High-sensitivity C-reactive protein in acute heart failure: Insights from the ASCEND-HF trial

Andreas P. Kalogeropoulos, W. H Wilson Tang, Amy Hsu, G. Michael Felker, Adrian F. Hernandez, Richard W. Troughton, Adriaan A. Voors, Stefan D. Anker, Marco Metra, John J V McMurray, Barry M. Massie, Justin A. Ezekowitz, Robert M. Califf, Christopher M. O'Connor, Randall C. Starling, Javed Butler

Research output: Contribution to journalArticlepeer-review


Background Inflammation is associated with progression of chronic heart failure (HF). Few data exist on high-sensitivity C-reactive protein (hsCRP) levels and their importance in acute HF. Methods and Results In this biomarker substudy of the ASCEND-HF trial, we measured hsCRP levels at admission (n = 794), 48-72 hours (n = 677), and 30 days (n = 581) and evaluated their association with outcomes. Levels of hsCRP were considerably elevated at admission (median 12.6 mg/L, interquartile range [IQR] 5.23-30.5) and 48-72 hours (median 11.0 mg/L, IQR 4.87-29.9) and declined only at 30 days (median 4.7 mg/L, IQR 1.83-13.1). Admission hsCRP was not associated with dyspnea improvement at 6 hours (74.1%) and 24 hours (86.2%), in-hospital death or worsening HF (n = 37; 4.7%), 30-day mortality or HF readmission (death: n = 25 [3.2%]; combined death and HF readmission: n = 95 [12.0%]), or 180-day mortality (n = 96; 12.1%). Hospital stay (median 5 days, IQR 3-7) was longer among patients with higher admission hsCRP levels (0.57 days per log2-hsCRP in adjusted models; 95% confidence interval [CI] 0.33-0.81; P 2-hsCRP: 1.23; 95% CI 1.04-1.45; P =.016). Patients with an hsCRP increase at day 30, defined as >10% increase over baseline value, had higher 180-day mortality risk compared with those with unchanged or decreased 30-day hsCRP (HR 2.29, 95% CI 1.16-4.52; P =.017). Conclusions Levels of hsCRP are elevated among patients with acute HF. Increasing levels at 30 days after discharge are associated with higher 180-day mortality.

Original languageEnglish
Pages (from-to)319-326
Number of pages8
JournalJournal of Cardiac Failure
Issue number5
Publication statusPublished - 2014


  • acute heart failure
  • biomarkers
  • C-Reactive protein
  • outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)


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