title: Higher C-reactive protein predicts worse prognosis in acute heart failure only in noninfected patients.
abstract: BACKGROUND
  The prognostic role of C-reactive protein (CRP) in acute heart failure (HF) is not fully understood, and the impact of an infectious process in its risk-stratification power was not previously evaluated.
  
  
  OBJECTIVE
  As CRP is an inflammatory marker, its prognostic value in acute HF is probably different in patients with and without concurrent infection.
  
  
  METHODS
  We recruited patients admitted to our hospital due to acute HF from October 2006 to October 2007. All patients were given treatment at the discretion of the attending physician. Serum CRP was measured at discharge in 225 patients. We followed patients for 3 months after discharge to assess occurrence of all-cause death or readmission due to HF. Infection was defined according to diagnoses registered on the discharge record. Patients were classified according to CRP tertiles, in the entire sample and in groups according to infection occurrence.
  
  
  RESULTS
  : An infectious condition occurred in 109 patients (first and second CRP tertiles: 8.8 and 27.4 mg/L, respectively). No infection was detected in 116 patients (5.0 and 12.3 mg/L, respectively). In the group with infection, CRP was not a good predictor of adverse outcome. In the noninfected group, the hazard ratio of those with CRP > 12.3 mg/L was 2.46 (95% confidence interval: 1.29-4.70) in comparison with those with lower CRP. Adjusted hazard ratio for ischemic heart disease and diabetes was 2.03 (95% confidence interval: 1.06-3.91).
  
  
  CONCLUSIONS
  CRP had no prognostic value in acute HF patients with an infectious complication. Noninfected patients with higher CRP at discharge had worse prognosis.
authors.affiliation: Internal Medicine Department, Faculty of Medicine of Porto University, Porto, Portugal. pamlourenco@yahoo.com
authors.forename: Patrícia
authors.initials: P
authors.lastname: Lourenço
authors.forename: José
authors.initials: J
authors.lastname: Paulo Araújo
authors.forename: Cristiana
authors.initials: C
authors.lastname: Paulo
authors.forename: Joana
authors.initials: J
authors.lastname: Mascarenhas
authors.forename: Fernando
authors.initials: F
authors.lastname: Friões
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D016009:Chi-Square Distribution; D003141:Communicable Diseases / Q000150:complications / Q000276:immunology* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000276:immunology* / Q000401:mortality; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission; D011174:Portugal; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D002097:C-Reactive Protein