High-sensitivity C-reactive protein in chronic heart failure: Patient characteristics, phenotypes, and mode of death

Pellicori, Pierpaolo; Zhang, Jufen; Cuthbert, Joe; Urbinati, Alessia; Shah, Parin; Kazmi, Syed; Clark, Andrew L.; Cleland, John G.F.

Abstract

Aims: Plasma concentrations of high-sensitivity C-reactive protein (hsCRP) are often raised in chronic heart failure (CHF) and might indicate inflammatory processes that could be a therapeutic target. We aimed to study the associations between hsCRP, mode and cause of death in patients with CHF. Methods and results: We enrolled 4423 patients referred to a heart failure clinic serving a local population. CHF was defined as relevant symptoms or signs with either a reduced left ventricular ejection fraction <40% or raised plasma concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP >125 pg/mL). The median [interquartile range (IQR)] plasma hsCRP for patients diagnosed with CHF (n = 3756) was 3.9 (1.6-8.5) mg/L and 2.7 (1.3-5.1) mg/L for those who were not (n = 667; P < 0.001). Patients with hsCRP ≥10 mg/L (N = 809; 22%) were older and more congested than those with hsCRP <2 mg/L (N = 1117, 30%). During a median follow-up of 53 (IQR 28-93) months, 1784 (48%) patients with CHF died. Higher plasma hsCRP was associated with greater mortality, independent of age, symptom severity, creatinine, and NT-proBNP. Comparing a hsCRP ≥10 mg/L to <2 mg/L, the hazard ratio for all-cause mortality was 2.49 (95% confidence interval 2.19-2.84; P < 0.001), for cardiovascular (CV) mortality was 2.26 (1.91-2.68; P < 0.001), and for non-CV mortality was 2.96 (2.40-3.65; P < 0.001). Conclusion: In patients with CHF, a raised plasma hsCRP is associated with more congestion and a worse prognosis. The proportion of deaths that are non-CV also increases with higher hsCRP.

Citation

Pellicori, P., Zhang, J., Cuthbert, J., Urbinati, A., Shah, P., Kazmi, S., Clark, A. L., & Cleland, J. G. (2020). High-sensitivity C-reactive protein in chronic heart failure: Patient characteristics, phenotypes, and mode of death. Cardiovascular research, 116(1), 91-100. https://doi.org/10.1093/cvr/cvz198

• Journal Article Type: Article
• Acceptance Date: Jul 9, 2019
• Online Publication Date: Jul 26, 2019
• Publication Date: Jan 1, 2020
• Deposit Date: Jul 23, 2019
• Publicly Available Date: Jul 27, 2020
• Journal: Cardiovascular Research
• Print ISSN: 0008-6363
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 116
• Issue: 1
• Pages: 91-100
• DOI: https://doi.org/10.1093/cvr/cvz198
• Keywords: Heart failure; CRP; Inflammation; Mortality; Prognosis
• Public URL: https://hull-repository.worktribe.com/output/2224958
• Publisher URL: https://academic.oup.com/cardiovascres/advance-article/doi/10.1093/cvr/cvz198/5539697
• Contract Date: Jul 23, 2019