Plasma interleukin-6 predicts cardiovascular mortality in hemodialysis patients
Plasma interleukin-6 predicts cardiovascular mortality in hemodialysis patients
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DOI：
10.1053/j.ajkd.2004.09.018
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发表时间：
2005-02-01
影响因子：
13.2
通讯作者：
Balakrishnan, VS
中科院分区：
文献类型：
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作者：
Rao, M;Guo, DQ;Balakrishnan, VS
背景：白细胞介素 - 6（IL - 6）是慢性炎症过程的介质和标志物，它是血液透析（HD）患者众多发病和死亡的原因。本研究在参与HEMO研究的一组稳定的血液透析患者中，评估循环血浆IL - 6作为全因死亡率和心血管死亡率的预测因子，并研究其与普遍存在的合并症和低白蛋白血症的关系。
方法：临床数据包括人口统计学、医学和常规实验室参数。使用共存疾病指数（ICED）对合并症进行分级。关注的结局是全因死亡率和心血管死亡率。在入组时及每年采集血液样本，并用高灵敏度酶联免疫吸附测定法测量血浆IL - 6水平。
结果：206名患者的血浆IL - 6水平中位数为7.9皮克/毫升（范围，0.1 - 90.3皮克/毫升），在患有血管疾病的患者中更高（P = 0.03），在ICED评分较高的患者中更高（P = 0.01），在卡氏功能状态评分较低的患者中更高（P < 0.01）。血清白蛋白与血浆IL - 6水平呈负相关（P = 0.03，r = - 0.16）。未经调整的中位生存时间在血浆IL - 6最低四分位数组为1209天，在最高组为806天（P = 0.02，对数秩检验）。血浆IL - 6每增加1个对数单位，全因死亡的调整后风险增加1.19倍（P = 0.04；95%置信区间，1.01 - 1.40），心血管死亡的调整后风险增加1.43倍（P = 0.02；95%置信区间，1.06 - 1.92）。当将随时间变化的IL - 6水平作为时间依赖性协变量纳入时，风险比估计值更高。
结论：血浆IL - 6水平与血液透析患者的合并症密切相关，是心血管和全因死亡率的有力预测因子。
Background: Interleukin-6 (IL-6) is a mediator and marker of the chronic inflammatory process that is responsible for much of the morbidity and mortality seen in hemodialysis (HD) patients. This study evaluated circulating plasma IL-6 as a predictor of all-cause mortality and cardiovascular mortality and studied its relationship to prevalent comorbidity and hypoalbuminemia, in a cohort of stable HD patients enrolled in the HEMO study. Methods: Clinical data included demographic, medical, and routine laboratory parameters. Comorbidities were graded using the Index of Co-Existing Diseases (ICED). Outcomes of interest were all-cause mortality and cardiovascular mortality. Blood samples were drawn at enrollment and annually, and plasma IL-6 levels measured with high-sensitivity enzyme-linked immunosorbent assay. Results: Median plasma IL-6 level in 206 patients was 7.9 pg/mL (range, 0.1 to 90.3 pg/mL) and was higher in patients with vascular disease (P = 0.03), higher ICED scores (P = 0.01), and lower Karnofsky indices (P < 0.01). Serum albumin was inversely related to plasma IL-6 levels (P = 0.03, r = -0.16). Unadjusted median survival time was 1,209 days in the lowest quartile of plasma IL-6 and 806 days in the highest (P = 0.02, log rank test). A 1-log increase in plasma IL-6 was associated with a 1.19-fold higher adjusted risk for all-cause mortality (P = 0.04; 95% confidence interval, 1.01 to 1.40) and a 1.43-fold higher adjusted risk of cardiovascular mortality (P = 0.02; 95% confidence interval, 1.06 to 1.92). Hazard ratio estimates were higher when IL-6 levels over time were incorporated as a time-dependent covariate. Conclusion: Plasma IL-6 levels are strongly associated with comorbidity in HD patients and are a powerful predictor of cardiovascular and all-cause mortality.