C-Reactive Protein – ABC CARDIOL

IJCS

Letter to the Editor

Prognostic Value of C-reactive Protein (CRP) in Patients With Acute Heart Failure (AHF) Admitted to General Wards in Brazil

Vanessa Souza Silva Medrado et al. João Emmanuel Coelho de Morais Domingos Sávio de Oliveira e Silva João Pedro Lopes Azevedo … Thalisson Gonçalves Almeida Pedro Pereira Tenório

Dear Editor,

We read with great interest the article by Ferigato et al. investigating the prognostic value of C-reactive protein (CRP) in patients with acute heart failure (AHF) admitted to general wards in Brazil. We would like to congratulate the authors for addressing a topic of substantial practical relevance: the search for accessible biomarkers in settings where gold-standard tools, such as natriuretic peptides, have inconsistent availability.

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IJCS

Original Article

Inflammatory and Atherogenic Markers as Predictors of Coronary Artery Disease in Patients with Suspected Coronary Artery Disease Undergoing Coronary Angiography

Veysi Can et al. Fuat Polat

Abstract

Background:

Coronary artery disease (CAD) remains a leading cause of death worldwide, with inflammation playing a key role in its pathophysiology. Inflammatory biomarkers may offer valuable insights into disease mechanisms and risk stratification, potentially informing therapeutic decisions.

Objectives:

This study aimed to investigate the association between key inflammatory markers — C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) — and both the presence and severity of coronary artery stenosis (CAS) in patients with suspected CAD undergoing coronary angiography.

Methods:

This retrospective study included 767 patients referred for coronary angiography due to suspected CAD. The primary outcome was the presence of significant CAS. Demographic data, medical history, and blood samples were collected. Statistical analyses included descriptive methods and regression modeling as well as receiver operating characteristic (ROC) curve analysis to determine optimal cutoff values for biomarkers, with area under the curve (AUC) used to assess predictive performance. A p-value < 0.05 was considered statistically significant.

Results:

Of the 767 patients (mean age 58.3±12.4 years; 56.7% men), 496 had significant CAS (≥ 50%) and 271 had nonsignificant CAS (< 50%). Levels of CRP (0.44 vs. 0.13 mg/dL, p = 0.01) and NLR (2.6 vs. 2.0, p = 0.05) were significantly higher in patients with CAS. No significant difference was observed for PLR (129.4 vs. 118.6, p = 0.13). In multivariable analysis, CRP (OR = 1.188, p = 0.044) and NLR (OR=1.567, p = 0.03) were identified as independent predictors of significant CAS. However, ROC curve analysis showed limited discriminative ability for both CRP (AUC = 0.526) and NLR (AUC = 0.510), with values only slightly above chance.

Conclusion:

Increased levels of CRP and NLR are significantly associated with CAS and may serve as potential biomarkers for detecting CAD.

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IJCS

Editorial

C-Reactive Protein as a Prognostic Tool in Acute Heart Failure: Evidence from Low-Resource Settings

Cristhian Espinoza Romero et al. Hernán Patricio García Mejía Fábio Fernandes

Acute heart failure (AHF) remains a leading cause of hospitalization and cardiovascular mortality worldwide, with an even greater burden in low- and middle-income countries. In Brazil, in-hospital mortality for AHF is approximately 12%, compared to 4% reported in high-income countries.^,

In this context, the prospective study by Ferigato et al., conducted at a public hospital in São Paulo, assessed the prognostic value of C-reactive protein (CRP) in patients with AHF. This investigation is particularly relevant given the structural limitations of the Brazilian public healthcare system, where conventional biomarkers such as natriuretic peptides are often unavailable. Therefore, CRP—a low-cost and widely accessible inflammatory marker—emerges as a promising alternative for risk stratification during hospitalization.

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IJCS

Original Article

Prognostic Implications of Increased C-Reactive Protein in Patients With Acute Heart Failure Admitted to a General Hospital Ward

Vinicius Ferigato et al. Fernanda Takeyama Mario De Divitiis Giulio Checchinato Facchini … Bruna Gandra Bruno Maciel Goncalves Helder Jorge Andrade Gomes Gustavo A. B. Boros Alcides Rocha de Figueredo Junior

Abstract

Background:

C-reactive protein (CRP) is a widely available inflammatory biomarker. Its prognostic role during hospitalization in patients with acute heart failure (HF) remains unclear.

Objective:

To assess whether CRP measured at hospital admission predicts in-hospital mortality in patients with acute HF admitted to a general public hospital ward.

Methods:

This prospective study enrolled patients (≥18 years old) admitted to a medical ward with a primary diagnosis of acute HF directly from the emergency department. CRP was measured within 72 hours of hospital admission. All patients underwent a structured clinical assessment by a cardiologist and transthoracic echocardiography (TTE). A p-value <0.05 was considered statistically significant.

Results:

A total of 44 patients were included (mean age 68 ± 16 years). TTE showed left ventricular ejection fraction (LVEF) <50% in 43% of patients, preserved LVEF in 43%, and specific causes of HF in the remaining 14%. The median CRP level (2.5 mg/dL) was used to define high and low CRP groups. Reduced LVEF (<50%) was more common, and heart failure with preserved ejection fraction (HFpEF) was less frequent, in the high CRP group (p = 0.014). Clinical assessment showed no differences in hemodynamic profiles (congestion vs. perfusion). Comorbidities, renal function, and infection diagnoses were also similar between groups. In-hospital mortality was 30% in the high CRP group versus 4.8% in the low CRP group (p = 0.046). In multivariable analysis, increased CRP remained independently associated with in-hospital mortality.

Conclusion:

CRP measured near the time of hospital admission may serve as a prognostic marker for in-hospital mortality in patients with acute HF.

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IJCS

Review Article

Inflammation in Cardiovascular Disease: Current Status and Future Perspectives

Francisco Antonio Helfenstein Fonseca et al. Maria Cristina Izar

Abstract

Atherosclerosis has been defined as an inflammatory disease. Three decades of research have pointed to a pivotal role of interleukin 6 for many aspects of cardiovascular disease, not the least of which is atherosclerosis. In this review, experimental and clinical studies are reported on a timeline, exploring mechanisms and possible explanations that form the basis of current knowledge. Some successful clinical trials were proof of concept studies, showing that not only inflammatory biomarkers are related to cardiovascular outcomes, but also that decreasing inflammation can reduce cardiovascular events. Great advances have been made in the management of residual cardiovascular risk due to cholesterol, thrombosis, and metabolic diseases, but the next frontier now seems to be targeting inflammation. In the upcoming years, the importance of inflammation will be evaluated in high-risk patients with chronic kidney disease, after acute coronary heart disease or heart failure with preserved ejection fraction. Inflammation seems to precede the development of cardiovascular risk factors. Moreover, counseling for a heathy lifestyle and, when necessary, the use of cardiometabolic therapies capable of decreasing inflammation, might be important.

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IJCS

Original Article

C-reactive Protein is a Predictor of Mortality in ST-segment Elevation Acute Myocardial Infarction

Sibele Sauzem Milano et al. Orlando Victorino de Moura Júnior Arthur Augusto Souza Bordin Gustavo Lenci Marques

Abstract

Background:

Inflammation is a major component of the response to tissue injury caused by myocardial infarction. High-sensitivity C-reactive protein (hs-CRP) levels might be a simple marker of the severity of this inflammatory response, providing prognostic information.

Objective:

To associate hs-CRP level on admission and other clinical characteristics with in-hospital mortality of patients with acute ST-segment elevation myocardial infarction (STEMI).

Methods:

A retrospective cohort study of patients admitted with STEMI was carried out. Patients were analyzed regarding clinical characteristics, reperfusion therapy, hs-CRP on admission and outcomes. Continuous variables were analyzed by non-parametric Mann-Whitney U test and categorical variables by chi-square test. A p value of < 0.05 was considered statistically significant.

Results:

Of the 118 patients analyzed, 20 died during hospitalization. Higher levels of hs-CRP (p = 0.001) and older ages (p = 0.003) were observed among those patients who died. Logistic regression showed that a one unit increase in hs-CRP increased the risk of death by 15% (p = 0.0017), after adjustment for established risk factors. Similarly, each one-year increase in age increases the risk of death by 6.6% (p = 0.003).

Conclusion:

Our results demonstrate a strong association between hs-CRP obtained on admission and in-hospital mortality after STEMI. It suggests that hs-CRP can be a marker of inflammatory response to myocardial ischemia, providing prognostic information regarding the risk of death.

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ABC

Original Article

Correlation between turbidimetric and nephelometric methods of measuring C-reactive protein in patients with unstable angina or non-ST elevation acute myocardial infarction

Luis C. L. Correia et al. José C. Lima Gary Gerstenblith Luis P. Magalhães … Agnaluce Moreira Octávio Barbosa Jr. Juliana Dumet Luiz Carlos S. Passos Argemiro D'Oliveira Júnior José Péricles Esteves

OBJECTIVE: To evaluate the performance of the turbidimetric method of C-reactive protein (CRP) as a measure of low-grade inflammation in patients admitted with non-ST elevation acute coronary syndromes (ACS). METHODS: Serum samples obtained at hospital arrival from 68 patients (66±11 years, 40 men), admitted with unstable angina or non-ST elevation acute myocardial infarction were used to measure CRP by the methods of nephelometry and turbidimetry. RESULTS: The medians of C-reactive protein by the turbidimetric and nephelometric methods were 0.5 mg/dL and 0.47 mg/dL, respectively. A strong linear association existed between the 2 methods, according to the regression coefficient (b=0.75; 95% C.I.=0.70-0.80) and correlation coefficient (r=0.96; P<0.001). The mean difference between the nephelometric and turbidimetric CRP was 0.02 ± 0.91 mg/dL, and 100% agreement between the methods in the detection of high CRP was observed. CONCLUSION: In patients with non-ST elevation ACS, CRP values obtained by turbidimetry show a strong linear association with the method of nephelometry and perfect agreement in the detection of high CRP.

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