Elevated serum interleukin-18 level is associated with all-cause mortality in stable hemodialysis patients independently of cardiac dysfunction
Journal
PLoS ONE
Journal Volume
9
Journal Issue
3
Pages
e89457
Date Issued
2014
Author(s)
Liu Y.-W.
Chang Y.-T.
Tsai W.-C.
Su Y.-R.
Wang S.P.H.
Yang C.-S.
Tsai L.-M.
Chen J.-H.
Sung J.-M.
Abstract
Background: High circulating interleukin (IL)-18 level predicts a higher hospitalization rate among dialysis patients, possibly through cardiovascular mechanisms; however, whether higher IL-18 level is associated with mortality in dialysis patients is less clear. In addition, its impacts on left ventricular (LV) function are also unknown. We conducted a cohort study to examine the impacts of IL-18 level on LV function and prognosis among clinically stable hemodialysis patients. Methods: Clinically stable patients undergoing maintenance hemodialysis (?3 months) were prospectively enrolled from December 2008 to January 2009, and were followed up for 31 months. The enrolled patients (41% male, 66.4±10.9 years of age) received 2-dimensional echocardiography and myocardial deformation (strain) analysis, including LV peak systolic longitudinal strain (GLS) and circumferential strain (CS). Laboratory measurements were also performed. Cox regression analysis was used to investigate prognostic factors. Results: Seventy-five patients were stratified into 2 groups by the median value of IL-18 (654.2 pg/ml). Between these 2 groups, there was no significant difference in baseline characteristics including LV ejection fraction. The high IL-18 group had a worse LV systolic function as demonstrated by reduced GLS and CS. Seventeen patients (22.7%) died during the follow-up period. Multivariate Cox regression analysis showed that low serum albumin, the presence of hypertension, high serum IL-18, and less negative GLS (>-15%) were independently associated with all-cause mortality. No significant interaction between IL-18 and less negative GLS was noted in the final Cox model. Conclusion: Hemodialysis patients with high IL-18 levels tend to have worse LV systolic function and higher mortality rate. However, elevated serum IL-18 level is predictive of poor prognosis among stable hemodialysis patients, independently of LV dysfunction. This suggests an additional value of IL-18 to echocardiographic study in predicting all-cause mortality, and IL-18 may be helpful in early risk stratification of hemodialysis patients. ? 2014 Liu et al.
SDGs
Other Subjects
interleukin 18; interleukin 18; interleukin 18 protein, human; adult; aged; article; cohort analysis; controlled study; female; heart disease; heart left ventricle ejection fraction; heart left ventricle function; heart muscle; hemodialysis patient; human; major clinical study; male; mortality; prognosis; prospective study; two dimensional echocardiography; blood; heart left ventricle hypertrophy; hospitalization; Kaplan Meier method; Kidney Failure, Chronic; middle aged; multivariate analysis; proportional hazards model; receiver operating characteristic; renal replacement therapy; Aged; Female; Hospitalization; Humans; Hypertrophy, Left Ventricular; Interleukin-18; Kaplan-Meier Estimate; Kidney Failure, Chronic; Male; Middle Aged; Multivariate Analysis; Proportional Hazards Models; Prospective Studies; Renal Dialysis; ROC Curve; Ventricular Dysfunction, Left; Ventricular Function, Left
Publisher
Public Library of Science
Type
journal article