Predictive accuracy of serum IL-6, IL-17 and sST2 levels for diuretic resistance in patients with chronic heart failure.

OBJECTIVE: To determine the predictive value of serum levels of Interleukin-6 (IL-6), interleukin-17 (IL-17), soluble suppression of tumorigenicity 2 protein (sST2) for diuretic resistance in patients with chronic heart failure (CHF). METHODS: His retrospective cohort study enrolled patients with CHF patients treated at Xiangyang Central Hospital between July 2019 and July 2022. Participants were categorized into two groups: the diuretic resistance (DR) group (n = 70) and non-DR group (n = 80). Diuretic resistance was established by a urine output < 0.5–1.0 mL/kg/h following the administration of ≥ 80 mg of furosemide. General clinical data and serum indexes were compared between groups. Multivariate logistic regression identified independent DR risk factors. Bootstrap resampling (1000 replicates) was used to estimate 95% confidence intervals for the area under the curve, sensitivity, and specificity in receiver operating characteristic analysis. RESULTS: Baseline characteristics, including age, sex, and comorbidities, were comparable between the diuretic resistance (DR) and non-DR groups (all P > 0.05). Compared with the non-DR group, patients with DR exhibited significantly lower urine output and urinary sodium concentration, alongside impaired renal function (higher Cr and lower eGFR), hypoalbuminemia, and elevated liver enzymes (ALT) (all P < 0.001). Furthermore, inflammatory markers (WBC, IL-6, IL-17, sST2) and cardiac dysfunction indicators (NT-proBNP, LVEDd, LAVI, and TRPG) were significantly elevated in the DR group (all P < 0.05). After adjusting for age, LVEF, and eGFR in the multivariate logistic regression, IL-6 (OR: 1.860 per 10 pg/mL), IL-17 (OR: 1.952 per 10 pg/mL), and sST2 (OR: 1.450 per 10 µg/L) remained independently associated with the risk of diuretic resistance (all P < 0.05). ROC curves analysis revealed that combined assessment of IL-6, IL-17 and sST2 provided the highest predictive accuracy for diuretic resistance, with an AUC of 0.861 (95% bootstrapped CI: 0.795–0.912), a sensitivity of 81.43%, and a specificity of 86.25%, outperforming individual biomarkers (P = 0.0001). CONCLUSION: Serum IL-6, IL-17, and sST2 levels are associated with diuretic resistance in hospitalized patients with chronic heart failure. The integration of these biomarkers may provide enhanced predictive value for identifying diuretic resistance compared to individual assessments.