title: High-sensitivity C-reactive protein in acute heart failure: insights from the ASCEND-HF trial.
abstract: BACKGROUND
  Inflammation is associated with progression of chronic heart failure (HF). Few data exist on high-sensitivity C-reactive protein (hsCRP) levels and their importance in acute HF.
  
  
  RESULTS
  In this biomarker substudy of the ASCEND-HF trial, we measured hsCRP levels at admission (n = 794), 48-72 hours (n = 677), and 30 days (n = 581) and evaluated their association with outcomes. Levels of hsCRP were considerably elevated at admission (median 12.6 mg/L, interquartile range [IQR] 5.23-30.5) and 48-72 hours (median 11.0 mg/L, IQR 4.87-29.9) and declined only at 30 days (median 4.7 mg/L, IQR 1.83-13.1). Admission hsCRP was not associated with dyspnea improvement at 6 hours (74.1%) and 24 hours (86.2%), in-hospital death or worsening HF (n = 37; 4.7%), 30-day mortality or HF readmission (death: n = 25 [3.2%]; combined death and HF readmission: n = 95 [12.0%]), or 180-day mortality (n = 96; 12.1%). Hospital stay (median 5 days, IQR 3-7) was longer among patients with higher admission hsCRP levels (0.57 days per log2-hsCRP in adjusted models; 95% confidence interval [CI] 0.33-0.81; P < .001). Levels of hsCRP at 48-72 hours did not predict 30-day mortality or HF readmission and were only marginally associated with 180-day mortality. However, higher hsCRP at 30 days among survivors was associated with higher 180-day mortality in models including admission hsCRP (adjusted hazard ratio [HR] per log2-hsCRP: 1.23; 95% CI 1.04-1.45; P = .016). Patients with an hsCRP increase at day 30, defined as >10% increase over baseline value, had higher 180-day mortality risk compared with those with unchanged or decreased 30-day hsCRP (HR 2.29, 95% CI 1.16-4.52; P = .017).
  
  
  CONCLUSIONS
  Levels of hsCRP are elevated among patients with acute HF. Increasing levels at 30 days after discharge are associated with higher 180-day mortality.
authors: Division of Cardiology, Emory University, Atlanta, Georgia.
authors: Andreas P
authors: AP
authors: Kalogeropoulos
authors: Cleveland Clinic, Cleveland, Ohio.
authors: W H Wilson
authors: WH
authors: Tang
authors: Cleveland Clinic, Cleveland, Ohio.
authors: Amy
authors: A
authors: Hsu
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors: G Michael
authors: GM
authors: Felker
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors: Adrian F
authors: AF
authors: Hernandez
authors: University of Otago, Christchurch, New Zealand.
authors: Richard W
authors: RW
authors: Troughton
authors: University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Adriaan A
authors: AA
authors: Voors
authors: Department of Cardiology, Charité Universitätsmedizin, Berlin, Germany.
authors: Stefan D
authors: SD
authors: Anker
authors: Department of Cardiology, University of Brescia, Brescia, Italy.
authors: Marco
authors: M
authors: Metra
authors: Western Infirmary, University of Glasgow, Glasgow, Scotland.
authors: John J V
authors: JJ
authors: McMurray
authors: San Francisco Veterans Affairs Hospital, University of California, San Francisco, California.
authors: Barry M
authors: BM
authors: Massie
authors: University of Alberta, Edmonton, Canada.
authors: Justin A
authors: JA
authors: Ezekowitz
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors: Robert M
authors: RM
authors: Califf
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors: Christopher M
authors: CM
authors: O'Connor
authors: Cleveland Clinic, Cleveland, Ohio.
authors: Randall C
authors: RC
authors: Starling
authors: Division of Cardiology, Emory University, Atlanta, Georgia. Electronic address: javed.butler@emory.edu.
authors: Javed
authors: J
authors: Butler
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein
keywords: C-Reactive protein; acute heart failure; biomarkers; outcomes