Volume 21, Issue 4, Pages 296-301 (December 2009)

4 of 18

ABSTRACT

ABSTRACT + REFS

FULL-TEXT PDF (175 KB)

High-sensitivity C-reactive Protein and Other Factors as Outcome Predictors in Acute Decompensated Heart Failure

Received 20 February 2009; received in revised form 10 April 2009; accepted 22 May 2009.

Abstract

Objective

Patients with acute decompensated heart failure (ADHF) have high mortality and rehospitalization rates. Although circulating levels of high-sensitivity C-reactive protein (hs-CRP) are an accurate prognostic factor in chronic heart failure, no data are available to indicate whether hs-CRP can predict outcomes in patients with ADHF.

Materials and Methods

We prospectively evaluated serum hs-CRP levels, patient characteristics, laboratory data, medications and management during hospitalization and two end points (inhospital mortality and 6-month readmission rate for heart failure) in 80 patients who presented with ADHF.

Results

No correlation was found between initial hs-CRP at admission and the two end points. The result was the same for all patients after excluding those in whom infection was a predisposing factor for ADHF. Cardiogenic shock significantly predicted inhospital mortality (odds ratio [OR] = 15.76; 95% confidence interval [CI] = 1.8–180.06; p = 0.026). A high serum peak creatinine level (OR = 1.39; 95% CI = 0.98–1.98; p = 0.064) and ischemic heart disease as the etiology of heart failure ((OR = 2.48; 95% CI = 0.93–6.58; p = 0.068) could predict 6-month readmission with borderline significance.

Conclusion

Hs-CRP may have no value as a predictor of the outcomes of inhospital mortality and 6-month readmission for heart failure in ADHF. Many clinical factors such as cardiogenic shock were found to be associated with inhospital mortality, and high serum peak creatinine levels and ischemic heart disease as the etiology of heart failure were found to be associated with 6-month readmission. Therefore, early detection of these high-risk groups to predict inhospital outcomes is possible.

Keywords: Acute decompensated heart failure , Hs-CRP , Risk predictor

No full text is available. To read the body of this article, please view the PDF online.

Article Outline

• Abstract

• References

• Copyright

References

1. 1 McCullough PA , Philbin EF , Spertus JA , Kaatz S , Sandberg KR , Weaver WD . Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study . J Am Coll Cardiol . 2002;39:60–69 . Full-Text PDF (144 KB) | CrossRef

2. 2 McMurray JJ , Pfeffer MA . Heart failure . Lancet . 2005;365:1877–1889 . Abstract | Full Text | Full-Text PDF (139 KB) | CrossRef

3. 3 Krumholz HM , Parent EM , Tu N , et al. Readmission after hospitalization for congestive heart failure among Medicare beneficiaries . Arch Intern Med . 1997;157:99–104 . MEDLINE

4. 4 Vinson JM , Rich MW , Sperry JC , Shah AS , McNamara T . Early readmission of elderly patients with congestive heart failure . J Am Geriatr Soc . 1990;38:1290–1295 . MEDLINE

5. 5 Cuffe MS , Califf RM , Adams KF , et al. Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) Investigators. Short-term intravenous milrinone for acute exacerbation of chronic heart failure. A randomized controlled trial . JAMA . 2002;287:1541–1547 . MEDLINE | CrossRef

6. 6 Clinical Quality Improvement Network Investigators . Mortality risk and pattern of practice in 4606 acute care patients with congestive heart failure: the relative importance of age, sex, and medical therapy . Arch Intern Med . 1996;156:1669–1673 . MEDLINE

7. 7 Brophy JM , Deslauriers G , Rouleau J . Long term prognosis of patients presenting to the emergency room with decompensated congestive heart failure . Can J Cardiol . 1994;5:543–547 .

8. 8 Chih MH , Goldman L . Correlates of early hospital readmission or death in patients with congestive heart failure . Am J Cardiol . 1997;79:1640–1644 . Abstract | Full Text | Full-Text PDF (215 KB) | CrossRef

9. 9 Rauchhaus M , Doehner W , Francis DP , et al. Plasma cytokine parameters and mortality in patients with chronic heart failure . Circulation . 2000;102:3060–3067 .

10. 10 Steele IC , Nugent AM , Maguire S , et al. Cytokine profile in chronic heart failure . Eur J Clin Invest . 1996;26:1018–1022 . MEDLINE

11. 11 Yin WH , Chen JW , Jen HL , et al. The prognostic value of circulating soluble cell adhesion molecules in patients with chronic heart failure . Eur J Heart Fail . 2003;5:507–516 . MEDLINE | CrossRef

12. 12 Ridker PM , Cushman M , Stampfer MJ , Tracy RP , Hennekens CH . Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men . N Engl J Med . 1997;336:973–979 . MEDLINE | CrossRef

13. 13 Ridker PM , Hennekens CH , Buring JE , Rifai N . C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women . N Engl J Med . 2000;342:836–843 . MEDLINE | CrossRef

14. 14 Pietll KO , Harmoinen AP , Jokiniitty J , Pasternack AI . Serum C-reactive protein concentration in acute myocardial infarction and its relationship to mortality during 24 months of follow-up in patients under thrombolytic treatment . Eur Heart J . 1996;17:1345–1349 .

15. 15 Pye M , Rae AP , Cobbe SM . Study of serum C-reactive protein concentration in cardiac failure . Br Heart J . 1990;63:228–230 . MEDLINE | CrossRef

16. 16 Gottdiener JS , Arnold AM , Aurigemma GP , et al. Predictors of congestive heart failure in the elderly: the cardiovascular health study . J Am Coll Cardiol . 2000;35:1628–1637 . Abstract | Full Text | Full-Text PDF (209 KB) | CrossRef

17. 17 Kaneko K , Kanda T , Yamauchi Y , et al. C-reactive protein in dilated cardiomyopathy . Cardiology . 1999;91:215–219 .

18. 18 Yin WH , Chen JW , Jen HL , et al. Independent prognostic value of elevated high-sensitivity C-reactive protein in chronic heart failure . Am Heart J . 2004;147:931–938 . Abstract | Full Text | Full-Text PDF (194 KB) | CrossRef

19. 19 Windram JD , Loh PH , Rigby AS , Hanning I , Clark AL , Cleland JG . Relationship of high-sensitivity C-reactive protein to prognosis and other prognostic markers in outpatients with heart failure . Am Heart J . 2007;153:1048–1055 . Abstract | Full Text | Full-Text PDF (211 KB) | CrossRef

20. 20 O'Brien RJ , Squire IB , Demme B , Davies JE , Ng LL . Pre-discharge, but not admission, levels of NT-proBNP predict adverse prognosis following acute LVF . Eur J Heart Fail . 2003;5:499–506 . MEDLINE | CrossRef

21. 21 Shenkman HJ , Zareba W , Bisognano JD . Comparison of prognostic significance of amino-terminal pro-brain natriuretic peptide versus blood urea nitrogen for predicting events in patients hospitalized for heart failure . Am J Cardiol . 2007;99:1143–1145 . Abstract | Full Text | Full-Text PDF (148 KB) | CrossRef

22. 22 Philbin EF , DiSalvo TG . Prediction of hospital readmission for heart failure: development of a simple risk score based on administrative data . J Am Coll Cardiol . 1999;33:1560–1566 . Abstract | Full Text | Full-Text PDF (199 KB) | CrossRef

23. 23 Lee DS , Austin PC , Rouleau JL , Liu PP , Naimark D , Tu JV . Predicting mortality among patients hospitalized for heart failure. Derivation and validation of a clinical model . JAMA . 2003;290:2581–2587 . CrossRef

24. 24 Abraham WT , Fonarow GC , Albert NM , et al. OPTIMIZE-HF Investigators and Coordinators. Predictors of in-hospital mortality in patients hospitalized for heart failure . J Am Coll Cardiol . 2008;52:347–356 . Abstract | Full Text | Full-Text PDF (412 KB) | CrossRef

25. 25 Sharma R , Coats AJS , Anker SD . The role of inflammatory mediators in chronic heart failure: cytokines, nitric oxide, and endothelin-1 . Intern J Cardiol . 2000;72:175–186 .

26. 26 Anker SD , von Haehling S . Inflammatory mediators in chronic heart failure: an overview . Heart . 2004;90:464–470 .

27. 27 Heywood JT , Fonarow GC , Costanzo MR , Mathur VS , Wigneswaran JR , Wynne J . ADHERE Scientific Advisory Committee and Investigators. High prevalence of renal dysfunction and its impact on outcome in 118465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database . J Cardiac Fail . 2007;13:422–430 .

28. 28 Sato Y , Takatsu Y , Kataoka K , et al. Serial circulating concentrations of C-reactive protein, interleukin (IL)-4, and IL-6 in patients with acute left heart failure . Clin Cardiol . 1999;22:811–813 . MEDLINE | CrossRef

29. 29 Zannad F , Briancon S , Juilliere Y , et al. Incidence, clinical etiologic features, and outcomes of advanced chronic heart failure: the EPICAL study . J Am Coll Cardiol . 1999;33:734–742 . Abstract | Full Text | Full-Text PDF (253 KB) | CrossRef

30. 30 Rathore SS , Foody JM , Wang Y , et al. Race, quality of care, and outcomes of elderly patients hospitalized with heart failure . JAMA . 2003;289:2517–2524 . MEDLINE | CrossRef

31. 31 Setoguchi S , Stevenson LW , Schneeweiss S . Repeated hospitalizations predict mortality in the community population with heart failure . Am Heart J . 2007;154:260–266 . Abstract | Full Text | Full-Text PDF (621 KB) | CrossRef

32. 32 Rich MW , Beckham V , Wittenberg C , Leven CL , Freedland KE , Carney RM . A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure . N Engl J Med . 1995;333:1190–1195 . MEDLINE | CrossRef

33. 33 Fonarow GC , Adams KF , Abraham WT , Yancy CW , Boscardin WJ . Risk stratification for in-hospital mortality in acutely decompensated heart failure. Classification and regression tree analysis . JAMA . 2005;293:572–580 . CrossRef

34. 34 Gheorghiade M , Abraham WT , Albert NM , et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure . JAMA . 2006;296:2217–2226 . CrossRef

35. 35 Yancy CW , Lopatin M , Stevenson LW , De Marco T , Fonarow GC . Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database . J Am Coll Cardiol . 2006;47:76–84 . Abstract | Full Text | Full-Text PDF (125 KB) | CrossRef

a Division of Cardiology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan

b College of Medicine, Tzu Chi University, Hualien, Taiwan

c Division of Thoracic Medicine, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan

d Department of Medical Education, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan

e Department of Family Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan

Corresponding author. Division of Cardiology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, 2, Min-Sheng Road, Chiayi, Taiwan

PII: S1016-3190(09)60059-8

doi:10.1016/S1016-3190(09)60059-8

4 of 18