The Importance of Pro-inflammatory Cytokines in Patients with Chronic Heart Failure and Chronic Kidney Disease and Type 2 Diabetes

Background: Heart failure (HF) often coincides with diabetes type 2 (DM) and chronic kidney disease (CKD). In the course of these disorders markers of inflammation such as tumour necrosis factor α (TNFα) and interleukin 6 (IL-6) are elevated. Inflammatory cytokines are markers of bad prognosis. The aim of the study was to assess the severity of inflammation in the course of HF, DM and CKD. We also evaluated the prognostic value TNFα and IL-6 serum concentration. Methods: 129 patients with HF were enrolled. 50% of the patients had DM, 50% CKD of the stage 3 and 30% patients had both diseases. The serum concentration of TNF-α and IL-6 were assessed by ELISA method. Endpoints are death and hospitalization due to worsening of HF during the 12 months of follow-up. Results: The lowest serum concentration of IL-6 was in patient with only HF, the highest in patients with HF and DM The highest serum concentration of TNF-α was found in patients with HF, DM and CKD and the lowest in patients with only HF. IL-6 was the predictor of the composite end point in multivariate analysis. TNF-α was not found to be a predictive factor. Conclusions: Inflammatory condition presented by concentration of pro-inflammatory cytokines seems to be the lowest in patients with heart failure only and increases when comorbidities appear. Only IL6 has the prognostic value. Elevated concentrations of IL-6 increases the risk of the composite end point.