Diagnostic and prognostic significance of alpha-defensin in patients with chronic heart failure during 2-year follow-up

Abstract

Background: Defensins play an important role in the processes associated with innate immunity. Their growth is observed in sites of intense inflammation, but also in less severe inflammation. Evaluation of alpha-defensin levels in patients with chronic heart failure (CHF) and its possible association with a long-term prognosis may be an interesting supplement to knowledge about the state of the immune system in heart failure. The aim of the study was to compare the plasma concentration of alpha-defensin between the patients with chronic heart failure with impaired ventricular ejection fraction (LVEF) <45% and the control group, as well as to evaluate the prognostic value of alpha-defensin as a possible predictor of death during a 24-month observation period. Methods: The study included 52 hospitalized patients with a primary diagnosis of CHF and LVEF <45%. 20 patients exhibited features of CHF exacerbation, the remaining 32 were hospitalized on schedule. The control group consisted of 28 healthy volunteers. The observation was conducted by telephone for 2 years. The end point of the study was death for all reasons. Results: Patients with CHF had significantly higher levels of alpha-defensin than control subjects. Similarly, plasma hs-CRP levels were significantly higher in the study group than in the control group, although in both groups the median hs-CRP did not exceed 5 mg / L. It has not been shown that exacerbation has an effect on alpha-defensin concentration. During the two-year follow-up, statistically significant effects on the endpoint of the following parameters were observed EF (p = 0.035, HR = 0.917), hs-CRP (p = 0.036; HR = 1.046) and NT-proBNP (p < 0.001, HR = 1.000078). ROC analysis showed that during both a 12-month (AUC = 0.333, p = 0.116) as well as a 24 month (AUC = 0.447, p = 0.616) observation period plasma concentration of alpha-defensin was not a good predictor of death in CHF patients. Conclusions: Higher levels of alpha-defensin in patients with CHF confirm subclinical inflammatory activation in this population. However, this marker does not have predictive value for predicting death in the medium-term observation.