[Correlation between dynamic changes of C-reactive protein during hospitalization and adverse prognosis in acute aortic intramural hematoma].

Objective

To investigate the correlation between dynamic changes of C-reactive protein (CRP) during hospitalization and adverse outcomes in patients with acute uncomplicated Stanford type B aortic intramural hematoma (IMH).

Methods

This was a single-center retrospective cohort study that consecutively enrolled patients diagnosed with acute uncomplicated Stanford type B IMH at the General Hospital of Northern Theater Command from January 2020 to November 2025. Based on the median value of the difference between the last and first CRP measurements during hospitalization (defined as ΔCRP), patients were divided into a low-change group (ΔCRP<-0.65 mg/L) and a high-change group (ΔCRP≥-0.65 mg/L). The primary endpoint was aortic-related adverse events (ARAE) within 12 months, defined as a composite of aortic-related death, progression to penetrating aortic ulcer (PAU) or aortic dissection, and rapid progression of IMH (marked hematoma thickening, progressive aortic dilation, signs of rupture, or uncontrollable clinical symptoms). Kaplan-Meier method was used to plot survival curves. Cox proportional hazards regression models were used to analyze the association between ΔCRP and ARAE, and subgroup analyses were performed stratified by sex (male, female), age (≥60 years,<60 years), body mass index (≥24 kg/m²,<24 kg/m²), smoking (yes, no), drinking (yes, no), hypertension (yes, no), and ulcer-like projection (yes, no).

Results

A total of 212 patients were enrolled, aged (64.3±9.1) years, and 66.0% (140/212) were male. The low-change and high-change groups each included 106 patients. The initial CRP level was significantly higher in the low-change group than in the high-change group (14.6 (5.2, 59.2) mg/L vs. 2.6 (1.8, 16.7) mg/L, P<0.001). Follow-up at 12 months was completed in 164 patients (77.4%), among whom 68 cases (41.5%) experienced ARAE. At the 12-month follow-up, the incidence of ARAE was significantly higher in the high-change group than in the low-change group (48.8% (42/86) vs. 33.3% (26/78), P=0.044), and the Kaplan-Meier survival analysis yielded consistent results (Plog-rank=0.022). Multivariable Cox proportional hazards regression analysis showed that ΔCRP was an independent associated factor for ARAE (HR=1.54, 95%CI 1.25-1.90, P<0.001). Subgroup analyses demonstrated that in subgroups of age≥60 years, body mass index≥24 kg/m², with smoking history, and with hypertension, the high-change group was significantly associated with an increased risk of ARAE (all P<0.05).

Conclusions

A non-significant decrease or an increase in CRP during hospitalization is an independent associated factor for ARAE in patients with acute uncomplicated Stanford type B IMH. Dynamic CRP monitoring facilitates early identification of high-risk patients and provides a simple and effective tool for clinical risk stratification.