title: Inflammatory cytokines provide limited early prognostic information in emergency department patients with suspected myocardial ischemia.
abstract: OBJECTIVE
  The aim of this study was to assess the early prognostic value of the inflammatory cytokines interleukin 6, interleukin 8, and tumor necrosis factor alpha in a cohort of emergency department (ED) patients with chest pain who have suspected myocardial ischemia.
  
  
  METHODS
  One hundred eighteen patients with chest pain presenting to 2 urban EDs were studied. Interleukin 6, interleukin 8, and tumor necrosis factor alpha levels were assayed at presentation. The end point was the occurrence of a serious cardiac event (death, nonfatal acute myocardial infarction, myocardial revascularization, or readmission with an acute coronary syndrome) during the index admission or subsequent 3 months.
  
  
  RESULTS
  Mean levels of all 3 cytokines were higher among patients experiencing a serious cardiac event, with the greatest differences observed in levels of interleukin 6 (mean 2.5 pg/mL [95% confidence interval (CI) 1.2 to 3.7 pg/mL] versus mean 9.8 pg/mL [95% CI 2.4 to 17.2 pg/mL]). Interleukin 6 had a sensitivity of 35% (95% CI 20% to 54%), a specificity of 86% (95% CI 76% to 92%), and an overall prognostic accuracy of 71% (95% CI 63% to 79%) for predicting serious cardiac events. However, logistic regression analysis revealed that the only independent predictor of an adverse outcome was an ECG suggestive of ischemia at presentation.
  
  
  CONCLUSIONS
  Among patients presenting to the ED with suspected myocardial ischemia, higher levels of inflammatory cytokines are associated with an increased risk of a serious cardiac event during the subsequent 3 months. There is, however, considerable overlap in levels among patients who do and do not have a serious cardiac event, limiting their utility as predictors of outcome in individual patients.
authors.affiliation: Albert Einstein Medical Center, Philadelphia, PA, USA. g.hillis@abdn.ac.uk
authors.forename: Graham S
authors.initials: GS
authors.lastname: Hillis
authors.forename: Carol A
authors.initials: CA
authors.lastname: Terregino
authors.forename: Pamela
authors.initials: P
authors.lastname: Taggart
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Killian
authors.forename: Antoinette
authors.initials: A
authors.lastname: Mangione
mesh_terms: D002637:Chest Pain / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D016209:Interleukin-8 / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
chemical_list: D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha