CONGESTION AND SISTEMIC INFLAMMATION IN ACUTE HEART FAILURE: CORRELATIONS AND PROGNOSTIC ROLE

Pietro Scicchitano^1*Daniele De Feo²Massimo Iacoviello³Stefano Albani⁴Gabriella Ricci²Anna Livrieri²Cosimo Campanella²Pasquale Caldarola²Marco Matteo Ciccone⁵Francesco Massari¹

• ¹ASLBari - Azienda Sanitaria Localedella provincia di Bari (ASL BA), Bari, Italy
• ²Ospedale San Paolo, Bari, Italy
• ³Universita degli Studi di Foggia, Foggia, Italy
• ⁴Ospedale Regionale Umberto Parini, Aosta, Italy
• ⁵Universita degli Studi di Bari Aldo Moro, Bari, Italy

BACKGROUND: the reciprocal correlation between systemic inflammation and heart failure (HF) is a hotline research topic although the exact role in risk stratification and prognosis within the acute setting is a matter of debate. The aim of this study was to evaluate the correlation among two inflammatory biomarkers – namely high sensitivity C-Reactive Protein (hs-CRP) and Neutrophil-lymphocyte ratio (NLR) –, congestion status, and prognosis in patients with acute HF (AHF). METHODS: we consecutively enrolled 314 AHF patients. Congestion biomarkers (brain natriuretic peptide, estimated plasma volume status [ePVS], hydration index [HI], blood urea nitrogen to creatinine ratio [BUN/Cr]) were evaluated in order to assess hemodynamic intravascular, peripheral, and venous congestion. We also measured hs-CRP and NLR as marker of inflammation. The endpoint was all-cause mortality at 90 days. RESULTS: hs-CRP concentrations at the admission (12.1 mg/L, 95% Confidential Interval [CI] 10-15) were associated to NRL values (4.8, 95% CI 4.3-5.3) (R2=0.11; P<0.0001). They both positively correlated with congestion indexes (log hs-CRP: ePVS: r = 0.2, HI: r = 0.24, p<0.0001 for both; log NRL: ePVS: r=0.20, HI: r=0.29, BUN/Cr: 0.14, log BNP r=0.16, p < 0.01 for all). After 90 days, the cumulative mortality rate was 26%. Inflammatory biomarkers (hs-CRP and NLR cut-offs were >60 pg/mL and >7.5, respectively) were predictors of death. By using all these parameters, we performed an index of inflammation (from 0 to 2) for each patient. Congestion and inflammation indexes were independent predictors of mortality (hazard ratio 1.4 and 2.3, respectively; C-index 0.72). CONCLUSIONS: Systemic inflammation seemed directly associated to congestion burden in patients with AHF. Both of them are able to differently impact on the prediction of adverse outcomes in these patients. Further studies are needed in order to address unmet needs.