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

KATAJA, Anu, 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, Jindřich ŠPINAR, Heli TOLPPANEN and Veli-Pekka HARJOLA. Kinetics of procalcitonin, C-reactive protein and interleukin-6 in cardiogenic shock – Insights from the CardShock study. International Journal of Cardiology. Clare: Elsevier, 2021, vol. 322, JAN 2021, p. 191-196. ISSN 0167-5273. Available from: https://dx.doi.org/10.1016/j.ijcard.2020.08.069.

Basic information

• Original name: Kinetics of procalcitonin, C-reactive protein and interleukin-6 in cardiogenic shock – Insights from the CardShock study
• Authors: KATAJA, Anu (246 Finland, guarantor), Tuukka TARVASMÄKI (246 Finland), Johan LASSUS (246 Finland), Alessandro SIONIS (724 Spain), Alexandre MEBAZAA (250 France), Kari PULKKI (246 Finland), Marek BANASZEWSKI (616 Poland), Valentina CARUBELLI (380 Italy), Mari HONGISTO (246 Finland), Ewa JANKOWSKA (616 Poland), Raija JURKKO (246 Finland), Toni JÄNTTI (246 Finland), Monika KASZTURA (616 Poland), John PARISSIS (300 Greece), Tuija SABELL (246 Finland), Jose SILVA-CARDOSO (620 Portugal), Jindřich ŠPINAR (203 Czech Republic, belonging to the institution), Heli TOLPPANEN (246 Finland) and Veli-Pekka HARJOLA (246 Finland).
• Edition: International Journal of Cardiology, Clare, Elsevier, 2021, 0167-5273.

Other information

• Original language: English
• Type of outcome: Article in a journal
• Field of Study: 30201 Cardiac and Cardiovascular systems
• Country of publisher: Ireland
• Confidentiality degree: is not subject to a state or trade secret
• WWW: URL
• Impact factor: Impact factor: 4.039
• RIV identification code: RIV/00216224:14110/21:00120857
• Organization unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.1016/j.ijcard.2020.08.069
• UT WoS: 000612679700043
• Keywords in English: Cardiogenic shock; Inflammation; Procalcitonin; Interleukin 6; C-reactive protein
• Tags: 14110115, rivok
• Tags: International impact, Reviewed

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 (0−120 h) from 183 patients in the CardShock study. The study population was dichotomized by PCT max ≥ and < 0.5 μg/L, and IL-6 and CRP max above/below median. Results PCT peaked already at 24 h [median PCT max 0.71 μg/L (IQR 0.24–3.4)], whereas CRP peaked later between 48 and 72 h [median CRP max 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). PCT max ≥ 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 CRP max. Similarly, IL-6 > median was associated with clinical signs and biochemical findings of systemic hypoperfusion. PCT max ≥ 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 CRP max 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.