Diagnostic Performance of Circulating Cardiac, Inflammatory, and Metabolic Biomarkers in Iraqi Patients with Congestive Heart Failure

Q: What are the key findings of this study?

Patients with congestive heart failure had significantly higher serum CRP (22.40 vs 5.68 mg/dL, P<0.001) and lower NT-proBNP (1.244 vs 19.704 pg/mL, P<0.001) than healthy controls.

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Congestive Heart Failure (n=100). Intervention: Congestive heart failure (assessed via circulating biomarkers: CRP, NT-proBNP, hs-cTnI, ET-1, IL-6, and insulin) vs. Apparently healthy controls. Primary outcome: Serum C-reactive protein (CRP) concentration (mg/dL) (p=<0.001).

Q: What does this research mean for the field?

Patients with congestive heart failure exhibit significantly elevated serum C-reactive protein levels but paradoxically lower NT-proBNP concentrations compared to healthy controls. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

Q: What question did this study set out to answer?

To assess circulating cardiac, inflammatory, endothelial, and metabolic biomarker profiles in Iraqi patients diagnosed with congestive heart failure compared to healthy controls.

ندى عبد المجيد صالح; Nada Abdulmajeed Salih; MARWAN AL-SAMARRAIE

doi:10.54153/sjpas.2026.v8i3/1.1640

October 31, 2026Samarra Journal of Pure and Applied ScienceOpen Access

Diagnostic Performance of Circulating Cardiac, Inflammatory, and Metabolic Biomarkers in Iraqi Patients with Congestive Heart Failure

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Key result

Congestive heart failure is linked to ~4-fold higher serum CRP levels compared to healthy controls.

P<0.001
n=100

Why the study?

Congestive heart failure is a multifactorial syndrome involving neurohormonal activation, myocardial injury, inflammation, endothelial dysfunction, and metabolic disturbances, motivating an evaluation of cardiac, inflammatory, endothelial, and metabolic biomarkers in Iraqi patients.

Do circulating levels of cardiac, inflammatory, endothelial, and metabolic biomarkers (NT-proBNP, hs-cTnI, CRP, IL-6, ET-1, and insulin) differentiate patients with congestive heart failure from healthy controls in an Iraqi cohort?

Key Points

To assess circulating cardiac, inflammatory, endothelial, and metabolic biomarker profiles in Iraqi patients diagnosed with congestive heart failure compared to healthy controls.
Hospital-based case-control study conducted in Iraq including 100 participants: 70 patients with clinically diagnosed congestive heart failure and 30 healthy controls.
Measured serum NT-proBNP, high-sensitivity cardiac troponin I (hs-cTnI), endothelin-1 (ET-1), interleukin-6 (IL-6), and insulin by ELISA, and serum C-reactive protein (CRP) using an automated analyzer.
Serum CRP was significantly higher in heart failure patients than in healthy controls (22.40 ± 12.20 vs. 5.68 ± 3.10 mg/dL, P < 0.001).
Serum NT-proBNP was significantly lower in heart failure patients compared to controls (1.244 ± 0.321 vs. 19.704 ± 3.48 pg/mL, P < 0.001), and hs-cTnI was 8.17 ± 1.93 vs. 11.11 ± 3.94 ng/L, while ET-1 (6.04 ± 2.18 vs. 6.59 ± 2.68 pg/mL, P = 0.33), IL-6 (4.52 ± 1.85 vs. 5.03 ± 1.89 pg/mL, P > 0.05), and insulin (3.90 ± 1.23 vs. 4.74 ± 1.46 mU/L, P = 0.574) showed no significant differences.
NT-proBNP correlated positively with hs-cTnI (r = 0.471, P < 0.001), insulin (r = 0.406, P < 0.001), and ET-1 (r = 0.286, P = 0.016), while CRP correlated positively with IL-6 (r = 0.374, P = 0.001).

Study Design

Type

Case-Control (n=100)

Multicenter

No

Structured PICO

Do circulating levels of cardiac, inflammatory, endothelial, and metabolic biomarkers (NT-proBNP, hs-cTnI, CRP, IL-6, ET-1, and insulin) differentiate patients with congestive heart failure from healthy controls in an Iraqi cohort?

P

Population

100 Iraqi adults (70 with clinically confirmed congestive heart failure and 30 healthy controls, mean age ~61 years, 36% female), free of acute myocardial infarction or active infection.

E

Exposure

Measurement of circulating cardiac, inflammatory, endothelial, and metabolic biomarkers in serum: NT-proBNP, high-sensitivity cardiac troponin I (hs-cTnI), endothelin-1 (ET-1), interleukin-6 (IL-6), insulin (via ELISA), and C-reactive protein (CRP, via automated analyzer).

C

Comparator

30 apparently healthy individuals without a history of cardiovascular disease or chronic inflammatory disorders.

O

Outcome

Discriminatory ability of circulating cardiac (NT-proBNP, hs-cTnI), inflammatory (CRP, IL-6), endothelial (ET-1), and metabolic (insulin) biomarkers to differentiate patients with CHF from apparently healthy controls.surrogate

Main Result

Absolute Event Rate: 22.4% vs 5.68%

p-value: p=<0.001

Limitations

Exclusion of ROC curve analysis limited the evaluation of the discriminatory and diagnostic performance of the biomarkers
Relatively limited sample size (N=100)
Restricted number of biochemical parameters evaluated
Potential confounding from patients' ongoing heart failure treatments and 3-month frozen sample storage prior to analysis
Exclusion of ROC curve analysis, which limited the evaluation of the discriminatory and diagnostic performance of the studied biochemical markers
Relatively limited sample size
Serum samples were stored for approximately three months before analysis, and pre-analytical or methodological factors (such as treatment status, late processing, assay calibration, dilution errors, or unit conversion errors) may have influenced the unexpectedly low NT-proBNP and hs-cTnI levels

Implication

In this case-control study of Iraqi patients with congestive heart failure, CRP was significantly elevated compared to healthy controls, whereas NT-proBNP and hs-cTnI were unexpectedly lower, highlighting the potential influence of medical therapy and pre-analytical laboratory factors on biomarker interpretation.

Abstract

يُعد فشل القلب الاحتقاني (CHF) متلازمة متعددة العوامل ترتبط بتنشيط الجهاز العصبي الهرموني، وأذية عضلة القلب، والالتهاب، واختلال وظيفة بطانة الأوعية الدموية، والاضطرابات الأيضية. هدفت هذه الدراسة المستشفوية من نوع الحالات والشواهد إلى تقييم مجموعة من المؤشرات الحيوية القلبية والالتهابية والبطانية والأيضية لدى المرضى العراقيين المصابين بفشل القلب الاحتقاني. شملت الدراسة 100 مشارك، بواقع 70 مريضًا مشخصين سريريًا بفشل القلب الاحتقاني و30 من الأفراد الأصحاء ظاهريًا كمجموعة ضابطة. تم قياس تراكيز NT-proBNP والتروبونين القلبي I عالي الحساسية (hs-cTnI) والإندوثيلين-1 (ET-1) والإنترلوكين-6 (IL-6) والإنسولين في مصل الدم باستخدام أطقم المقايسة المناعية المرتبطة بالإنزيم (ELISA)، في حين تم قياس البروتين المتفاعل C (CRP) باستخدام محلل مناعي كيميائي آلي (Elecsys 2010، Roche Diagnostics، Mannheim، Germany). أظهرت تراكيز CRP ارتفاعًا معنويًا في مرضى فشل القلب الاحتقاني مقارنةً بالمجموعة الضابطة (22.40 ± 12.20 مقابل 5.68 ± 3.10 ملغم/ديسيلتر، P < 0.001)، في حين كانت تراكيز NT-proBNP أقل معنويًا لدى مرضى فشل القلب الاحتقاني (1.244 ± 0.321 مقابل 19.704 ± 3.48 بيكوغرام/مل، P < 0.001). كما كانت تراكيز hs-cTnI أقل لدى مرضى فشل القلب الاحتقاني مقارنةً بالمجموعة الضابطة (8.17 ± 1.93 مقابل 11.11 ± 3.94 نانوغرام/لتر)، بينما بلغت تراكيز الإنسولين 3.90 ± 1.23 و4.74 ± 1.46 ملي وحدة/لتر لدى مرضى فشل القلب الاحتقاني والمجموعة الضابطة، على التوالي. ولم تُظهر تراكيز ET-1 فرقًا معنويًا بين مرضى فشل القلب الاحتقاني والمجموعة الضابطة (6.04 ± 2.18 مقابل 6.59 ± 2.68 بيكوغرام/مل، P = 0.33)، كما لم تختلف مستويات IL-6 معنويًا بين المجموعتين (4.52 ± 1.85 مقابل 5.03 ± 1.89 بيكوغرام/مل، P > 0.05). وأظهر NT-proBNP ارتباطات موجبة معنوية مع hs-cTnI (r = 0.471، P < 0.001) وET-1 (r = 0.286، P = 0.016) والإنسولين (r = 0.406، P < 0.001)، في حين ارتبط CRP ارتباطًا موجبًا مع IL-6 (r = 0.374، P = 0.001). وبصورة عامة، أظهرت النتائج وجود تغيرات متميزة في بعض المؤشرات الحيوية المدروسة لدى مرضى فشل القلب الاحتقاني، ولا سيما الارتفاع الواضح في CRP. وينبغي تفسير الانخفاض غير المتوقع في تراكيز NT-proBNP وhs-cTnI بحذر، مع الأخذ بنظر الاعتبار الحالة العلاجية للمرضى والظروف السابقة للتحليل المتعلقة بجمع العينات ومعالجتها. كما تدعم الارتباطات الملحوظة بين المؤشرات الحيوية التي تمثل مسارات بيولوجية مختلفة اعتماد نهج متعدد المؤشرات الحيوية لتوصيف الآليات المرضية المعقدة لفشل القلب الاحتقاني

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Cite This Study

صالح et al. (2026) conducted a case-control in Congestive Heart Failure (n=100). Congestive heart failure (assessed via circulating biomarkers: CRP, NT-proBNP, hs-cTnI, ET-1, IL-6, and insulin) vs. Apparently healthy controls was evaluated on Serum C-reactive protein (CRP) concentration (mg/dL) (p=<0.001). Patients with congestive heart failure had significantly higher serum CRP (22.40 vs 5.68 mg/dL, P<0.001) and lower NT-proBNP (1.244 vs 19.704 pg/mL, P<0.001) than healthy controls.

synapsesocial.com/papers/6ae92596a8a6b2adf62f6053 https://doi.org/10.54153/sjpas.2026.v8i3/1.1640

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Diagnostic Performance of Circulating Cardiac, Inflammatory, and Metabolic Biomarkers in Iraqi Patients with Congestive Heart Failure

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Diagnostic Performance of Circulating Cardiac, Inflammatory, and Metabolic Biomarkers in Iraqi Patients with Congestive Heart Failure

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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