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Quantifying inflammation using interleukin-6 for improved phenotyping and risk stratification in acute heart failure
Eleni Michou1, Desiree Wussler1,2, Maria Belkin1
1Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Basel, Switzerland.
European Journal of Heart Failure
|January 4, 2023
Summary
Systemic inflammation, measured by interleukin-6, is common in acute heart failure (AHF) and predicts mortality. This biomarker improves risk assessment in AHF patients, highlighting inflammation
Area of Science:
- Cardiology
- Immunology
- Biomarkers
Background:
- Systemic inflammation is implicated in the pathophysiology of acute heart failure (AHF).
- Accurate assessment of inflammation's role in AHF is crucial for understanding disease mechanisms and improving patient outcomes.
Purpose of the Study:
- To evaluate the role of systemic inflammation, specifically interleukin-6 (IL-6), in the pathophysiology, phenotyping, and risk stratification of AHF patients.
- To assess the prognostic value of IL-6 in predicting one-year mortality in patients presenting with acute dyspnea.
Main Methods:
- A multicenter study involving 2042 patients presenting with acute dyspnea.
- Quantification of systemic inflammation using a sensitive Interleukin-6 (IL-6) immunoassay.
- Analysis of one-year mortality as the primary prognostic endpoint.
- Correlation of IL-6 levels with AHF diagnosis, clinical parameters (NT-proBNP, hs-cTnT, infection), AHF phenotypes, and risk scores (BIOSTAT-CHF).
Main Results:
- Over 50% of patients (1026/2042) were diagnosed with AHF, with 83.7% exhibiting elevated IL-6 levels.
- IL-6 concentrations were significantly higher in AHF patients compared to other causes of dyspnea.
- Elevated IL-6 was independently associated with higher N-terminal pro-B-type natriuretic peptide, high-sensitivity cardiac troponin T, and infection.
- IL-6 levels varied across AHF phenotypes, being highest in cardiogenic shock and lowest in hypertensive AHF.
- IL-6 was a strong, independent predictor of one-year mortality in AHF patients, improving the discrimination of the BIOSTAT-CHF risk score.
Conclusions:
- A significant proportion of AHF patients exhibit subclinical systemic inflammation, as indicated by elevated IL-6.
- IL-6 contributes to AHF phenotyping and is a critical determinant of mortality risk in these patients.
- Measuring IL-6 offers valuable prognostic information and enhances risk stratification in acute heart failure.
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