Is there a C-reactive protein value beyond which one should consider infection as the cause of acute heart failure?

Abstract Background Heart Failure (HF) is a low grade inflammatory condition. High sensitivity C-reactive protein (hsCRP) is an established marker of inflammation. A cut-off value of hsCRP beyond which an infection should be sought has never been studied in HF. We aimed to determine the best hsCRP c...

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Main Authors: Joana Pereira, Ana Ribeiro, João Ferreira-Coimbra, Isaac Barroso, João-Tiago Guimarães, Paulo Bettencourt, Patrícia Lourenço
Format: Article
Language:English
Published: BMC 2018-02-01
Series:BMC Cardiovascular Disorders
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12872-018-0778-4
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spelling doaj-646791c3a52e459c882ff573bca770102020-11-25T03:37:16ZengBMCBMC Cardiovascular Disorders1471-22612018-02-011811810.1186/s12872-018-0778-4Is there a C-reactive protein value beyond which one should consider infection as the cause of acute heart failure?Joana Pereira0Ana Ribeiro1João Ferreira-Coimbra2Isaac Barroso3João-Tiago Guimarães4Paulo Bettencourt5Patrícia Lourenço6Department of Internal Medicine, São João HospitalDepartment of Internal Medicine, São João HospitalDepartment of Internal Medicine, São João HospitalDepartment of Biochemistry, São João HospitalDepartment of Clinical Pathology, São João HospitalUnidade de Investigação e Desenvolvimento Cardiovascular do Porto, Faculty of Medicine of University of PortoDepartment of Internal Medicine, São João HospitalAbstract Background Heart Failure (HF) is a low grade inflammatory condition. High sensitivity C-reactive protein (hsCRP) is an established marker of inflammation. A cut-off value of hsCRP beyond which an infection should be sought has never been studied in HF. We aimed to determine the best hsCRP cut-off for infection prediction in acute HF. Methods We analyzed patients included in an acute HF registry – EDIFICA (Estratificação de Doentes com InsuFIciência Cardíaca Aguda). Admission hsCRP measurement was available as part of the registry’s protocol. Patients with acute coronary syndrome as the cause of acute HF were excluded from the registry. Infection was considered according to the diagnosis registered in the discharge record. A receiver-operating characteristic (ROC) curve was used to determine the best hsCRP cut-off for infection prediction. Results We studied 615 patients. Mean age was 76 years, 45.2% were male, 60.3% had systolic dysfunction. Median admission hsCRP was 20.3 (9.5–55.5)mg/L; in 41.6% the cause of decompensation was an infection. The area under the ROC curve for admission hsCRP in the prediction of infection was 0.79 (0.76–0.83); the best hsCRP cut-off was 25 mg/L with a sensitivity of 72.7%, specificity 77.2%, positive predictive value 69.4% and negative predictive value 79.9%. Age and elevated hsCRP independently associated with an infection as the precipitant of acute HF. Conclusions We suggest 25 mg/L as a cut-off beyond which an infection should be sought underlying acute HF. Almost 80% of the patients with hsCRP< 25 mg/L are not infected and 69.4% of those with higher hsCRP have a concomitant infection.http://link.springer.com/article/10.1186/s12872-018-0778-4Acute heart failureC-reactive proteinInfectionCut-off
collection DOAJ
language English
format Article
sources DOAJ
author Joana Pereira
Ana Ribeiro
João Ferreira-Coimbra
Isaac Barroso
João-Tiago Guimarães
Paulo Bettencourt
Patrícia Lourenço
spellingShingle Joana Pereira
Ana Ribeiro
João Ferreira-Coimbra
Isaac Barroso
João-Tiago Guimarães
Paulo Bettencourt
Patrícia Lourenço
Is there a C-reactive protein value beyond which one should consider infection as the cause of acute heart failure?
BMC Cardiovascular Disorders
Acute heart failure
C-reactive protein
Infection
Cut-off
author_facet Joana Pereira
Ana Ribeiro
João Ferreira-Coimbra
Isaac Barroso
João-Tiago Guimarães
Paulo Bettencourt
Patrícia Lourenço
author_sort Joana Pereira
title Is there a C-reactive protein value beyond which one should consider infection as the cause of acute heart failure?
title_short Is there a C-reactive protein value beyond which one should consider infection as the cause of acute heart failure?
title_full Is there a C-reactive protein value beyond which one should consider infection as the cause of acute heart failure?
title_fullStr Is there a C-reactive protein value beyond which one should consider infection as the cause of acute heart failure?
title_full_unstemmed Is there a C-reactive protein value beyond which one should consider infection as the cause of acute heart failure?
title_sort is there a c-reactive protein value beyond which one should consider infection as the cause of acute heart failure?
publisher BMC
series BMC Cardiovascular Disorders
issn 1471-2261
publishDate 2018-02-01
description Abstract Background Heart Failure (HF) is a low grade inflammatory condition. High sensitivity C-reactive protein (hsCRP) is an established marker of inflammation. A cut-off value of hsCRP beyond which an infection should be sought has never been studied in HF. We aimed to determine the best hsCRP cut-off for infection prediction in acute HF. Methods We analyzed patients included in an acute HF registry – EDIFICA (Estratificação de Doentes com InsuFIciência Cardíaca Aguda). Admission hsCRP measurement was available as part of the registry’s protocol. Patients with acute coronary syndrome as the cause of acute HF were excluded from the registry. Infection was considered according to the diagnosis registered in the discharge record. A receiver-operating characteristic (ROC) curve was used to determine the best hsCRP cut-off for infection prediction. Results We studied 615 patients. Mean age was 76 years, 45.2% were male, 60.3% had systolic dysfunction. Median admission hsCRP was 20.3 (9.5–55.5)mg/L; in 41.6% the cause of decompensation was an infection. The area under the ROC curve for admission hsCRP in the prediction of infection was 0.79 (0.76–0.83); the best hsCRP cut-off was 25 mg/L with a sensitivity of 72.7%, specificity 77.2%, positive predictive value 69.4% and negative predictive value 79.9%. Age and elevated hsCRP independently associated with an infection as the precipitant of acute HF. Conclusions We suggest 25 mg/L as a cut-off beyond which an infection should be sought underlying acute HF. Almost 80% of the patients with hsCRP< 25 mg/L are not infected and 69.4% of those with higher hsCRP have a concomitant infection.
topic Acute heart failure
C-reactive protein
Infection
Cut-off
url http://link.springer.com/article/10.1186/s12872-018-0778-4
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