Corticosteroids May Improve Outcome in AHF Patients with Elevated CRP

Corticosteroids are potent agents used to reduce inflammation and hence could be considered as potential anti-inflammatory therapy to be administered intravenously (IV) in the emergency department (ED). To further explore, Dr Gad Cotter and his team conducted a study to evaluate whether the degree of inflammation, reflected by the C-reactive protein (CRP) level, modifies the effect of IV corticosteroids administered in the emergency department on clinical outcomes in patients with AHF.

In a sub-analysis of the Epidemiology of Acute Heart Failure in the Emergency Departments (EAHFE) registry, the researchers included 1109 patients diagnosed with AHF in the ED with confirmed N-terminal pro-B-type natriuretic peptide > 300 pg/mL and CRP > 5 mg/L in the ED. Patients included in the analysis were divided into two groups: patients receiving corticosteroids in the ED (corticosteroid-treated group, n=121) and patients who did not receive corticosteroids (corticosteroid-untreated group). The major outcome assessed was 30-day all-cause mortality. The researchers also assessed for in-hospital all-cause mortality and a 30-day post-discharge composite outcome comprising ED revisit, hospitalization, or death. They further performed subgroup analyses examining increasing CRP thresholds.

Key findings of the study:

• Although not statistically significant, the researchers observed that the HRs tended to decrease with increasing CRP levels with point estimates favouring corticosteroids at CRP levels above 20.
• Upon analysis, they found that in patients with CRP > 40 mg/L

♦ All-cause mortality at 30 days was 11.8% with corticosteroids and 19.4% without (HR 0.56).

♦ Post-discharge ED revisits at 30 days was 42.3% with corticosteroids and 43.8%without (HR 0.92).

♦ In-hospital all-cause mortality was 8.8%with corticosteroids and 13.4% without (HR 0.61).

The authors concluded, "The present analysis suggests that corticosteroids might have the potential to improve outcomes in AHF patients with inflammatory activation. Larger, prospective studies of anti-inflammatory therapy should be considered to assess potential benefit in patients with the highest degree of inflammation".

For further information:

DOI: https://doi.org/10.1002/ehf2.13926

Keywords:

Corticosteroid use, heart failure, Acute heart failure, IV Coticosteroid, elevated CRP, C-reactive protein, EAHFE Registry, anti-inflammatory therapy, degree of inflammation, ESH Heart Failure.