CARDIOGENIC SHOCK
30-day survival, Nt-proBNP, IL-6, revascularization, AMICRITICAL CARE MEDICINE (JUNE 2009)
Researchers in Austria have showed that early measurements of Nt-proBNP and IL-6 were independent predictors of 30-day mortality in cardiogenic shock.
In the June 2009 issue of Critical Care Medicine, Rudolph Jarai and colleagues demonstrated that levels of Nt-proBNP above the study median (12,782 pg/mL) was a significant predictor of 30-day mortality in patients with cardiogenic shock. Moreover, those patients with both Nt-proBNP levels about the median and IL-6 levels above 195 pg/mL were three times as likely to not survive after 30 days than those whose levels were below these figures (90.9% vs 29.4%, respectively).
Those patients with acute MI and high levels of Nt-proBNP, even those with successful revascularization, were at a highly significant disadvantage over those with lower levels (30-day mortality was 90.9% vs 29.4%, respectively). However, for those with lower levels, in a measure with less statistical power, there was not a significant difference between those with and without successful revascularization, although both groups did fairly well (30-day survival was 81.8% vs 75.0%).
Nt-proBNP did show highly significant correlation with patient age, body weight, eGFR, and CRP. It did not correlate, however, with "duration of shock, total Sequential Organ Failure Assessment score, or invasive hemodynamic parameters at the time of blood sampling."
Cardiogenic shock is a state of hypoperfusion of the body due to compromised cardiac function. The most common cause is acute myocardial infarction. It is considered to be a "shocklike" state in that insufficient blood reaches the tissues of the body, and is characterized by oliguria, hypotension, and altered mental status, as well as other symptoms. Other signs and symptoms may include pulmonary edema, cardiac gallop, and distention of the jugular vein (from Emedicine).Those patients with acute MI and high levels of Nt-proBNP, even those with successful revascularization, were at a highly significant disadvantage over those with lower levels (30-day mortality was 90.9% vs 29.4%, respectively). However, for those with lower levels, in a measure with less statistical power, there was not a significant difference between those with and without successful revascularization, although both groups did fairly well (30-day survival was 81.8% vs 75.0%).
Nt-proBNP did show highly significant correlation with patient age, body weight, eGFR, and CRP. It did not correlate, however, with "duration of shock, total Sequential Organ Failure Assessment score, or invasive hemodynamic parameters at the time of blood sampling."
Nt-proBNP (N-terminal fragment of pro-brain natriuretic peptide) is a peptide secreted with BNP (so-called brain natriuretic peptide) in both cardiac atria and ventricles, and has been the subject of many studies for its potential value in detecting the presence of various cardiac and vascular syndromes (e.g., acute MI, heart failure, renal failure) and predicting their outcomes. A recent study showed that Nt-proBNP is partially useful in guiding CHF treatment.
IL-6 (interleukin-6) is an inflammatory hormone that has been shown to be important in shock and in various cancers.
RESOURCES
Nt-proBNP
OMIM | Entrez Gene
IL-6 (interleukin-6; beta 2 interferon)
OMIM | Entrez Gene
Cardiogenic Shock
Emedicine
