Relationship between plasma C-reactive protein concentration on admission and long-term outcome in unselected hospitalized heart failure patients

Berry, C., Hogg, K., Stevenson, K., Norrie, J. and McMurray, J. (2004) Relationship between plasma C-reactive protein concentration on admission and long-term outcome in unselected hospitalized heart failure patients. Journal of the American College of Cardiology, 43(5), A229. (doi:10.1016/s0735-1097(04)90976-x)

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Abstract

Background: Although systemic inflammation is recognised in heart failure (HF) its importance in relation to outcome is uncertain. Plasma c-reactive protein (pCRP) concentration is typically elevated in inflammatory conditions and is recognised as a marker of systemic inflammation.

Methods: We studied all index emergency admissions with HF to one University hospital (which provides exclusive acute medical care to the local urban district) during the year 2000. Echocardiography was undertaken by a single operator. Reduced LVSF was defined as an ejection fraction of <40%. Hematological and biochemical data (from the initial blood samples taken on the day of admission) were obtained from hospital electronic records. Information on death was obtained from the national record linkage database for all patients.

Results: 528 consecutive first admissions with HF were identified. The median follow-up was 693 days (range 1 - 978 days). Median (interquartile range) pCRP concentration was 16 (5, 183) mg/L, and 65% of patients had an elevated (> 10 mg/L) pCRP concentration. 45% and 35% of patients had a pCRP concentration greater than 20 and 30 mg/L, respectively. Univariate predictors of an elevated pCRP concentration included hemoglobin, hematocrit, white cell count (WCC), platelet count, serum creatinine concentration and plasma fibrinogen, sodium and albumin concentrations. On multivariate analysis, predictors (odds ratio, 95% CI) of pCRP concentration included WCC (1.9 [1.4, 2.9]), fibrinogen count (1.9 [1.3, 2.6]), and albumin (0.7 [0.5, 0.9]). pCRP concentration was an independent predictor of in-hospital survival (Cox proportional hazard ratio (HR) 0.2 per SD (61 mg/L); 95% CI 0.1,0.6, P=0.001), and long-term mortality (CRP per SD, HR 1.4; 95% CI 1.2 -1.7; P <0.001 ).

Conclusion: Systemic inflammation, indicated by an elevated pCRP concentration, is very common in hospitalized HF patients, and predicts long-term adverse outcome. That CRP is an independent predictor of mortality suggests that this protein may have harmful effects.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Norrie, Prof John and McMurray, Professor John
Authors: Berry, C., Hogg, K., Stevenson, K., Norrie, J., and McMurray, J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:Journal of the American College of Cardiology
Publisher:Elsevier Inc.
ISSN:0735-1097
ISSN (Online):1558-3597

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