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

Abstract

Background: Early 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. Aim: To study the prognostic value of C-reactive protein (CRP) levels at admission and its role in predicting various clinical outcomes. Methods: In 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. Results: Out 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%. Conclusion: The 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. Keywords: Infective endocarditis, C-reactive protein, Prognostication, Valvular heart disease, Biomarker