C-reactive Protein Levels Predict Right Ventricular Failure and Mortality in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Assist Device Implantation: An INTERMACS Analysis

Abstract

Whether C-reactive protein (CRP) levels prior to left ventricular assist device implantation (LVAD) are predictive of post-implantation outcomes is not well established. Current data are limited to small, single-center studies. 5,183 adult recipients of continuous-flow left ventricular assist devices with pre-implant CRP measurement were identified from INTERMACS. Patients were divided into three groups based on pre-implant CRP levels: CRP of 0 to 10 mg/L (low), 11 to 30 mg/L (intermediate), and >30 mg/L (high). Outcomes of interest were mortality, gastrointestinal bleeding, device thrombosis, infection, stroke, and right heart failure. Analyses included Kaplan-Meier survival estimates and Cox proportional hazards models. Patients with higher pre-implant CRP were younger (55.3 vs 56.5 vs 57.8 yrs), had sicker INTERMACS profiles (Class I: 33.7% vs 22.6% vs 9.5%); higher use of IABP (34.1% vs 26.0% vs 14.5%) and ECMO (12.0% vs 6.9% vs 2.1%) compared to patients with intermediate and low CRP levels (all p <0.001). High CRP group had higher WBC count (10.4 vs 9.3 vs 8.0 × 10/uL), total bilirubin (1.6 vs 1.4 vs 1.2 mg/dL), and serum BNP levels (958 vs 887 vs 726 pg/mL) compared to lower CRP groups (all p<0.001). After adjustment for baseline characteristics, compared to the low CRP group, higher CRP was associated with greater risk of mortality (HR 1.14 for intermediate CRP, HR 1.29 for high CRP, p=0.006) and right heart failure (HR 0.91 for intermediate CRP, HR 1.41 for high CRP, p=0.004). Rates of device thrombosis, device-related infection, stroke, and gastrointestinal bleeding were similar across groups. Higher CRP levels indicate comorbidity prior to LVAD implantation and predict higher risk of post-implant right heart failure and mortality. These findings suggest that baseline CRP may be a useful predictor of clinical outcome after LVAD implantation.