IL-8 predicts early mortality in patients with acute hypercapnic respiratory failure treated with noninvasive positive pressure ventilation.
BACKGROUND
Patients with Acute Hypercapnic Respiratory Failure (AHRF) who are unresponsive to appropriate medical treatment, are often treated with Noninvasive Positive Pressure Ventilation (NPPV). Clinical predictors of the outcome of this treatment are scarce. Therefore, we evaluated the role of the biomarkers IL-8 and GDF-15 in predicting 28-day mortality in patients with AHRF who receive treatment with NPPV.


METHODS
The study population were 46 patients treated with NPPV for AHRF. Clinical and background data was registered and blood samples taken for analysis of inflammatory biomarkers. IL-8 and GDF-15 were selected for analysis, and related to risk of 28-day mortality (primary endpoint) using Cox proportional hazard models adjusted for gender, age and various clinical parameters.


RESULTS
Of the 46 patients, there were 3 subgroup in regards to primary diagnosis: Acute Exacerbation of COPD (AECOPD, n = 34), Acute Heart Failure (AHF, n = 8) and Acute Exacerbation in Obesity Hypoventilation Syndrome (AEOHS, n = 4). There was significant difference in the basic characteristic of the subgroups, but not in the clinical parameters that were used in treatment decisions. 13 patients died within 28 days of admission (28%). The Hazard Ratio for 28-days mortality per 1-SD increment of IL-8 was 3.88 (95% CI 1.86-8.06, p < 0.001). When IL-8 values were divided into tertiles, the highest tertile had a significant association with 28 days mortality, HR 10.02 (95% CI 1.24-80.77, p for trend 0.03), compared with the lowest tertile. This correlation was maintained when the largest subgroup with AECOPD was analyzed. GDF-15 was correlated in the same way, but when put into the same model as IL-8, the significance disappeared.


CONCLUSIONS
IL-8 is a target to explore further as a predictor of 28 days mortality, in patients with AHRF treated with NPPV.
The Department of Clinical Sciences Malmo, Faculty of Medicine, Lund University, Lund, Sweden. brynjajo@gmail.com.|Department of Lung- and Allergy Medicine, Skåne University Hospital, Malmö, Sweden. brynjajo@gmail.com.|Department of Internal Medicine and Emergency Medicine, Skåne University Hospital, Malmö, Sweden. brynjajo@gmail.com.
Brynja
B
Jónsdóttir
Department of Lung- and Allergy Medicine, Skåne University Hospital, Malmö, Sweden.
Åsa
Å
Jaworowski
Department of Internal Medicine and Emergency Medicine, Skåne University Hospital, Malmö, Sweden.
Carmen
C
San Miguel
The Department of Clinical Sciences Malmo, Faculty of Medicine, Lund University, Lund, Sweden.|Department of Internal Medicine and Emergency Medicine, Skåne University Hospital, Malmö, Sweden.
Olle
O
Melander
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D055436:Growth Differentiation Factor 15 / Q000097:blood; D006801:Humans; D006935:Hypercapnia / Q000150:complications; D016209:Interleukin-8 / Q000097:blood*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012131:Respiratory Insufficiency / Q000097:blood* / Q000401:mortality* / Q000628:therapy*; D013548:Sweden
D015415:Biomarkers; C508606:CXCL8 protein, human; C526140:GDF15 protein, human; D055436:Growth Differentiation Factor 15; D016209:Interleukin-8
Acute Respiratory Failure; Growth Differentiation Factor 15; Interleukin-8; Noninvasive Positive Pressure Ventilation; Short-time Mortality