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

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.