title: In patients with stable heart failure, soluble TNF-receptor 2 is associated with increased risk for depressive symptoms.
abstract: OBJECTIVE
  Researchers have proposed biological (inflammation) and psychological (depression) factors as potential mechanisms for poorer outcomes and readmissions in heart failure (HF) patients. However, studies investigating the link between inflammation and depressive symptoms in these patients are few. We examined the relationships between levels of the inflammatory markers C-reactive protein (CRP), interleukin (IL)-6, and soluble tumor necrosis factor receptor 2 (sTNR2) and depressive symptoms in HF outpatients.
  
  
  METHODS
  55 patients (74.5% men; 60% Whites; mean age 71.6 ± 11.3 years) with New York Heart Association Class II, III, or IV HF (49%, 47%, and 4%, respectively) and mean ejection fraction (EF) 29.9 ± 7.1% completed the Patient Health Questionnaire (PHQ)-9 as a measure of depressive symptoms. We also obtained height, weight, and CRP, IL-6, and sTNFR2 levels. We used multivariate regressions to assess the predictive value of PHQ-9 scores on each inflammatory marker.
  
  
  RESULTS
  22 (40%) participants reported depressive symptoms (PHQ-9 score ≥ 5). After controlling for age, gender, body mass index, HF etiology, EF, and statin use, we found significant relationships between levels of both sTNFR2 (β = .35, p = .01) and IL-6 (β = .30, p = .04), but not CRP (β = -.96, p = .52), and depression scores.
  
  
  CONCLUSIONS
  Our findings add to a growing body of evidence supporting the proposition that heightened inflammation explains the effect depression has on HF. Health care providers should screen for depression in HF patients, as they may be at higher risk of augmented inflammation and poor outcomes.
authors.affiliation: Department of Nursing, California State University, Northridge, CA, USA smoughrabi@gmail.com.
authors.forename: Samira
authors.initials: S
authors.lastname: Moughrabi
authors.affiliation: Program of Nursing Science, University of California, Irvine, CA, USA.
authors.forename: Lorraine S
authors.initials: LS
authors.lastname: Evangelista
authors.affiliation: Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Samer I
authors.initials: SI
authors.lastname: Habib
authors.affiliation: Cardiovascular Medical Consultant Groups, Los Angeles, CA, USA.
authors.forename: Leo
authors.initials: L
authors.lastname: Kassabian
authors.affiliation: Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, USA.
authors.forename: Elizabeth Crabb
authors.initials: EC
authors.lastname: Breen
authors.affiliation: School of Nursing, University of California, Los Angeles, CA, USA.
authors.forename: Adeline
authors.initials: A
authors.lastname: Nyamathi
authors.affiliation: Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Irwin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D002908:Chronic Disease; D003863:Depression / Q000209:etiology*; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D047889:Receptors, Tumor Necrosis Factor, Type II / Q000097:blood*
chemical_list: D015850:Interleukin-6; D047889:Receptors, Tumor Necrosis Factor, Type II; D002097:C-Reactive Protein
keywords: CRP; IL-6; TNF-Receptors; TNF-α; depressive symptoms; heart failure; inflammation
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