Baseline C-reactive protein levels and prognosis in patients with infective endocarditis: A prospective cohort study

Abstract

BackgroundEarly diagnosis and risk-stratification among infective endocarditis (IE) patients are limited by poor microbiological yield and inadequate characterization of vegetations. A simple tool that can predict adverse outcomes in the early phase of management is required.AimTo study the prognostic value of C-reactive protein (CRP) levels at admission and its role in predicting various clinical outcomes.MethodsIn a prospective study of consecutive IE patients diagnosed by modified Duke’s criteria, we measured the peak levels of CRP and erythrocyte sedimentation rate (ESR) in the first 3 days of admission and correlated it with in-hospital mortality, six-month mortality, embolic phenomena and the need for urgent surgery. Predefined laboratory-microbiological sampling protocols and antibiotic-initiation protocols were followed. Receiver-operating-characteristics curves were generated to identify a reliable cut-off for CRP in predicting various outcomes.ResultsOut of 101 patients who were treated, 85 patients had ‘definite’ IE. Blood cultures were positive in 55% (n = 39); and Staphylococcus species was the most common organism. Major complications occurred in 74.1% (n = 63) and in-hospital mortality was 32.9% (n = 28). Mean ESR and CRP levels were 102 ± 31 mm/h and 51 ± 20 mg/l, respectively. In multivariable analysis, high CRP levels were independently predictive of mortality, major complications, embolic events and need for urgent surgery. A CRP >40 mg/l predicted adverse outcomes with a sensitivity of 73% and specificity of 99%.ConclusionThe study shows that baseline CRP level in the first 3 days of admission is a strong predictor of short term adverse outcomes in IE patients, and a useful marker for early risk stratification.

Infective Endocarditis: Preliminary Results of a Cohort Study in the Southern Italian Population

“…Among laboratory investigations, we found a high level of CRP within three days from hospital admission confirming that high levels of CRP levels may be an inexpensive laboratory test to take to account for decision-making in febrile patients to prompt them in performing a TTE as also suggested by other studies [30]. This study analyzing the demographic variables found that age and gender influenced IE surgery therapy.…”

“…This result may be explained considering that males with IE have been reported to have a high probability of cardiac surgery as compared with females. Recent studies confirm that male gender and old age are variables that determine who may need surgery irrespective of the clinical status and comorbidities [30].…”

The Impact of C Reactive Protein in Prediction of the Outcome in Infective Endocarditis

“…Definition of Cut-Off Points of CRP, on Week 3 and 4 That Could Predict Death of A Patient During the Remaining Follow-Up.dictive of mortality, major complications, embolic events, and need for urgent surgery, and also a CRP >40 mg/l predicted adverse outcomes with a sensitivity of 73% and specificity of 99%(9). Similar to our results, in the study ofHeiro et al…”

Infective endocarditis complicated by embolic events: Pathogenesis and predictors

“…Serum C‐reactive protein (CRP), which is produced by the liver, is an important inflammatory biomarker. An elevated CRP level (CRP > 40 mg/L) is an independent predictor of EE 24 . CRP activates the coagulation cascade by inducing the production of TF that modify the platelet function within the vegetation causing it to become more friable.…”