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Association between levels of circulating soluble CD40 ligand on admission and in-hospital events among acute coronary syndrome patients.

AIM
to investigate the association between on admission circulating sCD40L level and in-hospital events among patients admitted with acute coronary syndrome.


METHODS
a short prognostic study which recruited consecutively patients with acute coronary syndrome (ACS) admitted in Intensive Coronary Care Unit (ICCU).


INCLUSION CRITERIA
between 35-70 years old, onset of chest pain 24 hours and approved informed consent. Patients with acute infection, renal failure, heart failure, liver cirrhosis, chronic inflammation, venous thromboemboli, malignancies and pregnancy were excluded. Blood samples of sCD40L was withdrawn on admission and measured with ELISA. Follow-up was conducted during intensive hospitalization. In-hospital events were re-infarction, acute heart failure, cardiogenic shock and mortality.


RESULTS
of 77 study patients, 64 (83%) were male with mean age 55 years old. In-hospital events occurred in 33 (43%) patients, namely mortality 6 (18%), acute heart failure 25 (75%) and cardiogenic shock 2 (6%). The level of circulating sCD40L was significantly higher in patients with in-hospital events compared with those without in-hospital events (8559.6 pg/ml vs. 7393.8 pg/ml respectively, p value <0.05). Using ROC curve, we determined cut-off point 7107.0 pg/ml. On multivariate analysis, high sCD40L (7107.0 pg/ml) had a trend to increase the risk of in-hospital events, although statistically not significant (adjusted OR 1.66, 95% CI : 0.56-4.87; p value 0.36).


CONCLUSION
on admission circulating sCD40L level was higher in patients with in-hospital events. Nonetheless, high sCD40L level did not significantly associate with increasing risk to develop in-hospital events among ACS.