{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:01:08Z","timestamp":1793210468611,"version":"4.5.0"},"reference-count":19,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,5,30]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the TriNetX Research Network, we identified 3615 adults hospitalised with acute myocarditis between 2005 and 2025. Patients were stratified according to baseline CRP &lt;10\u2009mg\/L (n=1001) vs \u226510\u2009mg\/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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the unmatched cohort, patients with CRP &lt;10\u2009mg\/L had a numerically higher 90-day incidence of the primary composite outcome compared with those with CRP \u226510\u2009mg\/L (16.4% vs 14.0%; log-rank p=0.087; HR 1.17, 95%\u2009CI 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%\u2009CI 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 &lt;10\u2009mg\/L and CRP \u226510\u2009mg\/L groups (16.4% vs 16.9%; log-rank p=0.735; HR 0.96, 95%\u2009CI 0.78 to 1.19). Individual endpoints (tachyarrhythmias and all-cause mortality) were also similar, with no statistically significant differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004028","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:05:36Z","timestamp":1783595136000},"page":"e004028","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["C-reactive protein and 90-day adverse clinical outcomes in acute myocarditis: a retrospective database analysis of patients requiring hospitalisation"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1835-6128","authenticated-orcid":false,"given":"Michele","family":"Marchetta","sequence":"first","affiliation":[{"name":"University of Virginia, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Filomia","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0141-0127","authenticated-orcid":false,"given":"Michele","family":"Golino","sequence":"additional","affiliation":[{"name":"University of Florida College of Medicine, Jacksonville, Florida, USA"},{"name":"Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Morini","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovico Luca","family":"Sicignano","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Orthopedics and Rheumatology, Universit\u00e0 Cattolica del Sacro Cuore, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8682-0322","authenticated-orcid":false,"given":"Maria Lucia","family":"Narducci","sequence":"additional","affiliation":[{"name":"Policlinico Universitario Agostino Gemelli, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Sanna","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Abbate","sequence":"additional","affiliation":[{"name":"Robert M Berne Cardiovascular Research Center and Department of Medicine, University of Virginia, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco Giuseppe","family":"Del Buono","sequence":"additional","affiliation":[{"name":"Catholic University of the Sacred Heart, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"2026091603500774000_13.2.e004028.1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.3371"},{"key":"2026091603500774000_13.2.e004028.2","doi-asserted-by":"crossref","unstructured":"Marchetta M , Weber BN , Gasperetti A , et al . Myocarditis and look-alikes: when the diagnosis matters. Heart 2026. doi:10.1136\/heartjnl-2025-326381","DOI":"10.1136\/heartjnl-2025-326381"},{"key":"2026091603500774000_13.2.e004028.3","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.118.035319"},{"key":"2026091603500774000_13.2.e004028.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.04.063"},{"key":"2026091603500774000_13.2.e004028.5","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000093381.57779.67"},{"key":"2026091603500774000_13.2.e004028.6","doi-asserted-by":"crossref","first-page":"3952","DOI":"10.1093\/eurheartj\/ehaf192","article-title":"2025 ESC Guidelines for the management of myocarditis and pericarditis","volume":"46","author":"Schulz-Menger","year":"2025","journal-title":"Eur Heart J"},{"key":"2026091603500774000_13.2.e004028.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2024.131901"},{"key":"2026091603500774000_13.2.e004028.8","article-title":"C-reactive Protein (CRP) in Patients With Myocarditis: A Systematic Review and Meta-Analysis","volume":"16","author":"Ghulam","year":"2024","journal-title":"Cureus"},{"key":"2026091603500774000_13.2.e004028.9","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-82592-8","article-title":"Increased C reactive protein, cardiac troponin I and GLS are associated with myocardial inflammation in patients with non-ischemic heart failure","volume":"11","author":"Schwuchow-Thonke","year":"2021","journal-title":"Sci Rep"},{"key":"2026091603500774000_13.2.e004028.10","doi-asserted-by":"publisher","DOI":"10.1536\/jhj.41.41"},{"key":"2026091603500774000_13.2.e004028.11","doi-asserted-by":"crossref","DOI":"10.3390\/jcm11237068","article-title":"A Machine-Learning Model for the Prognostic Role of C-Reactive Protein in Myocarditis","volume":"11","author":"Baritussio","year":"2022","journal-title":"J Clin Med"},{"key":"2026091603500774000_13.2.e004028.12","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.649939"},{"key":"2026091603500774000_13.2.e004028.13","doi-asserted-by":"crossref","unstructured":"Mensah GA , Arnold N , Prabhu SD , et al . Inflammation and Cardiovascular Disease: 2025 ACC Scientific Statement: A Report of the American College of Cardiology. J Am Coll Cardiol Published Online September 2025;07555\u20132. doi:10.1016\/j.jacc.2025.08.047","DOI":"10.1016\/j.jacc.2025.08.047"},{"key":"2026091603500774000_13.2.e004028.14","first-page":"391","article-title":"ACC Expert Consensus Decision Pathway on Strategies and Criteria for the Diagnosis and Management of Myocarditis: A Report of the American College of Cardiology Solution Set Oversight Committee","volume":"85","author":"Committee","year":"2024","journal-title":"J Am Coll Cardiol"},{"key":"2026091603500774000_13.2.e004028.15","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1161\/CIRCRESAHA.124.324674","article-title":"Clinical Characteristics and Mechanisms of Acute Myocarditis","volume":"135","author":"Heymans","year":"2024","journal-title":"Circ Res"},{"key":"2026091603500774000_13.2.e004028.16","doi-asserted-by":"publisher","DOI":"10.1002\/art.25042"},{"key":"2026091603500774000_13.2.e004028.17","doi-asserted-by":"crossref","first-page":"102998","DOI":"10.1016\/j.jaut.2023.102998","article-title":"Conformational state of C-reactive protein is critical for reducing immune complex-triggered type I interferon response: Implications for pathogenic mechanisms in autoimmune diseases imprinted by type I interferon gene dysregulation","volume":"135","author":"Svanberg","year":"2023","journal-title":"J Autoimmun"},{"key":"2026091603500774000_13.2.e004028.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2024.11.003"},{"key":"2026091603500774000_13.2.e004028.19","doi-asserted-by":"crossref","first-page":"24","DOI":"10.71079\/ASIDE.IM.03222516","article-title":"TriNetX and Real-World Evidence: A Critical Review of Its Strengths, Limitations, and Bias Considerations in Clinical Research","volume":"1","author":"Nassar","year":"2025","journal-title":"ASIDE Int Med"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2026-004028","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:50:13Z","timestamp":1789555813000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2026-004028"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":19,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,7,9]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/openhrt-2026-004028"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2026-004028","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}