Interleukin-6 and Outcomes in Acute Heart Failure: An ASCEND-HF Substudy.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Perez, AL; Grodin, JL; Chaikijurajai, T; Wu, Y; Hernandez, AF; Butler, J; Metra, M; Felker, GM; Voors, AA; McMurray, JJ; Armstrong, PW; O'Connor, C; Starling, RC; Tang, WHW

Published Date

  • June 2021

Published In

Volume / Issue

  • 27 / 6

Start / End Page

  • 670 - 676

PubMed ID

  • 33497809

Electronic International Standard Serial Number (EISSN)

  • 1532-8414

Digital Object Identifier (DOI)

  • 10.1016/j.cardfail.2021.01.006

Language

  • eng

Conference Location

  • United States