Skip to main content Skip to main navigation menu Skip to site footer

High-sensitivity C-reactive protein as a 6-month predictor of mortality and rehospitalization in patients with heart failure

  • Memorison Tarigan ,
  • Zainal Safri ,
  • Refli Hasan ,


Abstract

Background: C-reactive protein (CRP) is an acute phase protein that reacts as a non-specific systemic inflammatory marker. Recent studies indicate that high-sensitivity CRP (hs-CRP) is a strong risk factor for predicting ensuing cardiovascular events.

Objective: To investigate whether hs-CRP could serve as a parameter in predicting 6-month mortality and the likelihood of rehospitalization of patients with HF.

Method: A prospective cohort study observed a total of 44 patients admitted to RSUP Haji Adam Malik Medan diagnosed with primary heart failure (HF) from November 2016 to February 2017. Level of hs-CRP was analyzed at their initial assessment and subjects were followed up for 6 months for mortality and rehospitalization.

Result: Fourteen (31.8%) patients died and nineteen (42.3%) patients were rehospitalized during the 6 months follow up period. The mean value of hs-CRP was higher in the mortality group (4 group (4.386±1.75) than the survivor group (2.227±1.80), P=0.001. There was no significant difference in the mean value of hs-CRP between rehospitalized patients group (2.858±1.99) compared to the group that was not rehospitalized (2.759±2.15), P=0.880. The analysis using the receiving operating characteristic (ROC) curve obtained area under curve (AUC) of 81% (95% confidence interval [CI]: 0.68-0.94), P=0.001. Based on the ROC curve, an hs-CRP value of 4.25 result in a sensitivity value of 63% and a high specificity value of 90%, P=0.000.

Conclusion: Among HF patients, increasing level of hs-CRP with cut-off value of 4.25 can be used as a 6-month mortality predictor and have a sensitivity of 64% and specificity of 90%. There were no significant differences in hs-CRP level between patients with HF who experienced rehospitalization within 6 months and who did not, hence hs-CRP could not be used as a predictor of rehospitalization within 6 months in patients with HF.

Keywords: heart failure high-sensitivity C-reactive protein (hs-CRP) mortality rehospitalization

References

  1. Mann DL, Chakinala M. Heart failure: Pathophysiology and Diagnosis of Heart Failure. In: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editors. Harrison's Principles of Internal Medicine 19th ed. New York: McGraw-Hill Education. 2015. p. 1500-6.
  2. PERKI. Pedoman Tatalaksana Gagal Jantung 1st ed. Jakarta: Perhimpunan Dokter Spesialis Kardiovaskular Indonesia; 2015.
  3. Panggabean M. Gagal Jantung. In: Setiati S, Alwi I, Sudoyo A, K M, Setiyohadi B, Syam A, editors. Buku Ajar Ilmu Penyakit Dalam. 6th ed. Jakarta: Interna Publishing. 2014. p. 1132-5.
  4. Levine B, Kalman J, Mayer L, et al. Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. New England Journal of Medicine. 1990;323(4):236-41.
  5. Gullestad L, Ueland T, Vinge LE, et al. Inflammatory cytokines in heart failure: mediators and markers. Cardiology. 2012;122(1):23-35.
  6. Black S, Kushner I, Samols D. C-reactive protein. Journal of Biological Chemistry. 2004;279(47):48487-90.
  7. Aguiar FJB, Ferreira-Júnior M, Sales MM, et al. C-reactive protein: clinical applications and proposals for a rational use. Revista da Associação Médica Brasileira (English Edition). 2013;59(1):85-92.
  8. Clearfield MB. C-reactive protein: a new risk assessment tool for cardiovascular disease. Journal-american osteopathic association. 2005;105(9):409.
  9. Gottdiener JS, Arnold AM, Aurigemma GP, et al. Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. Journal of the American College of Cardiology. 2000;35(6):1628-37.
  10. Bursi F, Weston SA, Killian JM, et al. C-reactive protein and heart failure after myocardial infarction in the community. The American journal of medicine. 2007;120(7):616-22.
  11. Anand IS, Latini R, Florea VG, et al. C-reactive protein in heart failure. Circulation. 2005;112(10):1428-34.
  12. Greene SJ, Fonarow GC, Vaduganathan M, et al. The vulnerable phase after hospitalization for heart failure. Nature Reviews Cardiology. 2015;12(4):220-9.
  13. Cheraghi M, Sadeghi M, Sarrafzadegan N, et al. Prognostic factors for survival at 6-month follow-up of hospitalized patients with decompensated congestive heart failure. ARYA atherosclerosis. 2010;6(3):112.
  14. Mehta PA, Dubrey SW, McIntyre HF, et al. Improving survival in the 6 months after diagnosis of heart failure in the past decade: population-based data from the UK. Heart. 2009;95(22):1851-6.
  15. Cotter G, Metra M, Davison BA, et al. Worsening heart failure, a critical event during hospital admission for acute heart failure: results from the VERITAS study. European journal of heart failure. 2014;16(12):1362-71.
  16. Kozdag G, Ertas G, Kilic T, et al. Elevated level of high-sensitivity C-reactive protein is important in determining prognosis in chronic heart failure. Medical Science Monitor. 2010;16(3):CR156-CR61.
  17. Zhu L, Zou Y, Wang Y, et al. Prognostic Significance of Plasma Highâ€Sensitivity Câ€Reactive Protein in Patients With Hypertrophic Cardiomyopathy. Journal of the American Heart Association. 2017;6(2):e004529.
  18. Galal H, Awad O, Ghareeb M, et al. Prognostic Value of Plasma Levels of High Sensitivity C-Reactive Protein in Chronic Systolic Heart Failure of Ischemic Origin. Heart Mirror Journal. 2013;7(2).
  19. Villacorta H, Masetto AC, Mesquita ET. C-reactive protein: an inflammatory marker with prognostic value in patients with decompensated heart failure. Arquivos brasileiros de cardiologia. 2007;88(5):585-9.
  20. Kalogeropoulos AP, Tang WHW, Hsu A, et al. High-sensitivity C-reactive protein in acute heart failure: insights from the ASCEND-HF trial. Journal of cardiac failure. 2014;20(5):319-26.
  21. Yin W-H, Chen J-W, Jen H-L, et al. Independent prognostic value of elevated high-sensitivity C-reactive protein in chronic heart failure. American heart journal. 2004;147(5):931-8.
  22. AdukauskienÄ— D, ÄŒiginskienÄ— A, AdukauskaitÄ— A, et al. Clinical relevance of high sensitivity C-reactive protein in cardiology. Medicina. 2016;52(1):1-10.
  23. Engström G, Melander O, Hedblad B. Carotid intima-media thickness, systemic inflammation, and incidence of heart failure hospitalizations. Arteriosclerosis, thrombosis, and vascular biology. 2009;29(10):1691-5.
  24. Huang W-P, Yin W-H, Jen H-L, et al. C-reactive protein levels in chronic congestive heart failure. Acta Cardiologica Sinica. 2004;20(1):7-14.
  25. Seta Y, Shan K, Bozkurt B, et al. Basic mechanisms in heart failure: the cytokine hypothesis. Journal of cardiac failure. 1996;2(3):243-9.
  26. Scirica BM, Cannon CP, Sabatine MS, et al. Concentrations of C-reactive protein and B-type natriuretic peptide 30 days after acute coronary syndromes independently predict hospitalization for heart failure and cardiovascular death. Clinical chemistry. 2009;55(2):265-73.
  27. Bogaty P, Boyer L, Simard S, et al. Clinical utility of C-reactive protein measured at admission, hospital discharge, and 1 month later to predict outcome in patients with acute coronary disease: the RISCA (Recurrence and Inflammation in the Acute Coronary Syndromes) study. Journal of the American College of Cardiology. 2008;51(24):2339-46.
  28. Liebetrau CL, Gaede L, Szardien S, et al. High Sensitivity CRP Predicts Long-Term Mortality in Patients with Atrial Fibrillation and Evident Acute Coronary Syndrome. International Journal of Clinical Medicine. 2013;4(03):137.
  29. Alonsoâ€Martinez JL, Llorenteâ€Diez B, Echegarayâ€Agara M, et al. Câ€reactive protein as a predictor of improvement and readmission in heart failure. European journal of heart failure. 2002;4(3):331-6.

How to Cite

Tarigan, M., Safri, Z., & Hasan, R. (2019). High-sensitivity C-reactive protein as a 6-month predictor of mortality and rehospitalization in patients with heart failure. Bali Medical Journal, 8(3), 783–789. https://doi.org/10.15562/bmj.v8i3.929
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
0

Total
16

Share

Search Panel

Memorison Tarigan
Google Scholar
Pubmed
BMJ Journal

Zainal Safri
Google Scholar
Pubmed
BMJ Journal

Refli Hasan
Google Scholar
Pubmed
BMJ Journal