Open AccessEffect of systemic corticosteroid therapy for acute heart failure patients with elevated C‐reactive protein
Author(s) -
Miró Òscar,
Takagi Koji,
Davison Beth A.,
Edwards Christopher,
Freund Yonathan,
Jacob Javier,
Llorens Pere,
Mebazaa Alexandre,
Cotter Gad
Publication year - 2022
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.13926
Subject(s) - medicine , heart failure , c reactive protein , corticosteroid , cardiology , intensive care medicine , inflammation
Aims The current study explores whether degree of inflammation, reflected by C‐reactive protein (CRP) level, modifies the effect of intravenous (IV) corticosteroid administered in the emergency department (ED) on clinical outcomes in patients with acute heart failure (AHF). Methods and results We selected patients diagnosed with AHF in the ED, with confirmed N‐terminal pro‐B‐type natriuretic peptide > 300 pg/mL and CRP > 5 mg/L in the ED from the Epidemiology of Acute Heart Failure in the Emergency Departments (EAHFE) registry. In these 1109 patients, 121 were treated by corticosteroid. The corticosteroid therapy hazard ratio (HR) for 30 day all‐cause mortality was 1.26 [95% confidence interval (CI) 0.75–2.09, P = 0.38]. Although not statistically significant, HRs tended to decrease with increasing CRP level, with point estimates favouring corticosteroid at CRP levels above 20. In patients with CRP > 40 mg/L, with adjusted HRs of 0.56 (95% CI 0.20–1.55, P = 0.27) for 30 day all‐cause mortality, 0.92 (95% CI 0.52–1.62, P = 0.78) for 30 day post‐discharge ED revisit, hospitalization, or death, and adjusted odds ratio of 0.61 (95% CI 0.17–2.14, P = 0.44) for in‐hospital all‐cause mortality. Conclusions The present analysis suggests that corticosteroids might have the potential to improve outcomes in AHF patients with inflammatory activation. Larger, prospective studies of anti‐inflammatory therapy should be considered to assess potential benefit in patients with the highest degree of inflammation.