Independent prognostic value of elevated high-sensitivity C-reactive protein in chronic heart failure.
BACKGROUND
The serum concentration of C-reactive protein (CRP) is mildly elevated in patients with chronic congestive heart failure (CHF), but this level falls well within the range found in healthy subjects. Standard clinical assays for CRP lack sensitivity within the low reference range and thus cannot be used effectively for routine clinical risk prediction. Because assays for high-sensitivity CRP (hsCRP) are now available, we can measure hsCRP to determine its predictive value for the prognosis of patients with CHF.


METHODS
Serum levels of hsCRP in 108 patients with CHF and left ventricular ejection fraction (LVEF) <50% were examined. Major adverse cardiac events (death, heart transplantation, or hospitalization with worsening heart failure) during a median follow-up period of 403 days were determined.


RESULTS
The concentrations of hsCRP in this study population were significantly increased with the severity of CHF. In a multivariate analysis, LVEF and serum levels of hsCRP were independent significant predictors for adverse outcomes in these patients (hazard ratio, 3.714, P =.024, and hazard ratio, 2.584, P =.047, respectively). However, hsCRP was minimally correlated with LVEF (r = -0.167, P =.084). Further analysis indicated that hsCRP might identify a different high-risk group and could improve risk stratification beyond that of LVEF.


CONCLUSIONS
These findings suggest that an elevated level of hsCRP is an independent predictor of prognosis in CHF and can provide additional prognostic information for the risk stratification and treatment in patients with chronic CHF.
Yin
Wei-Hsian
WH
Division of Cardiology, Taipei, Taiwan.
Chen
Jaw-Wen
JW
Jen
Hsu-Lung
HL
Chiang
Meng-Cheng
MC
Huang
Wen-Pin
WP
Feng
An-Ning
AN
Young
Mason Shing
MS
Lin
Shing-Jong
SJ
D000368:Aged; D000704:Analysis of Variance; D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D013318:Stroke Volume; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein