Abstract 12370: Prognostic Value of Inflammatory Markers in Recurrent Pericarditis

Background: Expert guidelines recommended the use of inflammatory markers for the confirmatory diagnosis of recurrent pericarditis (RP), however the prognostic role in management is unknown. Inflammatory marker levels in RP fluctuate, therefore measurement during flare is paramount. We attempt to assess the prognostic value of inflammatory markers (ESR, hs-CRP) taken during active flare in idiopathic/viral RP. Methods: We retrospectively reviewed 130 patients with established RP from 2015 to 2019 with inflammatory markers during flare. RP was diagnosed if two of these features were present; pleuritic chest pain, EKG changes, rub, and effusion. Active flare was defined as pleuritic chest pain with raised inflammatory markers. Clinical improvement (CI) and remission (CR) were assessed. CI was defined as symptom improvement on dual anti-inflammatory therapy. CR was established with symptom resolution and cessation of therapy. Results: Mean age was 46 ± 16, 57% were female, and a median number of recurrences was 3. The median follow-up time was 633 days, and median time to first recurrence was 263 days. Patients with lower hs-CRP <10 mg/L were more likely to have CI as compared to the higher hs-CRP ≥10 mg/L group (79% vs 42%, p=0.012). Also, patients in the lower hs-CRP group showed a higher tendency to achieve CR (43% vs 20%, p = 0.081). ESR was statistically insignificant for the outcomes. The median time to CI in the low hs-CRP group was less compared to the high hs-CRP group (11 vs. 32 months). Majority of high hs-CRP patients did not achieve CR. The probability of CI and CR among low hs-CRP is higher as compared to high hs-CRP (log-rank p=0.001; log-rank p=0.034) [Figure 1]. Conclusion: Patients who had higher hs-CRP were less likely and required more time to achieve CI and CR as compared to patients with lower hs-CRP. This highlights the prognostic significance of hs-CRP that may assist management of RP even without a concurrent ESR level. Figure 1: Kaplan-Meier Analysis of CI and CR