Corticosteroids May Improve Outcome in AHF Patients with Elevated CRP
Abnormalities in the inflammatory cascade are well known to be associated with both the onset and progression of heart failure (HF) and related to outcome and cardiac remodelling, even though microbial infection is not involved in most cases. In a recent study, researchers reported that corticosteroids might have the potential to improve outcomes in acute HF (AHF) patients with inflammatory activation. The study findings were published in the journal ESH Heart Failure on April 08, 2022.
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.
