title: Circulating interleukin-10: association with higher mortality in systolic heart failure patients with elevated tumor necrosis factor-alpha.
abstract: BACKGROUND
  Interleukin-10 is an anti-inflammatory cytokine and consequently is considered by many to have a protective role in heart failure, as opposed to the notorious tumor necrosis factor-alpha.
  
  
  OBJECTIVE
  To test the hypothesis of the possible beneficial impact of IL-10 on mortality in systolic heart failure patients in relation to their circulating TNFalpha levels.
  
  
  METHODS
  We measured circulating levels of IL-10 and TNFalpha in 67 ambulatory systolic heart failure patients (age 65 +/- 13 years).
  
  
  RESULTS
  Mortality was or tended to be higher in patients with higher levels (above median level) of circulating TNFalpha (9/23, 39% vs. 6/44, 14%; P = 0.02) or IL-10 (10/34, 30% vs. 5/33, 15%; P = 0.10). However, mortality was highest in the subset of patients with elevation of both markers above median (7/16, 44% vs. 8/51, 16%; P = 0.019). Elevation of both markers was associated with more than a threefold hazard ratio for mortality (HR 3.67, 95% confidence interval 1.14-11.78).
  
  
  CONCLUSIONS
  Elevated circulating IL-10 levels in systolic heart failure patients do not have a protective counterbalance effect on mortality. Moreover, patients with elevated IL-10 and TNFalpha had significantly higher mortality, suggesting that the possible interaction in the complex inflammatory and anti-inflammatory network may need further study.
authors.affiliation: Department of Cardiovascular Medicine, Heart Failure Center, Carmel, Israel. offeram@012.net.il
authors.forename: Offer
authors.initials: O
authors.lastname: Amir
authors.forename: Ori
authors.initials: O
authors.lastname: Rogowski
authors.forename: Miriam
authors.initials: M
authors.lastname: David
authors.forename: Nitza
authors.initials: N
authors.lastname: Lahat
authors.forename: Rafael
authors.initials: R
authors.lastname: Wolff
authors.forename: Basil S
authors.initials: BS
authors.lastname: Lewis
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D002423:Cause of Death; D002784:Cholesterol / Q000097:blood; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000097:blood* / Q000000981:diagnostic imaging; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D016753:Interleukin-10 / Q000097:blood*; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011498:Protein Precursors / Q000097:blood; D013318:Stroke Volume / Q000502:physiology; D020107:Troponin T / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000000981:diagnostic imaging
chemical_list: D006454:Hemoglobins; D010446:Peptide Fragments; D011498:Protein Precursors; D020107:Troponin T; D014409:Tumor Necrosis Factor-alpha; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D016753:Interleukin-10; D002097:C-Reactive Protein; D002784:Cholesterol; D003404:Creatinine; D020780:Matrix Metalloproteinase 9