Lack of pro-inflammatory cytokine mobilization predicts poor prognosis in patients with acute heart failure

AimsThe aim of this study was to gain insight in the inflammatory response in acute heart failure (AHF) by assessing (1) plasma cytokine profiles and (2) prognostic value of circulating cytokines in AHF patients.Methods and resultsPlasma levels of 26 cytokines were quantified by multiplex protein arrays in 36 patients with congestive AHF, characterized by echocardiographic, radiologic, and clinical examinations on admission, during hospitalization and at discharge. Recurrent AHF leading to death or readmission constituted the combined end point, and all patients were followed for 120 days after discharge. Levels of 15 of the measured cytokines were higher in AHF than in healthy subjects (n = 22) on admission. Low levels of MCP-1, IL-1β and a low IL-1β/IL-1ra ratio predicted fatal and non-fatal AHF within 120 days. Patients with low circulating levels of IL-1β had lower left ventricular ejection fraction and higher levels of N-terminal pro-B-type natriuretic peptide, while patients with low levels of MCP-1 had higher E/E′ and inferior caval vein diameter, than patients with high levels.ConclusionImmune activation, reflected in increased cytokine levels, is present in AHF patients. Interestingly, failure to increase secretion of IL-1β and MCP-1 during AHF is associated with poor outcome.

► Plasma levels of 26 cytokines were quantified in 36 acute heart failure patients. ► Levels of 15 cytokines were higher in AHF than in healthy subjects on admission. ► Low levels of MCP-1, IL-1β or IL-1β/IL-1ra predicted recurrent acute heart failure. ► Low levels of IL-1β were associated with poor systolic function. ► Low levels of MCP-1 were associated with poor diastolic function.