The value of plasma levels of tumor necrosis factor-alpha and interleukin-6 in predicting the severity and prognosis in patients with congestive heart failure.
BACKGROUND
High plasma levels of pro-inflammatory cytokines play an important role in the pathophysiology of congestive heart failure (CHF). Therefore, we conducted a case-control study to determine the correlations between plasma levels of cytokines, i.e., tumor necrosis factor-alpha (TNF-alpha) and interleukin (IL)-6, and the severity and mortality in patients with CHF.


METHODS
One-hundred and 18 cases (62+/-15 years old) were classified into 3 groups: group 1 comprised 44 control cases with normal coronary arteriogram and left ventriculography and without valvular disorders or cardiomyopathy; group 2 comprised of 37 cases with mild CHF in New York Heart Association (NYHA) functional class (FC) II; group 3 had 37 cases with moderate/severe CHF in NYHA FC III or IV. Pre-catheterization plasma levels of TNF-alpha and IL-6 along with clinical and hemodynamic variables and follow-up data of cardiac death were assessed.


RESULTS
Patients of group 3 had smaller body mass index, lower systolic and diastolic blood pressures, faster heart rates, higher left ventricular end-diastolic pressure and lowered triglyceride levels than the patients of groups 1 and 2. The plasma levels of TNF-alpha and IL-6 increased significantly in patients of group 3 in comparison with patients of groups 1 and 2 (both p < 0.001). Over the following 1.5 years, 13 patients died. Univariate analysis identified the following variables to be associated with poor prognosis: NYHA FC (p < 0.001), plasma TNF-alpha (p = 0.013), plasma IL-6 (p < 0.001), systolic blood pressure (p = 0.001), heart rate (p = 0.045) and left ventricular end-diastolic pressure (p = 0.021). Multivariate Cox regression analysis identified the independent predictors of cardiac death as FC (p = 0.007) and plasma IL-6 (p = 0.021).


CONCLUSIONS
Our findings indicate that the plasma levels of IL-6 and TNF-alpha and especially the former, is a useful marker to correlate the progression of severity and late cardiac death in patients with CHF.
Pan
Ju-Pin
JP
Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. jppan@vghtpe.gov.tw
Liu
Tu-Ying
TY
Chiang
Shu-Chiung
SC
Lin
Yung-Kuo
YK
Chou
Chia-Yea
CY
Chan
Wan-leong
WL
Lai
Shiau-Ting
ST
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality / Q000473:pathology; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D015996:Survival Rate; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha