Value of high-sensitivity C-reactive protein assays in predicting atrial fibrillation recurrence: A systematic review and meta-analysis

Chia Hung Yo, Si Huei Lee, Shy Shin Chang, Matthew Chien Hung Lee, Chien Chang Lee

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Objectives: We performed a systematic review and meta-analysis of studies on high-sensitivity C-reactive protein (hs-CRP) assays to see whether these tests are predictive of atrial fibrillation (AF) recurrence after cardioversion. Design: Systematic review and meta-analysis. Data sources: PubMed, EMBASE and Cochrane databases as well as a hand search of the reference lists in the retrieved articles from inception to December 2013. Study eligibility criteria: This review selected observational studies in which the measurements of serum CRP were used to predict AF recurrence. An hs-CRP assay was defined as any CRP test capable of measuring serum CRP to below 0.6 mg/dL. Primary and secondary outcome measures: We summarised test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves and bivariate random effects models. Meta-regression analysis was performed to explore the source of heterogeneity. Results: We included nine qualifying studies comprising a total of 347 patients with AF recurrence and 335 controls. A CRP level higher than the optimal cut-off point was an independent predictor of AF recurrence after cardioversion (summary adjusted OR: 3.33; 95% CI 2.10 to 5.28). The estimated pooled sensitivity and specificity for hs-CRP was 71.0% (95% CI 63% to 78%) and 72.0% (61% to 81%), respectively. Most studies used a CRP cut-off point of 1.9 mg/L to predict long-term AF recurrence (77% sensitivity, 65% specificity), and 3 mg/L to predict short-term AF recurrence (73% sensitivity, 71% specificity). Conclusions: hs-CRP assays are moderately accurate in predicting AF recurrence after successful cardioversion.

Original languageEnglish
Article numbere004418
JournalBMJ Open
Volume4
Issue number2
DOIs
Publication statusPublished - Mar 4 2014
Externally publishedYes

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C-Reactive Protein
Atrial Fibrillation
Meta-Analysis
Recurrence
Electric Countershock
Sensitivity and Specificity
Information Storage and Retrieval
Serum
PubMed
ROC Curve
Observational Studies
Regression Analysis
Outcome Assessment (Health Care)
Databases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Value of high-sensitivity C-reactive protein assays in predicting atrial fibrillation recurrence : A systematic review and meta-analysis. / Yo, Chia Hung; Lee, Si Huei; Chang, Shy Shin; Lee, Matthew Chien Hung; Lee, Chien Chang.

In: BMJ Open, Vol. 4, No. 2, e004418, 04.03.2014.

Research output: Contribution to journalReview article

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abstract = "Objectives: We performed a systematic review and meta-analysis of studies on high-sensitivity C-reactive protein (hs-CRP) assays to see whether these tests are predictive of atrial fibrillation (AF) recurrence after cardioversion. Design: Systematic review and meta-analysis. Data sources: PubMed, EMBASE and Cochrane databases as well as a hand search of the reference lists in the retrieved articles from inception to December 2013. Study eligibility criteria: This review selected observational studies in which the measurements of serum CRP were used to predict AF recurrence. An hs-CRP assay was defined as any CRP test capable of measuring serum CRP to below 0.6 mg/dL. Primary and secondary outcome measures: We summarised test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves and bivariate random effects models. Meta-regression analysis was performed to explore the source of heterogeneity. Results: We included nine qualifying studies comprising a total of 347 patients with AF recurrence and 335 controls. A CRP level higher than the optimal cut-off point was an independent predictor of AF recurrence after cardioversion (summary adjusted OR: 3.33; 95{\%} CI 2.10 to 5.28). The estimated pooled sensitivity and specificity for hs-CRP was 71.0{\%} (95{\%} CI 63{\%} to 78{\%}) and 72.0{\%} (61{\%} to 81{\%}), respectively. Most studies used a CRP cut-off point of 1.9 mg/L to predict long-term AF recurrence (77{\%} sensitivity, 65{\%} specificity), and 3 mg/L to predict short-term AF recurrence (73{\%} sensitivity, 71{\%} specificity). Conclusions: hs-CRP assays are moderately accurate in predicting AF recurrence after successful cardioversion.",
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AB - Objectives: We performed a systematic review and meta-analysis of studies on high-sensitivity C-reactive protein (hs-CRP) assays to see whether these tests are predictive of atrial fibrillation (AF) recurrence after cardioversion. Design: Systematic review and meta-analysis. Data sources: PubMed, EMBASE and Cochrane databases as well as a hand search of the reference lists in the retrieved articles from inception to December 2013. Study eligibility criteria: This review selected observational studies in which the measurements of serum CRP were used to predict AF recurrence. An hs-CRP assay was defined as any CRP test capable of measuring serum CRP to below 0.6 mg/dL. Primary and secondary outcome measures: We summarised test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves and bivariate random effects models. Meta-regression analysis was performed to explore the source of heterogeneity. Results: We included nine qualifying studies comprising a total of 347 patients with AF recurrence and 335 controls. A CRP level higher than the optimal cut-off point was an independent predictor of AF recurrence after cardioversion (summary adjusted OR: 3.33; 95% CI 2.10 to 5.28). The estimated pooled sensitivity and specificity for hs-CRP was 71.0% (95% CI 63% to 78%) and 72.0% (61% to 81%), respectively. Most studies used a CRP cut-off point of 1.9 mg/L to predict long-term AF recurrence (77% sensitivity, 65% specificity), and 3 mg/L to predict short-term AF recurrence (73% sensitivity, 71% specificity). Conclusions: hs-CRP assays are moderately accurate in predicting AF recurrence after successful cardioversion.

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