Inflammation and long-term mortality in acute congestive heart failure

Background Systemic inflammation has long been recognized as a precipitator of acute congestive heart failure (CHF). The impact of inflammation on prognosis in acute CHF, however, is unknown. Methods This study evaluated the prognostic role of inflammation among 214 consecutive patients presenting with acute CHF to the emergency department. Patients were stratified according to C-reactive protein (CRP) levels determined on admission. The primary end point was all-cause mortality during 24-month follow-up. Results The median CRP level was 13.0 mg/L, with an intertertile range of 6.0 to 25.0 mg/L. Initial and long-term outcomes were significantly different to the detriment of patients with higher CRP levels. Patients in the highest CRP fertile significantly more often required admission to the intensive care unit (33% vs 14% in patients in the first fertile, P = .028) and died inhospital (15% vs 2% in patients in the first fertile, P = .027). Cumulative 24-month mortality rates were 33.5% in the first, 42.4% in the second, and 53.6% in the third fertile (P = .0265 by log-rank test). After multivariate adjustment, CRP remained an independent predictor of death (hazard ratio 1.4, 95% Cl 1.1-1.8 for each step up in fertile, P = .044). Conclusions Inflammation is a significant and independent predictor of long-term mortality in patients with acute CHF.