Association between high-sensitivity C-reactive protein and bleeding in non-ST-segment elevation acute coronary syndrome: A multicentre cohort of Chinese population

Abstract Background The association between high-sensitivity C-reactive protein (hs-CRP) and bleeding risk in acute coronary syndrome (ACS) patients remains unclear. This study aimed to examine the association between bleeding events and different hs-CRP levels in patients with non-ST elevation ACS (NSTE-ACS). Methods This study retrospectively included 2583 adults with NSTE-ACS between January 1, 2010, and December 31, 2014, at 5 medical centres in China. The primary outcome was major bleeding, defined by the Bleeding Academic Research Consortium definition (grades 3–5). Results Fifty-three (2.1%) patients experienced major bleeding in the hospital. Patients with hs-CRP levels greater than 8.20 mg/L had the highest incidence of in-hospital major bleeding (25 (3.9%), P < 0.001) compared with the other groups. Multivariable analysis indicated that hs-CRP was an independent factor associated with in-hospital major bleeding (continuous: adjusted OR = 1.01, 95% CI: 1.01–1.02, P < 0.001; quartiles: adjusted OR for quartile 4 (referring to quartile 1) = 3.71, 95% CI: 1.35 ~ 10.23, P = 0.011), which was further confirmed by subgroup analysis and receiver operating characteristic curves. The restricted cubic spline analysis demonstrated an S-shaped association between hs-CRP and major bleeding. During the 5-year follow-up, there was a significantly high risk of bleeding in patients with higher hs-CRP levels. Conclusion Higher hs-CRP level at admission in NSTE-ACS patients is associated with high risk of in-hospital major bleeding. An S-shaped association was found between hs-CRP and bleeding events. Further studies are warranted to optimize antithrombotic drug therapy in high-bleeding risk patients during follow-up.