Plasma Cytokine Parameters and Mortality in Patients with Chronic Heart Failure

Tools

Item Type:	Article
Title:	Plasma Cytokine Parameters and Mortality in Patients with Chronic Heart Failure
Creators Name:	Rauchhaus, M., Doehner, W., Francis, D.P., Davos, C., Kemp, M., Liebenthal, C., Niebauer, J., Hooper, J., Volk, H.D., Coats, A.J.S. and Anker, S.D.
Abstract:	BACKGROUND: Inflammatory immune activation is an important feature in chronic heart failure (CHF). Little is known about the prognostic importance of tumor necrosis factor-alpha (TNF-alpha), soluble TNF-receptor 1 and 2 (sTNF-R1/sTNF-R2), interleukin-6 (IL-6), and soluble CD14 receptors (sCD14) in CHF patients. METHODS AND RESULTS: In 152 CHF patients (age 61+/-1 years, New York Heart Association [NYHA] class 2.6+/-0.1, peak VO(2) 17.3+/-0.6 mL. kg(-1). min(-1), mean+/-SEM) plasma concentrations of immune variables were prospectively assessed. During a mean follow-up of 34 months (>12 months in all patients), 62 patients (41%) died. Cumulative mortality was 28% at 24 months. In univariate analyses, increased total and trimeric TNF-alpha, sTNF-R1, and sTNF-R2 (all P</=0.0001), sCD14 (P=0.0007), and IL-6 (P=0.005) predicted 24-month mortality. With multivariate analysis and receiver operating characteristics, sTNF-R1 emerged among all cytokine parameters as the strongest and most accurate prognosticator in this CHF population, regardless of follow-up duration and independently of NYHA class, peak VO(2), VE/VCO(2) slope, left ventricular ejection fraction, and wasting (P<0.001). The receiver operating characteristic area under the curve for sTNF-R1 was greater than for sTNF-R2 at 6, 12, and 18 months (all P<0.05). CONCLUSIONS: sTNF-R1 was the strongest and most accurate prognosticator, independent of established markers of CHF severity. Assessment of sTNF-R1 may be useful in identifying patients who are at high risk of death and in monitoring patients undergoing anti-TNF-alpha treatment.
Keywords:	Analysis of Variance, CD Antigens, CD14 Antigens, Biological Markers, Low Cardiac Output, Chronic Disease, Cytokines, Immunoassay, Interleukin-6, Prognosis, ROC Curve, Tumor Necrosis Factor Receptors, Tumor Necrosis Factor, Type I Receptors, Tumor Necrosis Factor, Type II Receptors, Solubility, Survival Analysis, Tumor Necrosis Factor-alpha
Source:	Circulation
ISSN:	0009-7322
Publisher:	American Heart Association
Volume:	102
Number:	25
Page Range:	3060-3067
Date:	19 December 2000
Official Publication:	http://circ.ahajournals.org/cgi/content/abstract/102/25/3060
PubMed:	View item in PubMed

Repository Staff Only: item control page