IJCS | Volume 32, Nº2, March/April 2019

120 Table 2 - Statistical association of risk variables with in-hospital mortality Variable Median (IQR) or n (%) p value Survived (n = 98) Died (n = 20) Age (in years) 59 (17) 73 (22.75) 0.003506 1 Male gender 69 (70.4%) 12 (60%) 0.5158 2 Diabetes 32 (32.65%) 8 (40%) 0.7089 2 Smoking habit 40 (40.81%) 5 (25%) 0.2826 2 Drinking habit 26 (26.53%) 3 (15%) 0.4199 2 Any reperfusion therapy* 61 (62.24%) 8 (40%) 0.1116 2 Hypertension 57 (58.16%) 10 (50%) 0.6716 2 hs-CRP (mg/dl) 2.13 (5.66) 10.47 (23.99) 0.001 1 BMI 26.9 (6.51) 25.5 (6.2) 0.5592 1 1. Data analyzed by non-parametric Mann-Whitney U test. 2. Data analyzed using the chi-square test. * Thrombolytic therapy or primary angioplasty. IQR: Interquartile range; hs-CRP: high-sensitivity C-reactive protein; BMI: body mass index. Milano et al. C-reactive protein as a predictor of mortality Int J Cardiovasc Sci. 2019;32(2)118-124 Original Article for categorical variables (frequency/percentage). Our data followed a non-normal distribution. Continuous variables were analyzed by non-parametric Mann- Whitney U test, whereas categorical variables were analyzed using the chi-square test. Also, predictive factors were identified using binary logistic regression analysis after adjusting for age and hs-CRP. Multivariate analysis was performed expressing odds ratio per one unit increase in independent continuous variables. Ap-value of < 0.05was considered statistically significant. The institutional review committee on human research approved the study protocol. Results We studied 118 patients admitted with STEMI identified at first admission to the emergency department or the coronary care unit. Of the 118 patients, 98 survived (median 59 years [IQR 17]; M:F=69:29) and 20 died (median 73 years [IQR 22.75]; M:F=12:8) during hospitalization. Clinical characteristics, hs-CRP levels at admission and use of reperfusion therapy of patients categorized by group, according to occurrence of in-hospital death, are shown in table 2. There were no significant differences regarding reperfusion therapy between patients who died and those who survived. Body mass index did not significantly differ between the two groups. The prevalence of diabetes was higher in patients who died (40%) comparing with those who survived (32.65%), but the difference was not significant between the groups (p = 0.7089). Smoking and drinking habits were not statistically associated with in-hospital death. Regarding sex distribution, the proportion of females was 40% among those who died and 29.6% among survivors. This difference was not statistically significant (p = 0.51). Systemic arterial hypertension had no influence on in- hospital mortality in this group of patients with infarction even on univariate analysis. In univariate analyses, we observed (Figure 1) significantly higher levels (p = 0.001) of hs-CRP in patients who died (median 10.47 [IQR 23.99]) compared to those who survived (median 2.13 [IQR 5.66]). Therefore, in patients with STEMI, an increase in the hs-CRP level at admission is associated with a poorer short-termprognosis andmay represent an independent factor for death in the hospital. A clear association between age and in-hospital death was also observed. Median age was significantly higher (p = 0.003) in patients who died (median 73 [IQR 22.75]) than in those who survived (median 59 [IQR 17]). Multiple logistic regression analysis was performed to evaluate the independent contribution of hs-CRP levels to the risk of death. By binary logistic regression analysis (Figure 2), in-hospital deathwas associatedwith higher concentration of hs-CRP (odds ratio = 1.15 per unit increase; p = 0.0017) and older age (odds ratio = 1.066 per one year increment; p = 0.003). Therefore, a one unit increase in hs-CRP increased the risk of death by 15%, after adjustment for established risk factors. Similarly, a one year increase in age increased the risk of death by around 6.6% in patients with same hs-CRP levels. Discussion Our results demonstrated an important relationship between hs‑CRP level on admission and in-hospital mortality after STEMI. The present study showed a mortality rate after AMI of 16.9%, which is similar with those reported in previous studies (3.2-20.6%). 11,12