Prognostic role of pro- and anti-inflammatory cytokines and their polymorphisms in acute decompensated heart failure

Abstract: Background: Cytokines play an important role in chronic heart failure (HF), but little is known about their involvement in acute decompensated heart failure (ADHF). Aim: To evaluate the prognostic role of inflammatory cytokines in patients with ADHF. Methods: Levels of interleukin (IL)-6, tumour necrosis factor alpha (TNF-α), IL-10 and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured in 423 patients with ADHF. In addition, appropriate cytokine gene polymorphisms were determined. Survival was followed up to 12 months, and prognostic factors were evaluated. Results: Elevated levels of IL-6 and TNF-α were strongly associated with increased 12-month mortality (P <0.001 for both), whereas the level of IL-10 was predictive only of 6-month mortality (P <0.01). In multivariate analysis IL-6, chronic renal insufficiency, NT-proBNP, age/10 years'' increase and TNF-α were identified as the most powerful predictors of 12-month mortality. Furthermore, high levels of both IL-6 and NT-proBNP were associated with >7-fold mortality. Cytokine gene polymorphisms were not associated with outcome. Conclusions: Circulating levels of pro-inflammatory cytokines IL-6 and TNF-α, and the level of an anti-inflammatory cytokine IL-10, but not their gene polymorphisms, provide novel and important prognostic information in patients with ADHF. Combining measurements of pro-inflammatory cytokines and NT-proBNP seems a promising tool in the prognostic assessment of these patients. [Copyright &y& Elsevier]