Kinetics of procalcitonin, C-reactive protein and interleukin-6 in cardiogenic shock - Insights from the CardShock study.

Abstract

BACKGROUND:

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.

• Authors: 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, CardShock investigators
• Journal: International journal of cardiology (Int J Cardiol) Vol. 322 Pg. 191-196 (01 01 2021) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 32841617 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Elsevier B.V. All rights reserved.

Chemical References

• Biomarkers
• Interleukin-6
• Procalcitonin
• C-Reactive Protein

Topics

• Biomarkers
• C-Reactive Protein (analysis)
• Humans
• Interleukin-6
• Kinetics
• Procalcitonin
• Prognosis
• Shock, Cardiogenic (diagnosis)