Abstract 1892: Prognostic Value of Plasma N-Terminal Pro-Brain Natriuretic Peptide, Interleukin 6, Tumor Necrosis Factor Alpha and Soluble CD40 Ligand in Patients with Acute Heart Failure
Plasma natriuretic peptide levels and cytokine levels are increased in heart failure. Furthermore, plasma natriuretic peptide levels can correlate with the severity of acute HF. However, little is known about NT-proBNP, cytokine and sCD40L levels and their correlation with the mortality. We assessed the relationship between plasma IL 6, TNFa, sCD40L and N-terminal pro brain natriuretic peptide (NT-proBNP) levels and short and long term mortality from all causes in patients with acute heart failure. NT-proBNP, IL 6, TNFalpha and soluble CD40 ligand were measured in baseline samples from 92 consecutive patients referred for acute heart failure to intensive care department. During one-year follow-up, 32 patients died. Mean plasma levels of NT-proBNP, IL 6 and TNF alpha were significantly lower among the patients who survived (NT-proBNP: 7 855.4±9919.9pg/mL, vs.15470.6±11273.1pg/mL, p<0.001, IL 6: 26.0 ± 20.4pg/mL, vs. 37.9±23.6pg/mL p<0.001, TNF alpha: 2.8±3.55, vs. 4.1± 5.6, p<0.001). There were no significant differences in mean ejection fraction (35.1±14.1 vs. 31.7±12.8%) and plasma sCD40L level (1.69±1.67pg/mL, vs. 1.4±1.69pg/mL) between survivors and non-survivors. In a multivariable Cox regression model, hazard ratio for death from any cause for the patients with NT-proBNP levels above median as compared with those with NT-proBNP below median was 2.91 (0.84–10.10) for 7-day mortality, 3.58 (1.17–11.1) for 28-day, and 3.76 (1.49 –9.55) for 1-year mortality. Similarly, hazard ratio for interleukin 6 over the median (27pg/mL) were 3 (0.96 –10.40) for 7-day mortality, 2.2 (0.92–7.92) for 28.day mortality, and 2.3 (0.94 –5.71) for 1-year mortality. NT-proBNP level added prognostic information beyond that provided by conventional risk factors, including the patient age, sex, hypertension, diabetes, smoking status, Killip class, and LVEF. NT-proBNP and IL 6 levels are the markers of short- and long-term mortality in patients with acute heart failure and provide prognostic information above and beyond that provided by conventional cardiovascular risk factors and degree of left ventricular dysfunction. Finantial suport of the research projects MSM0021620817and MZO 00179906.