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Parámetros de citoquinas plasmáticas y mortalidad en pacientes con insuficiencia cardíaca crónica
M Rauchhaus1, W Doehner, D P Francis
1Clinical Cardiology, National Heart and Lung Institute, Royal Brompton Hospital, London, UK. mathias.rauchhaus@medizin.uni-halle.de
Circulation
|January 11, 2000
Resumen
El receptor soluble del factor de necrosis tumoral 1 (sTNF-R1) es un fuerte predictor de la mortalidad en la insuficiencia cardíaca crónica (ICC). Los niveles más altos de sTNF-R1 indican un mayor riesgo de muerte en pacientes con ECH.
Área de la Ciencia:
- Cardiología Cardiología.
- Inmunología Inmunología.
- Investigación de biomarcadores Investigación de biomarcadores.
Sus antecedentes:
- La activación inmune inflamatoria es una característica clave de la insuficiencia cardíaca crónica (ICC).
- La importancia pronóstica de marcadores inflamatorios específicos como el factor de necrosis tumoral alfa (TNF-alfa), los receptores de TNF solubles (sTNF-R1 / sTNF-R2), la interleucina-6 (IL-6) y el CD14 soluble (sCD14) en pacientes con CHF sigue sin estar clara.
Objetivo del estudio:
- Investigar la importancia pronóstica del TNF-alfa, sTNF-R1, sTNF-R2, IL-6 y sCD14 en pacientes con insuficiencia cardíaca crónica.
- Identificar el biomarcador inflamatorio más preciso para predecir la mortalidad en la insuficiencia cardíaca congestiva.
Principales métodos:
- Evaluación prospectiva de las concentraciones plasmáticas de las variables inmunes en 152 pacientes con insuficiencia cardiaca congestiva.
- Seguimiento durante una media de 34 meses para registrar los eventos de mortalidad.
- Análisis univariados y multivariados, incluido el análisis de las características operativas del receptor (ROC), para evaluar la precisión del pronóstico.
Principales resultados:
- El aumento de los niveles de TNF-alfa, sTNF-R1, sTNF-R2, sCD14 e IL-6 se asoció con un aumento de la mortalidad a los 24 meses en análisis univariados.
- El TNF-receptor soluble 1 (sTNF-R1) surgió como el pronóstico más fuerte y preciso entre todos los parámetros de citoquinas evaluados.
- El valor pronóstico de sTNF-R1 fue independiente de los marcadores establecidos de gravedad de la ECH y la duración del seguimiento.
Conclusiones:
- sTNF-R1 es un marcador pronóstico altamente preciso e independiente para la mortalidad en pacientes con insuficiencia cardíaca crónica.
- La medición de sTNF-R1 puede ayudar a identificar a los pacientes con CHF de alto riesgo y monitorear las terapias anti-TNF-alfa.
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