Serum levels of interleukin-10 on admission as a prognostic predictor of human fulminant myocarditis.
OBJECTIVE
We assessed the significance of serum cytokine levels in patients with fulminant myocarditis.


BACKGROUND
Although many investigations have demonstrated the crucial role of cytokines in the development of myocarditis, it remains uncertain whether serum levels of cytokines enable one to predict the prognosis of human myocarditis, especially concerning cardiogenic shock (CS) requiring a mechanical cardiopulmonary support system (MCSS).


METHODS
We studied 22 consecutive patients with fulminant myocarditis and compared them with 15 patients with acute myocardial infarction (AMI) requiring MCSS. The patients with myocarditis were classified into three groups: eight patients with CS requiring MCSS on admission (group 1); six patients who unexpectedly lapsed into CS requiring MCSS more than two days after catecholamine had been initiated (group 2); and eight patients without MCSS (group 3). Furthermore, 14 patients with myocarditis requiring MCSS were divided into a fatal group (n = 5) and a survival group (n = 9). Biochemical markers, including serum cytokine levels and hemodynamic variables on admission, were analyzed.


RESULTS
Serum levels of interleukin (IL)-10 and tumor necrosis factor-alpha, but not other cytokines, were significantly higher in myocarditis than in AMI. Only serum levels of IL-10 were significantly higher in group 1 and 2 than in group 3 (49.1 +/- 37.5/20.7 +/- 17.6 pg/ml vs. 2.4 +/- 1.1 pg/ml; p = 0.0008/0.0012). Serum IL-10 levels were also significantly higher in the fatal group than in the survival group with myocarditis (74.0 +/- 27.0 pg/ml vs. 16.4 +/- 8.8 pg/ml; p = 0.003).


CONCLUSIONS
Serum IL-10 levels on admission enabled one to predict subsequent CS requiring MCSS and mortality of fulminant myocarditis patients.
Nishii
Mototsugu
M
Department of Internal Medicine and Cardiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. mototugu@med.kitasato-u.ac.jp
Inomata
Takayuki
T
Takehana
Hitoshi
H
Takeuchi
Ichiro
I
Nakano
Hironari
H
Koitabashi
Toshimi
T
Nakahata
Jun-ichi
J
Aoyama
Naoyoshi
N
Izumi
Tohru
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000097:blood; D016753:Interleukin-10 / Q000097:blood*; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D009205:Myocarditis / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D015415:Biomarkers; D020107:Troponin T; D014409:Tumor Necrosis Factor-alpha; D020097:Natriuretic Peptide, Brain; D016753:Interleukin-10; D007371:Interferon-gamma