Abstract 11284: Relationship of Inflammatory Cytokines and Six-Month Hospital Readmission in Heart Failure

Abstract

Hospital readmission rates (HRR) in heart failure (HF) remains high. Psychosocial and clinical factors are linked with HF hospital readmission. Brain natriuretic peptide (BNP) is strongly associated with acute decompensated HF. However, the relationships of inflammatory cytokines (i.e. tumor necrosis factor-alpha [TNFα], interleukin-6 [IL6], interleukin-10 [IL10]) and HRR in HF are rarely evaluated. Objective: Evaluate the relationship of BNP, TNF-α, IL6 and IL10 with all-cause HRR within 6 months post-HF hospital discharge. Methods: A cross-sectional study was conducted in 104 HF patients: age 68.4 ± 11.7 years, left ventricular ejection fraction 37.9% ± 17%, Specific Activity Scale (SAS) I/II- 40 (39%), and III/IV- 64 (61%) , Charlson Comorbidity Index (CCI) score: 0-1= 24%, 2-3= 26%, and =/>4= 50%. Hospital readmission rate is the number of hospital readmissions of all causes occurring 2 weeks to 6 months after HF hospital discharge. Initially, we analyzed bivariate correlations of HRR with sociodemographic, depression (via Hamilton depression rating scale [HDRS] score), functional status, comorbidities, BNP, and inflammatory cytokines (i.e. TNF-α, IL-6 and IL10). A multiple linear regression was performed, with important and significant psychosocial and clinical variables entered first as a block, followed by BNP and inflammatory cytokines. Results: Incidence of 6-month HRR: 0= 49 (47%); 1-2= 43 (41%); 3-6= 12 (12%). Bivariate correlation of HRR with: 1) sociodemographic: age- ( r = .21, p= .02), non-white- 37% ( r = .04, p= .36), living alone- 42% ( r = .17, p= .04); 2) functional status: SAS ( r = .28, p= .002); 3) CCI score ( r = .21, p= .02); 3) HDRS score ( r = .14, p= .07); 4) BNP: ( r = .14, p= .08); and 5) inflammatory cytokines: IL6 ( r = .41, p= <.001, and IL10 ( r = .16, p= .06). Together, age, living alone, being non-white, HDRS score, SAS, CCI score, and IL6 accounted for 24% of the variance in HRR (p= .001). Specific variables contributing significant variance to HRR were: higher IL6- 34% (p= .001), and living alone= 14% (p= .10). Conclusion: Six-month HRR in HF remains high. Higher IL6 is associated with high HRR. After HF hospital discharge, patients with high inflammatory cytokines may require more frequent monitoring and intervention.