ABC | Volume 111, Nº1, July 2018

Original Article Kalkan et al Adropin and Irisin Arq Bras Cardiol. 2018; 111(1):39-47 Figure 1 – Body weight difference between cachectic and non-cachectic groups. 140.00 120.00 100.00 80.00 60.00 40.00 Body Weight, kg Non-cachectic Cachectic 45 46 47 86 p < 0.001 The categorical variables are expressed as numbers and percentages. Visual (histograms and probability plots) and analytical methods (Kolmogorov–Smirnov) were used to determine whether the variables were normally distributed. The independent samples T-Test was used for the comparison of normally distributed continuous numerical variables, the Mann–Whitney U -test was used for non-normally distributed numerical variables, and the χ 2 -test was used for comparing categorical variables between the two groups. Receiver operating characteristic curves were plotted for BNP, adropin and irisin. When a significant cut-off value was observed, the sensitivity, specificity, positive and negative predictive values were recorded. Spearman’s correlation analysis was performed to determine the association of adropin and irisin levels with the examined variables. Multiple logistic regression analyses were performed to identify the independent risk factors associated with cachexia. Variables found to be statistically significant in the univariate analyses were entered into a multivariate logistic regression analysis. An overall 5% type-I error level was used to infer statistical significance, and a p -value less than 0.05 was considered significant. Statistical analyses were performed using the Statistical Package for Social Sciences (IBM SPSS 17 Statistics for Windows, Version 20.0. Armonk, NY, USA). Results The present study included 86 heart failure with reduced ejection fraction patients: 44 with cardiac cachexia (mean age, 65.4 ± 11.2 y; 61.4%men) and 42 with a normal body weight (mean age, 61 ± 16.5 y; 64.3% men). The weight difference between two groups is shown in Figure 1. The baseline demographic and clinical characteristics of the study groups are summarized in Table 1. As expected, BMI, TST and AMA were significantly lower in the cardiac cachexia group than the non-cachectic group. The NYHA class of the two groups was also significantly different, with more patients in the cardiac cachexia group classified as NYHA class III and IV, and more in the non-cachectic group classified as NYHA class I and II. The baseline laboratory characteristics of the two groups are presented in Table 1. Hemoglobin, albumin and HDL cholesterol levels were significantly higher in the non‑cachectic individuals compared to the cachectic patients. Furthermore, the serum BNP, adropin and irisin levels were significantly higher in the cachectic group than in the non-cachectic group [adropin (ng/L): 286.1 (231.3‑404.0) vs 213.7 (203.1-251.3), p < 0.001; irisin (μg/mL): 2.6 (2.2-4.4) vs 2.1 (1.8-2.4), p = 0.001; BNP (pg/mL): 698.0 (340.0‑1517.0) vs 1408.5 (725.0-4041.0), p = 0.001]. Analysis of the association between adropin and irisin levels and the clinical and laboratory parameters of the patients (Table 2) revealed that NYHA class and BNP levels were significantly positively correlated with both adropin and irisin levels. However, BMI, AMA, TST and serum albumin, which were significant indirect clinical and laboratory indicators of cardiac cachexia, were significantly inversely correlated with adropin and irisin levels. In addition, there was a direct correlation between adropin and irisin levels and heart failure with reduced ejection fraction. Creatinine levels were also positively correlated with irisin levels. 41