Interleukin-18: interleukin-10 ratio and in-hospital adverse events in patients with acute coronary syndrome.
BACKGROUND
Inflammatory mechanisms contribute to the development of acute coronary syndromes (ACS), and it has been suggested that an imbalance between pro- and anti-inflammatory responses may be an important determinant of recurrent cardiac events in this setting. Both increased serum levels of interleukin (IL)-18 and reduced concentrations of IL-10 have been shown to have prognostic significance in ACS. We sought to assess whether the ratio of serum IL-18/IL-10 levels has higher positive predictive value than the individual measurement of IL-10 and IL-18 in patients admitted to hospital with ACS.


METHODS
We recruited 107 consecutive patients (79 men, mean age 65+/-12 years) with ACS (41 STEMI, 39 NSTEMI and 27 UA). The composite of cardiac death, recurrence of unstable angina, re-infarction, life threatening arrhythmias, and urgent revascularization during hospitalization was the pre-specified study end-point. We assessed independent predictors of the combined end-point using multiple logistic regression analysis. Serum IL-10 and IL-18 levels were measured at study entry using commercially available ELISAs.


RESULTS
During hospitalization 44 patients (41%) had events and 63 (59%) had no events. Significantly higher odd ratios were found for IL-18/IL-10 ratio (1.74 95% CI 1.09-2.78) compared to individual IL-18 (1.46 95% CI 0.93-2.27) and 1/IL-10 (1.63 95% CI 1.04-2.56) measurements.


CONCLUSIONS
Serum IL-18/IL-10 ratio is an independent predictor of in-hospital adverse events in patients with ACS. Our study strongly endorses the notion that an imbalance between pro and anti-inflammatory forces predisposes to plaque disruption and recurrent cardiovascular events.
Chalikias
Georgios K
GK
University Cardiology Clinic, Democritus University of Thrace, Voulgaroktonou 23, 68100 Alexandroupolis, Greece.
Tziakas
Dimitrios N
DN
Kaski
Juan Carlos
JC
Hatzinikolaou
Eleni I
EI
Stakos
Dimitrios A
DA
Tentes
Ioannis K
IK
Kortsaris
Alexandros
A
Hatseras
Dimitrios I
DI
D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood* / Q000276:immunology / Q000401:mortality*; D005260:Female; D006801:Humans; D007297:Inpatients; D016753:Interleukin-10 / Q000097:blood*; D020382:Interleukin-18 / Q000097:blood*; D008055:Lipids / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis
D015415:Biomarkers; D020382:Interleukin-18; D008055:Lipids; D016753:Interleukin-10