Inflammation and anaemia in a broad spectrum of patients with heart failure.
OBJECTIVE
Anaemia in heart failure (HF) is associated with a poor prognosis. Although inflammation is assumed to be an important cause of anaemia, the association between anaemia and inflammatory markers in patients with HF has not been well established.


METHODS
Data from a multicentre randomised clinical trial, in which patients were eligible if they were >18 years of age and admitted for HF (New York Heart Association II-IV), were used. In a subset of 326 patients, haemoglobin (Hb), haematocrit, high sensitivity C-reactive protein (hsCRP), interleukin-(IL) 6, soluble tumour necrosis factor receptor (sTNFR)-1 and erythropoietin (Epo) were measured at discharge and the primary endpoint was all-cause mortality. Follow-up was 18 months.


RESULTS
Anaemia (Hb <13 g/dl (men) and <12 g/dl (women)) was present in 40% (130/326) of the study population. Median levels of IL-6, hsCRP and sTNFR-1 were significantly higher in anaemic patients than in non-anaemic patients. Logistic regression demonstrated that each increase in hsCRP values (OR 1.58 per SD log hsCRP; 95% CI 1.09 to 2.29; p=0.016) and each increase in sTNFR-1 values (OR 1.62 per SD log sTNFR-1; 95% CI 1.24 to 2.11; p<0.001) were independently associated with anaemia. Epo (HR 1.31 per log Epo; 95% CI 1.01 to 1.69; p=0.041) and sTNFR-1 (HR 1.47 per log sTNFR-1; 95% CI 1.16 to 1.86; p=0.001) levels were independently associated with outcome.


CONCLUSIONS
Anaemia is present in 40% of patients hospitalised for HF and is independently associated with inflammation.
Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
Lennaert
L
Kleijn
Anne M S
AM
Belonje
Adriaan A
AA
Voors
Rudolf A
RA
De Boer
Tiny
T
Jaarsma
Sudip
S
Ghosh
Joseph
J
Kim
Hans L
HL
Hillege
Wiek H
WH
Van Gilst
Dirk J
DJ
van Veldhuisen
Peter
P
van der Meer
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000453:epidemiology* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D016009:Chi-Square Distribution; D004921:Erythropoietin / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000453:epidemiology* / Q000401:mortality; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D047888:Receptors, Tumor Necrosis Factor, Type I / Q000097:blood; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
D015415:Biomarkers; C554270:EPO protein, human; D006454:Hemoglobins; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D047888:Receptors, Tumor Necrosis Factor, Type I; C506235:TNFRSF1A protein, human; D004921:Erythropoietin; D002097:C-Reactive Protein