Interaction of Soluble CXC Ligand 16 and Cardiac Injury Markers in Hemodialysis Patients

C-X-C Motif Chemokine Ligand 16 Is a Potent Predictor of Outcomes in Dialysis Patients

INTRODUCTION

C-X-C motif chemokine ligand 16 (CXCL16) is an inflammatory marker that has been found to be predictive of outcomes in patients with cardiovascular disease. Our previous work has also demonstrated its relation to cardiac injury in dialysis patients. However, it is yet unclear whether there is an association between CXCL16 and adverse outcomes in dialysis patients. We aimed to evaluate its prognostic value along with several traditional inflammatory markers in the current study.

METHODS

This is a multicenter longitudinal study of prevalent dialysis patients. Circulating inflammatory markers including CXCL16, C-reactive protein (CRP), tumor necrosis factor-α, and interleukin-6 (IL-6) were measured using a multiplex assay. The primary outcomes were all-cause mortality and a composite of major adverse cardiovascular events (MACEs). The associations between biomarkers and outcomes were analyzed using Cox proportional hazards regression models.

RESULTS

Of the 366 participants with available plasma samples, the average age was 52.5 (±12.1) years, and there were 160 (43.7%) female participants. For all-cause mortality, logarithmically transformed CXCL16, IL-6, and CRP were independent predictors after adjustment for covariates. When the 3 markers were included in the same model, CXCL16 was the only one remaining its significance. For MACEs, logarithmically transformed CXCL16 and IL-6 were significant predictors when analyzed separately and CXCL16 was an independent predictor even after adjustment for IL-6. When the biomarkers were analyzed as categorical variables, only CXCL16 was associated with both outcomes. Adding CXCL16 to established risk factors improved risk prediction as revealed by Net Reclassification Index (NRI).

CONCLUSION

Using a multimarker approach, we determined that CXCL16 is a potent predictor of all-cause mortality and cardiovascular events in dialysis patients. Our data suggest CXCL16 may improve risk stratification and could be a potential interventional target.

Association of Biomarker Level with Cardiovascular Events: Results of a 4-Year Follow-Up Study

Background

Given the high rates of morbidity and mortality from cardiovascular disease (CVD), the primary and secondary CVD prevention is one of the public health priority. Inflammation and endothelial dysfunction are the major drivers of atherosclerosis development and progression. In this regard, the study of the biomarker application as a tool to better identify high-risk individuals is an up-to-date sector of modern cardiology. The simultaneous measurement of multiple biomarkers can increase the risk stratification for people who are not known to have cardiovascular events in their history. The study aimed to investigate the predictive value of chemokine (C-X-C motif) ligand 16 (CXCL16), endocan, and heart-type fatty acid binding protein (H-FABP) in the cardiovascular event development in people who are not known to have cardiovascular events in their history.

Method

We examined 363 people aged 30 to 65 who have been living permanently in the city of Saran, Karaganda region. The selected participants were people registered at a clinic at the city of Saran, who were screened between August and September 2014.

Results

The follow-up period was 48 months (from August-September 2014 to November 2018). The results showed that CXCL16 (p < 0.001), endocan (p < 0.001), and H-FABP (p=0.002) biomarker levels are significantly higher in outcome groups compared with those of the no-outcome group. Univariate regression analysis proved the prognostic significance of all biomarkers in cardiovascular events development. The multivariate regression analysis after the adjustment confirmed that the CXCL16 increase was associated with the "composite endpoint" (CE) development (p < 0.001) while the endocan increased due to the development of major cardiovascular events (MACE) (p=0.008); we did not find the association of the risks of event development with the H-FABP level increase (p=0.83).