TY - JOUR
T1 - Depression and markers of inflammation as predictors of all-cause mortality in heart failure
AU - Mommersteeg, Paula M. C.
AU - Schoemaker, Regien G.
AU - Naude, Petrus J. W.
AU - Eisel, Ulrich L. M.
AU - Garrelds, Ingrid M.
AU - Schalkwijk, Casper G.
AU - Westerhuis, Bert W. J. J. M.
AU - Kop, Willem J.
AU - Denollet, Johan
PY - 2016/10
Y1 - 2016/10
N2 - Background: In patients with heart failure (HF) depressive symptoms have been associated with mortality, as well as biological risk factors, including inflammation, nitric oxide (NO) regulation, and oxidative stress. We investigated the joint predictive value of depressive symptoms, inflammation and NO regulation on all-cause mortality in patients with HF, adjusted for covariates. Methods: Serum levels of inflammation (TNF alpha, sTNFr1, sTNFr2, IL-6, hsCRP, NGAL), NO regulation (L-arginine, ADMA, and SDMA), and oxidative stress (isoprostane 8-Epi Prostaglandin F2 Alpha) were measured in 104 patients with HF (mean age 65.7 +/- SD 8.4 years, 28% women). Depressive symptoms (Beck Depression Inventory, BDI) were measured as continuous total, cognitive, and somatic symptoms, as well as categorized presence of mild moderate depression (cut-off BDI >= 10). In Cox proportional hazard models we adjusted for age, sex, poor exercise tolerance and comorbidity. Results: After on average 6.1 years follow-up (SD = 2.9, range 0.4-9.2), 49 patients died. Total and somatic depressive symptoms, mild/moderate depression, higher NGAL, sTNFr2, IL-6, hsCRP and SDMA serum levels were significantly associated with a higher all-cause mortality rate, adjusted for covariates. The findings were most consistent for CRP level and somatic depressive symptoms. When combined, both depressive symptoms and markers of inflammation and NO regulation remained significantly associated with all-cause mortality. These associations were not confounded by age, sex, poor exercise tolerance and comorbidity. Conclusion: Depressive symptoms and markers of inflammation and NO regulation are codominant risk factors for all- cause mortality in heart failure.
AB - Background: In patients with heart failure (HF) depressive symptoms have been associated with mortality, as well as biological risk factors, including inflammation, nitric oxide (NO) regulation, and oxidative stress. We investigated the joint predictive value of depressive symptoms, inflammation and NO regulation on all-cause mortality in patients with HF, adjusted for covariates. Methods: Serum levels of inflammation (TNF alpha, sTNFr1, sTNFr2, IL-6, hsCRP, NGAL), NO regulation (L-arginine, ADMA, and SDMA), and oxidative stress (isoprostane 8-Epi Prostaglandin F2 Alpha) were measured in 104 patients with HF (mean age 65.7 +/- SD 8.4 years, 28% women). Depressive symptoms (Beck Depression Inventory, BDI) were measured as continuous total, cognitive, and somatic symptoms, as well as categorized presence of mild moderate depression (cut-off BDI >= 10). In Cox proportional hazard models we adjusted for age, sex, poor exercise tolerance and comorbidity. Results: After on average 6.1 years follow-up (SD = 2.9, range 0.4-9.2), 49 patients died. Total and somatic depressive symptoms, mild/moderate depression, higher NGAL, sTNFr2, IL-6, hsCRP and SDMA serum levels were significantly associated with a higher all-cause mortality rate, adjusted for covariates. The findings were most consistent for CRP level and somatic depressive symptoms. When combined, both depressive symptoms and markers of inflammation and NO regulation remained significantly associated with all-cause mortality. These associations were not confounded by age, sex, poor exercise tolerance and comorbidity. Conclusion: Depressive symptoms and markers of inflammation and NO regulation are codominant risk factors for all- cause mortality in heart failure.
KW - Heart failure
KW - Depressive symptoms
KW - Inflammation
KW - CRP
KW - All-cause mortality
KW - NGAL
KW - NO regulation
KW - Methylarginines
KW - Prognosis
U2 - 10.1016/j.bbi.2016.03.012
DO - 10.1016/j.bbi.2016.03.012
M3 - Article
C2 - 27013355
SN - 0889-1591
VL - 57
SP - 144
EP - 150
JO - Brain Behavior and Immunity
JF - Brain Behavior and Immunity
ER -