INTRODUCTION: Patients with cardiogenic shock (CS) are at a high risk of developing infectious complications; however, their early detection is difficult, mainly due to a frequently occurring noninfectious inflammatory response, which accompanies an extensive myocardial infarction (MI) or a postcardiac arrest syndrome. The goal of our prospective study was to describe infectious complications in CS and the immune/inflammatory response based on a serial measurement of several blood-based inflammatory biomarkers. METHODS: Eighty patients with CS were evaluated and their infections were monitored. Inflammatory markers (C-reactive protein, procalcitonin, pentraxin 3, presepsin) were measured seven times per week. The control groups consisted of 11 patients with ST segment elevation myocardial infarction without CS and without infection, and 22 patients in septic shock. RESULTS: Infection was diagnosed in 46.3% of patients with CS; 16 patients developed an infection within 48 h. Respiratory infection was most common, occurring in 33 out of 37 patients. Infection was a significant or even the main reason of death only in 3.8% of all patients with CS, and we did not find statistically significant difference in 3-month mortality between group of patients with CS with and without infection. There was no statistically significant prolongation of the duration of mechanical ventilation associated with infection. Strong inflammatory response is often in patients with CS due to MI, but we found no significant difference in the course of the inflammatory response expressed by evaluated biomarkers in patients with CS with and without infection. We found a strong relationship between the elevated inflammatory markers (sampled at 12 h) and the 3-month mortality: the area under the curve of receiver operating characteristic ranged between 0.683 and 0.875. CONCLUSION: The prevalence of infection in patients with CS was 46.3%, and respiratory tract infections were the most common type. Infections did not prolong statistically significantly the duration of mechanical ventilation and did not increase the prevalence of hospital mortality in this high-risk CS population. CS due to acute myocardial infarction was accompanied by a strong and highly variable inflammatory response, but it did not reach the intensity of the inflammatory response observed in patients with septic shock. An extensive immune/inflammatory response in patients with CS is linked to a poor prognosis.

*Department of Internal Medicine and Cardiology University Hospital Brno Brno Czech Republic †Faculty of Medicine Masaryk University Brno Czech Republic ‡Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic §Department of Anaesthesiology and Intensive Care University Hospital Brno Brno Czech Republic ¶Université Paris Diderot PRES Sorbonne Paris Cité France ||Department of Anaesthesiology and Critical Care and Burn unit APHP Saint Louis Lariboisière University Hospitals Paris France U 942 INSERM Paris France **Department of Biochemistry University Hospital Brno Brno Czech Republic ††Department of Laboratory Methods Faculty of Medicine Masaryk University Brno Czech Republic ‡‡Department of Clinical Immunology and Allergology St Anne's University Hospital in Brno Brno Czech Republic §§Department of Biochemistry Faculty of Medicine Masaryk University Brno Czech Republic ¶¶Department of Pathological Physiology Faculty of Medicine Masaryk University Brno Czech Republic ||||Department of Anaesthesiology and Intensive Care University Hospital Ostrava Ostrava Poruba Czech Republic

Zobrazit více v PubMed

Awad HH, Anderson FA, Gore JM, Goodman SG, Goldberg RJ. Cardiogenic shock complicating acute coronary syndromes: insights from the Global Registry of Acute Coronary Events. Am Heart J 2012; 163:963–971. PubMed

Spinar J, Parenica J, Vitovec J, Widimsky P, Linhart A, Fedorco M, Malek F, Cihalik C, Spinarová L, Miklik R, et al. Baseline characteristics and hospital mortality in the Acute Heart Failure Database (AHEAD) Main registry. Crit Care 2011; 15:R291. PubMed PMC

Babaev A, Frederick PD, Pasta DJ, Every N, Sichrovsky T, Hochman JS. NRMI Investigators. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA 2005; 294:448–454. PubMed

Osmon S, Warren D, Seiler SM, Shannon W, Fraser VJ, Kollef MH. The influence of infection on hospital mortality for patients requiring >48 h of intensive care. Chest 2003; 124:1021–1029. PubMed

ThieleF H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367:1287–1296. PubMed

Perbet S, Mongardon N, Dumas F, Bruel C, Lemiale V, Mourvillier B, Carli P, Varenne O, Mira JP, Wolff M, et al. Early-onset pneumonia after cardiac arrest: characteristics, risk factors and influence on prognosis. Am J Respir Crit Care Med 2011; 184:1048–1054. PubMed

Kouraki K, Schneider S, Uebis R, Tebbe U, Klein HH, Janssens U, Zahn R, Senges J, Zeymer U. Characteristics and clinical outcome of 458 patients with acute myocardial infarction requiring mechanical ventilation. Results of the BEAT registry of the ALKK-study group. Clin Res Cardiol 2011; 100:235–239. PubMed

Kohsaka S, Menon V, Iwata K, Lowe A, Sleeper LA, Hochman JS. SHOCK Investigators. Microbiological profile of septic complication in patients with cardiogenic shock following acute myocardial infarction (from the SHOCK study). Am J Cardiol 2007; 99:802–804. PubMed

Alon D, Stein GY, Korenfeld R, Fuchs S. Predictors and outcomes of infection-related hospital admissions of heart failure patients. PloS One 2013; 8:e72476. PubMed PMC

Maisel A, Neath SX, Landsberg J, Mueller C, Nowak RM, Peacock WF, Ponikowski P, Möckel M, Hogan C, Wu AHB, et al. Use of procalcitonin for the diagnosis of pneumonia in patients presenting with a chief complaint of dyspnoea: results from the BACH (Biomarkers in Acute Heart Failure) trial. Eur J Heart Fail 2012; 14:278–286. PubMed PMC

Behnes M, Bertsch T, Lepiorz D, Lang S, Trinkmann F, Brueckmann M, Borggrefe M, Hoffmann U. Diagnostic and prognostic utility of soluble CD 14 subtype (presepsin) for severe sepsis and septic shock during the first week of intensive care treatment. Crit Care 2014; 18:507. PubMed PMC

Muller B, Peri G, Doni A, Torri V, Landmann R, Bottazzi B, Mantovani A. Circulating levels of the long pentraxin PTX3 correlate with severity of infection in critically ill patients. Crit Care Med 2001; 29:1404–1407. PubMed

Kohsaka S, Menon V, Lowe AM, Lange M, Dzavik V, Sleeper LA, Hochman JS. SHOCK Investigators. Systemic inflammatory response syndrome after acute myocardial infarction complicated by cardiogenic shock. Arch Intern Med 2005; 165:1643–1650. PubMed

Peberdy MA, Andersen LW, Abbate A, Thacker LR, Gaieski D, Abella B, Rittenberger JC, Clore J, Ornato J, Cocchi MN, et al. Inflammatory markers following resuscitation from out-of-hospital cardiac arrest—a prospective multicenter observational study. Resuscitation 2016; 103:117–124. PubMed

Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Thygesen K, Alpert JS, White HD, et al. Writing Group on the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction. ESC Committee for Practice Guidelines (CPG). Third universal definition of myocardial infarction. Eur Heart J 2012; 33:2551–2567. PubMed

Alexander JH, Reynolds HR, Stebbins AL, Dzavik V, Harrington RA, Van de Werf F, Hochman JS. TRIUMPH Investigators. Effect of tilarginine acetate in patients with acute myocardial infarction and cardiogenic shock: the TRIUMPH randomized controlled trial. JAMA 2007; 297:1657–1666. PubMed

Hamm CW, Bassand JP, Agewall S, Bax J, Boersma B, Bueno H, Caso P, Dudek P, Gielen S, Huber K, et al. ESC Committee for Practice Guidelines, ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011; 32:2999–3054. PubMed

Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G. SCCM/ESICM/ACCP/ATS/SIS, 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31:1250–1256. PubMed

Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36:309–332. PubMed

Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1998; 16:128–140. PubMed

Geurts M, Macleod MR, Kollmar R, Kremer PHC, van der Worp HB. Therapeutic hypothermia and the risk of infection: a systematic review and meta-analysis. Crit Care Med 2014; 42:231–242. PubMed

MelsenF WG, Rovers MM, Koeman M, Bonten MJM. Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies. Crit Care Med 2011; 39:2736–2742. PubMed

Schmidt M, Bréchot N, Hariri S, Guiguet M, Luyt CE, Makri R, Leprince P, Trouillet L, Pavie A, Chastre J, et al. Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Clin Infect Dis 2012; 55:1633–1641. PubMed PMC

Fraunberger P, Wang Y, Holler E, Parhofer KG, Nagel D, Walli AK, Seidel D. Prognostic value of interleukin 6, procalcitonin, and C-reactive protein levels in intensive care unit patients during first increase of fever. Shock 2006; 26:10–12. PubMed

Lagrand WK, Niessen HW, Wolbink GJ, Jaspars LH, Visser CA, Verheugt FW, Meijer CJ, Hack CE. C-reactive protein colocalizes with complement in human hearts during acute myocardial infarction. Circulation 1997; 95:97–103. PubMed

Griselli M, Herbert J, Hutchinson WL, Taylor KM, Sohail M, Krausz T, Pepys MB. C-reactive protein and complement are important mediators of tissue damage in acute myocardial infarction. J Exp Med 1999; 190:1733–1740. PubMed PMC

Takahashi T, Anzai T, Kaneko H, Mano Y, Anzai A, Nagai T, Kohno T, Maekawa Y, Yoshikawa T, Fukuda K, et al. Increased C-reactive protein expression exacerbates left ventricular dysfunction and remodeling after myocardial infarction. Am J Physiol Heart Circ Physiol 2010; 299:H1795–H1804. PubMed

Ikeda U, Maeda Y, Yamamoto K, Shimada K. C-Reactive protein augments inducible nitric oxide synthase expression in cytokine-stimulated cardiac myocytes. Cardiovasc Res 2002; 56:86–92. PubMed

Hochman JS. Cardiogenic shock complicating acute myocardial infarction: expanding the paradigm. Circulation 2003; 107:2998–3002. PubMed

Maruna P, Nedelníkova K, Gürlich R. Physiology and genetics of procalcitonin. Physiol Res 2000; 49 suppl 1:S57–S61. PubMed

Nauta AJ, Bottazzi B, Mantovani A, Salvatori G, Kishore U, Schwaeble WJ, Gingras AR, Tzima S, Vivanco F, Egido J, et al. Biochemical and functional characterization of the interaction between pentraxin 3 and C1q. Eur J Immunol 2003; 33:465–473. PubMed

Deban L, Russo RC, Sironi M, Moalli F, Scanziani M, Zambelli V, Cuccovillo I, Bastone A, Gobbi M, Valentino S, et al. Regulation of leukocyte recruitment by the long pentraxin PTX3. Nat Immunol 2010; 11:328–334. PubMed

Maugeri N, Rovere-Querini P, Slavich M, Coppi G, Doni A, Bottazzi B, Garlanda C, Cianflone D, Maseri A, Mantovani A, et al. Early and transient release of leukocyte pentraxin 3 during acute myocardial infarction. J Immunol 2011; 187:970–979. PubMed

Rey Nores JE, Bensussan A, Vita N, Stelter F, Arias MA, Jones M, Lefort S, Borysiewicz LK, Ferrara P, Labéta MO. Soluble CD14 acts as a negative regulator of human T cell activation and function. Eur J Immunol 1999; 29:265–276. PubMed

O’Donoghue ML, Glaser R, Cavender MA, Aylward PE, Bonaca MP, Budaj A, Davies RY, Dellborg M, Fox KAA, Gutierrez JAT, et al. Effect of losmapimod on cardiovascular outcomes in patients hospitalized with acute myocardial infarction: a randomized clinical trial. JAMA 2016; 315:1591–1599. PubMed

Harjola VP, Lassus J, Sionis A, Køber L, Tarvasmäki T, Spinar J, Parissis J, Banaszewski M, Silva-Cardoso J, Carubelli V, et al. Clinical picture and risk prediction of short-term mortality in cardiogenic shock. Eur J Heart Fail 2015; 17:501–509. PubMed

Soluble urokinase-type plasminogen activator receptor improves early risk stratification in cardiogenic shock