Inflammatory biomarkers in pericarditis: a comprehensive clinical review

Inflammatory biomarkers are increasingly recognized as key tools in diagnosing, stratifying risk, and monitoring treatment in pericarditis, though their value is limited by non-specificity, variability, and treatment interactions. This narrative review integrates current evidence and recommendations from recent studies, as well as the 2025 ESC and ACC guidelines, focusing on conventional and emerging biomarkers across acute, recurrent, and chronic pericarditis. C-reactive protein remains the most practical biomarker for diagnosis and therapeutic monitoring, with persistent elevation linked to recurrence. Troponin identifies myocardial involvement, guiding follow-up but not adversely affecting outcomes in idiopathic cases. Erythrocyte sedimentation rate and white blood cell count add supportive yet nonspecific information. Exploratory markers - such as interleukins, soluble urokinase plasminogen activator receptor, microRNAs, and hematologic indices - show potential for refined risk prediction but remain investigational due to limited access and a lack of standardization. Imaging, particularly cardiac magnetic resonance, complements biomarker data and is particularly crucial in cases where biomarkers are negative. Biomarkers are central yet imperfect components of pericarditis management. Their future utility will rely on integration with imaging, composite marker panels, and artificial intelligence-based analytics, promoting precision medicine while current practice remains grounded in combined clinical, laboratory, and imaging assessment.