C-Reactive Protein Predicts Outcomes in HeartMate 3 Left Ventricular Assist Device Recipients

C-reactive protein (CRP) is an inflammatory biomarker with prognostic value in heart failure, but its role in HeartMate 3 (HM3) left ventricular assist device recipients is unclear. We retrospectively analyzed 188 adult HM3 recipients (2016-2025), stratified by preoperative CRP into low-CRP (≤10 mg/L, n = 65) and high-CRP (>10 mg/L, n = 123) groups. High-CRP patients presented with a sicker phenotype, with higher INTERMACS profile 1/preoperative extracorporeal membrane oxygenation (ECMO) support (50% vs. 3%) and greater renal, hepatic, hematologic, and nutritional derangement. In-hospital and 30 day mortality were higher with high CRP (23% vs. 5%, p = 0.001; 19% vs 3%, p = 0.003); overall mortality did not differ (47% vs. 40%, p = 0.360). In a parsimonious multivariable model adjusted for age, preoperative CRP (odds ratio [OR], 1.05 per 10 mg/L, p = 0.006) and albumin (OR, 0.32 per g/dl, p = 0.003) independently predicted in-hospital mortality; a seven-variable model was unstable due to INTERMACS-ECMO collinearity. C-reactive protein discriminated in-hospital mortality (area under the curve [AUC] = 0.77); a 10 mg/L threshold was sensitive (90%) but not specific (40%). High CRP was also associated with a 4.5-fold increase in tracheostomy (36% vs. 8%, p < 0.001) and prolonged ventilation. Preoperative CRP, interpreted with albumin, is a practical risk signal identifying a high-risk inflammatory-nutritional phenotype with greater perioperative morbidity in HM3 recipients.