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Multicenter Study
. 2024 Sep 17;14(1):21672.
doi: 10.1038/s41598-024-72137-0.

High-sensitivity C-reactive protein and risk of clinical outcomes in patients with acute heart failure

Enrique Santas #  1   2 , Sandra Villar #  1 , Patricia Palau  1   2 , Pau Llàcer  3 , Rafael de la Espriella  1 , Gema Miñana  1   2 , Miguel Lorenzo  1 , Gonzalo Núñez-Marín  1 , Jose Luis Górriz  2   4 , Arturo Carratalá  5 , Enrique Rodríguez  5 , Antoni Bayes-Genís  6   7 , Juan Sanchis  1   2   6 , Julio Núñez  8   9   10
Affiliations
Multicenter Study

High-sensitivity C-reactive protein and risk of clinical outcomes in patients with acute heart failure

Enrique Santas et al. Sci Rep. .

Abstract

Inflammation is relevant in the pathogenesis and progression of heart failure (HF). Previous studies have shown that elevated high-sensitivity C-reactive protein (hsCRP) are associated with greater severity and may be associated with adverse outcomes. In this study, we sought to evaluate the prognostic role of hsCRP in a non-selected cohort of patients with acute HF. We prospectively included a multicenter cohort of 3,395 patients following an admission for acute HF. HsCRP levels were evaluated during the first 24 h following admission. Study endpoints were the risks of all-cause mortality, CV-mortality, and total HF readmissions. The mean age was 74.2 ± 11.2 years and 1,826 (53.8%) showed a left ventricular ejection fraction (LVEF) ≥ 50%. Median hsCRP was 12.9 mg/L (5.4-30 mg/L). Over a median follow-up of 1.8 (0.6-4.1) years, 1,574 (46.4%) patients died, and 1,341 (39.5%) patients were readmitted for worsening HF. After multivariable adjustment, hsCRP values were significantly and positively associated with a higher risk of all-cause and CV mortality (p = 0.003 and p = 0.001, respectively), as well as a higher risk of recurrent HF admissions (p < 0.001). These results remained consistent across important subgroups, such as LVEF, sex, age, or renal function. In patients with acute HF, hsCRP levels were independently associated with an increased risk of long-term death and total HF readmissions.

Keywords: C-reactive protein; Heart failure; Hospitalizations; Inflammation; Mortality; Prognosis.

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Conflict of interest statement

J. Núñez received board speaker fees and travel expenses from Novartis, Roche Diagnostics, Abbott, Rovi, Vifor Pharma, Daiichi Sankyo, Boehringer Ingelheim, and Astra Zeneca (modest). J. Sanchis reveived speaker fees from Astra Zeneca, Abbott, and Edwards Lifesciences (modest). A. Bayés-Genís received board membership fees and travel expenses from Novartis, Roche Diagnostics, Vifor Pharma, and Critical Diagnostics (modest). JL Górriz, received consultancy fees from Astellas, GSK, CSL VIFOR, and speaker fees from AstraZeneca, Boehringer Ingelheim, Esteve, Bayer, Lilly, Astellas, and Novonordisk (modest). The remaining authors have no disclosures to report.

Figures

Fig. 1
Fig. 1
Flowchart of the patients included in the study. HF heart failure, hsCRP high-sensitivity C-reactive protein.
Fig. 2
Fig. 2
Kaplan–Meier curves for all-cause mortality across quartiles of high-sensitivity C-reactive protein. HsCRP high-sensitivity C-reactive protein.
Fig. 3
Fig. 3
Cumulative incidence curves for cardiovascular mortality across quartiles of high-sensitivity C-reactive protein. CV cardiovascular, HsCRP high-sensitivity C-reactive protein.
Fig. 4
Fig. 4
Hazard ratio depiction for mortality risk along the continuum of high-sensitivity C-reactive protein in the multivariable model. (A) All-cause mortality, (B) cardiovascular mortality. HsCRP high-sensitivity C-reactive protein.
Fig. 5
Fig. 5
Risk of recurrent heart failure admissions along the continuum of high-sensitivity C-reactive protein in the multivariable model. HsCRP high-sensitivity C-reactive protein.
See this image and copyright information in PMC

References

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