Portuguese Hospital, Salvador/BA, Brazil.
Clin Chim Acta. 2010 Apr 2;411(7-8):540-5. doi: 10.1016/j.cca.2010.01.011. Epub 2010 Jan 18.
Increased cytokine and chemokine levels are associated with cardiovascular events in patients with non-ST-elevation acute coronary syndromes (ACS), but the incremental prognostic value of these inflammatory markers is not known. We determined if cytokine and chemokine assessment adds prognostic information to the GRACE Score in patients with ACS.
Five cytokines (interleukin (IL)-1beta, IL-6, IL-10, IL-12p70, and tumor necrosis factor (TNF)-alpha soluble receptor I), five chemokines (IL-8, CCL5, CXCL9, CCL2, and CXCL10) and C-reactive protein (CRP) were measured at admission of 87 patients admitted with ACS.
During hospitalization, the incidence of cardiovascular events was 13% (7 deaths, 1 nonfatal acute myocardial infarction, and 3 refractory unstable angina). Individuals who developed events had significantly greater levels of CRP, IL-1beta, IL-12, TNF-alpha, IL-8, CXCL9 and CCL2, compared with those free of events. Thus, these markers were used to build an Inflammatory Score, by the input of one point for each of these variables above the 75th percentile. After adjustment for the GRACE Score, the Inflammatory Score independently predicted events (OR=1.80; 95% CI=1.12-1.88). Incorporation of the Inflammatory Score into the GRACE Score promoted a C-statistics improvement from 0.77 (95% CI=0.58-0.96) to 0.85 (95% CI=0.71-1.0). Net reclassification improvement obtained with GRACE-Inflammatory Score was 13% (P=0.007), indicating a significant reclassification. When only CRP was incorporated into GRACE, the increase on C-statistics was not relevant (from 0.77 to 0.80).
Cytokines and chemokines measured at admission add prognostic information to the GRACE Score in patients admitted with ACS.
非 ST 段抬高型急性冠脉综合征（ACS）患者的细胞因子和趋化因子水平升高与心血管事件相关，但这些炎症标志物的增量预后价值尚不清楚。我们旨在确定细胞因子和趋化因子评估是否为 ACS 患者的 GRACE 评分提供了预后信息。
入院时，对 87 名 ACS 患者的 5 种细胞因子（白细胞介素 (IL)-1β、IL-6、IL-10、IL-12p70 和肿瘤坏死因子 (TNF)-α可溶性受体 I）和 5 种趋化因子（IL-8、CCL5、CXCL9、CCL2 和 CXCL10）及 C 反应蛋白（CRP）进行了测定。
住院期间，心血管事件的发生率为 13%（7 例死亡、1 例非致死性急性心肌梗死和 3 例难治性不稳定型心绞痛）。与无事件发生的患者相比，发生事件的个体 CRP、IL-1β、IL-12、TNF-α、IL-8、CXCL9 和 CCL2 的水平显著更高。因此，将这些标志物中的每一个变量的得分都设定为高于第 75 百分位数的 1 分，从而构建炎症评分。在调整 GRACE 评分后，炎症评分独立预测了事件的发生（OR=1.80；95%CI=1.12-1.88）。将炎症评分纳入 GRACE 评分可提高 C 统计量，从 0.77（95%CI=0.58-0.96）提高至 0.85（95%CI=0.71-1.0）。GRACE-炎症评分的净重新分类改善率为 13%（P=0.007），表明有显著的重新分类。当仅将 CRP 纳入 GRACE 评分时，C 统计量的增加并不相关（从 0.77 提高至 0.80）。
入院时测量的细胞因子和趋化因子为 ACS 患者的 GRACE 评分提供了预后信息。
