title: 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.
abstract: 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.
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. jppan@vghtpe.gov.tw
authors.forename: Ju-Pin
authors.initials: JP
authors.lastname: Pan
authors.forename: Tu-Ying
authors.initials: TY
authors.lastname: Liu
authors.forename: Shu-Chiung
authors.initials: SC
authors.lastname: Chiang
authors.forename: Yung-Kuo
authors.initials: YK
authors.lastname: Lin
authors.forename: Chia-Yea
authors.initials: CY
authors.lastname: Chou
authors.forename: Wan-leong
authors.initials: WL
authors.lastname: Chan
authors.forename: Shiau-Ting
authors.initials: ST
authors.lastname: Lai
mesh_terms: 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*
chemical_list: D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha