Inflammation and anaemia in a broad spectrum of patients with heart failure
- Lennaert Kleijn1,
- Anne M S Belonje1,
- Adriaan A Voors1,
- Rudolf A De Boer1,
- Tiny Jaarsma1,
- Sudip Ghosh2,
- Joseph Kim2,
- Hans L Hillege1,
- Wiek H Van Gilst1,
- Dirk J van Veldhuisen1,
- Peter van der Meer1
- 1Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
- 2Amgen Ltd, Cambridge, UK
- Correspondence to Dr Peter Van der Meer, Department of Cardiology, Thoraxcenter, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB Groningen, The Netherlands;
Contributors LK, AMSB, AAV and RADB were involved in writing the manuscript. LK is primary author. SG and JK contributed as external reviewers of the manuscript. HLH was involved with analysis. PvdM, DJvV, TJ WHvG were involved with supervision and finishing of the manuscript.
- Accepted 28 May 2012
- Published Online First 22 June 2012
Aims Anaemia in heart failure (HF) is associated with a poor prognosis. Although inflammation is assumed to be an important cause of anaemia, the association between anaemia and inflammatory markers in patients with HF has not been well established.
Methods Data from a multicentre randomised clinical trial, in which patients were eligible if they were >18 years of age and admitted for HF (New York Heart Association II–IV), were used. In a subset of 326 patients, haemoglobin (Hb), haematocrit, high sensitivity C-reactive protein (hsCRP), interleukin-(IL) 6, soluble tumour necrosis factor receptor (sTNFR)-1 and erythropoietin (Epo) were measured at discharge and the primary endpoint was all-cause mortality. Follow-up was 18 months.
Results Anaemia (Hb <13 g/dl (men) and <12 g/dl (women)) was present in 40% (130/326) of the study population. Median levels of IL-6, hsCRP and sTNFR-1 were significantly higher in anaemic patients than in non-anaemic patients. Logistic regression demonstrated that each increase in hsCRP values (OR 1.58 per SD log hsCRP; 95% CI 1.09 to 2.29; p=0.016) and each increase in sTNFR-1 values (OR 1.62 per SD log sTNFR-1; 95% CI 1.24 to 2.11; p<0.001) were independently associated with anaemia. Epo (HR 1.31 per log Epo; 95% CI 1.01 to 1.69; p=0.041) and sTNFR-1 (HR 1.47 per log sTNFR-1; 95% CI 1.16 to 1.86; p=0.001) levels were independently associated with outcome.
Conclusion Anaemia is present in 40% of patients hospitalised for HF and is independently associated with inflammation.
- Heart failure
- allied specialties
- cardiac function
- cardiac remodelling
- cardiac function
- heart failure
- systolic dysfunction
- heart failure
- systolic heart failure
- heart failure treatment
Funding The COACH study was supported by a large program from the Netherlands Heart Foundation (grant 2000Z003). Additional unrestricted grants were obtained from Roche Diagnostics, The Netherlands (N-terminal pro BNP) and Novartis Pharma BV, The Netherlands. The present study was additionally supported by separate grants from BG-medicine, USA and Amgen Inc, Thousand Oaks, USA. AMSB is supported by the Netherlands Heart Foundation (grant 2007T20). DJvV and AAV are Clinical Established Investigators of the Netherlands Heart Foundation (D97-017 and 2006T37).
Competing interests AAV has received unrestricted research grants from Amgen, Vifor and Ortho Biotech. PvdM received consulting fees and an unrestricted research grant from Vifor. DJvV has received consulting fees from Amgen and Vifor and is a member of the Executive Committee of the Darbepoetin morbidity/mortality Heart Failure trial (RED-HF). SG and JK are employees of Amgen Ltd.
Ethics approval Ethics approval was provided by local medical ethics committees.
Provenance and peer review Not commissioned; externally peer reviewed.