Prognostic value of serial C-reactive protein measurements in left-sided native valve endocarditis.
BACKGROUND
The clinical course of left-sided native valve infective endocarditis varies from uncomplicated disease to fulminant infection. Although several factors are known to affect clinical outcome, it is difficult to predict morbidity and mortality in individual patients. The objective of this study was to determine the value of serial C-reactive protein (CRP) measurements as a predictor of clinical outcome.


METHODS
One hundred twenty-three consecutive patients who fulfilled the Duke criteria for definite left-sided native valve infective endocarditis were prospectively enrolled. Poor outcome was defined as serious infectious complications or death. Patients were followed up for 12 weeks after the end of antimicrobial therapy. Multivariate analysis was used to examine the relative importance of the CRP level as a predictor of poor outcome after adjusting for age, abscess, multivalvular involvement, and Staphylococcus aureus infection.


RESULTS
After 1 week of therapy, the adjusted odds ratio for poor outcome was 10.3 (95% confidence interval, 2.2-49.4) for patients with CRP levels in the highest tertile (>122 mg/L [to convert to nanomoles per liter, multiply by 9.524]) vs the lowest tertile (1-69 mg/L). A low percentage decline during the first week of treatment was statistically significantly associated with a higher risk of poor outcome (logistic regression coefficient, 1.1; P = .009). At no point in time did CRP level predict the need for cardiac surgery.


CONCLUSIONS
High CRP level after 1 week of treatment and a slow percentage decline in CRP level during the first week of treatment are indicators of poor clinical outcome.
Verhagen
Dominique W M
DW
Division of Infectious Diseases, Tropical Medicine, and AIDS, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, F4-217, 1105 AZ Amsterdam, the Netherlands.
Hermanides
Jeroen
J
Korevaar
Joke C
JC
Bossuyt
Patrick M M
PM
van den Brink
Renee B A
RB
Speelman
Peter
P
van der Meer
Jan T M
JT
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis*; D004697:Endocarditis, Bacterial / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D005260:Female; D006349:Heart Valve Diseases / Q000097:blood* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D015415:Biomarkers; D002097:C-Reactive Protein