title: Plasma cytokine parameters and mortality in patients with chronic heart failure.
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.
  
  
  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.
authors: Clinical Cardiology, National Heart and Lung Institute, Royal Brompton Hospital, London, UK. mathias.rauchhaus@medizin.uni-halle.de
authors: M
authors: M
authors: Rauchhaus
authors: W
authors: W
authors: Doehner
authors: D P
authors: DP
authors: Francis
authors: C
authors: C
authors: Davos
authors: M
authors: M
authors: Kemp
authors: C
authors: C
authors: Liebenthal
authors: J
authors: J
authors: Niebauer
authors: J
authors: J
authors: Hooper
authors: H D
authors: HD
authors: Volk
authors: A J
authors: AJ
authors: Coats
authors: S D
authors: SD
authors: Anker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015703:Antigens, CD / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002303:Cardiac Output, Low / Q000097:blood / Q000276:immunology* / Q000401:mortality*; D002908:Chronic Disease; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D007118:Immunoassay; D015850:Interleukin-6 / Q000097:blood; D018950:Lipopolysaccharide Receptors / Q000097:blood; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood; D047888:Receptors, Tumor Necrosis Factor, Type I; D047889:Receptors, Tumor Necrosis Factor, Type II; D012995:Solubility; D016019:Survival Analysis; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D015703:Antigens, CD; D015415:Biomarkers; D016207:Cytokines; D015850:Interleukin-6; D018950:Lipopolysaccharide Receptors; D018124:Receptors, Tumor Necrosis Factor; D047888:Receptors, Tumor Necrosis Factor, Type I; D047889:Receptors, Tumor Necrosis Factor, Type II; D014409:Tumor Necrosis Factor-alpha