C-reactive protein and 90-day adverse clinical outcomes in acute myocarditis: a retrospective database analysis of patients requiring hospitalisation

Q: What are the key findings of this study?

In adults hospitalized with acute myocarditis, baseline CRP levels <10 mg/L were not associated with a difference in 90-day risk of death or tachyarrhythmias compared to CRP ≥10 mg/L (HR 0.96).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocarditis (n=3615). Intervention: Baseline C-reactive protein (CRP) <10 mg/L vs. Baseline CRP ≥10 mg/L. Primary outcome: 90-day composite of all-cause death and tachyarrhythmias (HR 0.96, 95% CI 0.78 to 1.19, p=0.735).

Q: What does this research mean for the field?

Baseline elevated C-reactive protein levels are not associated with increased 90-day risk of death or tachyarrhythmias in adults hospitalized with acute myocarditis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate whether initial C-reactive protein levels measured at presentation are associated with 90-day adverse clinical outcomes in adults hospitalized with acute myocarditis.

Antonio Abbate; Simone Filomia; Michele Golino; Sofia Morini; Ludovico Luca Sicignano; Maria Lucia Narducci; Tommaso Sanna; Antonio Abbate; Marco Giuseppe Del Buono

doi:10.1136/openhrt-2026-004028

July 1, 2026Open HeartOpen Access

C-reactive protein and 90-day adverse clinical outcomes in acute myocarditis: a retrospective database analysis of patients requiring hospitalisation

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Key result

Baseline CRP <10 mg/L shows no difference in 90-day death or tachyarrhythmias in acute myocarditis.

HR 0.96
95% CI 0.78 to 1.19
P=0.735
n=3,615

Figures

Why the study?

The prognostic value of C-reactive protein in acute myocarditis remains uncertain due to heterogeneous populations, variable thresholds, and differing outcome definitions.

Does elevated baseline CRP (≥10 mg/L) predict a 90-day composite of all-cause death and tachyarrhythmias in adults hospitalized with acute myocarditis?

Key Points

To evaluate whether initial C-reactive protein levels measured at presentation are associated with 90-day adverse clinical outcomes in adults hospitalized with acute myocarditis.
Analyzed data from the TriNetX Research Network for 3615 adults hospitalized with acute myocarditis between 2005 and 2025, stratified by presentation CRP <10 mg/L (n=1001) versus ≥10 mg/L (n=2614).
Performed 1:1 propensity score matching based on age, sex, and race, resulting in two balanced cohorts of 997 patients each.
Tracked a 90-day primary composite endpoint of all-cause mortality and tachyarrhythmias (atrial fibrillation, ventricular tachycardia, ventricular fibrillation, or torsades de pointes).
In the unmatched cohort, the 90-day primary composite outcome occurred in 16.4% (164 of 1001) of patients with CRP <10 mg/L compared with 14.0% (365 of 2614) with CRP ≥10 mg/L (HR 1.17, 95% CI 0.98 to 1.41; log-rank p=0.087).
After propensity score matching, 90-day primary composite outcome rates were 16.4% (164 of 997) in the CRP <10 mg/L group and 16.9% (168 of 997) in the CRP ≥10 mg/L group (HR 0.96, 95% CI 0.78 to 1.19; log-rank p=0.735).
Matched secondary endpoints revealed no significant differences for all-cause death (2.9% [29 of 997] vs 3.6% [36 of 997]; HR 0.80, 95% CI 0.49 to 1.30; log-rank p=0.369) or tachyarrhythmias (14.1% [141 of 997] vs 13.9% [139 of 997]; HR 1.00, 95% CI 0.79 to 1.27; log-rank p=0.970).

Study Design

Type

Cohort (n=3,615)

Multicenter

Yes

Structured PICO

Does elevated baseline CRP (≥10 mg/L) predict a 90-day composite of all-cause death and tachyarrhythmias in adults hospitalized with acute myocarditis?

P

Population

3,615 adults hospitalized with acute myocarditis, free of sepsis, evaluated for baseline C-reactive protein levels and followed for 90 days.

E

Exposure

Baseline C-reactive protein (CRP) ≥10 mg/L measured within 3 days of index myocarditis diagnosis

C

Comparator

Baseline C-reactive protein (CRP) <10 mg/L

O

Outcome

90-day composite of all-cause death and tachyarrhythmias (atrial fibrillation, ventricular tachycardia, ventricular fibrillation or torsades de pointes)composite

Main Result

Hazard Ratio: 0.96 (95% CI 0.78–1.19)

Absolute Event Rate: 16.4% vs 16.9%

p-value: p=0.735

A single baseline CRP measurement at presentation is not consistently associated with 90-day adverse outcomes in adults hospitalized with acute myocarditis and has limited value for risk stratification.

Limitations

Retrospective design introduces selection bias and misclassification.
Identification relied on ICD-10-CM codes without biopsy or advanced imaging confirmation.
Residual confounding from unmeasured covariates despite propensity score matching.
Methodological variability in CRP measurements across sites.
Ascertainment of clinical outcomes limited by the use of administrative data.
Retrospective design introduces selection bias, misclassification, and incomplete capture of clinical information.
Identification relied on ICD-10-CM codes lacking diagnostic accuracy of endomyocardial biopsy or advanced imaging.
Methodological variability in CRP assays across sites and reliance on a single baseline value.
Ascertainment of clinical outcomes limited by administrative data lacking clinical granularity.

Implication

Baseline CRP does not predict 90-day outcomes in acute myocarditis; leaves open whether serial measures or other markers aid stratification.

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.

Discussion

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Cite This Study

Abbate et al. (2026) conducted a cohort in Acute myocarditis (n=3,615). Baseline C-reactive protein (CRP) <10 mg/L vs. Baseline CRP ≥10 mg/L was evaluated on 90-day composite of all-cause death and tachyarrhythmias (HR 0.96, 95% CI 0.78 to 1.19, p=0.735). In adults hospitalized with acute myocarditis, baseline CRP levels <10 mg/L were not associated with a difference in 90-day risk of death or tachyarrhythmias compared to CRP ≥10 mg/L (HR 0.96).

synapsesocial.com/papers/6a534ff4985393734a594c91 https://doi.org/10.1136/openhrt-2026-004028

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C-reactive protein and 90-day adverse clinical outcomes in acute myocarditis: a retrospective database analysis of patients requiring hospitalisation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

C-reactive protein and 90-day adverse clinical outcomes in acute myocarditis: a retrospective database analysis of patients requiring hospitalisation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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