Prognostic value of C-reactive protein as an inflammatory and n-terminal probrain natriuretic peptide as a neurohumoral marker in acute heart failure (from the Korean heart failure registry)

The neurohumoral and inflammatory pathways are regarded as the main mechanisms for the progression of heart failure. We sought to investigate the prognostic value of high-sensitivity C-reactive protein (hs-CRP) and N-terminal probrain natriuretic peptide (NT-proBNP) by evaluating their relation with 12-month mortality rate in this prospective cohort study from 24 academic hospitals in Korea. In 1,608 patients with acute heart failure (AHF), the median hs-CRP and NT-proBNP values were 0.77 mg/dl (interquartile range 0.29 to 2.84) and 4,638 pg/ml (interquartile range 1,945 to 10,852), respectively. During the 12-month follow-up, 213 patients (13.3%) died. The mortality rate increased from the lowest to the highest hs-CRP quartiles (Q1 7.4%, Q2 9.5%, Q3 16.9%, Q4 19.3%, p <0.001) and NT-proBNP quartiles (Q1 7.0%, Q2 13.4%, Q3 11.6%, Q4 20.4%, p <0.001). After adjustment, both hs-CRP (hazard ratio [HR] 1.811, 95% confidence interval [CI] 1.138 to 2.882) and NT-proBNP (HR 1.971, 95% CI 1.219 to 3.187) were independent predictors of 12-month mortality among others. When combining both hs-CRP and NT-proBNP and stratifying the patients according to their median values, patients with elevation of both hs-CRP and NT-proBNP values had 2.4-fold increased hazards (HR 2.382, 95% CI 1.509 to 3.761) compared with those without elevation of both markers. In Korean patients with AHF, patients with increased levels of both hs-CRP and NT-proBNP had worse clinical outcomes. The combination of the neurohumoral and inflammatory markers may provide a better strategy for risk stratification of Asian patients with AHF.