C-Reactive Protein Levels in Chronic Congestive Heart Failure

慢性心臟衰竭病人血中C-反應蛋白數值之臨床意義

黃文彬(Wen-Pin Huang) ； 殷偉賢(Wei-Hsian Yin) ； 任勗龍(Hsu-Lung Jen) ； 江孟橙(Meng-Cheng Chiang) ； 馮安寧(An-Ning Feng) ； 楊茂勳(Mason-Shing Young)

《Acta Cardiologica Sinica》 20卷1期 (2004/03) Pp. 7-14

摘要

Background: Serum concentrations of C-reactive protein (CRP) are elevated in patients with congestive heart failure (CHF). However, clinical data about the prognostic value of CRP levels in patients with chronic stable CHF are spare. We hypothesized that measurement of CRP might provide prognostic information in these patients.
Methods: We measured serum levels of CRP in 72 patients with chronic CHF and left ventricular ejection fraction (LVEF) ＜50%. Major adverse cardiac events (death or hospitalization with worsening CHF) during a median follow-up period of 449 days were determined. Multivariate Cox regression analysis was performed to identify independent predictors of major adverse cardiac events.
Results: The concentrations of CRP in the sample population were significantly increased with the severity of CHF. The 25 patients who had adverse events had significantly higher CRP levels (p = 0.0065) than the 47 patients who were event-free. We further divided the 72 CHF patients into tertiles on the basis of this sample, with the cutoff points for each tertile being ≤2.69, ＞ 2.69 to ≤ 5.38, and ＞5.38 mg per liter, respectively. The differences between event-free curves were insignificant between tertiles 1 and 2 but were significant between tertiles 1 and 3 and between tertiles 2 and 3 (p = 0.0048, p = 0.0103, respectively). In a multivariate analysis (n =58), left ventricular end-diastolic pressure (LVEDP) and serum levels of CRP ＞ 5.38 mg per liter were found to be independently significant predictors for major adverse cardiac events in patients with chronic CHF. The CRP levels were significantly correlated with LVEDP (r = 0.26, p = 0.048; n=58).
Conclusions: These findings suggest that the levels of CRP are related to clinical outcomes and that measurement of CRP has the potential to play an important role as an adjunct for risk assessment in patients with chronic CHF.

關鍵字

C-反應蛋白 ； 心臟衰竭 ； 預後

並列摘要

Background: Serum concentrations of C-reactive protein (CRP) are elevated in patients with congestive heart failure (CHF). However, clinical data about the prognostic value of CRP levels in patients with chronic stable CHF are spare. We hypothesized that measurement of CRP might provide prognostic information in these patients.
Methods: We measured serum levels of CRP in 72 patients with chronic CHF and left ventricular ejection fraction (LVEF) ＜50%. Major adverse cardiac events (death or hospitalization with worsening CHF) during a median follow-up period of 449 days were determined. Multivariate Cox regression analysis was performed to identify independent predictors of major adverse cardiac events.
Results: The concentrations of CRP in the sample population were significantly increased with the severity of CHF. The 25 patients who had adverse events had significantly higher CRP levels (p = 0.0065) than the 47 patients who were event-free. We further divided the 72 CHF patients into tertiles on the basis of this sample, with the cutoff points for each tertile being ≤2.69, ＞ 2.69 to ≤ 5.38, and ＞5.38 mg per liter, respectively. The differences between event-free curves were insignificant between tertiles 1 and 2 but were significant between tertiles 1 and 3 and between tertiles 2 and 3 (p = 0.0048, p = 0.0103, respectively). In a multivariate analysis (n =58), left ventricular end-diastolic pressure (LVEDP) and serum levels of CRP ＞ 5.38 mg per liter were found to be independently significant predictors for major adverse cardiac events in patients with chronic CHF. The CRP levels were significantly correlated with LVEDP (r = 0.26, p = 0.048; n=58).
Conclusions: These findings suggest that the levels of CRP are related to clinical outcomes and that measurement of CRP has the potential to play an important role as an adjunct for risk assessment in patients with chronic CHF.

並列關鍵字

C-reactive protein ； congestive heart failure ； Prognosis