Mortality in cardiogenic shock is stronger associated to clinical factors than contemporary biomarkers reflecting neurohormonal stress and inflammatory activation. (17th August 2020)

• Record Type: Journal Article
• Authors: Josiassen, Jakob; Frydland, Martin; Holmvang, Lene; Lerche Helgestad, Ole Kristian; Okkels Jensen, Lisette; Goetze, Jens Peter; Eifer Møller, Jacob; Hassager, Christian
• Is Part Of: Biomarkers. Volume 25:Number 6(2020)
• Page Start: 506
• Page End: 512
• Publication Date: 2020-08-17
• Subjects: Cardiogenic shock -- STEMI -- IABP-SHOCK II risk score -- biomarkers -- neurohormonal activation -- inflammation -- myocardial infarction; Biochemical markers -- Periodicals; 610.28
• DOI: 10.1080/1354750X.2020.1795265
• Languages: English
• ISSNs: 1354-750X

Abstract

Abstract: Purpose: To validate the IABP-SHOCK II risk score in a Danish cohort and assess the association between the IABP-SHOCK II risk score and admission concentration of biomarkers reflecting neurohormonal – (Copeptin, Pro-atrial natriuretic peptide (proANP), Mid-regional pro-adrenomedullin (MRproADM)) and inflammatory (ST2) activation in patients with CS complicating ST segment elevation myocardial infarction (STEMI). Methods: A total of 137 consecutive patients admitted with STEMI and CS at two tertiary heart centres were stratified according to the IABP-SHOCK II risk score (0–2; 3/4; 5–9), and had blood sampled upon admission. Results: Plasma concentrations of Copeptin (median (pmol/L) score 0–2: 313; score 3/4: 682; score 5–9: 632 p < 0.0001), proANP (pmol/L) (1459; 2225; 2876 p = 0.0009) and MRproADM (nmol/L) (0.86; 1.2; 1.4 p = 0.04) were significantly associated with the risk score, whereas ST2 (ng/mL) was not (44; 60; 45 p = 0.23). The IABP-SHOCK II risk score predicted 30-day mortality (score 0–2: 22%; score 4/3: 51%; score 5–9: 72%, area under the curve (AUC): 0.73, p logrank < 0.0001), while the tested biomarkers did not (AUC: 0.51< p logrank < 0.57). Conclusion: Plasma concentrations of Copeptin, MRproADM and proANP were associated with the IABP-SHOCK II risk score in STEMI patients admitted with CS. The risk score predicted 30-day mortality, with no improvement in prediction when concentrations of the assessed biomarkers were added.