title: Interleukin-18: interleukin-10 ratio and in-hospital adverse events in patients with acute coronary syndrome.
abstract: 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.
authors.affiliation: University Cardiology Clinic, Democritus University of Thrace, Voulgaroktonou 23, 68100 Alexandroupolis, Greece.
authors.forename: Georgios K
authors.initials: GK
authors.lastname: Chalikias
authors.forename: Dimitrios N
authors.initials: DN
authors.lastname: Tziakas
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Kaski
authors.forename: Eleni I
authors.initials: EI
authors.lastname: Hatzinikolaou
authors.forename: Dimitrios A
authors.initials: DA
authors.lastname: Stakos
authors.forename: Ioannis K
authors.initials: IK
authors.lastname: Tentes
authors.forename: Alexandros
authors.initials: A
authors.lastname: Kortsaris
authors.forename: Dimitrios I
authors.initials: DI
authors.lastname: Hatseras
mesh_terms: 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
chemical_list: D015415:Biomarkers; D020382:Interleukin-18; D008055:Lipids; D016753:Interleukin-10