PMID- 12034159
OWN - NLM
STAT- MEDLINE
DCOM- 20021016
LR  - 20220316
IS  - 1388-9842 (Print)
IS  - 1388-9842 (Linking)
VI  - 4
IP  - 3
DP  - 2002 Jun
TI  - C-reactive protein as a predictor of improvement and readmission in heart 
      failure.
PG  - 331-6
AB  - OBJECTIVES: Only recently, new risk factors to explain atherosclerotic disease 
      have been identified. One of the most important clinical manifestations of 
      atherosclerosis is heart failure. Our study was aimed at investigating C-reactive 
      protein (CRP), a marker of systemic inflammation, in the context of heart 
      failure, and to determine its usefulness in predicting the need for readmission 
      in patients with heart failure and their degree of improvement. DESIGN: We 
      studied patients admitted to our hospital due to heart failure, independent of 
      the cause. CRP levels were measured with a sensitive standard assay on a 
      Nephelometer analyser. Patients were classified on admission and discharge 
      following New York Heart Association (NYHA) functional criteria; left ejection 
      fraction was also determined by transthoracic echocardiography. Patients 
      presenting clear sources of infection or inflammatory disease were excluded. Our 
      control group consisted of patients admitted for syncope. Each patient was 
      followed up through a computer system controlling admissions to and discharge 
      from the hospital, for a period of 18 months after initial admission. End points 
      considered were NYHA functional class on discharge, readmission and death. 
      RESULTS: We studied prospectively 76 patients with a mean age of 73.5+/-11 [95% 
      confidence interval (CI) 71.2-75.8]; 44 were male (58%) and 32 female (42%). The 
      mean CRP level in patients with heart failure was 3.94+/-5.87 (95% CI, 
      1.26-7.60), while in 15 patients with syncope it was 0.84+/-1.95 (95% CI, 
      0.96-2.94) (P=0.0007). The principal causes of heart failure included dilated 
      cardiomyopathy due to coronary arterial disease (30%), valvular disease (28%) and 
      heart failure secondary to hypertension (25%). The mean left ejection fraction 
      adequately measured in 72 (95%) patients was 50.41+/-9.88 (95% CI, 41.20-59.65). 
      We observed a trend of higher CRP levels in relation to ejection fractions below 
      35%: 7.50+/-9.88 vs. 3.75+/-4.57, (P=0.09). Our results showed that on discharge 
      CRP levels increased in relation to NYHA class: I: 0.74+/-0.69; II: 3.78+/-3.76; 
      III: 7.4+/-8.65; IV: 12.2+/-15.27 (P<0.05). On follow-up of each patient for 18 
      months, 32 (43%) were readmitted due to deterioration of their heart condition. 
      For patients who were readmitted, those presenting CRP levels >0.9 mg/dl were 
      identified as candidates for earlier hospitalisation than those with levels below 
      0.9 mg/dl (P=0.02) RR=1.43. In logistic-regression analysis the only group of 
      tested variables predicting readmission were levels of CRP, NYHA class and 
      plasmatic K on discharge and left ventricle ejection fraction. Analysis of 
      covariates yields CRP levels as being an independent predictor of readmission. 
      CONCLUSIONS: An inflammatory response is present in deteriorating heart failure. 
      We observed higher CRP levels in patients with higher NYHA functional class, 
      perhaps signalling a poor therapeutic response. Higher CRP levels were also 
      related to higher rates of readmission and mortality and it could be an 
      independent marker of improvement and readmission in heart failure.
FAU - Alonso-Martinez, J L
AU  - Alonso-Martinez JL
AD  - Department of Internal Medicine, Hospital de Navarra, Irunlarrea 3, 31008, 
      Pamplona, Spain. jalonsom@cfnavarra.es
FAU - Llorente-Diez, B
AU  - Llorente-Diez B
FAU - Echegaray-Agara, M
AU  - Echegaray-Agara M
FAU - Olaz-Preciado, F
AU  - Olaz-Preciado F
FAU - Urbieta-Echezarreta, M
AU  - Urbieta-Echezarreta M
FAU - Gonzalez-Arencibia, C
AU  - Gonzalez-Arencibia C
LA  - eng
PT  - Clinical Trial
PT  - Controlled Clinical Trial
PT  - Journal Article
PL  - England
TA  - Eur J Heart Fail
JT  - European journal of heart failure
JID - 100887595
RN  - 0 (Biomarkers)
RN  - 9007-41-4 (C-Reactive Protein)
SB  - IM
MH  - Aged
MH  - Biomarkers/blood
MH  - C-Reactive Protein/*analysis
MH  - Female
MH  - Heart Failure/*blood/mortality/physiopathology
MH  - Humans
MH  - Inflammation/physiopathology
MH  - Male
MH  - *Patient Readmission
MH  - Prospective Studies
MH  - Regression Analysis
MH  - Statistics, Nonparametric
MH  - Stroke Volume
EDAT- 2002/05/30 10:00
MHDA- 2002/10/17 04:00
CRDT- 2002/05/30 10:00
PHST- 2002/05/30 10:00 [pubmed]
PHST- 2002/10/17 04:00 [medline]
PHST- 2002/05/30 10:00 [entrez]
AID - S1388984202000211 [pii]
AID - 10.1016/s1388-9842(02)00021-1 [doi]
PST - ppublish
SO  - Eur J Heart Fail. 2002 Jun;4(3):331-6. doi: 10.1016/s1388-9842(02)00021-1.