부산대학교 도서관

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. 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. 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. Inflammatory markers are highly related to signs of systemic hypoperfusion in CS. Moreover, high PCT and IL-6 levels are associated with poor prognosis. • Inflammatory marker levels are considerably elevated during the first days of CS. • PCT peaks early at 24 h, while CRP continues to rise until 48 to 72 h in CS. • High levels of PCT and IL-6 are strongly associated with systemic hypoperfusion in CS. • High inflammatory marker levels are associated with increased mortality in CS. [ABSTRACT FROM AUTHOR]