α-Defensins and outcome in patients with chronic heart failure

-Defensins are part of the innate immune system. Low-grade inflammation seems to play a crucial role in development and progression of chronic heart failure (CHF). The aims of the present study were to compare plasma levels of -defensins in CHF patients and healthy controls and to examine the predictive ability of -defensins, alone and combined with N-terminal pro brain natriuretic peptide (NT-proBNP), with respect to all-cause mortality. In a prospective observational study lasting 2.6 years we examined the prognostic value of plasma -defensins with respect to mortality in 194 CHF patients, and compared plasma levels with those of 98 age-matched healthy controls. -Defensin levels were twice as high among CHF patients in New York Heart Association (NYHA) functional class IIIIV than in patients in NYHA class III and healthy controls (P 0.001). The absolute increase in risk of mortality for patients with -defensin levels in the upper tertile vs. the lowest tertile was 30 (P 0.002). After adjusting for potential confounders including NT-proBNP, plasma -defensins remained independently associated with an increased risk of all-cause mortality (hazard ratio 1.65, 95 confidence interval 1.192.28, P 0.002) per 1 standard deviation increment in Ln (natural logarithm)-transformed -defensin values. The combination of high -defensins and NT-proBNP levels provided incremental prognostic information independent of well-known prognostic biomarkers in heart failure. Plasma -defensins appear to have prognostic information regarding mortality among patients with CHF and seem to provide incremental information to established clinical risk markers.