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Kinetics of procalcitonin in cardiogenic shock and in septic shock. Preliminary data
Claudio Picariello1, Chiara Lazzeri, Serafina Valente
1Intensive Cardiac Care Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. claudx@hotmail.com
Insights
Procalcitonin (PCT) levels in cardiogenic shock patients varied dynamically. Survivors showed a significant PCT reduction, unlike non-survivors, suggesting dynamic monitoring is key for these cardiac acute patients.
Area of Science:
- Biochemistry
- Critical Care Medicine
- Cardiology
Background:
- Procalcitonin (PCT) interpretation in cardiac patients is challenging due to influencing factors.
- Limited data exists on PCT dynamics in cardiogenic shock (CS).
Purpose of the Study:
- To evaluate serum PCT evolution in CS patients post-ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous intervention (PCI).
- To compare PCT kinetics in CS patients with septic shock patients.
Main Methods:
- Monitored PCT levels in 24 CS patients and 24 septic shock patients during intensive cardiac care unit (ICCU) stay.
- Analyzed PCT kinetics in relation to survival outcomes.
Main Results:
- Septic shock: No significant PCT kinetic difference between survivors and non-survivors.
- Cardiogenic shock: Survivors showed a significant PCT reduction; non-survivors did not.
Conclusions:
- Cardiogenic shock (STEMI) exhibits heterogeneous PCT patterns, unlike septic shock.
- A significant PCT reduction during ICCU stay is linked to survival in CS patients.
- Dynamic PCT monitoring is more reliable than static values in CS.
Background:
In cardiac acute patients, data on procalcitonin (PCT) are controversial and the clinical interpretation of absolute PCT values represents a major challenge since they may be influenced by several factors. No data are so far available on the dynamics of PCT levels in patients with cardiogenic shock.
Aims:
to evaluate the serum evolution of PCT during intensive cardiac care unit (ICCU) staying in a group of 24 patients with cardiogenic shock (CS) following ST-elevation myocardial infarction (STEMI) submitted to primary percutaneous intervention (PCI) with no laboratory or clinical sign of infection. Furthermore we assessed the kinetics of PCT in a series of 24 patients with septic shock.
Results:
In septic shock, no significant difference was detectable in PCT kinetics between survivors (R2 = 0.90; P = 0.051) and non-survivors (R2 = 0.63; P = 0.204). In cardiogenic shock, survivors exhibited a significant reduction in PCT values (R2 = 0.94; P = 0.032) while non survivors did not (R2 = 0.68; P = 0.178).
Conclusions:
differently from septic shock, cardiogenic shock following STEMI was associated with heterogeneous patterns of temporal PCT variations since only patients who survived exhibited a significant PCT reduction during ICCU stay. Our findings support the contention that the 'dynamic' approach may be more reliable that the static one especially in cardiogenic shock.
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