International Journal of Cardiovascular Sciences. 06/ago/2025;38:e20240235.

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

Vinicius Ferigato , 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

DOI: 10.36660/ijcs.20240235

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.