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Prognostic value of high-sensitivity C-reactive protein in heart failure: a systematic review
José Paulo Araújo1, Patricia Lourenço, Ana Azevedo
1Heart Failure Clinic, Serviço de Medicina Interna, Hospital S. João, Unidade I&D Cardiovascular do Porto, Porto, Portugal.
Insights
High-sensitivity C-reactive protein (hsCRP) predicts heart failure (HF) risk and outcomes. This marker of inflammation is a consistent prognostic indicator in diverse patient groups for both developing and established HF.
Area of Science:
- Cardiology
- Inflammation Research
- Biomarker Discovery
Background:
- Low-grade inflammation, indicated by high-sensitivity C-reactive protein (hsCRP), is linked to acute myocardial infarction and cardiovascular mortality.
- In heart failure (HF) patients, inflammation can exacerbate disease progression.
Purpose of the Study:
- To systematically review the role of hsCRP in predicting HF incidence in general and high-risk populations.
- To evaluate the prognostic value of hsCRP in patients with established HF.
Main Methods:
- A Medline database search was conducted using keywords: C-Reactive Protein, Heart Failure, Cardiomyopathy, Cardiac Failure, Prognosis, and Death.
- Studies measuring hsCRP and referencing morbidity and mortality outcomes were selected.
Main Results:
- hsCRP is associated with incident HF in general and high-risk populations.
- hsCRP provides prognostic information in HF patients, independent of other risk factors.
- Proposed hsCRP cutoffs vary significantly across studies and contexts.
Conclusions:
- The prognostic value of hsCRP is consistent for predicting incident HF and adverse outcomes in established HF across various patient populations.
Background:
Several studies have suggested that high-sensitivity C-reactive protein (hsCRP) is a strong independent predictor of acute myocardial infarction and cardiovascular death. In the specific heart failure (HF) context, a low-grade inflammatory state can contribute to HF progression.
Aims:
To perform a systematic review on the current knowledge about low-grade inflammation, as assessed by hsCRP, in the prediction of HF in general and in high-risk populations as well as its prognostic value in established HF.
Methods:
We used a computerized literature search in the Medline database using the following key words: C-Reactive Protein, Heart Failure, Cardiomyopathy, Cardiac Failure, Prognosis, and Death. Articles were selected if they had measurements of hsCRP in different patient samples and reference to outcomes in terms of morbidity and mortality.
Results:
hsCRP is associated with incident HF in general and high-risk populations and provides prognostic information in HF patients. In almost all studies, the association of hsCRP with clinical events was independent of other baseline variables known to influence morbidity and mortality. Very different cutoffs have been proposed in each context across studies.
Conclusions:
The prognostic power of hsCRP, whether we consider incident HF or adverse outcomes in established HF, is consistent in different patient populations.
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