Prognostic value of N-terminal pro-B-type natriuretic peptide, cytokines and sCD40L in patients with acute heart failure

Plasma natriuretic peptide, cytokine (interleukin 6, IL6, tumor necrosis factor alpha, TNFα) and soluble CD40 ligand (sCD40L) levels are increased in heart failure (HF). However, little is known about cytokine and sCD40L levels and their correlation with the mortality. We assessed the relation between plasma IL 6, TNFα, sCD40L and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and mortality in patients with acute HF. NT-proBNP, IL 6, TNFα and sCD40L were measured in 92 consecutive patients. NT-proBNP was assessed with the use of electrochemiluminiscence method; TNFα, IL 6 and sCD40L were measured using ELISA method. During one-year follow-up, 32 patients died. Mean plasma levels of NT-proBNP, IL 6 and TNFα were significantly lower among the survivors (NT-proBNP: 7 855.4 ± 9 919.9 pg/mL vs.15 470.6 ± 11 273.1, P < 0.001, IL 6: 26.0 ± 20.4 pg/mL vs. 37.9 ± 23.6 pg/mL, P < 0.001, TNFα: 2.8 ± 3.55 pg/mL vs. 4.1 ± 5.6 pg/mL, P < 0.001). There were no significant differences in mean ejection fraction and sCD40L level between survivors and non-survivors. In a multivariable Cox regression model, Hazard ratio (HR) 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. HR for IL6 over the median (27 pg/mL) was 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 and IL6 can serve as the independent markers of short- and long-term mortality in patients with acute HF.