Predictive power of C-reactive protein shifts based on cirrhosis or coronary disease

A new study reveals that the predictive power of key inflammatory markers, such as C-reactive protein, shifts fundamentally depending on whether a patient suffers from cirrhosis or acute/chronic coronary disease.

Measured using an electrocardiogram, ventricular repolarization, which refers to the duration of time the heart muscle takes to electrically "reset" after each beat, is the core indicator of heart health stability. The main factors governing this essential electrical function are the pumping ability of the left ventricle and the activity of the autonomic nervous system - since systemic diseases like liver failure or coronary blockage disrupt these factors, inflammation often rises.

This study aimed to contrast how the relationship between inflammation and heart rhythm instability manifests across diseases localized in different systems.

"Most of the knowledge about markers of inflammation such as white blood cell count and C-reactive protein in the field of internal medicine comes from studies in patients with cardiovascular diseases, namely coronary artery disease," explains doctor Niya Emilova of the University Emergency Medicine Hospital Pirogov in Sofia, Bulgaria, who led the research project.

"We present a study which is the first contemporary exploration of the differences in inflammation regarding arrhythmia risk and clinical outcome of patients with cirrhosis, stable coronary artery disease and acute myocardial infarction."

The researchers measured three primary inflammation markers: white blood cell count (the number of infection-fighting cells), C-reactive protein (a protein produced in response to systemic inflammation), and procalcitonin (a highly specific indicator of bacterial infection).

Their paper, titled "C-reactive protein is closely related to cardiac repolarization in patients with coronary artery disease in contrast to patients with cirrhosis", and published in the open-access journal Bulgarian Society of Medical Sciences Journal, reveals that C-reactive protein is associated with the risk of ventricular arrhythmias in stable coronary disease, while both C-reactive protein and white blood cell count correlated with repolarization indices in acute myocardial infarction.

In cirrhosis, only high white blood cell count showed a trend for linking to unstable rhythms; C-reactive protein by contrast did not correlate with heart rhythms in this group.

"The count of white blood cells and procalcitonin are associated with risk of complications in alcoholic cirrhosis. In patients with cirrhosis and infection on therapy, white blood cell count is a specific marker of increased dispersion of repolarization," the researchers write in their paper.

Certain medications used to treat heart failure and coronary disease, such as beta-blockers, may have preventive value in reducing the risk of life-threatening cardiac arrhythmias in patients with cirrhosis, the researchers suggest.