死亡和MACE率为6.4％。衰弱和c衰弱是全因死亡和MACE的独立预测因子（危险比[HR]：2.55，95％置信区间[CI]：1.35-4.83，p = 0.004； HR：3.67，95％CI：1.83– 7.39，p <0.001）。在脆弱模型中添加hsCRP会使ROC曲线下的面积从0.74（95％CI：0.70–0.77）显着增加到0.77（95％CI：0.71-0.84）（p = 0.0132）和净重分类指数7.9％（95％CI：1.96％–12.56％，p = 0.012）。

结论

在脆弱评估中添加hsCRP有助于确定在1年内具有较高死亡和MACE风险的老年CVD患者亚组。

试用注册： ChiCTR1800017204；注册日期：2018年7月18日。网址：http：//www.chictr.org.cn/showproj.aspx？proj = 28931。