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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.


Pierpaolo Pellicori

Jufen Zhang

Alessia Urbinati

Parin Shah

Syed Kazmi

Andrew L. Clark

John G.F. Cleland


Pierpaolo Pellicori
Contact Person

Jufen Zhang

Joe Cuthbert

Alessia Urbinati

Parin Shah

Syed Kazmi

Andrew L Clark

John GF Cleland


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.


Pellicori, P., Zhang, J., Cuthbert, J., Urbinati, A., Shah, P., Kazmi, S., …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.

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
Electronic ISSN 1755-3245
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 116
Issue 1
Pages 91-100
Keywords Heart failure; CRP; Inflammation; Mortality; Prognosis
Public URL
Publisher URL


Accepted manuscript (344 Kb)

Copyright Statement
©2019 University of Hull

This is a pre-copyedited, author-produced version of an article accepted for publication in Cardiovascular Research following peer review. The version of record Pierpaolo Pellicori, Jufen Zhang, Joe Cuthbert, Alessia Urbinati, Parin Shah, Syed Kazmi, Andrew L Clark, John G F Cleland, High-sensitivity C-reactive protein in chronic heart failure: patient characteristics, phenotypes, and mode of death, Cardiovascular Research, , cvz198 is available online at:

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