Repeated hsCRP may predict mortality risk among patients of acute HF

High-sensitivity C-reactive protein (hsCRP) has long been recognized as a marker of inflammation in various medical contexts. Among patients hospitalized for heart failure, elevated hsCRP levels at admission have been associated with worse outcomes. However, a recent study delves deeper into the long-term cumulative effects of hsCRP levels on the prognosis of heart failure patients.

The study results were published in the Journal of the American Heart Association. 

The study enrolled a total of 1281 patients who were hospitalized for heart failure. These patients were monitored at admission and at 1 and 12 months after discharge to collect hsCRP data. The researchers employed two approaches to assess long-term cumulative hsCRP levels: quartiles of cumulative hsCRP levels and cumulative instances of high hsCRP levels. Patients were categorized into four groups based on these criteria.

A total of 1281 patients with a median age was 64 (interquartile range, 54–73) years were included. Of these 35.4% were women.During a follow-up period averaging 4.8 years, 374 (29.2%) patients passed away. The study found a compelling link between elevated long-term cumulative hsCRP levels and increased mortality risk.

Findings: 

• When compared to quartile 1 (used as a reference), the hazard ratios (HRs) for mortality were 1.29 (95% CI, 0.92–1.81) for quartile 2, 1.62 (95% CI, 1.16–2.25) for quartile 3, and 2.38 (95% CI, 1.75–3.23) for quartile 4 demonstrating a progressively higher mortality risk with increasing quartiles of cumulative hsCRP levels.
• Likewise, patients were grouped based on the cumulative times their hsCRP levels exceeded cutoff values.
• When compared to patients with 0-times (hsCRP levels below cutoff values in all three time points), those with 1-time had an HR of 1.36 (95% CI, 0.92–2.01), those with 2-times had an HR of 1.95 (95% CI, 1.34–2.82), and those with 3-times had an HR of 2.80 (95% CI, 1.97–4.00) which suggests a substantial increase in mortality risk with each additional instance of high hsCRP levels. 

Thus, the study's findings underscore the significance of long-term cumulative hsCRP levels in predicting outcomes for patients hospitalized for acute heart failure. Monitoring hsCRP levels over time could assist physicians in identifying patients at a higher risk of mortality. Early identification and intervention for patients with elevated long-term hsCRP levels may offer a valuable tool in improving their prognosis and overall care. 

Further reading: Long‐Term Cumulative High‐Sensitivity C‐Reactive Protein and Mortality Among Patients With Acute Heart Failure. https://doi.org/10.1161/JAHA.123.029386, Journal of the American Heart Association. 2023;12:e029386.