Open AccessThe Role of Serum VCAM ‐1 and TNF ‐α as Predictors of Mortality and Morbidity in Patients with Chronic Heart Failure
Author(s) -
SavicRadojevic Ana,
Radovanovic Slavica,
Pekmezovic Tatjana,
PljesaErcegovac Marija,
Simic Dragan,
Djukic Tatjana,
Matic Marija,
Simic Tatjana
Publication year - 2013
Publication title -
journal of clinical laboratory analysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.536
H-Index - 50
eISSN - 1098-2825
pISSN - 0887-8013
DOI - 10.1002/jcla.21570
Subject(s) - vcam 1 , medicine , heart failure , exacerbation , endothelial dysfunction , tumor necrosis factor alpha , brain natriuretic peptide , endothelium , gastroenterology , cell adhesion molecule , proportional hazards model , brachial artery , natriuretic peptide , cardiology , immunology , icam 1 , blood pressure
Background To assess the prognostic significance of four inflammatory markers ( TNF ‐α, high sensitive C‐reactive protein (hs‐ CRP ), intercellular cell adhesion molecule‐1 ( ICAM ‐1), vascular cell adhesion molecule‐1 ( VCAM ‐1)) in chronic heart failure ( CHF ) patients with respect to individual outcomes, especially disease exacerbation and mortality. Methods Plasma adhesion molecules, ICAM ‐1, and VCAM ‐1, together with TNF ‐α and hs‐ CRP were determined in 120 CHF patients and 69 healthy controls. Endothelial function was also estimated by flow‐mediated brachial artery dilatation. Results Increased levels of all investigated inflammatory markers were found in CHF patients compared to controls, with the rise more pronounced in New York Heart association ( NYHA ) functional IV class. Significant correlations were obtained for VCAM ‐1 and brain natriuretic peptide ( r = 0.191; P = 0.038), as well as, ICAM ‐1 and endothelium‐dependent vasodilatation ( r = −0.235; P = 0.01). K aplan– M eier analysis showed disease exacerbation in patients with TNF ‐α levels >2.78 pg/ml significantly shorter compared to those with TNF ‐α levels <2.78 pg/ml (log‐rank test = 8.270; P = 0.004), while similar association was observed for patients with hs‐ CRP levels >4.76 mg/l (log‐rank test = 5.052; P = 0.025) and VCAM ‐1 levels >1200 ng/l (log‐rank test = 5.45; P = 0.020) with respect to mortality. Cox regression analysis demonstrated only VCAM ‐1 ( HR = 4.7; 95% confidence interval ( CI ): 1.1–18.7; P = 0.030) as independent death predictor, while TNF ‐α was associated with disease exacerbation ( HR = 8.2; 95% CI : 1.1–23.0; P = 0.045). Conclusions VCAM ‐1 appears to be useful in risk stratification of CHF patients and in screening, to identify subjects at risk for heart failure related events. J. Clin. Lab. Anal. 27:105–112, 2013. © 2013 Wiley Periodicals, Inc.