Key result
Elevated cumulative hsCRP linked to ~138% higher mortality among patients hospitalized for acute heart failure.
Why the study?
Elevated hsCRP is associated with worse prognosis in patients hospitalized for heart failure, but the prognostic value of long-term cumulative hsCRP remains unknown.
Cohort (n=1,281)
Hazard Ratio: 2.38 (95% CI 1.75–3.23)
May support serial hsCRP for risk stratification in acute HF; leaves open whether targeting inflammation improves outcomes.
Background Elevated hsCRP (high-sensitivity C-reactive protein) level is associated with worse prognosis among patients hospitalized for heart failure. However, the prognostic value of the long-term cumulative hsCRP remains unknown. Methods and Results We consecutively enrolled patients hospitalized for heart failure and collected their hsCRP data at admission and 1 and 12 months after discharge. Long-term cumulative hsCRP was evaluated using 2 approaches, cumulative hsCRP level quartiles and cumulative times of high hsCRP levels. Patients were classified into 4 groups by cumulative hsCRP level quartiles and cumulative times of high hsCRP levels (0- to 3-times: number of times that hsCRP levels were higher than cutoff values at admission or 1 or 12 months), respectively. Multivariable Cox models were used to assess the association of mortality with cumulative hsCRP. A total of 1281 patients were included; the median age was 64 (interquartile range, 54-73) years, and 35.4% were women. Over a 4.8-year (interquartile range, 4.2-5.1) follow-up, 374 (29.2%) patients died. Elevated long-term cumulative hsCRP level was related to higher mortality. Specifically, taking the quartile 1 as the reference, the hazard ratios (HRs) were 1.29 (95% CI, 0.92-1.81) for quartile 2, 1.62 (95% CI, 1.16-2.25) for quartile 3, and 2.38 (95% CI, 1.75-3.23) for quartile 4. Similarly, compared with the patients with 0-times (hsCRP level lower than the cutoff values in all 3 time points) of high hsCRP level, the HRs were 1.36 for 1-time (hsCRP level higher than the cutoff value in one of the 3 time points) (95% CI, 0.92-2.01), 1.95 for 2-times (hsCRP levels higher than the cutoff values in 2 of the 3 time points) (95% CI, 1.34-2.82), and 2.80 for 3-times (hsCRP levels higher than the cutoff values in the 3 time points) (95% CI, 1.97-4.00). Conclusions Increasing long-term cumulative hsCRP level was associated with worse outcomes in patients hospitalized for acute heart failure. Repeated hsCRP measurements could assist physicians in identifying patients with a high risk of death. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02878811.
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Zhang et al. (2023) conducted a cohort in Acute Heart Failure (n=1,281). Elevated long-term cumulative hsCRP vs. Lowest quartile of cumulative hsCRP was evaluated on Mortality (HR 2.38, 95% CI 1.75-3.23). Elevated long-term cumulative hsCRP levels (quartile 4 vs 1) were associated with higher mortality among patients hospitalized for acute heart failure (HR 2.38; 95% CI 1.75-3.23).
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