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Meta-Analysis
. 2021 Sep;26(5):1141-1150.
doi: 10.1007/s10741-020-09927-x.

Diagnostic and prognostic value of serum C-reactive protein in heart failure with preserved ejection fraction: a systematic review and meta-analysis

Ishan Lakhani  1 , Michelle Vangi Wong  1 , Joshua Kai Fung Hung  1 , Mengqi Gong  2 , Khalid Bin Waleed  3 , Yunlong Xia  3 , Sharen Lee  1 , Leonardo Roever  4 , Tong Liu  2 , Gary Tse  2   3   5 , Keith Sai Kit Leung  6 , Ka Hou Christien Li  7
Affiliations
Meta-Analysis

Diagnostic and prognostic value of serum C-reactive protein in heart failure with preserved ejection fraction: a systematic review and meta-analysis

Ishan Lakhani et al. Heart Fail Rev. 2021 Sep.

Abstract

Heart failure (HF) is a major epidemic with rising morbidity and mortality rates that encumber global healthcare systems. While some studies have demonstrated the value of CRP in predicting (i) the development of HFpEF and (ii) long-term clinical outcomes in HFpEF patients, others have shown no such correlation. As a result, we conducted the following systematic review and meta-analysis to assess both the diagnostic and prognostic role of CRP in HFpEF. PubMed and Embase were searched for studies that assess the relationship between CRP and HFpEF using the following search terms: (((C-reactive protein) AND ((preserved ejection fraction) OR (diastolic heart failure))). The search period was from the start of database to August 6, 2019, with no language restrictions. A total of 312 and 233 studies were obtained from PubMed and Embase respectively, from which 19 studies were included. Our meta-analysis demonstrated the value of a high CRP in predicting the development of not only new onset HFpEF (HR: 1.08; 95% CI: 1.00-1.16; P = 0.04; I2 = 22%), but also an increased risk of cardiovascular mortality when used as a categorical (HR: 2.52; 95% CI: 1.61-3.96; P < 0.0001; I2 = 19%) or a continuous variable (HR: 1.24; 95% CI: 1.04-1.47; P = 0.01; I2 = 28%), as well as all-cause mortality when used as a categorical (HR: 1.78; 95% CI: 1.53-2.06; P < 0.00001; I2 = 0%) or a continuous variable: (HR: 1.06; 95% CI: 1.02-1.06; P = 0.003; I2 = 61%) in HFpEF patients. CRP can be used as a biomarker to predict the development of HFpEF and long-term clinical outcomes in HFpEF patients, in turn justifying its use as a simple, accessible parameter to guide clinical management in this patient population. However, more prospective studies are still required to not only explore the utility and dynamicity of CRP in HFpEF but also to determine whether risk stratification algorithms incorporating CRP actually provide a material benefit in improving patient prognosis.

Keywords: C-reactive protein; Diastolic heart failure; HFpEF; Meta-analysis.

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Figures

Fig. 1
Fig. 1
Study identification and selection process from PubMed and Embase
Fig. 2
Fig. 2
High CRP as a continuous variable and risk of new onset HFpEF: a without the exclusion of overlapping cohorts; b with the exclusion of overlapping cohorts
Fig. 3
Fig. 3
High CRP as a a categorical variable and risk of cardiovascular mortality; as a b continuous variable and risk of cardiovascular mortality
Fig. 4
Fig. 4
High CRP as a a categorical variable and risk of cardiovascular outcomes; as a b continuous variable and risk of cardiovascular outcomes
Fig. 5
Fig. 5
High CRP as a a categorical variable and risk of all-cause mortality; as a b continuous variable and risk of all-cause mortality
See this image and copyright information in PMC

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