Protein-based cardiogenic shock patient classifier. (17th June 2019)

• Record Type: Journal Article
• Authors: Rueda, Ferran; Borràs, Eva; García-García, Cosme; Iborra-Egea, Oriol; Revuelta-López, Elena; Harjola, Veli-Pekka; Cediel, Germán; Lassus, Johan; Tarvasmäki, Tuukka; Mebazaa, Alexandre; Sabidó, Eduard; Bayés-Genís, Antoni
• Is Part Of: European heart journal. Volume 40:Number 32(2019)
• Page Start: 2684
• Page End: 2694
• Publication Date: 2019-06-17
• Subjects: Cardiogenic shock -- Proteome -- Mortality -- 90 days; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehz294
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: Cardiogenic shock (CS) is associated with high short-term mortality and a precise CS risk stratification could guide interventions to improve patient outcome. Here, we developed a circulating protein-based score to predict short-term mortality risk among patients with CS. Methods and results: Mass spectrometry analysis of 2654 proteins was used for screening in the Barcelona discovery cohort ( n = 48). Targeted quantitative proteomics analyses ( n = 51 proteins) were used in the independent CardShock cohort ( n = 97) to derive and cross-validate the protein classifier. The combination of four circulating proteins (Cardiogenic Shock 4 proteins—CS4P), discriminated patients with low and high 90-day risk of mortality. CS4P comprises the abundances of liver-type fatty acid-binding protein, beta-2-microglobulin, fructose-bisphosphate aldolase B, and SerpinG1. Within the CardShock cohort used for internal validation, the C-statistic was 0.78 for the CardShock risk score, 0.83 for the CS4P model, and 0.84 ( P = 0.033 vs. CardShock risk score) for the combination of CardShock risk score with the CS4P model. The CardShock risk score with the CS4P model showed a marked benefit in patient reclassification, with a net reclassification improvement (NRI) of 0.49 ( P = 0.020) compared with CardShock risk score. Similar reclassification metrics were observed in the IABP-SHOCK II risk score combined with CS4P (NRI =0.57; P = 0.032). The CS4P patient classification power was confirmed by enzyme-linked immunosorbent assay (ELISA). Conclusion: A new protein-based CS patient classifier, the CS4P, was developed for short-term mortality risk stratification. CS4P improved predictive metrics in combination with contemporary risk scores, which may guide clinicians in selecting patients for advanced therapies.