title: α-Defensins and outcome in patients with chronic heart failure.
abstract: OBJECTIVE
  α-Defensins are part of the innate immune system. Low-grade inflammation seems to play a crucial role in development and progression of chronic heart failure (CHF). The aims of the present study were to compare plasma levels of α-defensins in CHF patients and healthy controls and to examine the predictive ability of α-defensins, alone and combined with N-terminal pro brain natriuretic peptide (NT-proBNP), with respect to all-cause mortality.
  
  
  RESULTS
  In a prospective observational study lasting 2.6 years we examined the prognostic value of plasma α-defensins with respect to mortality in 194 CHF patients, and compared plasma levels with those of 98 age-matched healthy controls. α-Defensin levels were twice as high among CHF patients in New York Heart Association (NYHA) functional class III-IV than in patients in NYHA class I-II and healthy controls (P = 0.001). The absolute increase in risk of mortality for patients with α-defensin levels in the upper tertile vs. the lowest tertile was 30% (P = 0.002). After adjusting for potential confounders including NT-proBNP, plasma α-defensins remained independently associated with an increased risk of all-cause mortality (hazard ratio 1.65, 95% confidence interval 1.19-2.28, P = 0.002) per 1 standard deviation increment in Ln (natural logarithm)-transformed α-defensin values. The combination of high α-defensins and NT-proBNP levels provided incremental prognostic information independent of well-known prognostic biomarkers in heart failure.
  
  
  CONCLUSIONS
  Plasma α-defensins appear to have prognostic information regarding mortality among patients with CHF and seem to provide incremental information to established clinical risk markers.
authors.affiliation: Department of Cardiology, Herlev University Hospital, Herlev Ringvej 75, Herlev, Denmark. heidichristensen@dadlnet.dk
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Christensen
authors.forename: Jan
authors.initials: J
authors.lastname: Frystyk
authors.forename: Jens
authors.initials: J
authors.lastname: Faber
authors.forename: Morten
authors.initials: M
authors.lastname: Schou
authors.forename: Allan
authors.initials: A
authors.lastname: Flyvbjerg
authors.forename: Per
authors.initials: P
authors.lastname: Hildebrandt
authors.forename: Ilan
authors.initials: I
authors.lastname: Raymond
authors.forename: Tobias W
authors.initials: TW
authors.lastname: Klausen
authors.forename: Caroline
authors.initials: C
authors.lastname: Kistorp
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers; D002097:C-Reactive Protein; D016022:Case-Control Studies; D016001:Confidence Intervals; D003718:Denmark; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000473:pathology*; D016014:Linear Models; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D023084:alpha-Defensins / Q000097:blood*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D023084:alpha-Defensins; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein