High sensitivity C-Reactive Protein in Chronic Heart Failure: Patient Characteristics, Phenotypes and Mode of Death

Pellicori, Pierpaolo and Zhang, Jufen and Cuthbert, Joe and Urbinati, Alessia and Shah, Parin and Kazmi, Syed and Clark, Andrew L. and Cleland, John G. F. (2019) High sensitivity C-Reactive Protein in Chronic Heart Failure: Patient Characteristics, Phenotypes and Mode of Death. Cardiovascular Research. ISSN 1755-3245

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Official URL: https://doi.org/10.1093/cvr/cvz198

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 4,423 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 (LVEF) <40% or raised plasma concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP >125 pg/ml). The median (IQR) plasma hsCRP for patients diagnosed with CHF (n = 3,756) 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=1,117, 30%). During a median follow up of 53 (IQR: 28-93) months, 1,784 (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 >10mg/L to <2mg/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). Conclusions: 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.

Item Type: Journal Article
Keywords: heart failure, CRP, inflammation, mortality, prognosis
Faculty: Faculty of Health, Education, Medicine & Social Care
Depositing User: Jufen Zhang
Date Deposited: 31 Jul 2019 14:10
Last Modified: 14 Nov 2019 16:07
URI: http://arro.anglia.ac.uk/id/eprint/704604

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