Kinetics of procalcitonin, C-reactive protein and interleukin-6 in cardiogenic shock – Insights from the CardShock study
Anu Kataja , Tuukka Tarvasmäki , Johan Lassus , Alessandro Sionis , Alexandre Mebazaa , Kari Pulkki , Marek Banaszewski , Valentina Carubelli , Mari Hongisto , Ewa Jankowska , Raija Jurkko , Toni Jäntti , Monika Kasztura , John Parissis , Tuija Sabell , Jose Silva-Cardoso , Jindrich Spinar , Heli Tolppanen , Veli-Pekka Harjola
AbstractBackground: Inflammatory responses play an important role in the pathophysiology of cardiogenic shock (CS). The aim of this study was to investigate the kinetics of procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6) in CS and to assess their relation to clinical presentation, other biochemical variables, and prognosis. Methods: Levels of PCT, CRP and IL-6 were analyzed in serial plasma samples (0−120h) from 183 patients in the CardShock study. The study population was dichotomized by PCTmax ≥ and < 0.5 μg/L, and IL-6 and CRPmax above/below median. Results: PCT peaked already at 24 h [median PCTmax 0.71 μg/L (IQR 0.24–3.4)], whereas CRP peaked later between 48 and 72 h [median CRPmax 137 mg/L (59–247)]. PCT levels were significantly higher among non-survivors compared with survivors from 12 h on, as were CRP levels from 24 h on (p < 0.001). PCTmax ≥ 0.5 μg/L (60% of patients) was associated with clinical signs of systemic hypoperfusion, cardiac and renal dysfunction, acidosis, and higher levels of blood lactate, IL-6, growth-differentiation factor 15 (GDF-15), and CRPmax. Similarly, IL-6 > median was associated with clinical signs and biochemical findings of systemic hypoperfusion. PCTmax ≥ 0.5 μg/L and IL-6 > median were associated with increased 90-day mortality (50% vs. 30% and 57% vs. 22%, respectively; p < 0.01 for both), while CRPmax showed no prognostic significance. The association of inflammatory markers with clinical infections was modest. Conclusions: Inflammatory markers are highly related to signs of systemic hypoperfusion in CS. Moreover, high PCT and IL-6 levels are associated with poor prognosis.
|Journal series||International Journal of Cardiology, ISSN 0167-5273, e-ISSN 1874-1754, (N/A 100 pkt)|
|Publication size in sheets||0.5|
|Keywords in English||Cardiogenic shock, Inflammation, Procalcitonin, Interleukin 6, C-reactive protein|
|Score||= 100.0, 28-04-2021, ArticleFromJournal|
|Publication indicators||= 0; = 0; : 2018 = 0.724; : 2019 = 3.229 (2) - 2019=3.804 (5)|
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