The Serum Level of Proinflammatory TNF-alpha Cytokine in Cyanotic and Acyanotic Congenital Heart Diseases in Mosul City

Background: Tumor necrosis factor – alpha (TNF-α) has been proposed to play an important role in the etiopathology of congenital heart diseases (CHD) worldwide. However, no previous study about the role of TNF-α in the pathogenesis of CHDs in Mosul city / Iraq has been reported . Objectives: 1) To evaluate the serum levels of TNF-α cytokine in cyanotic and a cyanotic congenital heart diseases (CHDs and to compare the results with control healthy children in Mosul city 2) To find any association between the level of this pro-inflammatory marker and other demographic parameters such as age and gender 3) To test the diagnostic validity of this cytokine for the diagnosis of CHD at different cut-off values. Patients, materials and methods: A case-control study was conducted in the Department of Microbiology / College of Medicine / University of Mosul over two years and 3 months from April 2019 to July 2021. Twenty nine (29) child with a cyanotic congenital heart diseases and seventeen (17) child with cyanotic heart diseases were included. Another Thirty one (31) healthy child were also included as a controls. . All patients were collected from Al-Khansa teaching hospital in Mosul city. The serum TNF-α concentration was measured in all participants by using ELISA. Results: Mean age of children with acyanotic heart diseases (2.7 ± 2.9 years) did not significantly differ from that of cyanotics (2.1 ± 1.9) or healthy controls (3.1 ± 1.7) , (P>0.05). The average TNF-α level in acyanotic heart diseases was 321.18 ± 325.71 ng/l compared to 120.63 ± 84.33 ng/l in cyanotics and 119.01 ± 139.71 in healthy controls. TNF- α was significantly elevated in acyanotic heart diseases in comparison to healthy children (P = 0.003). No significant difference was noted between acyaotics and cyanotic heart diseases in regards to TNF- α concentrations (P = 0.07). No age or gender effects were noted on TNF-α concentration in both acyanotic and cyanotic heart diseases (P>0.05). At the best cut-off value of 124 ng/l TNF-α had a specificity of 90.32% , sensitivity of 48.28% and accuracy rate of 39% as indicated by AUC-ROC curve . Conclusion: The current study showed higher TNF- α in acyanotic (but not in cyanotic) heart diseases compared to healthy controls. TNF-α had poor diagnostic utility to discriminate between CHD and healthy individuals and therefore not recommended as valuable biological marker for the diagnosis of CHD.