Serviço de Medicina Interna.
Serviço de Patologia Clínica, Centro Hospitalar São João.
J Cardiovasc Med (Hagerstown). 2019 Jan;20(1):23-29. doi: 10.2459/JCM.0000000000000726.
The prognostic role of high-sensitivity C-reactive protein (hsCRP) in acute heart failure is less well established than for chronic heart failure and the impact of its variation is unknown. We studied the impact of hsCRP variation in acute heart failure and whether it differed according to left ventricular function.
We analyzed patients prospectively included in an acute heart failure registry. Admission and discharge hsCRP were evaluated as part of the registry's protocol and its relative variation (ΔhsCRP) was assessed. ΔhsCRP during hospitalization = [(admission hsCRP - discharge hsCRP)/admission hsCRP] × 100. Endpoint: all-cause death; follow-up: 3 years. A multivariate Cox-regression model was used to assess the prognostic value of ΔhsCRP (continuous and categorical variable: cut-off 40% decrease); analysis was stratified according to ventricular function.
We studied 439 patients: mean age 75 years, 50.1% men and 69.2% had heart failure with reduced ejection fraction (HFrEF). Median discharge hsCRP was 12.4 mg/l and median ΔhsCRP was ∼40%. During follow-up 247 patients (56.3%) died: 73 (54.1%) heart failure with preserved ejection fraction (HFpEF) patients and 174 (57.2%) HFrEF patients. The multivariate-adjusted hazard ratio of 3-year mortality in HFpEF patients with hsCRP decrease of at least 40% during hospitalization was 0.56 (95% CI 0.32-0.99). A decrease of at least 40% in hsCRP was not mortality-associated in HFrEF patients. There was interaction between ΔhsCRP and left ventricular ejection fraction.
A decrease of at least 40% in hsCRP in acute heart failure was associated with a 44% decrease in 3-year death risk in HFpEF patients. No association between ΔhsCRP and prognosis existed in HFrEF patients. Inflammation appears to play a different role according to left ventricular function.
与慢性心力衰竭相比，高敏 C 反应蛋白（hsCRP）在急性心力衰竭中的预后作用尚未得到充分证实，其变化的影响尚不清楚。我们研究了急性心力衰竭中 hsCRP 变化的影响，以及它是否因左心室功能而异。
我们前瞻性分析了急性心力衰竭登记研究中纳入的患者。入院和出院时 hsCRP 作为登记研究方案的一部分进行评估，其相对变化（ΔhsCRP）进行评估。住院期间的 ΔhsCRP = [(入院 hsCRP-出院 hsCRP)/入院 hsCRP]×100。终点：全因死亡；随访：3 年。采用多变量 Cox 回归模型评估 ΔhsCRP 的预后价值（连续和分类变量：截断值 40%下降）；根据心室功能进行分层分析。
我们研究了 439 例患者：平均年龄 75 岁，50.1%为男性，69.2%为射血分数降低的心力衰竭（HFrEF）。出院时 hsCRP 中位数为 12.4mg/L，ΔhsCRP 中位数约为 40%。随访期间，247 例患者（56.3%）死亡：73 例（54.1%）射血分数保留的心力衰竭（HFpEF）患者和 174 例（57.2%）HFrEF 患者。住院期间 hsCRP 至少下降 40%的 HFpEF 患者 3 年死亡率的多变量校正风险比为 0.56（95%CI 0.32-0.99）。HFrEF 患者 hsCRP 至少下降 40%与死亡率无关。ΔhsCRP 与左心室射血分数之间存在交互作用。
急性心力衰竭患者 hsCRP 至少下降 40%与 HFpEF 患者 3 年死亡风险降低 44%相关。HFrEF 患者 ΔhsCRP 与预后之间无关联。根据左心室功能，炎症似乎发挥不同的作用。
