Key result
Each doubling of IL-6 between day-1 and day-7 predicted 180-day all-cause mortality (HR 1.18; 95% CI 1.07-1.30; p=0.0013), independent of baseline IL-6 and changes in BNP.
Why the study?
Elevated IL-6 concentrations are common in acute heart failure, but the predictive value of serial IL-6 measurements beyond BNP remains poorly characterized.
Do serial plasma interleukin-6 (IL-6) levels provide additive prognostic value over changes in brain natriuretic peptide (BNP) in patients with acute heart failure?
Cohort (n=2,033)
Do serial plasma interleukin-6 (IL-6) levels provide additive prognostic value over changes in brain natriuretic peptide (BNP) in patients with acute heart failure?
Hazard Ratio: 1.18 (95% CI 1.07–1.3)
p-value: p=0.0013
Serial measurements of IL-6 in acute heart failure provide independent prognostic information for 180-day mortality beyond standard risk models and BNP changes.
Serial IL-6 rise may refine post-acute HF risk stratification beyond BNP; leaves open whether targeted anti-inflammatory therapy improves survival.
BACKGROUND: Elevated plasma interleukin-6 (IL-6) concentrations are frequently observed in patients with acute heart failure (AHF). However, the predictive value of serial IL-6 measurements beyond brain natriuretic peptide (BNP) remains poorly characterized. METHODS AND RESULTS: This was a retrospective analysis of the PROTECT cohort (2033 patients with AHF). Plasma IL-6 and BNP levels were determined on days 1, 2, 7 and 14 after admission for AHF in 1591 (78.3%), 1462 (71.9%), 1445 (71.1%) and 1451 (71.4%) patients, respectively. The primary endpoint was 180-day all-cause mortality. The median day-1 IL-6 concentration was 11.1 pg/mL (IQR: 6.6, 20.9) and decreased to 10.1 pg/mL (IQR: 5.6-18.5) at day-7. Higher cross-sectional IL-6 concentrations at all time-points predicted the primary endpoint, independent of a risk model for this cohort and changes in BNP. Each doubling of IL-6 between day-1 and day-7 predicted the primary endpoint independent of baseline IL-6 concentrations, the risk model, baseline BNP and changes in BNP [HR (95% CI): 1.18 (1.07-1.30), p=0.0013]. Collectively, 214 (17%) patients experienced at least a doubling of their IL-6 concentrations between day-1 and day-7. CONCLUSIONS: We demonstrate that the temporal evolution patterns of IL-6 in patients with AHF have additive prognostic value independent of changes in BNP.
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Markousis‐Mavrogenis et al. (2021) conducted a cohort in acute heart failure (n=2,033). Doubling of IL-6 between day-1 and day-7 was evaluated on 180-day all-cause mortality (HR 1.18, 95% CI 1.07-1.30, p=0.0013). Each doubling of IL-6 between day-1 and day-7 predicted 180-day all-cause mortality (HR 1.18; 95% CI 1.07-1.30; p=0.0013), independent of baseline IL-6 and changes in BNP.
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