{
  "abstract": "Background C-reactive protein (CRP) is commonly used to assess systemic inflammation, yet its prognostic value in acute myocarditis remains uncertain. Evidence is limited by heterogeneous populations, variable CRP thresholds and differing outcome definitions. We therefore aimed to evaluate whether CRP levels measured at presentation are associated with 90-day clinical outcomes in adults hospitalised with acute myocarditis.Methods Using the TriNetX Research Network, we identified 3615 adults hospitalised with acute myocarditis between 2005 and 2025. Patients were stratified according to baseline CRP <10 mg/L (n=1001) vs ≥10 mg/L (n=2614). Propensity score matching (1:1) was performed using age, sex and race. The primary outcome was a 90-day composite of all-cause death and tachyarrhythmias (atrial fibrillation, ventricular tachycardia, ventricular fibrillation or torsades de pointes). Secondary outcomes included the individual components.Results In the unmatched cohort, patients with CRP <10 mg/L had a numerically higher 90-day incidence of the primary composite outcome compared with those with CRP ≥10 mg/L (16.4% vs 14.0%; log-rank p=0.087; HR 1.17, 95% CI 0.98 to 1.41), driven by a borderline higher incidence of tachyarrhythmias (14.1% vs 11.7%; log-rank p=0.059; HR 1.21, 95% CI 0.99 to 1.48), while all-cause mortality was similar between groups. After propensity score matching, the 90-day incidence of the primary composite outcome was virtually identical in the CRP <10 mg/L and CRP ≥10 mg/L groups (16.4% vs 16.9%; log-rank p=0.735; HR 0.96, 95% CI 0.78 to 1.19). Individual endpoints (tachyarrhythmias and all-cause mortality) were also similar, with no statistically significant differences.Conclusion In this large dataset analysis, elevated baseline CRP was frequent in patients with acute myocarditis and was not consistently associated with 90-day adverse outcomes. A single CRP measurement at presentation appears to have limited value for risk stratification in this setting.",
  "authors": [
    {
      "affiliations": [
        "University of Virginia, Charlottesville, Virginia, USA"
      ],
      "name": "Michele Marchetta"
    },
    {
      "affiliations": [
        "Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy"
      ],
      "name": "Simone Filomia"
    },
    {
      "affiliations": [
        "University of Florida College of Medicine, Jacksonville, Florida, USA",
        "Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA"
      ],
      "name": "Michele Golino"
    },
    {
      "affiliations": [
        "Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy"
      ],
      "name": "Sofia Morini"
    },
    {
      "affiliations": [
        "Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy"
      ],
      "name": "Ludovico Luca Sicignano"
    },
    {
      "affiliations": [
        "Policlinico Universitario Agostino Gemelli, Roma, Italy"
      ],
      "name": "Maria Lucia Narducci"
    },
    {
      "affiliations": [
        "Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy"
      ],
      "name": "Tommaso Sanna"
    },
    {
      "affiliations": [
        "Robert M Berne Cardiovascular Research Center and Department of Medicine, University of Virginia, Charlottesville, Virginia, USA"
      ],
      "name": "Antonio Abbate"
    },
    {
      "affiliations": [
        "Catholic University of the Sacred Heart, Rome, Italy"
      ],
      "name": "Marco Giuseppe Del Buono"
    }
  ],
  "title": "C-reactive protein and 90-day adverse clinical outcomes in acute myocarditis: a retrospective database analysis of patients requiring hospitalisation",
  "uid": "4b6ef508-1d50-5d49-aa1d-0edcfebf83d5"
}