Aims 

Chronic kidney dysfunction (CKD) and persistent congestion influence heart failure prognosis, but little is known about the role of inflammation in this association. We assessed the relationship between inflammatory biomarkers, persistent congestion and CKD and their prognostic implications in patients with acute heart failure.

Methods 

We enrolled 97 hospitalised patients (mean age: 66 ± 12 years, ejection fraction: 30 ± 8%) with acute heart failure. Before discharge, congestion was assessed using a heart failure scoring system on the basis of Framingham criteria. Circulating levels of high-sensitivity C-reactive protein, TGF-β-1, IL-1, IL-6, IL-10, TNF-α, soluble tumour necrosis factor receptor type 1 and 2 were measured. Patients were divided into four groups according to the presence of CKD (estimated glomerular filtration rate <60 ml/min/1.73 m²) and congestion (Framingham heart failure score ≥2). The primary end point was the combination of death and rehospitalisation for acute heart failure.

Results 

During a median follow-up of 32 months, 37 patients died and 14 were rehospitalised for acute heart failure. Patients with CKD and congestion had significantly higher TNF-α (P = 0.037), soluble tumour necrosis factor receptor type 1 (P = 0.0042) and soluble tumour necrosis factor receptor type 2 (P = 0.001), lower TGF-β-1 (P = 0.02) levels, and the worst outcome (P < 0.0001). Congestion (P = 0.01) and CKD (P = 0.02) were independent predictors of the end-point together with N-terminal prohormone of brain natriuretic peptide (P = 0.002) and TNF-α (P = 0.004). TNF-α attenuated the direct relation between CKD, congestion and outcome, explaining 40% of the difference in the outcome.

Conclusion 

In patients hospitalised with acute heart failure, the prognostic impact of persistent congestion and CKD is associated with increased cytokine levels, which may also interfere with the outcome.

中文翻译：

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急性心力衰竭持续性充血，肾功能不全和炎性细胞因子的预后研究。

目的 

慢性肾功能不全（CKD）和持续性充血影响心力衰竭的预后，但对于炎症在这种关联中的作用知之甚少。我们评估了炎症性生物标志物，持续性充血和CKD之间的关系及其对急性心力衰竭患者的预后意义。

方法 

我们招募了97例急性心力衰竭的住院患者（平均年龄：66±12岁，射血分数：30±8％）。出院前，根据弗雷明汉标准使用心力衰竭评分系统评估充血情况。测量了高敏C反应蛋白，TGF-β-1，IL-1，IL-6，IL-10，TNF-α，可溶性肿瘤坏死因子受体1和2的循环水平。根据CKD的存在（估计肾小球滤过率<60 ml / min / 1.73 m ²）和充血（Framingham心力衰竭评分≥2）将患者分为四组。主要终点是急性心力衰竭的死亡和重新住院治疗。

结果 

在中位随访期32个月中，有37例患者死亡，另有14例因急性心力衰竭而住院。CKD和充血患者的TNF-α（P = 0.037），可溶性肿瘤坏死因子受体1型（P = 0.0042）和可溶性肿瘤坏死因子受体2型（P = 0.001），TGF-β-1（P = 0.02）水平，最差的结果（P <0.0001）。充血（P = 0.01）和CKD（P = 0.02）是终点，与脑钠肽（P = 0.002）和TNF-α（P= 0.004）。TNF-α减弱了CKD，充血和结局之间的直接关系，解释了结局差异的40％。

结论 

在因急性心力衰竭住院的患者中，持续充血和CKD的预后影响与细胞因子水平升高有关，这也可能会影响预后。