title: Increased interleukin-6 but not tumour necrosis factor-alpha predicts mortality in the population of elderly heart failure patients.
abstract: BACKGROUND
  Increased proinflammatory cytokines have mainly been studied in younger patients with heart failure and are regarded as prognostic markers. However, whether this holds true in elderly patients with heart failure remains uncertain.
  
  
  OBJECTIVE
  To determine whether inflammation is equally important in the progression of heart failure in the elderly as has been previously reported in younger patients, and whether cytokine level can predict mortality in this population of elderly heart failure patients.
  
  
  METHODS
  The cytokine profile in an elderly patient group with severe heart failure (n=54, mean [+/- SD] age of 80.1+/-5.0 years, New York Heart Association class III or IV) was compared with that of age-matched healthy individuals (n=70). Of the 54 study patients, 46% were hypertensive, 54% had coronary artery disease, 43% had atrial fibrillation and 24% had a previous stroke. One-year mortality was 24%.
  
  
  RESULTS
  The results showed increased levels of interleukin-6 (IL-6), tumour necrosis factor-alpha and epidermal growth factor in the heart failure patients compared with those in the control group. Moreover, IL-6, tumour necrosis factor-alpha and vascular endothelial growth factor were significantly increased in patients who died within one year. Further logistic regression analyses showed that IL-6 was the only significant predictor of one-year mortality. In a subgroup of heart failure patients with atrial fibrillation, there were significant cytokine activations, whereas in a subgroup with ischemia or diabetes, cytokines were less activated.
  
  
  CONCLUSIONS
  In the present octogenarian group with heart failure, there were significant increases of inflammatory cytokines that were associated with mortality, and IL-6 was the only cytokine to predict one-year mortality. Cytokine activation was more pronounced in the subgroup of patients with heart failure and concomitant atrial fibrillation.
authors.affiliation: Department of Molecular and Clinical Medicine, Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, Gothenburg University.
authors.forename: Espen
authors.initials: E
authors.lastname: Haugen
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Gan
authors.forename: Azra
authors.initials: A
authors.lastname: Isic
authors.forename: Tomas
authors.initials: T
authors.lastname: Skommevik
authors.forename: Michael
authors.initials: M
authors.lastname: Fu