title: Value of high-sensitivity C-reactive protein assays in predicting atrial fibrillation recurrence: a systematic review and meta-analysis.
abstract: OBJECTIVE
  We performed a systematic review and meta-analysis of studies on high-sensitivity C-reactive protein (hs-CRP) assays to see whether these tests are predictive of atrial fibrillation (AF) recurrence after cardioversion.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  PubMed, EMBASE and Cochrane databases as well as a hand search of the reference lists in the retrieved articles from inception to December 2013.
  
  
  METHODS
  This review selected observational studies in which the measurements of serum CRP were used to predict AF recurrence. An hs-CRP assay was defined as any CRP test capable of measuring serum CRP to below 0.6 mg/dL.
  
  
  METHODS
  We summarised test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves and bivariate random effects models. Meta-regression analysis was performed to explore the source of heterogeneity.
  
  
  RESULTS
  We included nine qualifying studies comprising a total of 347 patients with AF recurrence and 335 controls. A CRP level higher than the optimal cut-off point was an independent predictor of AF recurrence after cardioversion (summary adjusted OR: 3.33; 95% CI 2.10 to 5.28). The estimated pooled sensitivity and specificity for hs-CRP was 71.0% (95% CI 63% to 78%) and 72.0% (61% to 81%), respectively. Most studies used a CRP cut-off point of 1.9 mg/L to predict long-term AF recurrence (77% sensitivity, 65% specificity), and 3 mg/L to predict short-term AF recurrence (73% sensitivity, 71% specificity).
  
  
  CONCLUSIONS
  hs-CRP assays are moderately accurate in predicting AF recurrence after successful cardioversion.
authors.affiliation: Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Yo
authors.forename: Si-Huei
authors.initials: SH
authors.lastname: Lee
authors.forename: Shy-Shin
authors.initials: SS
authors.lastname: Chang
authors.forename: Matthew Chien-Hung
authors.initials: MC
authors.lastname: Lee
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Lee
mesh_terms: D001281:Atrial Fibrillation / Q000097:blood* / Q000628:therapy; D002097:C-Reactive Protein / Q000378:metabolism*; D004554:Electric Countershock; D006801:Humans; D011237:Predictive Value of Tests; D012008:Recurrence
chemical_list: D002097:C-Reactive Protein
keywords: C - reactive protein; cardioversion; meta-analysis