title: Relationship of high-sensitivity C-reactive protein to prognosis and other prognostic markers in outpatients with heart failure.
abstract: BACKGROUND
  Inflammatory markers are increased in chronic heart failure (CHF), including high-sensitivity C-reactive protein (hsCRP), but there is little information on its relationship to prognosis or other prognostic markers. We aimed to investigate the relationship between hsCRP and prognosis in patients with CHF and left ventricular systolic dysfunction (LVSD).
  
  
  METHODS
  Patients with CHF and LVSD (n = 957), but without infection or inflammatory disease, were identified. Patients had their medical history taken, underwent physical examination, had electrocardiographic and echocardiographic assessment, and had a 6-minute corridor walk test (6MWT) and blood tests, including hsCRP and N-terminal pro-B natriuretic peptide (NT-pro-BNP).
  
  
  RESULTS
  Patients with worse New York Heart Association class (P = .02), shorter 6-minute corridor walk test distance (P < .001), higher NT-pro-BNP levels (P < .001), anemia (P < .001), and renal dysfunction (P < .001), but not lower LV ejection fraction, had higher plasma concentrations of hsCRP. Patients with a CRP of >11.0 pg/mL had a hazard ratio for death of 3.0 compared with those with a CRP of <2.8 pg/mL (P < .001). Of 402 patients who had a second sample taken for hsCRP at 1 year, 46% showed a substantial change from baseline levels. Marked increases in hsCRP were associated with a fall in hemoglobin level. NT-pro-BNP was noted to be a more accurate prognostic marker than hsCRP (area under the curve of 0.74 compared with 0.67 for hsCRP, P < .05).
  
  
  CONCLUSIONS
  Patients with CHF and LVSD have increased serum concentrations of hsCRP that are related to functional limitation and prognosis but not to the severity of LV ejection fraction.
authors.affiliation: Academic Cardiology Department, University of Hull, Hull Royal Infirmary Castle Hill Hospital, Hull, United Kingdom. jonwindram@hotmail.com
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Windram
authors.forename: Puan H
authors.initials: PH
authors.lastname: Loh
authors.forename: Alan S
authors.initials: AS
authors.lastname: Rigby
authors.forename: Ian
authors.initials: I
authors.lastname: Hanning
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000378:metabolism*; D006801:Humans; D008297:Male; D010045:Outpatients / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein