TY - JOUR
T1 - Interleukin-6 and Outcomes in Acute Heart Failure
T2 - An ASCEND-HF Substudy
AU - Perez, ANTONIO L.
AU - GRODIN, JUSTIN L.
AU - CHAIKIJURAJAI, THANAT
AU - WU, YUPING
AU - HERNANDEZ, ADRIAN F.
AU - BUTLER, JAVED
AU - METRA, MARCO
AU - FELKER, G. MICHAEL
AU - VOORS, ADRIAAN A.
AU - MCMURRAY, JOHN J.
AU - ARMSTRONG, PAUL W.
AU - O'CONNOR, CHRISTOPHER
AU - STARLING, RANDALL C.
AU - TANG, W. H.WILSON
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/6
Y1 - 2021/6
N2 - Background: The inflammatory cytokine IL-6 has been previously implicated in the pathophysiology of acute decompensated heart failure (HF). Prior observations in acute HF patients have suggested that IL-6 may be associated with outcomes and modulated by nesiritide. We aimed to evaluate the associations between serial IL-6 measurements, mortality and rehospitalization in acute HF. Methods and Results: We analyzed the associations between IL-6 in acute HF, readmission, and mortality (30 and 180 days) using a cohort of 883 hospitalized patients from the ASCEND-HF trial (nesiritide vs placebo). Plasma IL-6 was measured at randomization (baseline), 48–72 hours, and 30 days. The median IL-6 was highest at baseline (14.1 pg/mL) and decreased at subsequent time points (7.6 pg/mL at 30 days). In a univariable Cox regression analysis, the baseline IL-6 was associated with 30- and 180-day mortality (hazard ratio per log 1.74, 95% confidence interval 1.09–2.78, P =. 021; hazard ratio 3.23, confidence interval 1.18–8.86, P =. 022, respectively). However, there was no association after multivariable adjustment. IL-6 at 48–72 hours was found to be independently associated with 30-day mortality (hazard ratio 8.2, confidence interval 1.2–57.5, P=. 03), but not 180-day mortality in multivariable analysis that included the ASCEND-HF risk model and amino terminal pro-B-type natriuretic peptide as covariates. In comparison with placebo, nesiritide therapy was not associated with differences in serial IL-6 levels. Conclusions: Although elevated IL-6 levels were associated with higher all-cause mortality in acute HF, no independent association with this outcome was identified at baseline or 30-day measurements. In contrast with prior reports, we did not observe any impact of nesiritide over placebo on serial IL-6 levels.
AB - Background: The inflammatory cytokine IL-6 has been previously implicated in the pathophysiology of acute decompensated heart failure (HF). Prior observations in acute HF patients have suggested that IL-6 may be associated with outcomes and modulated by nesiritide. We aimed to evaluate the associations between serial IL-6 measurements, mortality and rehospitalization in acute HF. Methods and Results: We analyzed the associations between IL-6 in acute HF, readmission, and mortality (30 and 180 days) using a cohort of 883 hospitalized patients from the ASCEND-HF trial (nesiritide vs placebo). Plasma IL-6 was measured at randomization (baseline), 48–72 hours, and 30 days. The median IL-6 was highest at baseline (14.1 pg/mL) and decreased at subsequent time points (7.6 pg/mL at 30 days). In a univariable Cox regression analysis, the baseline IL-6 was associated with 30- and 180-day mortality (hazard ratio per log 1.74, 95% confidence interval 1.09–2.78, P =. 021; hazard ratio 3.23, confidence interval 1.18–8.86, P =. 022, respectively). However, there was no association after multivariable adjustment. IL-6 at 48–72 hours was found to be independently associated with 30-day mortality (hazard ratio 8.2, confidence interval 1.2–57.5, P=. 03), but not 180-day mortality in multivariable analysis that included the ASCEND-HF risk model and amino terminal pro-B-type natriuretic peptide as covariates. In comparison with placebo, nesiritide therapy was not associated with differences in serial IL-6 levels. Conclusions: Although elevated IL-6 levels were associated with higher all-cause mortality in acute HF, no independent association with this outcome was identified at baseline or 30-day measurements. In contrast with prior reports, we did not observe any impact of nesiritide over placebo on serial IL-6 levels.
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U2 - 10.1016/j.cardfail.2021.01.006
DO - 10.1016/j.cardfail.2021.01.006
M3 - Article
C2 - 33497809
AN - SCOPUS:85100713854
SN - 1071-9164
VL - 27
SP - 670
EP - 676
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 6
ER -