title: Plasma pro-inflammatory cytokines, IgM-uria and cardiovascular events in patients with chest pain: A comparative study.
abstract: BACKGROUND
  Risk stratification of patients presenting with acute chest pain is crucial for immediate and long-term management. Traditional predictors are suboptimal; therefore inflammatory biomarkers are studied for clinical assessment of patients at risk. Recently, we reported the association of IgM-uria with worse cardiovascular outcome in patients with acute chest pain. In this study, in the same cohort of patients with chest pain, we compared the value of IgM-uria to pro-inflammatory cytokines in predicting the occurrence of subsequent cardiovascular events.
  
  
  METHODS
  A total of 178 consecutive patients presenting with acute chest pain to the emergency department at the University Hospital of Lund, were recruited. Twenty-seven of 57 patients with acute coronary syndrome (ACS), and 18 of 118 patients with non-specific chest pain at baseline developed a subsequent major cardiovascular event during the 18 months follow-up. Urinary proteins (IgM-uria and Microalbuminuria) and plasma inflammatory markers (IL-6, Il-8, IL-10, IFN-γ and TNF-α) were measured at time of admission.
  
  
  RESULTS
  Using the receiver operating characteristic curves, the area under the curve for predicting cardiovascular events was 0.71 (95%CI 0.61-0.81) for IgM-uria, 0.61 (95%CI 0.51-0.71) for IL-6, 0.63 (95%CI 0.53-0.72) for IL-8, 0.65 (95%CI 0.56-0.74) for IL-10, and 0.64 (95% CI 0.54-0.74) for TNF-α. In multivariate Cox-regression analysis adjusted for age, microalbuminuria, IgM-uria, IL-10, TNF-α, troponin T, hsCRP and ACS at baseline; IgM-uria was the only biomarker that remained an independent predictor of outcome (HR = 4.2, 95%CI 2.2-7.8, p < 0.001).
  
  
  CONCLUSIONS
  In patients with chest pain with or without acute coronary syndrome, IgM-uria could better predict the occurrence of cardiovascular events than plasma pro-inflammatory cytokines.
authors.affiliation: a Department of Emergency Medicine , Skåne University Hospital , Lund , Sweden.|b Department of Nephrology , Clinical Sciences Lund, Lund University , Lund , Sweden.
authors.forename: Rafid
authors.initials: R
authors.lastname: Tofik
authors.affiliation: c Department of Orthopaedics , Clinical Sciences Lund, Lund University , Lund , Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Swärd
authors.affiliation: a Department of Emergency Medicine , Skåne University Hospital , Lund , Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Ekelund
authors.affiliation: c Department of Orthopaedics , Clinical Sciences Lund, Lund University , Lund , Sweden.
authors.forename: André
authors.initials: A
authors.lastname: Struglics
authors.affiliation: b Department of Nephrology , Clinical Sciences Lund, Lund University , Lund , Sweden.
authors.forename: Ole
authors.initials: O
authors.lastname: Torffvit
authors.affiliation: b Department of Nephrology , Clinical Sciences Lund, Lund University , Lund , Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Rippe
authors.affiliation: b Department of Nephrology , Clinical Sciences Lund, Lund University , Lund , Sweden.|d Department of Internal Medicine , College of Medicine, UAE University , UAE.
authors.forename: Omran
authors.initials: O
authors.lastname: Bakoush
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000652:urine; D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002637:Chest Pain / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000652:urine; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000652:urine; D012372:ROC Curve
chemical_list: D015415:Biomarkers; D016207:Cytokines; D007075:Immunoglobulin M
keywords: IgM-uria; acute coronary syndrome; albuminuria; cardiovascular mortality; cytokines