Tumor necrosis factor-alpha and mortality in heart failure: a community study.
Tumor necrosis factor-alpha and mortality in heart failure: a community study.
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肿瘤坏死因子-α 和心力衰竭死亡率：一项社区研究。
DOI：
10.1161/circulationaha.107.759191
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发表时间：
2008-08-05
期刊：
影响因子：
37.8
通讯作者：
Roger VL
中科院分区：
文献类型：
--
作者：
Dunlay SM;Weston SA;Redfield MM;Killian JM;Roger VL
据报道，肿瘤坏死因子 α (TNFα) 是一种炎症细胞因子，在射血分数 (EF) 降低的心力衰竭 (HF) 试验中升高，且与死亡率相关。对于具有保留 EF 的 HF 是否属实尚不清楚，并且缺乏社区数据。我们评估了 TNFα 的分布、其与基线特征和死亡率的关联，及其对评估社区心力衰竭患者风险的益处。前瞻性招募了 2004 年 7 月至 2007 年 3 月期间患有活动性心力衰竭的奥姆斯特德县居民（n=486，平均年龄 76.7 岁，55% EF ≥50%）。测量临床特征和 TNFα。 143 例 (29%) 中存在 TNFα 升高（> 正常检测限 2.8pg/mL）。较高的 TNFα 与肌酐清除率降低、不吸烟状态、贫血和较高的合并症相关（全部 ptrend<0.05）。死亡率随着 TNFα 的增加而增加 (p=0.016)，从最低四分位数到最高四分位数，1 年死亡率估计分别为 16%、18%、23% 和 32%。调整年龄、性别和 EF 后，从第二个到最高 TNFα 四分位数的死亡风险比分别为 1.24、1.37 和 1.90 (ptrend=0.007)。 TNFα 对风险评估有贡献，如所有检查模型中接受者操作特征曲线下面积的增加所示（所有模型的 p<0.05）。 EF 的结果没有差异（TNFα 和 EF 的相互作用项 p=0.60）。大部分社区心力衰竭患者的 TNFα 水平升高，与生存率大幅下降相关，并且使风险评估显着增加至高于既定指标。 TNFα 可用于 EF 保留或降低的心力衰竭患者的风险评估。
Tumor necrosis factor α (TNFα), an inflammatory cytokine, was reported to be elevated in trials of heart failure (HF) with reduced ejection fraction (EF) and associated with mortality. Whether this is true for HF with preserved EF is unknown and community data are lacking. We evaluated the distribution of TNFα, its association with baseline characteristics and mortality, and its benefit to assess risk in community HF patients. Olmsted County residents with active HF from July 2004 to March 2007 (n=486, mean age 76.7 years, 55% EF ≥50%) were prospectively recruited. Clinical characteristics and TNFα were measured. Elevated TNFα (> assay limit of normal of 2.8pg/mL) was present in 143 (29%). Higher TNFα was associated with decreased creatinine clearance, non-smoking status, anemia, and greater comorbidity (ptrend<0.05 for all). Mortality increased with increasing TNFα (p=0.016), with 1-year mortality estimates of 16%, 18%, 23%, and 32% from lowest to highest quartile, respectively. After adjustment for age, sex, and EF, the hazard ratios for death were 1.24, 1.37, and 1.90 from second to highest TNFα quartile, respectively (ptrend=0.007). TNFα contributed to risk assessment as indicated by the increases in the area under the receiver operating characteristics curves in all models examined (p<0.05 for all). Results did not differ by EF (p=0.60 interaction term of TNFα and EF). TNFα was elevated in a large portion of community HF patients, was associated with a large decrease in survival, and provided a significant incremental increase in risk assessment above established indicators. TNFα is useful for risk assessment in HF patients with preserved and reduced EF.