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Open Access 20-11-2023 | Cardiogenic Shock | Original Paper

Association of systemic inflammation with shock severity, 30-day mortality, and therapy response in patients with cardiogenic shock

Authors: Angela Dettling, Jessica Weimann, Jonas Sundermeyer, Benedikt N. Beer, Lisa Besch, Peter M. Becher, Fabian J. Brunner, Stefan Kluge, Paulus Kirchhof, Stefan Blankenberg, Dirk Westermann, Benedikt Schrage

Published in: Clinical Research in Cardiology

Abstract

Background

Mortality in cardiogenic shock (CS) remains high even when mechanical circulatory support (MCS) restores adequate circulation. To detect a potential contribution of systemic inflammation to shock severity, this study determined associations between C-reactive protein (CRP) concentrations and outcomes in patients with CS.

Methods

Unselected, consecutive patients with CS and CRP measurements treated at a single large cardiovascular center between 2009 and 2019 were analyzed. Adjusted regression models were fitted to evaluate the association of CRP with shock severity, 30-day in-hospital mortality and treatment response to MCS.

Results

The analysis included 1116 patients [median age: 70 (IQR 58–79) years, 795 (71.3%) male, lactate 4.6 (IQR 2.2–9.5) mmol/l, CRP 17 (IQR 5–71) mg/l]. The cause of CS was acute myocardial infarction in 530 (48%) patients, 648 (58%) patients presented with cardiac arrest. Plasma CRP concentrations were equally distributed across shock severities (SCAI stage B–E). Higher CRP concentrations were associated with 30-day in-hospital mortality (8% relative risk increase per 50 mg/l increase in CRP, range 3–13%; p < 0.001), even after adjustment for CS severity and other potential confounders. Higher CRP concentrations were only associated with higher mortality in patients not treated with MCS [hazard ratio (HR) for CRP > median 1.50; 95%-CI 1.21–1.86; p < 0.001], but not in those treated with MCS (HR for CRP > median 0.92; 95%-CI 0.67–1.26; p = 0.59; p-interaction = 0.01).

Conclusion

Elevated CRP concentrations are associated with increased 30-day in-hospital mortality in unselected patients with cardiogenic shock. The use of mechanical circulatory support attenuates this association.

Graphical abstract

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Title: Association of systemic inflammation with shock severity, 30-day mortality, and therapy response in patients with cardiogenic shock
Authors: Angela Dettling
Jessica Weimann
Jonas Sundermeyer
Benedikt N. Beer
Lisa Besch
Peter M. Becher
Fabian J. Brunner
Stefan Kluge
Paulus Kirchhof
Stefan Blankenberg
Dirk Westermann
Benedikt Schrage
Publication date: 20-11-2023
Publisher: Springer Berlin Heidelberg
Keywords: Cardiogenic Shock
Cardiogenic Shock
Shock
Shock
ECMO
ECMO
Published in: Clinical Research in Cardiology
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-023-02336-8

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Association of systemic inflammation with shock severity, 30-day mortality, and therapy response in patients with cardiogenic shock

Abstract

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Graphical abstract

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