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European Heart Journal Advance Access published online on April 26, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi277
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received November 25, 2004
Revised February 19, 2005
Accepted March 18, 2005

Clinical research

Utility of serum C-reactive protein in assessing the outcome of infective endocarditis

Maija Heiro 1*, Hans Helenius 2, Jari Sundell 2, Pertti Koskinen 3, Erik Engblom 1, Jukka Nikoskelainen 1, and Pirkko Kotilainen 1

1 Department of Medicine, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
2 Department of Biostatistics, University of Turku, Turku, Finland
3 Central Laboratory, Turku University Central Hospital, Turku, Finland

* To whom correspondence should be addressed.
Maija Heiro, E-mail: maija.heiro{at}tyks.fi


  Abstract

Aims To evaluate the diagnostic usefulness of serial serum C-reactive protein determinations in monitoring the outcome of infective endocarditis (IE).

Methods and results C-reactive protein, erythrocyte sedimentation rate (ESR), and white blood cell count (WBC) were measured from admission until week 10 in 129 patients with 134 episodes of IE. Need for cardiac surgery and final outcome were assessed until 3 months from admission. Data were evaluated using extensive statistical analyses. The fall in serum C-reactive protein or WBC was significantly faster when a patient had an uncomplicated recovery than when complications developed or death ensued, but no such behaviour was observed in ESR. None of the 80 patients who had normal C-reactive protein by week 10 died of IE. Moreover, none of the 22 patients who had normal C-reactive protein by week 4 needed cardiac surgery and only two of the 33 patients who had normal C-reactive protein by week 6 needed cardiac surgery, both after successful medical treatment of IE. Of the 87 patients whose WBC normalized within 4 weeks, six died and 15 needed valve surgery.

Conclusion The normalization of C-reactive protein proved to be a good predictor of a favourable late outcome (surgery, death) of IE. Also WBC count proved useful in the assessment of patients with IE, but the value of ESR was negligible.

Keywords: C-reactive protein; Erythrocyte sedimentation rate; Infective endocarditis; White blood cell count.
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