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.

Acute and Intensive Cardiac Care Unit Cardiology Department Hospital de la Santa Creu i Sant Pau IIB Sant Pau CIBER CV Universitat Autonoma de Barcelona Spain

Cardiology Department of Medical and Surgical Specialties Radiological Sciences and Public Health University and Civil Hospital of Brescia Brescia Italy

Cardiology University of Helsinki and Heart and Lung Center Helsinki University Hospital Helsinki Finland

Department of Clinical Chemistry University of Turku and Turku University Hospital Turku Finland

Department of Food Hygiene and Consumer Health Protection Faculty of Veterinary Medicine Wroclaw Poland

Department of Heart Diseases Wroclaw Medical University and Center for Heart Diseases University Hospital in Wroclaw Poland

Emergency Medicine University of Helsinki and Department of Emergency Medicine and Services Helsinki University Hospital Helsinki Finland

Heart Failure and ER Attikon University Hospital University of Athens Athens Greece

INSERM U942 APHP Hôpitaux Universitaires Saint Louis Lariboisière and University Paris Diderot Paris France

Intensive Cardiac Therapy Clinic Institute of Cardiology Warsaw Poland

Internal Cardiology Department University Hospital St Ann and Medical Faculty Brno Czech Republic

São João University Hospital Center Department of Cardiology and CINTESIS Center for Health Technology and Services Research Faculty of Medicine University of Porto Portugal

References provided by Crossref.org