Plasma B-type natriuretic peptide and anti-inflammatory cytokine interleukin-10 levels predict adverse clinical outcome in chronic heart failure patients with depressive symptoms: a 1-year follow-up study

• Published in: European journal of heart failure Vol. 11; no. 10; pp. 967 - 972
• Main Authors: Parissis, John T., Farmakis, Dimitrios, Nikolaou, Maria, Birmpa, Dionysia, Bistola, Vassiliki, Paraskevaidis, Ioannis, Ikonomidis, Ignatios, Gaitani, Stavroula, Venetsanou, Koula, Filippatos, Gerasimos, Kremastinos, Dimitrios Th
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.10.2009; Oxford University Press
• Subjects: Adult; Aged; Analysis of Variance; Biomarkers; Cause of Death; Chronic Disease; Cohort Studies; Cytokines - blood; Depression; Depression - blood; Depression - complications; Depression - mortality; Disease-Free Survival; Female; Heart failure; Heart Failure - blood; Heart Failure - complications; Heart Failure - mortality; Hospitalization; Humans; Inflammation; Inflammation Mediators - blood; Interleukin-10 - blood; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain - blood; Predictive Value of Tests; Probability; Prognosis; Proportional Hazards Models; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Survival Analysis; Heart failure; Biomarkers; Depression; Inflammation; Prognosis
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1093/eurjhf/hfp125

Aims To assess the prognostic value of a wide spectrum of neurohormonal and inflammatory markers along with functional status and exercise capacity, in hospitalized chronic heart failure (CHF) patients with depressive symptoms. Methods and results A total of 300 consecutive hospitalized CHF patients were screened for depressive symptomatology using the Zung self-rated depression scale (SDS). Patients with depressive symptoms (Zung SDS ≥40) underwent a 6 min walking test, and evaluation of left ventricular ejection fraction, B-type natriuretic peptide (BNP), and plasma inflammatory/anti-inflammatory factors [interleukin (IL)-6, IL-10, tumour necrosis factor-α, soluble intercellular adhesion molecule-1, and vascular cell adhesion molecule-1]. Patients were subsequently followed for up to 1 year for major adverse cardiovascular events (MACE, death or hospitalization due to cardiovascular causes). One hundred and fourteen patients (38%) had a Zung SDS ≥40. One-year event-free survival of these patients was 19% (mean ± SE, 150 ± 12 days). In multivariate analysis, only BNP (HR = 1.001, P = 0.002) and IL-10 (HR = 0.864, P = 0.049) were independent predictors of MACE. Using receiver operator characteristics analysis-derived cut-offs, a BNP value of 290 pg/mL predicted MACE with 86% sensitivity and 69% specificity, whereas an IL-10 value of 5 pg/mL predicted MACE with 61% sensitivity and 78% specificity. Event-free survival differed significantly between patients with BNP < 290 pg/mL and IL-10 > 5 pg/mL (261 ± 44 days) and those with BNP > 290 pg/mL and IL-10 < 5 pg/mL (79 ± 11 days, P = 0.0001). Conclusion Neurohormonal activation and defective anti-inflammatory properties are independent predictors of long-term outcome in hospitalized CHF patients with depressive symptoms.