Papel dos biomarcadores inflamatórios na predição de desfechos adversos na Endocardite Infecciosa

Abstract

Introduction: Despite advances in diagnostic and therapeutic strategies, infective endocarditis (IE) continues to be associated with high morbidity and mortality rates. Elevated levels of inflammatory biomarkers, such as cytokines, have been linked to adverse outcomes. This study aims to evaluate cytokine levels at three time points during hospitalization to predict adverse outcomes in IE patients. Methods: Patients diagnosed with IE according to the 2023 Duke’s Modified Criteria were included, along with a control group of healthy individuals. Using a high-performance Luminex assay, 27 cytokines, chemokines, and growth factors were analyzed. The primary outcome was in-hospital mortality, while the secondary endpoint was a composite of in-hospital death, cardiac, or infectious complications. Logistic and multinomial regression models were employed for each cytokine, and network and cluster analyses were conducted to identify potential markers of poor prognosis. Results: A total of 372 samples were collected from 160 IE patients and 49 samples from the control group. The temporal evolution of cytokines revealed that higher levels of CCL2 were associated with in-hospital mortality (OR = 1.029, 95% CI: 1.026-1.031, p<0.001), and higher levels of IL-6 with infectious complications (OR = 1.057, 95% CI: 1.026-1.090, p<0.001) and with overall complications (OR = 1.144, 95% CI: 1.057-1.23, p<0.05). CCL4 and CCL11 elevation also predicted cardiac complications (OR = 1.014, 95% CI: 1.013-1.016, p<0.001 and OR = 1.010, 95% CI: 1.009-1.012, p<0.001, respectively). Patients with poor outcomes exhibited higher levels of CCL5, IL-1Ra, and PDGF, and lower levels of IFN-γ and IL-13. Conclusion: Cytokine measurements during hospitalization for IE can help identify patients at high risk of mortality or IE-related complications. Among these, IL-6 is strongly associated with infectious and overall complications, highlighting its potential role as a prognostic biomarker.