Interleukin-6, infection and cardiovascular outcomes in acute heart failure: Findings from the EDIFICA registry. (December 2022)

• Record Type: Journal Article
• Authors: Vasques-Nóvoa, Francisco; Pedro Ferreira, João; Marques, Pedro; Sergio Neves, João; Vale, Catarina; Ribeirinho-Soares, Pedro; Marques, José; Martins, Sandra; Tiago Guimarães, João; Barros, António S.; Leite-Moreira, Adelino F.; Roncon-Albuquerque, Roberto; Almeida, Jorge; Bettencourt, Paulo; Friões, Fernando
• Is Part Of: Cytokine. Volume 160(2022)
• Publication Date: 2022-12
• Subjects: Acute heart failure -- Interleukin-6 -- Inflammation -- Infection; Cytokines -- Periodicals; 571.844
• DOI: 10.1016/j.cyto.2022.156053
• Languages: English
• ISSNs: 1043-4666

Abstract

Abstract: Aims: Interleukin-6 (IL-6) is upregulated in response to infectious and inflammatory triggers and independently predicts all-cause mortality in acute heart failure (AHF). However, the association of IL-6 with cardiovascular outcomes and its interplay with C-reactive protein and infection, a major precipitating factor in AHF, remains poorly understood. Methods and results: The association between IL-6 and clinical outcomes (180 days) in AHF was evaluated using a cohort of 164 patients from the EDIFICA registry. Median IL-6 levels at admission were 17.4 pg/mL. Patients in the higher admission IL-6 tertile presented with lower blood pressure and more congestion, were diagnosed more frequently with infection, and had a longer hospital stay. Higher IL-6 levels were associated with increased risk of HF rehospitalization (hazard ratio per log2 3.69, 95% confidence interval (CI) 1.26–10.8, p =.017) and the composite of HF rehospitalization or cardiovascular death (hazard ratio per log2 3.50; 95% CI 1.28–9.57; p =.014), independently of major AHF prognosticators, including B-type natriuretic peptide and renal function. However, no independent associations were found for all-cause rehospitalization or mortality. Despite a moderate correlation of IL-6 with C-reactive protein (CRP) levels (R = .51), the latter were not associated with clinical outcomes in this population. Conclusions: IL-6 levels associate with higher rate of cardiovascular events in AHF, independently of classical prognosticators and evidence of infection, outperforming CRP as an inflammatory outcome biomarker.