THE PROGNOSIS SIGNIFICANCE OF BLOOD PLASMA LEVELS OF HIGH SENSITIVITY C-REACTIVE PROTEIN AND THE SYSTEM OF CYTOKINES FOR THE ASSESSMENT OF RISK OF ATRIAL FIBRILLATION DEVELOPING IN PATIENTS WITH ARTERIAL HYPERTENSION, CORONARY ARTERY DISEASE AND HF
About the author:
Yalovenko M. I., Khaniukov O. O.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
The object of study was to evaluate the predictive potential of high-sensitivity C-reactive protein and cytokines (interleukin-1, interleukin-6 and interleukin-10) as the main markers of chronic inflammation to predict the development of a permanent form of atrial fibrillation in patients with arterial hypertension, coronary artery disease and heart failure. Object and methods. 78 patients were examined; the average age was 66,3±1,0. The 1st group included 42 patients with permanent form of atrial fibrillation (AF), arterial hypertension (AH), coronary artery disease (CAD) and heart failure (HF). The 2nd group consisted of 36 patients with AH, CAD, HF without heart rhythm disturbances. Both groups’ patients were comparative by age, sex and clinical manifestation. Results. The analysis of high-sensitivity C-reactive protein and cytokines in the study group showed a significant positive correlation between the severity of chronic inflammation and permanent form of AF for hs-CRP (rs = +0,32; p = 0.005), IL-1 (rs = +0,24; p = 0,03), IL-6 (rs = +0,23; p = 0,04), IL-10 (rs = + 0,42; p <0,001). Average levels of these parameters in patients who have permanent form of AF were significantly higher compared with the 2nd group of patients: hs-CRP (4,12 mg/l [3,51; 6,77] vs 3,15 mg/l [2,67; 5,24], p = 0,005), IL-1 (11,21 pg/ml [4,64; 17,24] vs 4,57 pg/ml [3,52; 12,44], p = 0,03), IL-6 (7,09 pg/ml [5,87; 13,77] vs 5,89 pg/ml [4,61; 12,90], p = 0,04), IL-10 (33,04 pg/ ml [15,91; 35,54] vs 14,50 pg/ ml [6,49; 21,74], р<0,001). Through the ROC analysis, optimal cut off points were determined for the studied parameters that characterize the development of AF. It has been established that the best performance characteristics for the prediction of AF have an increase in the level of hs-CRP in plasma up to 3,18 mg/l and above (area under the ROC curve AUC = 0,687; 95% CI 0,572-0,787; sensitivity = 92,9%; specificity = 52,8%), the level of IL-1 in the plasma ≥ 8,64 pg/ml (AUC = 0,640; 95% CI 0,523-0.,745; sensitivity = 61,9%; specificity = 72,2%); level IL-6 in plasma ≥ 5,34 pg/ ml (AUC = 0,633; 95% CI 0,516-0,739; sensitivity = 88,1%; specificity = 47,2%); IL-10 levels in plasma ≥ 23,0 pg/ml (AUC = 0,745; 95% CI 0,633-0,837; sensitivity = 66,7%; specificity = 86,1%). According to the results of one-factor logit-regression analysis, it was found that in achieving the critical value of hs-CRP ≥ 3,18 mg/l determined by means of the ROC analysis, chances of developing a permanent form of AF in patients with AH, CAD and HF significantly increase in 14,53 times (hazard ratio (HR)) = 14,53; 95% CI 3,71-56,96), and the probability of occurrence of such an event achieve Pmax. = 69,6%. Provided the determination of IL-1 in blood plasma of more than 8,63 pg/ml the probability of the risk increases in 4,22 times (HR = 4,22; 95% CI 1,59-11,20, achieving Pmax. = 72,2%. If the level of IL-6 in blood plasma exceeds 5,33 pg/ ml, then HR = 6,62; 95% CI 2,08-21,10; Pmax. = 66,1%. For the level of IL-10 in blood plasma over 22,9 pg/ml HR = 12,40; 95% CI 3,89-39,57; Pmax. = 84,9%). Conclusion. Thus, we have found the reliable increase of hs-CRP, IL-1, IL-6, IL-10 in blood plasma levels in patients with permanent form of AF and AH, CAD, HF (in comparison with patients without AF) that indicates the presence of more active chronic systemic inflammation. It has been determined that the increasing of levels of hs-CRP ≥ 3,18 mg/l, IL-1 ≥ 8,64 pg/ml, IL-6 ≥ 5,34 pg/ml, ІL-10 ≥ 23,0 pg/ml in blood plasma essentially increases chances of AF development and could be used as predictive markers for the occurrence of permanent AF in patients with AH, CAD, HF. It has also been determined that the predictive potential of inflammatory markers for evaluating the probability of AF development increases to 91,0-100% in case simultaneously taking into account 3-4 factors of inflammation (with indicative sensitive variations 83,3% to 95,2%, specificity — from 72,2% to 88,9%).
atrial fibrillation, coronary artery disease, heart failure, chronic inflammation, cytokines, prognosis.
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 1 Part 2 (149), 2019 year, 215-220 pages, index UDK 616.12-008.331.1-005.4-008.315-036.1:616.125-008.313-037:616.15-07